CDC: Needle exchange sharply reduced sharing in an Indiana city wracked by an HIV outbreak

A new federal study shows that needle sharing plummeted in Austin, Indiana after people who shoot up drugs began using a syringe exchange started in response to the largest drug-fueled HIV outbreak ever to hit rural America.

U.S. Centers for Disease Control and Prevention researchers asked 124 injection drug users in Scott County about needle sharing before and after the exchange was established in April 2015. They found the proportion who shared syringes dropped from 74 percent to 22 percent.

They also found 86 percent of those surveyed in 2016 – including 98 percent of those with HIV – used the needle exchange. And 82 percent disposed of spent needles safely in "sharps" containers for medical waste, up from 18 percent before the exchange opened.

More than 5,000 clean syringes were distributed in the first couple of weeks after the exchange opened.

"As a result of the public health response, there was a huge decrease in high-risk practices, especially among HIV-positive people," said Sharoda Dasgupta, author of the analysis, which was presented Wednesday at a medical conference in Boston. "The results from this study were substantial."

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Needle exchanges allow intravenous drug users to trade dirty needles for clean ones. Public health experts say they're essential tools that effectively control disease, but opponents argue they enable drug use. There are more than 220 exchange programs nationwide.

Scott County's needle exchange opened as a "one-stop shop" in downtown Austin where people can also get free HIV testing, educational information, job counseling, drug treatment and other services. Austin, population 4,200, is the epicenter of the outbreak, which was caused by rampant intravenous painkiller abuse and now includes 230 cases of HIV – a rate comparable to many countries in Africa.

Outside organizations, including the CDC, Indiana University Health and the giant, California-based AIDS Healthcare Foundation, have converged on Austin to create a safety net of sorts.

A related study out Wednesday, based on 2016 interviews with 200 Scott County IV drug users, pointed to other positive effects of that response. For example, HIV testing rose substantially. The syringe exchange was the most common testing site, and those who used it were far more likely to be aware of a daily oral medication, called PrEP, that helps reduce the risk of spreading HIV.

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Dr. Will Cooke, Austin's lone doctor during the outbreak, said the study results reflect what he sees day-to-day. He said drug users with HIV are injecting more responsibly than other IV drug users in an attempt to protect themselves and others – defying "this misconception that they're bad people." He stressed that addiction is a disease and these people are suffering. "They need help."

Cooke said he's glad the syringe exchange has linked more residents to medical care. Most HIV patients also have hepatitis C, and the state has a new program to help them, which allows rural doctors like him to consult remotely about cases with experts at Indiana University School of Public Health.

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Gradually, Cooke said, Austin is recovering from addiction and related disease,

"We're getting there. We're getting more people into (drug) recovery. It's like roots growing into the soil," he said. "Time is the only real answer to addiction. Time and community."

Laura Ungar: 502-582-7190; lungar@courier-journal.com; Twitter: @laura_ungar; Support strong local journalism by subscribing today: www.courier-journal.com/laurau.