Indiana HIV outbreak has peaked, officials say

At the height of Indiana’s worst HIV outbreak, centered on the tiny rural town of Austin, health officials diagnosed as many as 22 new cases a week.

Fueled by a rural intravenous drug epidemic, the number of cases more than doubled to 153 between late March and mid-May. And many involved in combating the outbreak said they feared it could reach well into the hundreds.

But in recent weeks, the number of newly diagnosed HIV cases has dropped sharply, to two or fewer a week. And with 175 confirmed cases currently, public health officials say the outbreak in Scott County appears to be reaching its limits.

“We certainly do feel that at this point the outbreak has peaked,” said Pam Pontones, state epidemiologist for Indiana. “We are seeing very few new cases. We might have one, maybe two in a week (and sometimes none).”

Dr. William Cooke, the only private physician in the Scott County town of 4,200, located a half-hour’s drive from Louisville, said while the numbers are “still concerning,” the trend is “much, much better than where we were” — which he attributed to testing of at-risk individuals and outside help.

But while the blinking highway sign announcing a needle exchange has been taken down and the national media glare dimmed, Austin still has a long battle against addiction to opiate pain pills that users crush up and inject, local officials said. Many still need addiction or HIV treatment, and opiate drugs have far from disappeared, even if some say they are slightly harder to obtain amid stepped-up enforcement.

“I could point out all kinds of houses where people are doing drugs — it’s still going on,” said resident Tammy Breeding, who sat this week next to a homemade sign serving as a warning to drug dealers and prostitutes and taking down the license plate numbers of cars she suspected were involved in drug sales.

The outbreak, linked to IV use of the painkiller Opana, was unusual for the large numbers in a rural community. It prompted officials with the U.S. Centers for Disease Control and Prevention to issue a health advisory alerting states, health departments and doctors nationwide to be on the lookout for clusters of HIV and hepatitis C among IV drug users, particularly in rural areas.

Pontones said no other outbreaks have been detected in Southern Indiana. National statistics show more than 20 percent of people with HIV don’t realize it.

That’s partly why state and federal public health investigators are still working to seek out people for testing who could have been at risk for sharing needles or having sex with those diagnosed with HIV in Scott County, Pontones said.

So far, she said they have reached about 85 percent of the 494 people identified as being at risk. Along with connecting those diagnosed with antiviral medication, those targeted get referrals to insurance, counseling and substance abuse treatment.

Although more were engaged in care, slightly fewer than half of those diagnosed with HIV had been prescribed anti-viral treatments at last estimate in late June, Pontones said, something officials are working hard to increase.

Jeanni McCarty, a nurse who works for Cooke, whose office serves many of those with HIV, said some people simply don’t follow up after initial lab work or their first antiviral prescriptions. Their care also may stall out after running into red tape with medical insurance, even those signing the Health Indiana Plan, which provides insurance to low-income residents, she said.

Cooke stopped holding special HIV clinics and instead sees those patients along with others to reduce stigma. He said follow-up is often complicated because those struggling with drugs and poverty move, get evicted or become unreachable because their phones get disconnected.

State figures show about one in five Scott County adults live in poverty, have not completed high school or are on disability. It ranks at the bottom of 92 Indiana counties on most health indicators, according to the Robert Wood Johnson Foundation national health rankings.

McCarty said another challenge is that those needing in-patient drug treatment or methadone clinics still have to travel far afield, often to Louisville or Indianapolis, she said. An outpatient drug treatment provider is planning to open next month next to the needle exchange.

Brittany Combs, a Scott County public health nurse, said the exchange’s recent move next to a police station, done to save money, hasn’t deterred the 207 people who are using it. The exchange has handed out nearly 39,000 needles.

“Some of them are injecting 20 times a day,” Combs said, noting some are being connected to treatment through the exchange, although she did not provide any figures. “They’re asking us about treatment options. For in-patient, it still takes several weeks to get them in.”

Across town, an Austin church leader has begun a recovery center for “when everyone around you is entrenched in the culture of drug use, and you don't want to be using,” Cooke said, describing it as a place where people can “play ping-pong, or get a coffee or meet with other people who are in recovery.”

Scott County Sheriff Dan McClain said that “we are slowing down the flow of drugs into the community,” partly with the help of Indiana State Police officers assigned to the area and a new local full-time narcotics officer. Last month, authorities reported that four men had been arrested after allegedly distributing drugs that helped fuel the outbreak.

McClain also said that doctors in surrounding areas “are getting the idea,” and noted that “there’s a lot of heat being applied to some of the pain clinics in the surrounding counties.” He declined to comment further.

Still, he said it would be “a long road” to turning things around, and Cooke agreed.

“If somebody wants to use, they can find it. There may be a little more trouble with people finding it, but they find it,” Cooke said. “We're dealing with lifestyle issues, so a lot of education and social support ... will be needed.”

Still, he hopes the work by providers, churches, nonprofits and public officials may turn the tide. “I really see this recovery culture superseding the drug abuse culture,” he said. “There's going to be a number of people entering recovery that will reach critical mass, and that will tip the scales.”

Reporter Chris Kenning can be reached at (502) 582-4697. Follow him on Twitter at @ckenning_cj.