The nation’s drug crisis, as bad as it is, is spreading new epidemics of the AIDS virus and hepatitis. Nationally, the risk is high in this part of the country, and Kentucky is the state at highest risk, according to the U.S. Centers for Disease Control and Prevention.
HIV, the AIDS virus, and hepatitis are being spread through the sharing of needles used to inject heroin and other addictive painkillers. In rural Scott County, Indiana last year, HIV spread rapidly through needle sharing among addicts.
Alarmed that the virus spread so quickly in a county of only 20,000 people, CDC officials became concerned about it happening elsewhere. The agency analyzed every county in the U.S. to see how vulnerable they were to an outbreak.
They identified 220 counties (out of 3,007) as being at risk. Then they ranked those counties.
They found that Kentucky is the most vulnerable state in the nation for an HIV outbreak. Eight of the top 10 at-risk counties are in Kentucky, and 13 of the top 20.
Jim Thaxton, a Northern Kentucky health official, has seen the maps and the analysis.
"My face went ashen when I saw it," he said. "Our region is at risk."
The maps below show the counties in Ohio, Kentucky and Indiana that the Centers for Disease Control and Prevention identified as being vulnerable to an outbreak of the AIDS virus or hepatitis C due to needle use.
The risk is concentrated in the Appalachian regions of Kentucky, southern Ohio, West Virginia and Tennessee. Several counties in southeastern Indiana are also on the list. These are areas, largely rural, where years ago doctors set up so-called "pill mills" and prescribed millions of pain pills, creating legions of opiate addicts.
“The biggest concentration of risk is in this part of the world,” said Dr. Judith Feinberg, a Cincinnati-based public health expert who’s been briefed on the CDC analysis.
In metro Cincinnati, Northern Kentucky’s Campbell County made the list and is ranked No. 212 nationally. Grant, Gallatin and Carroll counties are also on the list.
Kentucky's at-risk counties are clustered in the southeastern part of the state, a region that’s among the poorest and most remote in the country. Kentucky's Wolfe County is No. 1 on the at-risk list. People who live there earn a median household income of only $21,198, and 36 percent live below the poverty line.
In Ohio, the neighboring counties of Brown and Adams are on the list, as is the tier of Appalachian counties stretching from Brown and Clinton to Athens and Meigs.
In Indiana, Dearborn County (Lawrenceburg and surroundings), Switzerland County (Vevay) and Ripley County (Versailles) are three of the 10 counties identified in that state.
Indiana’s at-risk counties include Scott, where a fast-spreading HIV outbreak spurred the CDC to do its national analysis in the first place. There, the small town of Austin, population 4,200, was the epicenter of an outbreak of the AIDS virus that began in early 2015. Since then, nearly 200 people have contracted HIV. It spread quickly through the sharing of needles used to inject the heroin-like painkiller Opana.
"As soon as Scott County happened, it was clear that this would not be unique," Feinberg said.
Disease trackers at the CDC say a similar outbreak could happen elsewhere because of the widespread use of needles to inject drugs, and the practice among drug users of sharing needles.
Rural areas are at high risk, according to the CDC’s formula, which takes into account several factors.
The analysis looked for counties that had similar characteristics to Scott County: “Substantial unemployment, a high proportion of adults who have not completed high school, a substantial proportion of the population living in poverty, and limited access to health care.” They also factored in the volume of pain pills prescribed in the counties.
"There are many other Scott Counties out there," Feinberg said. "I think we'll see this phenomenon again."
Because the study has not been published yet, CDC officials were reluctant to talk about it. But In March, Dr. Jonathan Mermin, who heads up the CDC’s center for HIV and AIDS prevention, wrote to local health officials about it.
He encouraged health departments to get ready and prepare plans to respond to potential outbreaks. He also asked them to ensure that jails, treatment centers and emergency rooms -- places that come into frequent contact with addicts -- offer testing for HIV and hepatitis.
The CDC also has encouraged local health departments to expand on the CDC's analysis and examine local data on drug overdose deaths, admissions for drug treatment and drug arrests.