A Southeastern Illinois county has several characteristics that put it at risk of an outbreak of HIV and Hepatitis C among injection drug-users, according to a study from the Centers for Disease Control and Prevention.
Hardin County, which sits on the Ohio River, ranked 68 out of 220 of the most vulnerable in the country based on factors related to the opioid epidemic.
Hardin County was the only county from Illinois on the list. Most were from the central Appalachian Mountains of eastern Kentucky, Ohio, Tennessee and western West Virginia.
The study, published in November, was written in the wake of an HIV outbreak in rural Scott County, Indiana, in which 181 people contracted the virus between November 2014 through October 2015. In the previous 10 years, the 24,000-person county, which ranked 32nd on the CDC’s list, had reported fewer than five new HIV cases.
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It was “a perfect storm” of circumstances, Scott County Health Department director Michelle Goodin said.
Ironically, part of the problem stemmed from a new formula drug-makers unveiled to help stop illegal drug use, Goodin said. When someone tried to crush a pill, instead of turning it into a powder, it became a viscous goop. This caused drug-users to switch to a wider-gauge needle that transferred disease more easily.
The particular culture and demographics of Scott County played a role in making residents vulnerable. For example, the tight-knit community in Austin, a city in Scott County, made it difficult to break the cycle of drug use, Goodin said.
A large contingent of people moved there from Hazard, Kentucky, a small town in the Appalachian Mountains, to work at the Austin Canning Company in the 1950s. With multiple generations living together, patterns took root, and when someone got out of jail and sobered up, the only place that person could go was their old home. Sometimes, even people who tried to stop using drugs were pressured back into it so they wouldn’t report others to the police, Goodin said.
Generational poverty and a lack of education about drug use made the outbreak worse. At the same time, an interstate made it easy for traffickers to distribute drugs, but many people lacked transportation to get to treatment centers.
“If you’ve been recognized by the CDC for the possibility of something like this, you should take it seriously,” Goodin said.
Nancy Holt, the director of public health for the Southern Seven Health District, which includes Hardin County, Illinois, said she thought the indicators in the CDC’s study explained part of the problem there, but that the rank assigned to the county was lacking.
“It doesn’t accurately reflect the risk,” she said.
The counties identified in our analysis were overwhelmingly rural.
The Centers for Disease Control and Prevention
Part of the reason is because the study used fast-changing data.
For instance, the study used Medicaid data from 2014, and private insurance coverage data from 2012 and 2013, but now there are more people with both forms of health care, which means more people covered for drug treatment, Holt said.
Still, Hardin County ranked disfavorably in a variety of areas:
▪ It leads the state in commercial opioid purchases per person, according to the federal Drug Enforcement Agency.
▪ It has a low opioid addiction treatment capacity. There are only two doctors in Hardin County who’ve been approved to treat up to 60 people for opioid addiction as of March, according to the Substance Abuse and Mental Health Services Administration.
▪ It has a higher white-only population, which is an indication of vulnerability. The median, or middle, county the CDC reviewed was 85 percent white, but, according to 2013 Census estimates, Hardin County was 95 percent white.
▪ It has higher levels of poverty and unemployment. In 2013, an estimated 23.6 percent of Hardin County residents lived below the poverty level, the third-highest in the state at the time. In the same year, Hardin County’s unemployment rate was 13.8 percent, the second-highest in Illinois.
▪ It is very rural.
When the outbreak hit Scott County, it was the first time “prescription opioids was linked to an outbreak of HIV infections in a rural US community,” the CDC wrote. It “illustrated the need for harm reduction strategies suited to the rural context.”
Indiana health officials responded with several measures, including setting up preventative needle exchanges in nine or 10 counties, Goodin said. She had advice for counties who share Scott’s company on the agency’s study: If you’re on t list, pay attention and review available services.
But in this area, Hardin County isn’t doing as well as it once was. For example, the health department’s front-line staffing levels have fallen by 80 percent since 2008. Back then, each of its seven county offices had two women-and-children nurses, two public health nurses and two clerks who handled scheduling, intake and billing. Today, to cover the entire area, there are just three women-and-children nurses, two family case managers, three public health nurses and five clerks.
Despite these trends, so far there have been only one new HIV case in Hardin County since 2010 and about three cases of Hepatitis C in each year for the past five years, according to the Illinois Department of Public Health. Still, IDPH has already planned for the worst.
“IDPH’s HIV surveillance team monitors all areas throughout the state,” spokeswoman Melaney Arnold said in an email. Should an outbreak occur, “we would quickly implement broader prevention messaging, more aggressive targeted outreach, education and screening.”