Most of the Southern Indiana patients diagnosed with HIV in the epidemic are referred to the University of Louisville Physicians clinic that treats HIV and AIDS patients in downtown Louisville.
Ruth Carrico, a nurse and infectious diseases and global health specialist with U of L Physicians, said her facility treats HIV patients from all over the region, but the upswing in patients — particularly from Southern Indiana — is illustrative of the disease’s continuing spread.
“We have received a number of referrals for people that are newly diagnosed with HIV from the Scott County, Southern Indiana area,” Carrico said. “We have thought recently that the HIV epidemic is under control and it certainly is not. We continue to see 20 new patients every month diagnosed with HIV and a number of them are from [that area]. That shows us that HIV spread is alive and well.”
But not all of those patients who have been diagnosed are making their way to treatment centers like hers. She said while they keep in touch with referring agencies on the number of patients headed their way, there’s no guarantee a diagnosis will lead patients to seeking treatment. She said along with any existing addiction issues that patients have, social issues and stigmas compound the problem and sometimes prevent those who are infected with HIV from seeking medical attention. She said housing and transportation hurdles also prevent some from getting to treatment centers.
To help combat those issues, she said a staff of 20 full-time case managers are the front line in working with public agencies.
“It’s one of these that we call a wicked problem,” Carrico said. “There’s no simple solution and no one right way or wrong way. We have to look at each individual as an individual.”
Money also is a concern for patients. Treatment for HIV can cost thousand of dollars a month, Carrico said, and while many patients can’t afford that, she said they work to help find ways to make sure patients can get the drugs and other treatment to help at least improve their quality of life. She said case managers also help patients — whether insured, uninsured or receiving subsidized health care — find those pockets of money that can help them pay for the treatment they need.
“Even with the Affordable Care Act, people are not immediately enrolled,” Carrico said. “You find someone that’s enrolling, but we have delays before it’s implemented, so we have to have providers like us that are willing to see patients even if we’re not going to get paid for this.”
She said it’s also important to note that an HIV outbreak like Scott County’s isn’t limited to low-income patients. As the use of drugs like heroin and Opana — which run the risk of needle-sharing and directly injecting the blood of an infected person along with the drug — continues to grow, the epidemic is getting in the hands of people across the board.
She said while stereotypes of HIV and AIDS transmission, as well as heroin use, have existed for years, the reality isn’t limited to one group or another.
“This is not like other people we think of; these are kids from middle class and upper class America that are involved of heroin use,” Carrico said. “The face of the heroin epidemic is changing the face of the HIV epidemic.”