Indiana Governor Mike Pence has declared a state of emergency amidst the worst HIV outbreak in the state’s history. Thursday, March 26, Pence issued an official order declaring a public health emergency for Scott County, which has had 79 confirmed cases of HIV since mid-December. (The county usually averages no more than six new cases a year.)
"Scott County is facing an epidemic of HIV,” Pence said in a press release. “But this is not a Scott County problem; this is an Indiana problem."
Some residents of the hard-hit county disagree, arguing the area’s problems have been long ignored. (Read expert analysis on what has contributed to this crisis here.) Austin, Indiana, may be the biggest city in the state's southeastern county, but the town of 4,270 doesn’t even have a grocery store, much less a rehabilitation facility or HIV testing facility.
“Boarded-up windows decorate nearby houses," says The Chicago Tribune, describing the town. "Metal cages surround air conditioners to bar people from stealing parts to scrap for change…. Discarded syringes lie on the side of the road in Austin — evidence of the addiction that grips the city.”
As the colorful language suggests, times are tough in Austin.
“We have kind of a recipe for disaster,” said Dr. William Cooke, medical director for Family Foundations Medicine in Austin. “All the bad ingredients — unemployment, high dropout rate, high teen pregnancy rate, high drug abuse rate.”
It's the latter that is reportedly at the root of the sudden HIV outbreak. All of the current cases have reportedly been linked to injection drug use, specifically of the prescription opioid Opana, which is liquid oxymorphine.
A poor and mostly rural county, Scott isn't set up to deal with the current crisis. In fact, much like its eight neighboring counties, Scott didn't even have a single HIV testing site. Instead residents had to travel to Clark County’s Health Department to access state funded testing.
At least now free testing has come to Austin. Cooke told the Tribune that health officials are now making home visits and locals are taking full advantage of the sudden access: "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."
The governor’s declaration sets certain things into motion. For example, it mandates that law enforcement, emergency agencies, and health officials develop a response plan that provides direction to hospitals and health care providers.
The CDC has also issued recommendations, which include a public awareness campaign focused on needle disposal and safe sex, a short-term needle exchange program, and providing access to addiction services, HIV testing, and treatment.
Republican Governor Pence has already begun implementing some of those suggestions, including authorizing a temporary needle exchange program, despite having previously been opposed to such interventions.
Knowing that HIV can take up to three months to show up in a person's blood, health officials are also urging that people who have participated in risky behavior, such as needle sharing and condomless sex, be tested for HIV immediately and again in three months.
"I am confident that together we will stop this HIV outbreak in its tracks," Pence said.
Advocates on the ground say his willingness to follow the CDC recommendations is at least a start in the right direction.