Indiana Politicians and Communities At Odds Over How To Combat Spreading HIV Outbreak

Apr 24, 2015

More than 130 people have tested positive since December, and the outbreak is no longer contained to just Scott County.

As the number of people living with HIV in Indiana increases, health officials, politicians and everyday people remain at odds over how to stop the disease from spreading.


A Decades-Old Drug Problem

The streets of Austin, Ind., are lined with campaign signs focusing on the future of this struggling small town. They’re on every corner, in every yard, even greeting drivers on the outskirts of town.

But it’s the handwritten sign posted on Tammy Breeding’s lawn that sends perhaps the most powerful message of all. The sign reads “No loitering, prostituting in front of or around these premises. Violators will be prosecuted.”

I had to make a statement,” Breeding says. “I want to take back my community, my neighborhood.”

Breeding’s neighborhood is the epicenter of an HIV outbreak unlike anything the Centers for Disease Control has seen in rural America. Health Department officials say people are spreading the disease primarily through intravenous drug use.

IV drug use is a problem Austin has been struggling with for years. Breeding says you don’t have to walk far down North Church Street before you find someone looking to buy or sell drugs.

I think if they continue this needle exchange, you're going to have the worst epidemic with drugs coming in from all over, that it's not going to be able to be contained - Tammy Breeding, Austin, Ind. resident.

“The main drag is Church and Broadway,” Breeding says. “This is like a meeting corner for the drug deals, the prostitutes. You can see it go from one house to another of where they’re going to get their next fix. And they call them the shooting galleries because they go to get a shot then they get high.”

It’s gotten so bad that some neighbors are putting up barricades to prevent addicts and dealers from using their driveways as trade-off points.

And Breeding says a temporary needle exchange program Gov. Mike Pence authorized is only making the situation worse. “I think if they continue this needle exchange, you’re going to have the worst epidemic with drugs coming in from all over that it’s not going to be able to be contained the way they want to contain it,” she says.

How The State Is Addressing The Outbreak

The exchange, setup in a Community Outreach Center in Austin, is part of the Indiana’s efforts to curb the outbreak. It allows addicts to get enough clean needles for one week. They give their first names and they get an ID card with a unique, identifying number as part of the program.

So far, Scott County Public Health Nurse Brittany Combs says participation has been lower than she hoped.We had to design the program from scratch,” Combs says. “It takes a while to gain people’s trust. Especially this population – they’re not trusting. It takes a while for them to realize that they can trust us and partake in a program.” 

The governor’s executive order authorizes the program through May 25 and only in Scott County. But HIV is spreading. There are now five cases in Jackson County – Scott County’s northern neighbor.

“The five cases that have been reported in Jackson County, all of the contact tracing is complete, so we feel that those five cases have been isolated and contained,” says State Deputy Public Health Commissioner Jennifer Walthall.

That’s a line some folks aren’t buying.

For the governor to think that he can contain the epidemic in Scott County with an emergency order is reckless and will cost the lives of thousands of Hoosiers. - Scott County doctor Shane Avery

Legislators Debating Needle Exchange Bill

Dr. Shane Avery, a family doctor in Scott County, was one of several people who testified during a House committee hearing this week asking legislators to make needle exchange programs legal.

“For the governor to think that he can contain the epidemic in Scott County with an emergency order is reckless and will cost the lives of thousands of Hoosiers,” Avery said during the hearing.

The proposed bill would allow for local needle exchange programs in areas with the high rates of Hepatitis C, which is often an indicator of HIV.

Rates of Hepatitis C Infection by Indiana County. Source: Rural Center for AIDS/HIV Prevention

Proponents say needle exchange programs effectively quell outbreaks — but not if they’re restricted to particular areas.

“They know it’s a bigger problem than Scott. I’ve not heard anyone make the statement that the state has been making which is ‘this is only Scott…and when it’s all over it’s all over,’” says Beth Meyerson, co-director of the Rural Center for AIDS and STD Prevention at Indiana University. “I think everyone knows this is a long-distance run, this is a lifetime need until these people have treatment services available to them.”

David Powell, executive director of the Indiana Prosecuting Attorneys Council, was the only person at the hearing to speak out against the needle exchange bill.

He says legislators need a more long-term solution to the outbreak that addresses funding and substance abuse treatment.

“If you at some point want to incorporate a needle exchange program in that mix, then that’s your call obviously,” Powell said. “We just think it’s too early to do that. And I’m worried that if you do that, you think you’ve fixed the problem. Without treatment, without testing, without addressing these other more critical, more expensive health needs, you don’t fix anything.”

On the streets of Austin, residents including Clyde Polly worry about what will happen if legislators don’t make the needle exchange permanent. His son was diagnosed with HIV and is now in rehab, trying to kick the habit. “They do it three and four and five times a day,” Polly says. “They can’t do it just one time a day. They do the thing one time, and then a little bit later, they’ll be looking for another dose.”

Polly sees the needle exchange program as a godsend. He says extending it and getting more legislative help and state resources could combat the town’s crippling drug problem and lead to real change on Austin’s streets.

“I don’t know what’s going to happen down the road,” Polly says. “I’d like to see it all change. I don’t know how much hope there is for it to change though.”

This story was republished by permission from indianapublicmedia.org