Spike in HIV cases is an unsettling reminder

Kalkaska County shares a long list of similarities with Scott County, Indiana.

They’re both rural, Midwestern counties with rural Midwestern county challenges. Their economic and demographic statistics are like mirror images of one another slapped down on a map 500 miles apart along major highways in the extremities of adjacent states.

Median household incomes just shy of $50,000. Median home values of about $100,000. Similar numbers of employers. Similar population. Similar struggles with the social problems that hurt small, rural counties — things like alcoholism, poverty and drug abuse.

And now HIV.

A recent announcement by public health officials with the District Health Department No. 10 that there was a pronounced spike in HIV infections in Kalkaska County in recent years rings alarm bells that many familiar with Scott County’s history will remember.

DHD No. 10 officials said they were alerted to new infection numbers in Kalkaska from 2019 that showed the county had four times more new infections per capita that year than the statewide rate, and about three times the rate observed in the counties that comprise the Detroit Metropolitan Area.

Worse, the transmission rate (the number that tracks new infections) was about 10 times higher than statewide or in the Detroit Metro Area.

What does that have to do with Scott County?

Well, in 2015 Scott County, Indiana grabbed attention worldwide when an HIV outbreak ran through the community like an out of control freight train. Said and done, about 200 people became infected with HIV in a single year in Scott County. The spread was fueled by some of the same rural community problems that linger year after year in Kalkaska County.

In Scott County, intravenous drug use, driven by the opioid epidemic accelerated both HIV and hepatitis C infections at alarming rates. There, after a widely-criticized delay in response because of political and ideological infighting, the outbreak was finally tamped down by vigorous testing, public education and needle exchanges that aimed to disrupt the chains of infection.

That’s where the most concerning caveat in the news from Kalkaska County hit us. The data that was bad enough for local public health officials to call it “alarming” is stale at best. Probably because the clog the pandemic threw into our public health system nationwide, we’re just now seeing 2019 numbers. That means the outbreak likely has an 18-month head start.

It’s almost inconceivable that public health officials won’t find more HIV infections in Kalkaska County in the coming months as they launch efforts to assess and combat the outbreak.

In the meantime they appear to be taking a proactive stance — increasing and encouraging testing, encouraging safe sex and pointing those who inject drugs toward clean needle exchanges.

Now, the only question is how quickly can they install and scale systems to disrupt the chain of new infections, and how long will it take to assess how many people have been infected during the past 18-months.

There are dozens of similarities between Kalkaska and Scott counties, now including struggles with HIV.

But a swift and focused effort to combat this outbreak could ensure the similarities end there.


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