AUSTIN — As Scott County enters its second month of emergency health provisions, its HIV outbreak is sounding alarms across the country for areas at risk of a similar epidemic.
“I think the reason that we see it here is that we found it,” Dr. Jennifer Walthall, Indiana Deputy State Health Commissioner, said Tuesday at Austin City Hall during a press conference. “ ... We would have our heads in the sand if we thought that this wasn’t occurring somewhere else.”
Southeastern Indiana has reached 143 positive cases of HIV — 138 confirmed and five preliminary positives — linked almost exclusively to injection of the opioid oxymorphone and sharing contaminated needles. It’s part of a national opioid addiction trend that began more than 10 years ago.
And while national support is pouring into the region and comprehensive services are branching into surrounding counties, the unprecedented rural outbreak is highlighting the need for longer term and preventative measures, said Dr. Jonathan Mermin, director for the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.
“Ultimately, it will be decided by the local community and the health department and the state,” Mermin said Tuesday. “But it will have to include both providing care for people with HIV and hepatitis, helping people recover from drug addiction and ultimately looking at trying to improve the social determinants that have led this community to have such high rates of drug use in the first place.”
That could include permanent needle-exchange programs, providing Indiana lawmakers approve a proposal on or before Wednesday that would allow communities with high rates of hepatitis C and injection drug use at epidemic levels to launch an exchange.
As of Tuesday, 166 Scott County residents were taking part in that needle-exchange program, which has distributed more than 7,100 clean needles.
WHAT THEY’RE DOING
Long-term recovery is one of the Centers for Disease Control and Prevention’s three tasks as representatives meet in Scott County with state officials this week. The other two are surveillance mechanisms to see if similar outbreaks are happening elsewhere and preventative measures throughout the nation for communities at risk.
The CDC issued a national health alert Friday for HIV and other infectious diseases spread through intravenous drug abuse.
Dr. Jerome Adams, Indiana State Health Commissioner, said that Gov. Mike Pence wants Indiana’s response to be a model for other communities.
“Quite frankly, I don’t think this will be the last time we see an outbreak like this,” Adams said.
Scott County is not the only county in Southeastern Indiana that has been affected by the outbreak. Jackson County has five preliminary cases, though all contacts have been traced and the infection rate there is said to be contained. Those cases related back to Scott County.
Amy Reel, spokeswoman for the Indiana State Department of Health, said that counties with less than five recently infected patients aren’t identified in the total 143 — though they’re present.
And HIV testing is extending to several surrounding counties where it wasn’t offered before wherever it’s needed, Walthall said, although those weren’t identified by name.
Austin sits along Interstate 65 — which extends from Gary to Mobile, Ala. — that carries truck drivers who stop in Scott County and solicit prostitutes, some who have been infected with HIV. Reel said the response team is working with trucking companies for marketing campaigns that warn against risky behavior.
Transport Topics, a trucking and freight transportation publication, reported that the Indiana State Health Department sent a letter to the state trucking association asking it to place placards and site-based Wi-Fi for drivers along I-65.
Disease intervention specialists, meanwhile, are dwindling down the list of contacts who may have been exposed to HIV in Scott County. Walthall said on a given day, more than 100 people are on the ground following up on contact tracing or administering services such as HIV testing and care coordination.
“We need to get every HIV-positive citizen into treatment and every HIV-negative citizen with high-risk exposures also in treatment,” she said. “We need to trace every contact. We need to overcome fear and rumor in order to test broadly for HIV and Hepatitis C. We need to mobilize resources for substance abuse treatment programs.”