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It’s not so much the drug use. It’s the poverty and the lack of resources.

That’s what officials at the Centers for Disease Control and Prevention (CDC) are saying about an outbreak of hepatitis C in the Appalachian region of the eastern United States.

The CDC report stated that the disease occurrence has more than tripled in Kentucky, Tennessee, Virginia, and West Virginia.

In fact, Kentucky has the highest rate of hepatitis C of any state in the country, at 4.1 per 100,000 people. That’s six times the national average.

The CDC report looked at data from 2006 to 2012. The virus soared 364 percent in those four states during that six-year time span.

Appalachia

Rates of infection were highest among people under the age of 30. In fact, almost 45 percent of the 1,377 cases reported were people in that age bracket.

Laureen Smith, Ph.D., R.N., director of the Appalachian Translational Research Network, said the outbreak is more than a drug issue — it’s an economical and societal issue, too. Her organization is dedicated to public health in the rural area.

“The hepatitis C outbreak is rooted in the poverty that has gripped the region,” Smith said.

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Resources Lacking

In order to stop the outbreak, professionals must communicate with drug users. That is difficult because there are so few resources in that region to screen and treat for the virus, experts said.

“In the areas that I travel, there is one infectious disease specialist who treats all who are diagnosed with hepatitis C in the region,” Smith said. “The lack of resources for outreach and screening, as well as treatment, are some of the greatest challenges to overcome.”

April M. Young, Ph.D., an assistant professor at the University of Kentucky College of Public Health, agreed.

“Poverty and unemployment are root causes that underlie many issues related to drug use, hepatitis, and HIV,” Young said.

The cost of hepatitis C treatment is another challenge in stopping the spread of the virus, Young added.

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Needle Exchanges a Solution?

Some experts say that needle exchanges would provide a solution, but Smith said that is not enough. To have a meaningful impact, a multi-pronged approach is needed.

“Needle exchange programs are effective but do not reach those at the primary prevention level,” she said. 

Smith said officials need to turn to communities to stop the spread of the virus. She said that community members often understand how to devise the best solutions.

“At the primary level, teaching and education are critical. At the secondary prevention level, outreach and screening are very much needed,” Smith said.

I never want to forget that the user is someone’s son, daughter, husband, wife, father, or mother. The user has a family.
Dr. Laureen Smith, Appalachian Translational Research Network

Smith wants drug users to know they are not alone. She said she understands their struggle is part of a larger issue. Simply telling them to “stop using” is not an effective remedy. The users and their families need the support and tools to overcome addiction.

“I never want to forget that the user is someone’s son, daughter, husband, wife, father, or mother. The user has a family,” Smith said. “In Appalachia, family is very important and families care for each other.”

Young said the communities in Appalachia have strengths that can be leveraged by engaging members of the community.

“Unfortunately, the public discourse too often focuses on the challenges and barriers in these settings without attention to their social assets and their resilience,” Young said.

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Preventing the Spread and Seeking Treatment

Young noted that users should not share needles or other injection equipment if possible. She understands that is easier said than done when it is hard to access clean equipment.

“So, in situations where obtaining clean equipment is not an option, they should thoroughly bleach their equipment,” Young said.

If any user would like to seek treatment, the Substance Abuse and Mental Health Services Administration has a free and user-friendly treatment facility locator.