Report: County at risk for HIV outbreak

A Birmingham physician says Walker County is 37th in the nation among counties most at risk for an HIV outbreak, pointing out how drug use has made that danger more possible.

Dr. James Galbraith, an emergency physician at UAB Hospital, spoke about Walker County's risk of experiencing an infectious disease outbreak at the Rotary Club of Jasper's Tuesday meeting.

"Due to injection and unsterile needle reuse and sharing, we're seeing a Hepatitis C virus epidemic, and there is a risk of an HIV outbreak," he said.

Galbraith has applied for two grants to fund a study on the prevalence of Hepatitis C and HIV among local intravenous drug users.

Walker County was one of 220 counties in the nation identified as being highly vulnerable for an HIV outbreak in a Centers for Disease Control and Prevention (CDC) report released in 2015, he said. The county ranked 37th on the list of most at-risk counties nationally in the report.

"That number is so high because Walker County shares a border with Jefferson County, where one in every 240 persons is living with HIV infection. We have a high prevalence for HIV and evidence of clusters of possible transmission of Hepatitis C along this border. The concern is that there is the potential for an outbreak in the west side of Jefferson County or in Walker County," Galbraith said.

He added that it is impossible to know when an outbreak could occur, though increased testing would help assess the risk.

Galbraith said the scope of the problem is hard to determine, because it is currently being measured in deaths and arrests.

"For every death and arrest, there are 50 more people who have a problem that we are unaware of. We need to know the true size of the problem, where the problem is and how prevalent some of these infections are so we can target an intervention effectively," Galbraith said.

Marion, Winston and Franklin counties also made the list of vulnerable counties. They were ranked 100th, 109th and 206th, respectively.

The CDC report was prompted by a 2015 HIV outbreak in Scott County, Ind., that probably started at least four years prior.

To date, over 200 people in Austin, Ind., which has a population of 4,000, have been diagnosed with HIV.

"They were all white. They were all younger. It was mostly males, and it was secondary to injecting a medication that was being prescribed by pill mill providers," Galbraith said.

Galbraith said he began screening patients for Hepatitis C five years ago after heroin overdose cases began to spike.

At UAB Hospital, one in eight white patients born after 1965 tests positive for Hepatitis C.

"It alarms me every day. We're going through six or seven new diagnoses a day in our emergency department right now," Galbraith said.

Hepatitis C is caused by a blood-born virus and kills more Americans than any other infectious disease, according to a 2016 CDC report.

In 2014, deaths associated with hepatitis C reached an all-time high of 19,659, according to the report.

Galbraith said better access to addiction recovery is needed to address the opioid crisis, as well as the potential for an infectious disease outbreak.

A more immediate solution that has produced results is harm reduction, such as needle exchange programs and making Naloxone accessible to family members of heroin users.

"The theory behind it is if we are not able to stop the behavior, can we reduce the risks associated with the behavior and the consequences it has on the individual as well as the public," Galbraith said.

The state has taken steps to make Naloxone more widely available. However, syringe service programs, which would include a needle exchange component as well as peer coaching and surveillance of users, are currently not allowed by law.

If the laws are changed, such programs need to be strategically placed and should be operated by local health departments, according to Galbraith.

He added that curbing opioid prescriptions alone will not fix the current crisis.

"Individuals who have been on long-term opiates can't get it anymore. The street value of pills that were once $5 a pill is now $20 a pill. People jump to heroin, and the consequences get worse," Galbraith said.

Galbraith has applied for grants through the Centers for AIDS Research and the National Institutes of Health to fund a study in Walker and Jefferson counties.

Galbraith said he is not optimistic about the chance of getting funding from the NIH. Word from the Centers for AIDS Research is expected as early as October.

If approved, between eight and 10 drug users would be recruited from local treatment centers, jails and emergency rooms. They would receive $60 in exchange for having blood drawn and agreeing to a series of interviews. They would also receive referrals for addiction care or infectious disease treatment.

Participants would also be asked to invite others to participate in the study. "I would not do any intervention unless it was driven by the people in this room and the Walker County Health Department. My plan is to try to figure out how bad the problem is, where it is geographically and give a better idea of the risk for an outbreak," Galbraith said.