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HIV Outbreak In Southern Indiana Worst In State's History
Throughout the city of Austin in southeastern Indiana, signs advertise free HIV testing at the Scott County Health Department.
Boarded-up windows decorate nearby houses; metal cages surround air conditioners to bar people from stealing parts to scrap for change. Austin has no drug rehabilitation facility, much less a grocery store.
It's also the epicenter of the worst HIV outbreak in Indiana history.
While state and federal officials are flocking to Scott County in response to staggeringly high rates of recent HIV cases, the outbreak is no surprise to local residents.
"We have kind of a recipe for disaster, all the bad ingredients — unemployment, high dropout, high teen pregnancy rate, high drug abuse rate," said Dr. William Cooke, medical director for Family Foundations Medicine in Austin.
Health officials have confirmed 55 cases of HIV in Scott County since December. A month ago, the number of confirmed cases was 24. Cooke, along with others, is advocating for more resources in handling the outbreak that is soon expected to reach triple digits.
But he's also advocating for preventive measures, specifically a behavioral health addiction clinic, to stave off drug abuse that he said is 100 percent responsible for the current HIV outbreak. Discarded syringes lie on the side of the road in Austin — evidence of the addiction that grips the city.
"I work in the emergency department down here as well, and I see it every shift — somebody comes in, overdosed on drugs," Cooke said. "You save them, you ask them why they do it, they say they don't want to. … Nobody in middle school had the plan to be an (intravenous) drug user when they grew up. It's something that happens. Even the IV drug users don't want to be the IV drug users."
An immediate response
Cooke met with a team from the Centers for Disease Control and Prevention on Tuesday after it arrived in Scott County.
Amy Reel, director of the office of public affairs for the Indiana Department of Health, said some CDC officials will stay for a week and a half.
They'll be analyzing data to determine whether the virus is new or if it's a strain that has been circulating for a while.
"And they're also going to be looking at HIV treatment and substance abuse systems, so helping us ensure that we have those systems in place so that we can get them into the care that we need," Reel said.
CDC officials will be reaching out to those who have tested positive to receive continued care. Meanwhile, Gov. Mike Pence is scheduled to travel with state health commissioner Dr. Jerome Adams and state epidemiologist Pam Pontones to Scottsburg for a meeting Wednesday afternoon.
The governor will issue a public health disaster emergency Thursday for Scott County, but the scope of that order will be determined by what he hears from local officials.
The Clark County Health Department — the only department in nine contiguous counties in southeastern Indiana that receives state funding for HIV testing — and the state department have been administering free HIV testing from the Family Foundations Medicine and in the Scott County Health Department offices.
But mostly, officials have been making home visits. "They call their friends and family and they come over to get tested as well," he said. "They usually bring five to 10 extra kits with them to each home because they know that once they get there, there's going to be others that will come over."
Cooke said no one in his office is qualified for free testing, though nurses are being trained by the state health department this week.
"My goal is to have availability to testing for anybody that walks into the door at any time," he said.
Dr. Janet Arno, an infectious disease specialist at IU Health University Hospital, is opening a clinic next week at Family Foundations for ongoing care with HIV-positive patients, "long after the CDC leaves," Cooke said.
Cooke is speaking Wednesday at an Indiana House Public Health Committee hearing on the HIV outbreak and a proposal to allow Scott County officials to launch an emergency needle-exchange program to stem the spread of the virus, which causes AIDS.
State Rep. Terry Goodin, D-Austin, said he supports this method of preventing proliferation of the disease.
"What I'm going to support is what the professionals say is going to work," Goodin said.
Cooke is also petitioning the state health commissioner and the Indiana Family and Social Services Administration to open an addiction treatment center in Scott County.
Treatment facilities are in other counties, and many Scott County residents lack transportation.
"How do you get in touch with a program on a regular basis (out of the county)?" Cooke said. "So we need to bring it here."
An overwhelming issue
Cooke was born in New Albany and grew up in Jeffersonville, but he located in Austin specifically because of its lack of resources.
He said more than half of Scott County deaths are due to IV drug overdose.
"The scary part of using IV drugs is not going to keep people from using IV drugs," Cooke said. "They need help."
Debbie and Jerry Ousley founded Oasis of Hope Missions that provides meals every two weeks to those in need. Some are those with substance abuse issues, which she's seen escalate year after year.
"We worked down here for the least year and a half to two years," Ousley said. "It's just nothing new to us."
Austin has a particularly high number of prostitutes, almost all who are driven by a means to pay for their drug addictions.
