According to a study recently released by the South Dakota Department of Health, Yankton is among 13 counties at higher risk for HIV and Hepatitis C infections.

The South Dakota Vulnerability Assessment examined opioid-related deaths in each county to assess the risk of opioid overdose and increased incidence of HIV and viral hepatitis (HCV).

“There’s been a lot of focus at the national level in trying to identify areas that are higher-risk areas within the country with everything that has been going on with the opioid epidemic,” said Joshua Clayton, state epidemiologist for South Dakota. “We just completed our County Vulnerability Assessment, and with that, there are 13 counties that are considered more vulnerable to opioid overdose or potential cases or spread of HIV or HCV in the community.”

Rural communities in the United States are disproportionately impacted by drug overdose deaths despite having lower drug use rates than urban communities, according to the assessment.

The 13 higher-risk counties identified in the assessment represent the top 20 percent in the state in terms of risk.

The goal of the study was to estimate the amount of intravenous drug use (IDU) in South Dakota by county as accurately as possible, based on a number of factors, including healthcare access, socioeconomic data, rates of death by opioid overdose and cases of HIV and HCV in people under 40.

Counties in the top 20 percent risk-wise were designated as relatively more vulnerable to an increase in opioid deaths and new cases of HIV and HCV. Those counties have not been ranked, and are listed here in alphabetical order. They include: Brown, Buffalo, Charles Mix, Corson, Dewey, Hughes, Lyman, Minnehaha, Oglala Lakota, Pennington, Roberts and Yankton counties.

“The work that we did is something that all states across the nation are doing,” Clayton said. “This is something that has been done before by (the Centers for Disease Control and Prevention) at the national level.”

That national data did not identify any South Dakota counties being at high risk, he said.

“That doesn’t mean we are zero risk. So, we took on this analysis to identify areas for our opioid analysis group to focus their efforts on,” Clayton said. “The overall picture was to say, ‘There is a risk if a person is using drugs and, especially if a person is injecting those drugs, they put themselves at risk of HIV and hepatitis C.’”

Once the data was compiled, Yankton County was in the top 20 percent for risk.

“There is no single data source that we looked at to make that determination,” he said. “We looked at 20 data sources — plus — to come to that conclusion.”

Clayton outlined the path opioid addiction can take in that it tends to move from pills to IDU.

“When a person starts off, they might start out with a prescription from a doctor and maybe they are having a higher pain level, misuse the prescription and become addicted,” he said. “As the doctors focus less on prescribing oral medications, individuals may turn to street drugs, like heroin, and may start injecting those street drugs.”

Most overdose deaths involve opioid prescription or illicit opioid street drugs, he added.

“Mainly, when we talk about injection drugs, it is moving into street drugs, heroin being a large piece of that,” Clayton said. “Also, with fentanyl and fentanyl analogs that are becoming more and more common across the United States, including in South Dakota, they are getting something that is cut with fentanyl and they are injecting that a lot of times.”

In 2017, there were 35 opioid overdose deaths in the state. Twenty-nine of them included a prescription drug and eight included a street drug or an illicit opioid, he said. Two individuals had both in their system.

Other behaviors associated with addiction may not lead directly to overdose, but they could increase the risk of new cases of HIV and HCV.

“Anytime a person is exchanging drugs or money for sex, they are at higher risk of HIV,” Clayton said. “Individuals may also be at higher risk because they are sharing the equipment for injecting drugs into their system.”

Once vulnerable communities are identified, the plan is to raise awareness and, hopefully, prevent an increase in overdoses and new cases of blood-borne pathogens.

“Part of that outreach is to open a discussion with community-based organizations, state agencies that have offices there, the communities themselves, the health-care providers (and) the mental-health providers,” Clayton said. “We’ve identified that there is a risk of drug use and blood-borne pathogens HIV and hepatitis C. Now, let’s see what we can do to help ensure the community is resilient and that this does not come true, that Yankton doesn’t have a large number of overdoses or have a large number of HIV or Hepatitis C cases.”

South Dakota now also has a strategic plan to tackle opioid abuse that covers four main areas, the first of which is raising public awareness about the risks associated with opioid abuse, followed by prevention, treatment and support and improving provider resources.  

“This is an opioid roadmap in terms of the activities that are underway at the state level,” Clayton said. “Then, there will be follow-up as we discuss the results of this vulnerability analysis and assessment to bring that information to communities who can then identify what can be done to have a positive impact.”

For more information on data specific to Yankton in the vulnerability study, go to: https://doh.sd.gov/statistics/VulnerabilityAssessment/Yankton.pdf.

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