Overview: Due the opioid epidemic and shared use of syringes and needles, the demographics of HIV infections have shifted across racial, geographic, gender, and age lines. While LGBTQ men remain at the most risk of HIV transmission, upward trends in rural areas and among women and younger people are of particular concern. HIV diagnosis and demographics make opioid recovery more of a challenge due to lack of resources and access.
The Changing Face of HIV
While the overall incidence of HIV diagnoses has been steadily decreasing between 2015 and 2019, there have been some worrying trends in the U.S. People between 25 and 44, for example, are now the groups with the highest rates of new infections, and the rate of infections among women has held even as the rates among men have declined.
In addition, rural areas are seeing upward trends. In 2019, the US government identified seven states in the Southeast and Midwest that are of concern due to possible rural outbreaks.
A Lancet study has found these trends in HIV are driven at least in part by the opioid epidemic. As the study notes, rural areas in particular have been hard hit by substance use disorders (SUD). As prescriptions have been curtailed, many struggling with an SUD have turned to injectable drugs such as heroin.
Meanwhile, urban areas had instituted policies, such as needle exchanges, to reduce HIV infections among intravenous drug users, which steadily reduced infection rates in those areas. However, rural areas have fewer resources and are less likely to have such policies in place, shifting the demographics.
For example, in 1990, intravenous drug users represented 30% of all new HIV infections, and within that group, 38% were White and 38% were African American. In 2015, intravenous drug use was responsible for only 7% of infections, but of that group, 54% were White and 19% were African American. Similarly, women are one to two times more likely to become infected, according to the Lancet study,
A Confluence of Epidemics
All of this was compounded in 2020 and 2021 by the COVID-19 pandemic, which made resources that many rural people already struggled to access even more difficult to use. In order to address the risk effectively, counties and states should take the following steps:
- Bolster the ability of the health care systems already in use, such as rural hospitals and storefront clinics, to increase outreach and administer basic care.
- Use the policies that reduced outbreaks in urban areas, such as syringe exchanges, medication-based treatment, pre-exposure prophylaxis (PrEP), and HIV treatment as prevention.
- Work to reduce stigma and misinformation through public health campaigns and personal intervention. Often myths about HIV and misconceptions about SUDs can prevent sufferers from seeking help or family members from spotting concerns and intervening.
- Identify and remove barriers such as transportation needs and lack of funds.
- Make self-testing and rapid testing available, especially in more remote rural areas with less health care access.
On the personal level, injection drug users may find it helpful to step away from their current environment for a time. A supportive environment can help people working towards recovery and managing other concerns find and stay on their path.
Harris House Can Help
To learn more about how Harris House can help you or a loved one recover from a substance abuse disorder, call us to learn about admissions.