Debbie said most are in their early 20s. She sees cars circle around the same neighborhood looking for them.
"We have a whole new outlook on this … because when we see the girls on the street, getting picked up, it breaks our heart because we know that it's all about drugs," she said.
Jerry said that because there are no drug rehabilitation programs nearby, many prostitutes return to their addictions after release from jail for lack of help.
"If you talk to any girls, they do not want to do what they're doing," he said.
However, many Austin residents have a different opinion of the issue — quick to blame prostitution despite drug use being the cause of the outbreak.
Richard Barrett, who lives in Jefferson County but has family in Scott County, said Austin has a bad reputation.
"Back in the day it used to be racism, then it went to drugs, then poverty, now it's been hit with the HIV outbreak," Barrett said. "A lot of things go hand in hand, in my opinion."
Municipal action
Austin City Council President Jim Kallembach said the city has had plenty of drug problems that it hasn't been able to fix.
"We should have had a handle on a lot of this stuff for a long time," Kallembach said. "We've let this community run wild."
He blamed Mayor Douglas Campbell's administration for not pushing the police force enough to bust drug dealers.
"When there's a drug house on every corner, someone ought to be getting arrested," he said. "I mean, it's pretty simple. And everybody knows what's going on."
Lately, the Indiana State Police have been making arrests — as many as 100, he said.
He said the drug abuse problem saturates "the whole town" and is "overwhelming."
"The CDC hasn't even got a clue (how bad the problem is)," Kallembach said. "They can't even imagine."
Austin police Chief Donald Spicer said a lack of resources means fewer drug arrests. The department has seven paid officers, including the chief, and about 15 volunteers.
"Drugs is a problem that's hard to contain," he said. "When you find one home, it spawns two or three more. It snowballs."
Spicer doesn't agree with Kallembach's "negative" outlook on the issue and insists his department is doing everything it can in making drug-related arrests.
"Yes, there's drug dealers on every corner, but so is there in Louisville and so is there in Indianapolis or any other city," he said.
An officer needs probable cause to arrest someone.
"Yes, we know so and so is dealing drugs, but that doesn't give me the legal authority to go in arrest them," Spicer said.
"I have to be able to prove it … so we protect your rights, we have to protect the drug dealer's rights. We take an oath to follow the rules."
He said he's been communicating with state police, the Scott County Sheriff's Department and the Scottsburg Police Department to turn his department "into 20 or 25 by working together."
Spicer has a hopeful outlook in dealing with the HIV outbreak.
"It's a bad thing, but I also see that we can make some positive from it," he said. "We can maybe get doors open to get some of the resources we need."
Associated Press
Originally Published: March 25, 2015 at 5:35 PM EDT
Pence's History Managing HIV Crisis In Indiana Under Scrutiny Now That He's Overseeing Coronavirus
CNN —
When President Donald Trump appointed Vice President Mike Pence in charge of the US government's response to the novel coronavirus on Wednesday, he said the former Indiana governor had "a certain talent for this."
Pence indeed has executive experience during a public health emergency: he was governor from 2013 to 2017, when an HIV outbreak struck parts of his state. But his response to that crisis – one different in several important ways from coronavirus – is again under scrutiny as he works to coordinate the US effort to protect against worldwide calamity that is still unfolding.
The Indiana emergency peaked during Pence's governorship, when public health officials noticed a cluster of HIV and hepatitis C in rural Indiana around November 2014. It was the largest outbreak of the virus in the state's history, NPR reported at the time.
Free HIV testing had not been available in the community since a local Planned Parenthood clinic closed in 2013, and the virus had quickly spread among people in Scott County who were reusing needles to inject a prescription opioid called Opana. In 2017, at the US Food and Drug Administration's request, pharmaceuticals company Endo International took the powerful opioid off the market because it was widely abused.
The infections had reached 126 cases in a relatively small geographical area around January 2015, but it took until March of that year for Pence to declare a public health emergency.
"I am confident that together we will stop this HIV outbreak in its tracks," Pence said at the time.
One study that ran in The Lancet medical journal in 2018 found that if Pence had acted sooner, a quicker public health response could have substantially reduced the total number of HIV infections. What was needed, experts said, was a needle exchange program, which is controversial but has been strongly recommended by the Centers for Disease Control and Prevention as an impactful way of preventing transmission of disease among drug users. At the time of the Indiana outbreak, it was illegal under state law and opposed by Pence.
