By March 2015, the number of confirmed HIV cases in Scott County, Indiana had climbed to 26. It now stands at 150. For a population of 4,200, the burden of the twin towns of Austin and Scottsburg is enormous.
The situation is so grave, Indiana Governor Mike Pence declared a state of emergency at the end of March and extended it on April 20 for another 30 days. The Centers for Disease Control and Prevention (CDC) and other non-profits have joined Indiana and Scott County officials in an attempt to identify the infected.
Mimicking the first AIDS outbreaks in the 1980s, HIV is being spread by intravenous drug use in the largely rural population where there is little infrastructure to manage the crisis.
Beth Keeney is the vice president of development at LifeSpring, which has been providing mental health care to Scott County since 1964 at their outpatient office in Scottsburg. She told The Fix: "This year, so far, we've admitted 22 patients to Turning Point (medically monitored detox). In the whole of last year we admitted 16."
The Centers for Disease Control (CDC) persuaded Pence to lift the syringe and needle ban. Previously, it had been illegal to possess the paraphernalia needed to "fix" drugs. But the newly introduced exchange program has been beset by interference from local law enforcement. According to Aljazeera, addicts and community activists have had needles and syringes confiscated by police. Dan Bigg, director of the Chicago Recovery Alliance, a non-profit invited to Indiana to share expertise, complained about law enforcement officials intent on enforcing the now defunct anti-paraphernalia laws.
Without access to clean needles, addicts are sharing needles up to a staggering 300 times, Brittany Combs, the public health nurse for Scott County, told the New York Times. And it's not getting any easier. The process of getting clean needles is hampered by red tape and a fear of the police.
A routine approach to needle distribution in urban areas is to allow addicts to hand out clean needles to their peers. But to get new needles in Scott County, drug users are expected to register at the exchange.
"If they've got one needle and they're not in the program, they're going to jail," Sheriff Dan McClain stated to the New York Times when asked about arrests. McClain believes arresting those who do not carry a registration card will scare addicts into joining up.
The police are one thing, but it's education about HIV and AIDS that's been the biggest problem. In a rural area devastated by unemployment and a new wave of drug dependency characterized by prescription pain medication use. Education about needle hygiene was never on a list of priorities for the old fashioned, tough-on-crime Republican governor.
Scott County has been in the news before. Three years ago, Reuters reported Opana abuse from the area. Opana, which when crushed and diluted is a potent high when injected, took over as the number one oxymorphone when OxyContin was reformulated to stop abuse in 2010. And it's still the first choice of drug for addicts.
Sheriff McClain was interviewed then, too: "Most of them sleep until noon, get up, and try to find a way to get another pill." He also said they were unable to break the chain of poverty because of their habits. Yet, Opana is still easy to obtain illegally.
Recently, steps to inform the population and help stem the risk of HIV infection have come from the grassroots level and a media blitz by local health officials. A campaign to educate not only IV drug users but reach out to other high-risk groups kicked off a month ago. State Health Commissioner Jerome Adams says HIV is now on the road and truck drivers passing through Scott County, who frequent prostitutes, are in particular danger:
"When you factor in that Interstate 65 passes right through the epicenter of the current outbreak, the risk is even greater. We are concerned about the health and safety of all travelers, including truck drivers, as well as the spread of HIV. Our hope is to continue to raise awareness about HIV prevention through these targeted messages."
The "You Are Not Alone" campaign, already running on TV and radio, online, and on social media, is being posted with unambiguous instructions: "Limit your number of sex partners, do not hire commercial sex workers, and always use condoms."
The homecoming queen at Austin High School has launched her own awareness campaign. Holli Reynolds, 18, wrote of the epidemic in her editorial for the school paper, The Eagle:
"Scott County is making national and world headlines for all of the wrong reasons. Austin has been dealing with poverty and a drug problem for over 50 years, but recently the problem has escalated and taken an ugly turn with the massive HIV outbreak in the community."
Reynolds and other students have started a club called "Stand Up." They talk to kids in second through eighth grade raising awareness, dismissing myths and rumors about HIV and AIDS.
Jerome Adams also addressed many of those misconceptions in an editorial for the Indy Star at the beginning of May. He pointed out that much of the prejudices re-surfacing are decades old. He reasserted the difference between HIV and AIDS,the former having no major symptoms for infection. Once a person has tested positive for HIV they should start receiving retro viral drugs immediately and not wait until they become ill. In the article, he also deals with issues of transmission—it's not possible to catch HIV from casual contact, using telephones, or toilet seats previously used by someone HIV positive will not transmit the virus.
Specifically, he mentioned Ryan White, an Indiana resident, who, as a hemophiliac in the 1980s, received a contaminated blood transfusion and was diagnosed with AIDS. His middle school in Kokomo, Indiana, expelled him. The ensuing nasty legal battle with the school and parents helped White to become one of the earliest spokesman to raise awareness for HIV and AIDS. Despite this, much of the fears and ignorance about HIV and AIDS persist in this corner of the state.
The Ryan White Comprehensive AIDS Resources Emergency Act (Ryan White CARE Act), is a federal program, set up to help people living with HIV and AIDS. It was passed by Congress four months after his death in 1990. CARE act programs subsidize treatment when no other resources are available—for those with no insurance and/or living in poverty. They also give support to local organizations to create new programs.
It seems apt that the people most needing the CARE act in the new few years are residents of Ryan White's home state.
Hopefully, the number of HIV positive cases has peaked. The focus should now be on those living with the virus and those still in the throes of addiction. Jennifer Walthall, Indiana's Deputy State Health Commissioner told The Fix, "Every individual in Scott County interested in inpatient treatment for addiction has either begun treatment or has a date for beginning treatment."
Neville Elder is a regular contributor to The Fix. He's also a photographer and writer. Originally from the UK, he's lived in the unfashionable end of Brooklyn for 13 years. He last wrote about the forgotten victory in the War on Drugs and how the DEA under Michele Leonahrt was rotten to the core.
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