From the CDC and to be published in the Journal of Acquired and Immune Dificiency Syndromes. *
Two newspapers have now covered what is presumed to be the major compoenents of the alert. The Wall Street Journal and The Guardian. The WSJ article is the better one but can’t link to it. While not as good, The Guardian did do some actual reporting on it in Kentucky.
A new alarm for the HIV epidemic sounded early last year when a small, rural town in Indiana was beset with a staggering 188 cases of the hard-to-control disease – and the sirens have been heard in similar towns across the country.
The threat of another outbreak such as the one in Austin, Indiana, so concerned the Centers for Disease Control and Prevention (CDC) that the federal agency drafted a report showcasing which places in the US are most vulnerable to a similar outbreak.
The vulnerabilities are the same as what many have learned about the opioid epidemic. The concern now is that HIV and Hepatitis C could begin to spread quickly through this addict population.
The map in The Guardian pinpoints that counties that are currently at most risk. Do read the article and study the map.
It feels almost like we. as a nation, are right back where we were in 1964 when the War on Poverty was proposed. A major impetus for the Great Society programs was the 1962 publication of Michael Harrington’s The Other America. Four years ago, Harold Myerson in the The American Prospect wrote an excellent piece putting Harrington’s work within the context of the times and its impact on public opinion and government actions and policies. Difficult not to wonder if Americans were better back then at a social conscience level. Maybe we were, but if so, not by much. The big difference between then and now is that New Dealers were prevalent in DC and politicians, mostly Democrats, were better at selling “doing the right thing.”
In 1968 RFK toured the an area of KY and recognized they we have only just begun.
Empathy was easier to elicit from working/middle class Americans when they saw the images of shacks for shelter and emaciated bodies from Mississippi and the Appalachian region. Times are different. While the underlying core problems remain the same, the images are far different. While watching live coverage of the impacts of Katrina in New Orleans and Mississippi with a friend, she remarked, “They’re all so fat.” I likely scowled, but did say it’s the result of the poor diet in the south and that’s aggravated by plethora of cheap calories that exists today. Obesity is now an epidemic — study the map. Notice the similarities between this one and the rural counties at risk for opioids, HIV, and Hepatitis C. (It’s a correlation and no, obesity isn’t causing opioid addiction or HIV.)
My scary thought is that the clusters for opioid addiction-HIV-Hep C that the CDC has identified are incomplete. Could there be a reason why they are popping up in these locations other than prevalence rates?
One more map to look at. The at-risk couty map distorts the visual interpretation. For example, Utah counties are geographically large but their populations are small. To a lesser extent, the same is true with regard to Maine. That leaves only two states with a significant number of counties on the risk-list that are withot the Medicaid expansion. Unfortunately, without access to the CDC data it’s not yet known how high they are on the list and to what extent reports of HIV-Hep infection among opioid addicts, as contrasted with the other risk factors including opioid addiction rates. There may also be something unique about the availibilty of medical care in TN that I’m not familiar with beyond the fact that Tennessee ranks 18th in number of primary care physicians per capita.
(As with most measure of health, MS is near the bottom on physicians/capita #49, although on this criteria UT at #44 is surprisingly low as well.)
Arkansas appears to be an anomaly as Medicaid was expanded there when it was introduced nationwide. However, the program in AR was done with a DHS waiver and may not be as robust as KyNect which despite its name is the standard Medicaid expansion. Or opioid addictions may be low there.
Louisiana didn’t implement the Medicaid expansion until June 1, 2016. So, too soon to tell.
I suppose that honesty requires noting that Governor Pence and the State of Indiana haven’t been lax since the HIV outbreak in their state. A syringe exchange program was implemented.
Once again encourage others to read at least The Guardian article. This is a matter of national health and one more horrible aspect of the opioid use epidemic.
* If it isn’t free to read when published then the USG is going down another slippery slope. One the Aaron Swartz was ringing a bell about this with his hack of JSTOR.)