ROBERT SIEGEL, HOST:
An outbreak of HIV in southeastern Indiana drew the attention of public health experts, media and lawmakers. Most of the cases are linked to sharing needles to inject drugs. And we're going to hear about another epidemic that injection drug use is fueling. From Rhode Island Public Radio, Kristin Espeland Gourlay reports on the growing threat of hepatitis C.
KRISTIN ESPELAND GOURLAY, BYLINE: All it takes is contact with a tiny drop of blood - even a microscopic smear of blood can be teaming with the hepatitis C virus. That's why sharing a needle or other paraphernalia to inject drug spreads hepatitis C. It's much more contagious than HIV. Brown University epidemiologist Brandon Marshall studies patterns of drug abuse and infectious disease.
BRANDON MARSHALL: So if someone starts injecting, they have about a 50 percent chance of becoming infected with hepatitis C within three years, so that's a very high risk of infection.
GOURLAY: Plus, more Americans are injecting drugs than they did 10 years ago. Many got hooked on painkillers like Vicodin then turned to something similar but cheaper - heroin. Marshall says today's younger injection drug users might not know they're at risk, but that risk is becoming reality. The Centers for Disease Control and Prevention reports 150 percent increase in new hep C cases nationwide just in the past three years - triple that in some pockets of the country. The disease now kills more people than HIV, but it doesn't have to. That's the message Arien Daly and Keith Thompson deliver every Tuesday when they pull their yellow van into this noisy church parking lot. They're with a small nonprofit called AIDS Care Ocean State, and we're in a small town in northern Rhode Island. Like many others, it's been ravaged by opioid addiction.
KEITH THOMPSON: Let me just get the stuff and let me set up.
GOURLAY: Thompson opens the back of the van and sets up his testing supplies - swabs for HIV, sticks for hepatitis C. His first client of the day arrives. She takes a seat on the carpeted floor of the van and rolls up her sleeve.
THOMPSON: Oh, I just need your finger. There we go. All right, you see, so that's it. So hold that for one second. Let me put a Band-Aid on it.
GOURLAY: Thompson pricks her finger and collects a drop of blood to screen for hep C. In 15 minutes, she has an answer. Despite a history of injecting drugs, she's negative. Meanwhile, Arien Daly preps the needle exchange kits. People who inject drugs can enroll in the program anonymously. They turn in used needles for a bag of sterile supplies.
ARIEN DALY: You have your clean cookers. Oh, and then, of course, we have our two sizes of needles that we carry in our bags 'cause we're talking about anything where blood is going to be, you have a possibility of spreading infectious disease.
GOURLAY: Needle exchange programs still stir up controversy. There's a ban on using federal dollars to fund them, but a recent HIV outbreak in Indiana sent public health officials scrambling to revive an exchange program there.
JOHN WARD: The urgency around this HIV outbreak is not misplaced by any means.
GOURLAY: This is John Ward, head of the CDC's division of viral hepatitis.
WARD: It's just there should be an equal sense of urgency regarding these epidemics of hepatitis C around the country.
GOURLAY: Ward says he and his colleagues are just beginning to get a handle on the true scope of the problem, but the very nature of the disease makes it tough. First, most people have no idea when they get infected.
WARD: They don't even seek medical attention. If they do, the health care provider may not order a test to detect that infection, and then those cases may not be reported to the health department or on to CDC.
GOURLAY: Ward says most people never get tested. Years from now, some will develop serious complications, like liver cancer or cirrhosis. Back in the church parking lot, a young woman with a long brown ponytail approaches the yellow van. Her name is Nicole. She doesn't want to use her last name because of the stigma she and her family could face. She says she's not here for the needles, not this time.
NICOLE: I've been clean for nine months.
GOURLAY: Nicole found out she had hepatitis C about six months ago, but it was more than a decade ago that she began using opioids - at first, a prescription for the painkiller Demerol after a C-section.
NICOLE: They weaned me from them to nothing. And I was sick and a friend of mine had told me, oh, well, there's this stuff called heroin and, you know, it's cheap and you'll feel better.
GOURLAY: Things got so bad for Nicole that she shared needles with someone she knew had hepatitis C.
NICOLE: I didn't have a needle to use and they had one. Even though they warned me, I was sick. For anybody who doesn't know, being dope sick is equivalent to the flu times 500. So I would've did anything.
GOURLAY: Now Nicole says she's ready to put that behind her. Keith Thompson gives her some good news.
THOMPSON: So we'll set you up with some treatment because, you know, there's a cure for hep C now.
NICOLE: Yes, but I have been struggling finding a place for treatment.
THOMPSON: We can get you in there for free.
GOURLAY: Thompson sets her up with a free doctor visit. And new drugs have just hit the market that can probably cure her faster without the side effects of older treatments, but they're so expensive, patients are struggling to gain access. For NPR News, I'm Kristin Espeland Gourlay in Rhode Island. Transcript provided by NPR, Copyright NPR.
