Officials see hope in response to HIV outbreak in Scott County
Editor's note: This story from The Bloomington Herald-Times is being published here as a courtesy for readers of IU in the News.
A little more than a year ago, the Indiana State Department of Health was only just starting to take notice of what the federal Centers for Disease Control and Prevention would later call one of the worst HIV outbreaks among injection drug users in decades.
Public health officials such as Brittany Combs, a nurse for the Scott County Health Department, were seeing more and more tests for hepatitis C come back positive. Emergency room patients were seeking care for abscesses and endocarditis, both caused by repeated injection drug use. Entire families were using the same needles to sustain addictions to opiates, in the process also transmitting the human immunodeficiency virus.
Over the course of a year, Scott County would typically report five new cases or fewer of HIV. In a town only a few hours away from where AIDS patient and activist Ryan White grew up, more than 180 people would soon be diagnosed with virus.
“We encountered an entire generation of citizens without basic knowledge of what HIV is and how it’s transmitted,” said Jennifer Walthall, deputy health commissioner for the Indiana State Department of Health.
Walthall, Combs and other Indiana public health officials recounted their experiences in Scott County and the city of Austin Tuesday evening at a panel discussion Indiana University’s School of Public Health hosted to mark World AIDS Day.
“Austin was kind of the perfect storm,” said Amy Hays, a care coordinator at Positive Link, Indiana University Community Health’s HIV/AIDS prevention and education program. “Poverty, lack of education, lack of resources in the community. That normalcy of a drug family culture.”
In the United States, HIV is transmitted predominantly by sexual contact, Walthall said, and much of the public health research and education on contracting the virus focuses on that mode of transmission. Of the 184 individuals in Scott County who tested positive for HIV, 96 percent were injection drug users, the state department of health found, and users injected drugs such as the prescription painkiller Opana anywhere from four to 16 times a day.
“We have to stop the tide of these medications being available,” Walthall said.
After a deadly tornado swept through neighboring Henryville, government officials set up a central command center to provide those affected by the disaster with as many necessary relief services as possible in one space. Using this model of a “one-stop shop,” Scott County, with the help of state and national agencies, created the Austin Community Outreach Center to deal with the HIV crisis, where thousands of residents could be treated with comprehensive health care, as well as receive new copies of their birth certificates in order to sign up for health insurance.
“We just learned as we went,” Combs said. “It’s kind of what you had to do.”
For those who had worked in HIV prevention and education for years, going into Scott County felt like a trip back in time. Social workers such as Hays had to dispel myths of HIV transmission, and reiterate information about the disease that she had thought was public knowledge in 2015.
“It really doesn’t matter how educated someone is, they may not be educated as far as HIV, drug use and prevention,” she said.
At the same time, public health officials were also working on a state level to legalize needle exchanges, expand the use of naloxone, a drug that reverses the effects of an overdose of drugs such as opioids, and to provide every county health department with the information and tools needed to respond to a similar outbreak.
“You know that it could happen,” said Emily Brinegar, a prevention coordinator with Positive Link. “It just hasn’t happened yet.”
In the months since the state ended its declaration of a public health emergency in Scott County, three Indiana counties have begun needle exchange programs, and more than 20 others, including Monroe County, have begun the process to formally request a needle exchange program from the state department of health.
More than 500 high-risk individuals in Scott County were retested for HIV in November, and only three new cases of the virus were identified, Walthall said. Of those who were diagnosed with HIV, 40 percent are now virally suppressed.
There is hope in a town Hays said her clients once described to her as hopeless. But there is still work to be done, the panelists said.