The then-governor eventually approved a short-term needle exchange program, the Indianapolis Star reported at the time, but only did so reluctantly.
"I do not enter into this lightly," he said, the Star reported. "In response to a public health emergency, I'm prepared to make an exception to my long-standing opposition to needle exchange programs."
The program was effective. Some 277 people enrolled in the program and more than 90,000 syringes were distributed and returned between April and October 2015, a study in the New England Journal of Medicine found, and the number of new HIV infections decreased.
Appearing on Fox News Thursday night, Pence defended his actions as governor, stating, "Indiana would go on to change the law to mirror what action I had taken, but it was a moment where we had brought all of the resources to bear, first from a health perspective, a law enforcement perspective, and I'm glad to say that we got all of those people treated."
Pence also said he doesn't "believe in needle exchanges as a way to combat drug abuse but in this case we came to the conclusion that we had a public health emergency and so I took executive action to make a limited needle exchange available."
At Wednesday's news conference announcing Pence's appointment, Trump said Indiana has established "great health care" in the Hoosier State. But during Pence's tenure as governor, Indiana only moved up the nationwide ranks slightly, remaining near the bottom of America's Health Rankings, a survey of how states manage health. In 2017, US News and World Report ranked Indiana 41 among states for health care.
Meanwhile, substance-use treatment in rural Indiana remained "woefully inadequate," according to a perspective piece written by public health experts for the New England Journal of Medicine that called the state's approach to the outbreak a "cautionary tale." The state's "suboptimal coverage" of HIV and hepatitis C testing also delayed people getting treatment and that allowed for more people to become infected, the medical journal piece said.
And the public health spending in Indiana for 2017 ranked near the bottom of states, according to the Trust for America's Health.
Reached for comment by CNN, Pence's office pointed to an October 2019 op-ed written by Joey Fox, a former legislative director for Indiana's state health department, who defended Pence's response. In particular, Fox noted that needle exchange programs were illegal in Indiana before Pence took office and that it took time to effectively implement the program when Pence made it available.
"Acting as if the community refused to use a proven public health tool is disingenuous at best. The tool was illegal. Law had to be changed. The Governor intervened by executive order. The legislature passed a bill changing the law on the final night of the session, and Governor Pence signed it shortly thereafter," Fox wrote.
After this story published, Surgeon General Jerome Adams, who served as Indiana's state health commissioner during the HIV crisis, said efforts taken by himself and Pence served as an example to other states in handling an HIV outbreak.
"Working together, we helped address the outbreak by implementing comprehensive syringe services programs (SSPs) that helped change the scope of the unprecedented crisis," Adams said. "As a result, our efforts became a model for how other states and localities respond to similar crises – states like Kentucky, for example, went from zero to more than 70 comprehensive SSPs, to prevent future outbreaks and help people in need of care."
Some Democrats, including House Speaker Nancy Pelosi, have pointed to Pence's record in Indiana to criticize Trump's decision to put him in charge of the government response.
At a CNN town hall on Wednesday night, Massachusetts Sen. Elizabeth Warren said Pence was "actively disqualified" from managing the response.
"Do keep in mind that this vice president has dealt with a public health emergency before, in Indiana. And what was his approach? It was to put politics over science and let a serious virus expand in his state and cost people lives. He is not the person who should be in charge," she said.
This story has been updated to include a response from Pence.
Indiana Needle Exchange That Helped Contain A Historic HIV Outbreak To Be Shut Down
Enlarge this image Kelly Hans holds a box of Narcan nasal spray at the county's One-Stop Shop in Austin. Mitch Legan/WTIU/WFIU News hide caption
toggle caption Mitch Legan/WTIU/WFIU NewsKelly Hans holds a box of Narcan nasal spray at the county's One-Stop Shop in Austin.
Mitch Legan/WTIU/WFIU NewsIn 2015, Indiana's rural Scott County found itself in the national spotlight when intravenous drug use and sharing needles led to an outbreak of HIV.
Mike Pence, who was Indiana's governor at the time, approved the state's first syringe exchange program in the small manufacturing community 30 minutes north of Louisville, as part of an emergency measure.
"I will tell you that I do not support needle exchange as anti-drug policy," he said during a 2015 visit to the county. "But this is a public health emergency."
In all, 235 people became infected with HIV over the course of the outbreak, most of them within the first year. In all of last year, there was one new case. Health officials credit the needle exchange for the dramatic drop-off in cases.
Sponsor MessageBut with cases the lowest in years, Scott County commissioners voted 2-1 on Wednesday to end the program.
