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HIV outbreak calls for improved public health in rural America

By Michael Meit, NORC Walsh Center for Rural Health Analysis co-director and NRHA board member, and Brock Slabach, NRHA membership services senior vice president
The HIV outbreak in rural Scott County, Ind., took many by surprise last week. For others, the news was sad but not so surprising. The combination of rural poverty, lack of rural public health resources and a high uninsured population is manifesting in an epidemic. The devastating truth is it has taken an HIV outbreak to point out these deficiencies. The proverbial chickens have come home to roost. While rural communities have many assets, some also experience longstanding poverty that results in despair which often can lead to drug abuse. The 80 or more cases of HIV infection in Scott County has been linked to intravenous use of prescription pain medications. The drug of choice in this community was Opana, a long-acting form of Oxymorphone. When altered and injected it produces a powerful high. The chief Indiana health officer told the New York Times: “There’s a feeling of hopelessness within this community. They’re addicted, and they’re getting HIV because they’re addicted.” While there is a critical need to address the underlying social conditions that lead to this sense of hopelessness, we also need to ensure that our rural communities have the health care, public health and social services resources necessary to prevent substance abuse, treat addiction, and identify and contain infectious and communicable diseases. Our rural communities bring much to the table in addressing these challenges, including strong social networks, a culture of self-sufficiency, and robust faith communities. At the same time, however, America’s rural community systems need proper investment, training and technical assistance to effectively leverage these assets and ensure the health and wellbeing of the people they serve. It is heartbreaking that a preventable disease like HIV has to be epidemic before it highlights what the National Rural Health Association and public health professionals have been saying for decades: Investment in both the economic and public health of rural communities is essential. State and local governments have been slashing public health and social services funds for several years, particularly following the economic recession. At the same time, federal resources have also declined. This results in rural communities being more reliant on federal funds as an overall proportion of their budgets, even as their overall budgets have dwindled. Together, these cuts have both decreased available funding to address social and public health issues in our rural communities, while impeding the flexibility rural areas have to address the unique issues they face. Yes, the chickens have come home to roost due to years of neglect. Let’s use this tragedy to change policy and ensure that this is the last epidemic we have to endure. Help advance rural public health during NRHA's Annual Rural Health Conference in two weeks, and learn about drug abuse intervention and HIV prevention and treatment efforts specific to rural areas.

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