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Rural US counties with active HIV transmission lack prevention services
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HIV prevention services such as pre-exposure prophylaxis and harm-reduction programs were offered in only about one-quarter of rural West Virginian counties, where health officials identified an increase in new infections among men who have sex with men and people who inject drugs, according to findings presented today at the CDC’s annual Epidemic Intelligence Service conference.
The results highlight the need to expand HIV prevention efforts in these areas because currently available services may not be enough to curb rapid transmission, Mary (Molly) Evans, MD, MPH, Epidemic Intelligence Service (EIS) officer with CDC’s Division of HIV/AIDS Prevention, and colleagues reported.
According to the researchers, officials with the West Virginia Department of Health and Human Resources consulted the CDC in July 2017 after they detected an increase in new HIV diagnoses. CDC investigators responding to the alert identified 57 patients with HIV in 15 rural counties, 70% of whom were diagnosed in 2017. The patients were more often men (89%) who were white (75%). Approximately half were aged younger than 30 years.
“Though we were very concerned about the potential for rapid HIV transmission among people who inject drugs in this region, we found the majority of transmission was attributed to male-to-male sexual contact,” Evans told Infectious Disease News.
Overall, 60% of HIV transmission was linked to sexual contact among men who have sex with men (MSM), whereas 9% of transmission was related to injection drug use (IDU), and 5% was attributed to a combination of IDU and sexual contact among MSM.
After identifying transmission patterns, the researchers interviewed patients, health care providers and local health department staff to determine how accessible HIV prevention services were in the affected areas.
“Our interviewees most frequently used the word ‘stigma’ to describe their perceived barriers to HIV prevention and care services,” Evans said.
However, there were physical barriers to prevention services, as well, according to Evans. Only 27% of HIV and primary care providers in the affected counties offered PrEP, and it took some patients up to an hour and a half to travel on mountain roads to a PrEP clinic. In addition, only three counties (20%) provided syringe service programs, despite previous research showing that these programs can reduce risky behaviors among injection drug users.
HIV outbreaks have been identified in other rural areas of the U.S. More than 180 new infections were reported in rural Indiana from Nov. 18, 2014, to November 1, 2015. The outbreak was traced primarily to IDU among white men.
“In response to this investigation, West Virginia is expanding access to PrEP, including training clinicians in some county health departments,” Evans said. “The state has also provided funding for syringe service programs for five counties in the affected region.
“There are other related medical needs in the region,” she continued. “CDC is working to understand HIV transmission patterns, and is working with West Virginia to identify coinfections with syphilis, hepatitis B and hepatitis C.” – by Stephanie Viguers
Reference:
Evans M, et al. HIV in a Mostly Rural Area Affected by the Opioid Epidemic — West Virginia, 2017. Presented at: Epidemic Intelligence Service conference; April 16-19, 2018; Atlanta.
Disclosures: The authors report no relevant financial disclosures.