Rural Risk Environment For Hepatitis C Among Young Adults Who Use Opioids In Appalachian Kentucky

Author: David H. Cloud, April M. Young, Umedjon Ibragimov and Hannah LF Cooper

Theme: Social Science & Policy Research Year: 2018

Background: Hepatitis C (HCV) is surging in communities across rural Kentucky among people
who inject drugs (PWID). The Risk Environment Framework has been used widely to study and
address socio-ecological determinants of infectious disease among PWID. Yet, most studies
have focused on urban environments. The dearth of research on features of risk environments
in rural Appalachia is a significant gap in understanding the epidemiology of the opioid epidemic
and tailoring harm reduction interventions to these communities.
Methods: From March to August 2017, we conducted nineteen in-depth, semi-structured
interviews with young adults (age 18-34) who use prescription opioids and/or heroin and reside
in Appalachian Kentucky. Participants were asked to discuss places where they use or inject
drugs; their ability to or perceptions of access to clean injection equipment; and features of their
environment that increase or decrease risk of HCV. Interviews were transcribed and analyzed
using a grounded-theory approach.
Results: Participants reported a range of environmental risk factors for HCV among young
adults who use/inject opioids. These included: geographic isolation from healthcare services
and syringe exchange programs; rushing to inject in public bathrooms, car washes, graveyards,
abandoned trailers, and other spaces without running water or access to sterile equipment;
reliance on diabetic patients for syringes; familial opioid-use in close-knit residential
communities; a sense of hopelessness due to dwindling employment opportunities; stigma as a
barrier to HCV testing and treatment; normalization of HCV infection among PWID; and fear of
police as contributing to risky injection practices.
Conclusion: This exploratory study provides important contextual information about the
features of rural risk environments that may contribute to HCV. Findings will help to better
understand the epidemiology of HCV in rural Appalachia and inform interventions to abate a
mounting epidemic in Kentucky.
Disclosure of Interest: The National Institute of Drug Abuse within the National Institute of
Health funds this study. The authors report no conflicts of interest.

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