"It's not only possible; it's probably it will happen somewhere else," said Austin Clerk Treasurer Dillo Bush. "And . . . it could get out of control very quickly."
The federal Centers for Disease Control and Prevention has issued a national advisory to states, health departments and doctors to become aware of groups of drug users who have HIV and hepatitis C. HIV is already a problem in other rural areas. More than half the cases of HIV outside metropolitan areas are in Alabama, Mississippi, South Carolina and North Carolina. In Kentucky, Tennessee, Virginia and West Virginia, prescription painkiller abuse—which caused Indiana's outbreak—more than tripled between 2006 and 2012, Ungar and Kenning note.
In Austin, the drug problem went undetected by outsiders for many years. Families injected drugs together, often sharing needles, and some addicts would inject themselves between four and 15 times per day. "Drug culture often thrives in economically marginalized rural areas without treatment centers like Austin, where one in five residents live in poverty, one in five have no high-school diploma and there's little to do," said Ruth Carrico, an infectious-disease expert at the University of Louisville.
A lack of health education, transportation and funds compound the issue, they write. Historical funding has historically neglected rural areas, said Janice Probst, director of the South Carolina Rural Health Research Center. "HIV rates have been going up in rural areas . . . (but) there's an exclusive focus on the largest public health agencies."
"If you're not investing in public health at all levels, these kinds of things can go on," Carrico said. "Even a small community needs public health. Small communities can have big problems." (Read more)