Hepatitis C Outbreak in Appalachia Could Lead to Outbreak of HIV

By John Lavitt 06/05/15

The state has dumped the decision to implement a needle exchange program onto the counties.

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Given the rapid spread of new hepatitis C infections in rural Appalachia, Dr. Jennifer Havens believes that one person could be the Typhoid Mary of HIV. In Appalachia, injection drug use rates have rapidly escalated. With the nation's highest rate of acute hepatitis C due to injection drug use, western Kentucky might be a few dirty needles away from a similar HIV catastrophe.

Dr. Havens, an epidemiologist at the University of Kentucky's Center on Drug and Alcohol Research, has been studying and observing Perry County drug users as the hepatitis rate spiraled out of control. She believes, "One person could be Typhoid Mary of HIV," because, when it came to hepatitis C, "there's a sense of inevitability about it. Some say, 'I'm surprised it took me this long,'" she said.

In a recent study, the Centers for Disease Control and Prevention found that hepatitis C cases across four Appalachian states—Kentucky, Tennessee, West Virginia and Virginia—more than tripled between 2006 and 2012. Kentucky leads the nation in the rate of acute hepatitis C, with 4.1 cases for every 100,000 residents, more than six times the national average, according to the CDC.

In her microcosm, of research, Dr. Havens has tracked 503 drug users since 2008. Now 70% have hepatitis C. The recent outbreak is centered in rural areas among young, white drug users. With HCV bearing down on Appalachia and HIV close behind, local governments are scrambling to figure out how to stop it.

Although hepatitis C infection has run rampant throughout Appalachia, cases of HIV are starting to appear as well. The time it takes for a person who has been infected with HIV to show a positive test result is called the window period. It is longer than HCV, although a test taken at least 12 weeks after exposure to the virus provides highly accurate results. In rare cases, a person could take up to six months to test positive if their immune system has been severely compromised, and such can be the case with drug addicts.

In March, Kentucky became the first of the four Appalachian states battered by the hepatitis outbreak to pass a law allowing local health departments to create needle exchange programs. Dr. Stephanie Mayfield Gibson, commissioner of the state's Department of Public Health, said her office recently distributed guidelines for counties to implement the programs. But the counties themselves must decide whether if and how to set up a needle exchange.

Sue Yates, who oversees drug court programs in 20 counties knows that needle exchange programs are not the final answer like long-term recovery, but a stop-gap measure to promote harm reduction.

"We have to change the way we think, we have to open our minds and think of other options and, yes, that includes needle exchanges," Yates said. "It's better than doing nothing, which is what we're doing now."

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Growing up in Manhattan as a stutterer, John Lavitt discovered that writing was the best way to express himself when the words would not come. After graduating with honors from Brown University, he lived on the Greek island of Patmos, studying with his mentor, the late American poet Robert Lax. As a writer, John’s published work includes three articles in Chicken Soup For The Soul volumes and poems in multiple poetry journals and compilations. Active in recovery, John has been the Treatment Professional News Editor for The Fix. Since 2015, he has published over 500 articles on the addiction and recovery news website. Today, he lives in Los Angeles, trying his best to be happy and creative. Find John on Facebook, Twitter, and LinkedIn.