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HCV Call To Action
  The study "provides a call to action," John Ward, director of the CDC's division of viral hepatitis, said in an interview. "We have a major problem with hepatitis C," he said, noting that acute infection reports nationwide rose by 150% between 2010 and 2013.
CDC Reports 350% Surge in HCV Infections Among Young in Apalachia; federal ineptitude & refusal to respond to HCV persists - (05/06/15)
Links to WSJ article reporting on the rising rates of HCV.
Rural U.S. Struggles to Combat IV Drug
Hepatitis C and HIV outbreaks test public-health resources in Midwestern states
Abuse of opioid painkillers and heroin in rural areas and small cities is causing hepatitis C and HIV to spread in regions where they were uncommon two decades ago. New hepatitis C infections nationwide rose 150% between 2010 and 2013, with the largest increases in rural areas, according to the Centers for Disease Control and Prevention. Last month, the CDC said new hepatitis C infections in young adults more than quadrupled in four states-Kentucky, Tennessee, Virginia and West Virginia-from 2006 to 2012, with many cases linked to injection-drug use. Infections in Ohio have grown by 50% over the past five years.
Nor does anyone know how high the public-health costs could climb. Left untreated, hepatitis C can lead to cirrhosis or cancer of the liver, and ultimately to the need for a liver transplant. New drugs have high cure rates, but can cost more than $80,000 per patient. Lifetime treatment of HIV can run as much as $400,000.
"The cost of this epidemic is spectacular," says Judith Feinberg, a University of Cincinnati doctor who treats intravenous-drug users for hepatitis and other problems.
Big cities have been dealing with injection-drug use for decades. Substance-abuse facilities and needle exchanges are common, as are public-health campaigns warning about the risks of abuse. But in rural areas and smaller cities, young users have no memory of the 1980s AIDS epidemic and typically view such risks as urban problems, health officials say.
"In many urban settings in the U.S., people who inject drugs have had years of preventive counseling and messaging and know how to protect themselves," said Jonathan Mermin, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, earlier this year. In rural areas, he said, many may not have received counseling, "and it presents a problem."


Long Struggle for Midwestern Needle Exchange....Dr Judy Feinberg opens needle exchange......http://www.wsj.com/article_email/long-struggle-for-midwestern-needle-exchange-1434726248-lMyQjAxMTA1MzEyOTkxMTkxWj
A mobile needle exchange in Cincinnati was shunned by several neighborhoods before it finally got rolling
June 19, 2015 11:04 a.m. ET


It took Judith Feinberg years to gain political backing to open a needle exchange for injection-drug users in Ohio's Hamilton County, even as heroin and painkiller abuse spurred a flood of hepatitis C infections in the region.
Six weeks after it opened last year in a recreational vehicle in a Cincinnati suburb, the local government shut it down, saying residents felt it encouraged drug use and attracted addicts to the neighborhood. Several other communities also rejected the project. Eventually, a church offered its parking lot.
The struggles of Dr. Feinberg, an infectious-disease specialist at University of Cincinnati, highlight the challenge of fighting the plague of blood-borne infections like hepatitis and HIV hitting small cities and rural areas.
Needle exchanges, where users can swap dirty syringes for clean ones, are one of few effective tools for curbing the spread of disease among drug users who share needles. Since HIV's arrival in the 1980s, exchanges have been operating in big cities such as New York. One analysis there found that drug injectors who didn't participate in the programs were 3.35 times more likely to become infected with HIV than those who did. Advocates say the programs also can steer addicts into treatment for addiction or infection.
Supporters are pushing to open such programs in Midwestern and Appalachian areas that have become hotbeds of drug abuse and infections. But federal funding for needle exchanges is banned, and in most states they face legal barriers and political and community opposition.
Dr. Feinberg, who first faced opposition from Cincinnati officials, got a break when a suburb just north of the city-Springdale, population 11,000-offered to host the project. "You'd have to be a member of the Flat Earth Society not to believe we have a heroin epidemic in this country and region," says Springdale Mayor Doyle Webster.
The Cincinnati Exchange Project first opened for business in a Springdale parking lot in February 2014, in a recreational vehicle donated by Planned Parenthood. "Immediately I started getting a lot of complaints," Mr. Webster says.
Discontent boiled over at a city council meeting that March, when more than a dozen residents took the floor to denounce the program. "We want this program out of Springdale tonight!" Julie Matheny said. The council voted that night to eject the RV from Springdale.
By early 2014, Cincinnati had a new police chief and city manager, who seemed more sympathetic to the needle exchange, according to Dr. Feinberg and her partner on the project, local HIV activist Adam Reilly. They decided to try Cincinnati again. They first tried a low-income neighborhood called Lower Price Hill, but the community's council voted to block the RV.
Paula Jackson, the rector of an Episcopal Church in Cincinnati's Mount Auburn neighborhood, emailed Dr. Feinberg to offer a parking lot. A member of the church had died a few months earlier after using heroin. "We're talking about our people," says Rev. Jackson. "Anybody can be an addict."
The needle exchange parks next to the church every Wednesday, and has since won permission to park in two other Cincinnati neighborhoods.
A counter top in the vehicle is covered with pamphlets on disease prevention and addiction treatment, along with baskets of free condoms and heroin cookers. The RV also offers finger-prick screening for hepatitis C, HIV and syphilis, with results available in 10 minutes. The program encourages users to get treated for infections and addiction, and refers for treatment anyone who is willing.
About 350 addicts have used the RV so far, sometimes driving more than an hour from rural areas in Ohio and Kentucky. About 35 have entered addiction treatment, sometimes accompanied to appointments by Libby Harrison, who helps run the RV. About 70% of the users who have agreed to screening have tested positive for hepatitis C, and about 4% positive for HIV, Dr. Feinberg says.
The project gets no government funding, aside from a supply of a heroin-overdose antidote, which it gets from the state and distributes to drug users. It cobbled together a $50,000 budget this year with money from a local charitable foundation, individual donations and T-shirt sales.
"We try to make every buck we can," Ms. Harrison says.

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