Challenges Facing a Rural Opioid Epidemic: Treatment and Prevention of HIV and Hepatitis C

Curr HIV/AIDS Rep. 2018 Jun;15(3):245-254. doi: 10.1007/s11904-018-0393-0.


Purpose of review: This article reviews recent epidemiologic trends in HIV and hepatitis C virus (HCV) and strategies for treatment and prevention of these infections as they relate to the opioid epidemic.

Recent findings: Among people who inject drugs (PWID) in the United States (US), HIV diagnoses are decreasing, while HCV is increasing. Care for HIV and HCV relies heavily on specialist infrastructure, which is lacking in rural areas. Antiretrovirals for HIV and direct-acting antivirals for HCV are effective among PWID, yet multiple barriers make it difficult for rural injectors to access these treatments. Similarly, access to syringe service programs, medication-assisted therapy for opioid addiction, and pre-exposure prophylaxis for HIV are all limited in rural areas. Previous research on HIV and HCV among PWID has focused on urban or international populations, yet the US opioid epidemic is moving away from metropolitan centers. Increasing rurality of opioid injection brings unique challenges in treatment and prevention. Research into the care of HIV, HCV, and opioid use disorder among rural populations is urgently needed.

Keywords: HIV; Hepatitis C; Opiate-related disorders; Rural health; Substance abuse, intravenous.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Retroviral Agents / therapeutic use
  • HIV
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology*
  • HIV Infections / prevention & control
  • Hepacivirus
  • Hepatitis C / drug therapy
  • Hepatitis C / epidemiology*
  • Hepatitis C / prevention & control
  • Humans
  • Needle Sharing / adverse effects
  • Opioid-Related Disorders / epidemiology*
  • Pre-Exposure Prophylaxis
  • Rural Health / statistics & numerical data*
  • Rural Population
  • Substance Abuse, Intravenous / epidemiology*
  • United States / epidemiology


  • Anti-Retroviral Agents