On a recent afternoon, Eddie Rudd heads west from Bozeman in a white Chevy van, smoking unfiltered Camel cigarettes and drinking Mountain Dew. In the front seat, he carries a bagful of condoms, lube and what's known as a "vein care kit" or "fit pack," which includes bleach for disinfecting syringes. The goods are a gift for a Gallatin Valley couple that's been mainlining meth.
"I'll bring them water, oranges, whatever," Rudd says. "I build up a relationship with them. And trust is the main thing, because they're always paranoid. They're always thinking that you're a cop."
Rudd is clearly not a cop. Fading prison tattoos line his forearms—lightning bolts, skulls and "FTW," which stands for "Fuck the World," among others. Rudd, 46, says he's been sober and law abiding for 10 years, and the once hard-edged felon is, admittedly, softening. The items he's delivering to the Gallatin County couple are part of a statewide outreach effort to keep high-risk residents from getting sick from sharing needles.
"I do it from my heart, because I'm [hepatitis C] positive," says Rudd, who was diagnosed with the virus in 1999. "And I want to go out there and make a difference."
Until June, Eddie Rudd and his wife Casey worked with the Montana Targeted Prevention program (MTAP). The Centers for Disease Control and Prevention (CDC) distributed $325,000 last year to the Missoula Aids Council, which then hired subcontractors like the Rudds into the MTAP program, deploying the outreach workers across the state to test residents for HIV and hepatitis C (HCV). The subcontractors also armed their target populations with tools to ward off blood-borne illnesses.
MTAP outreach workers focus on those most at risk of contracting HIV, such as men who have sex with men, and those disproportionately affected by HCV, like intravenous drug users. Each MTAP representative is uniquely equipped to communicate with a defined demographic.
The Rudds, for instance, work mainly with drug users. The couple, along with a third MTAP outreach worker affiliated with their Bozeman nonprofit, Connections, administer roughly 60 HIV and HCV tests monthly.
But the Rudds' workload is in danger of significantly dropping off.
CDC did not renew MTAP's grant in June. That leaves the Rudds and 13 other outreach workers across the state with fewer resources to stop the preventable, incurable and costly diseases.
"We are going to run out of money shortly to do outreach work like we used to," Casey Rudd says. "It is frustrating that we've built up all these bonds with people and now we don't have what we need to do our work. It's extremely frustrating, not to mention dangerous—not only for them, because they're using drugs, but for the entire community."
Eddie Rudd picked up a heroin habit while serving time for burglary in California's Folsom State Prison in the 1980s. Even for Rudd, a repeat offender who was hardened early in life, Folsom was tough to stomach. The drug helped him ride out his time.
"When you're in a maximum security prison," Rudd explains, "you can't go and run and tell the guard that some guy is getting stabbed or some guy is getting thrown off the tier. For me to deal with that, I took to using heroin."
Rudd isn't sure if he contracted HCV from sharing a syringe or from the jailhouse tattoo needles that etched gang markings into his arms. It's a moot point now.
"It doesn't matter what I take for it," he says. "It's not going away."
HCV spreads through contact with infected blood. Blood transfusions were a common transmission route until 1992, when more efficient screening procedures were introduced. Today, the disease is most frequently spread through intravenous drug use. Sex with an infected person is a possible infection route, as well, although the CDC says it's rare.
HCV causes nausea, fatigue, joint pain and fever. Chronic liver inflammation develops in as many as 75 percent of people infected. About 20 percent of those testing HCV positive develop cirrhosis, or advanced liver scarring, from long-term inflammation. Liver failure from chronic HCV is one of the most common reasons for liver transplants in the United States.
There were 943 cases of HCV on record in Montana in 2008, the most recent data available. Because symptoms can take decades to appear, the CDC and hepatitis experts like the Rudds say the virus is drastically underreported, especially among intravenous drug users.
"It is running rampant in this state, especially among young people," says Casey Rudd. "I'm talking high school, junior high—they're coming up positive, and they know nothing about hep C. That's not education that they get in school. They get HIV education. But they don't get hep C education. We're trying to reach them on the street at a young age, so they know about this disease."