Commissioners President Mike Jones says the access to needles is leading to more overdoses in Scott County. Jones and the other commissioner who voted to end the exchange say they can't live with a program that makes it easier to abuse drugs.
"I know people that are alcoholics, and I don't buy him a bottle of whiskey, and ... I have a hard time handing a needle to somebody that I know they're going to hurt theirself with," Jones says.
Scott County health officials say they're dismayed at the decision, which requires them to phase out the needle exchange by the end of the year.
Needle exchanges provide intravenous drug users with clean syringes and a place to dispose of used ones. Research shows they help reduce the spread of infectious diseases like HIV and can help people overcome substance abuse by acting as an access point to health services for those who are unlikely to seek them out.
Shots - Health News 5 Years After Indiana's Historic HIV Outbreak, Many Rural Places Remain At Risk Michelle Matern, Scott County's health administrator, doesn't want to see the syringe program end.
"I think a lot of people forgot kind of what 2015 was like, and what we went through as a community," says Matern.
Enlarge this image Hans goes through the contents of one of the kits the exchange provides intravenous drug users. Mitch Legan/WTIU/WFIU News hide caption
toggle caption Mitch Legan/WTIU/WFIU NewsHans goes through the contents of one of the kits the exchange provides intravenous drug users.
Mitch Legan/WTIU/WFIU NewsResidents have testified to the effectiveness of the exchange during recent meetings. Former U.S. Surgeon General Dr. Jerome Adams attended a commissioners' meeting in early May and praised Scott County's exchange as the gold standard.
"I've seen syringe service programs all over the nation; I've been to Canada and seen how they do it over there," Adams said. "And the way you're doing it here is the way it's supposed to be done."
The county's One-Stop Shop in Austin, Ind., provides testing for HIV, hepatitis C or sexually transmitted infections. There's food and the people who work there can connect users with health insurance, housing and recovery opportunities. It serves around 170 people a month.
"We don't call it a needle exchange anymore," Matern says. "We call it a 'syringe service program,' because we realize that it's a lot more than just exchanging used syringes for new ones."
The two commissioners who are against the program say it enables drug users by providing supplies needed to inject drugs and is leading to overdoses.
"It's aggravating for a first responder to Narcan somebody, and this is one of the things I really struggle with is that there's no accountability," commissioner Mike Jones said during a recent meeting. "They walk out of the ER, there's no – nothing happens. I mean, nothing happens."
In a since-deleted Facebook post, commissioner Randy Julian referred to the program as "a welfare program for addicts."
Carrie Lawrence, associate director of the Rural Center for AIDS/STD Prevention at Indiana University says eliminating the supply of clean syringes is not going to help people who are struggling with addiction stop injecting drugs. They're likely to continue even with dirty needles. "That's how Indiana got known for our HIV outbreak," she says.
Closing the syringe exchange she says, "is putting more people at risk."
Kelly Hans was struggling with addiction before the outbreak and now works at the needle exchange as its HIV prevention outreach coordinator. She says getting rid of the program would be a huge blow to the county's recovery system.
"I wish there would have been some place like this prior to the outbreak in 2015, when I was using and when I was a mess," she says. "There was nowhere for me to go to ask for help. Recovery wasn't very loud here in Scott County. So, I didn't even know who to go to."
Sponsor MessageAt THRIVE Recovery Community Organization in Scottsburg, 1,885 people from around the area reached out for help last year. Over a quarter of them were referred there by the county's needle exchange.
The exchange provides Narcan and information to help people use drugs safely, both to prevent disease and avoid overdoses.
Lawrence began researching the situation in Scott County from the start. She says the trust that has been built between the exchange and IV drug using community is what has made it effective.
"You can't just throw up a tent in the middle of the parking lot to do this," she says.
But the commissioners say there are treatments for HIV and are frustrated they don't see more people in recovery from drug use.
"I don't know how you get to someone to say, 'Enough's enough,'" Mike Jones said at a recent meeting.
Health officials have warned of what's happening in West Virginia, where cases of HIV and hepatitis C are spiking as elected officials crack down on needle exchanges.
In Scott County, Matern says they could transition to a harm reduction program without needles – sharing addiction resources and STD and HIV testing services. But she doubts it will be as effective, because what gets people in the door is the needles. If the needle exchange is halted, she expects a rise in HIV cases to follow.
Carrie Lawrence agrees. "Given the history of the Scott County outbreak, another one could happen," she says.
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