HIV outbreak hits heartland of U.S.
Rural Indiana county plagued by drug abuse sees unprecedented rise in cases
In Indiana, a tiny rural community has become ground zero for an unprecedented health crisis: the largest HIV outbreak in state history.
Since December, 89 cases have been reported in Scott County, a region that typically sees five HIV cases a year. Most are in Austin, a crumbling city of about 4,300 located near the Kentucky border.
The crisis has triggered a state of emergency and urgent response measures, including a temporary needle exchange program, which is normally illegal under Indiana state law. But as public health officials scramble to contain the outbreak, a troubling question looms: how could this have happened? Drug addiction Investigators say the HIV outbreak was caused by another epidemic that has long plagued Scott County: drug addiction. “One hundred per cent of cases have reported IV drug use so far,” Dr. Jerome Adams, Indiana’s health commissioner, told the Star.
While unsafe sex has helped spread the virus, Adams believes this is the “largest or first outbreak of its kind solely related to prescription drug abuse.”
In Austin, where public parks are littered with syringes, police are pointing the finger at Opana, the area’s “drug of choice,” a prescription painkiller that can be crushed and injected. In 2012, Reuters reported that Opana was the “new scourge of America,” gaining popularity after the painkiller OxyContin was changed to become more difficult to abuse. Poverty Scott County is one of Indiana’s poorest areas and 17 per cent of people live in poverty, with a median household income of $43,650. “Austin has historically been a poor community,” said Cpl. Carey Huls, a public information officer with Indiana State Police. “Over time, because of joblessness, the drugs crept in.”
Many of the confirmed patients — who are mostly male, white and between the ages of 19 and 56 — live in “dilapidated homes” without electricity, said local physician William Cooke. “The roof has fallen in; some- times they don’t even have windows,” he said. “I think to some degree, this outbreak is just a result of years of poverty, unemployment . . . and the hopelessness that sets in with that.” “Doctor desert” Scott County is what Adams refers to as a “doctor desert.”
“This is an area where there’s a definite shortage of health care providers,” he said.
Cooke is the only physician within Austin’s city limits. His family practice — where he will treat anyone for $10 — sees 70 to 80 patients a day. Prior to the outbreak, the closest clinic offering HIV treatment was 60 kilometres away in Louisville, Ky., according to Cooke — even though many Austin residents don’t have cars.
“It was very frustrating practising medicine without the access to other services that I really felt we needed,” Cooke said. “People deserve to have doctors come to them, not forced to travel long distances just to get access to a specialist.” Patient zero For years, Scott County has been ripe for an HIV outbreak. The conditions were all there; the only thing missing was Patient Zero.
“We have people that are injecting drugs as groups,” said Ruth Carrico, an associate professor with the University of Louisville’s division of infectious diseases. “And it only takes one person with HIV to enter the group . . . then you’ve got that perfect storm and that’s exactly what has happened here.”
The first known case was reported in December but it remains unclear if he or she is the “index case,” said Adams.
Investigators are now tracking another 100 people who may have been exposed to the virus. “We don’t know the true index case or source of the outbreak,” Adams said. “But we are working (to see) if we can figure out who the index case is and where this outbreak originated.” The solutions? Health officials have scrambled to establish an HIV clinic, where residents can get diagnosed and treated. This “one-stop shop” also helps people get birth certificates and identification cards so they can sign up for medical insurance.
Indiana Gov. Mike Pence has authorized a 30-day needle exchange in Scott County, despite his own “longstanding opposition” to such programs, which are banned in Indiana. The exchange has had only four visitors since Saturday but 300 dirty needles have already been collected.
“One woman stated to me that she would use the same needle for up to two weeks,” public health nurse Brittany Combs said Tuesday. “Out the door, she said, ‘I’ll see ya next week.’ So she’s going to come back and that’s the goal.”
But everyone agrees that the real solution is to tackle the root problems of poverty, drug addiction and despair — none of which are unique to this area. “I don’t think Scott County is vastly different to hundreds or thousands of other places across the U.S.,” Adams said. “All it would take is the right spark to light off this powder keg: an HIV person coming into the community.”