Scott County

Photo by Seth Tackett WTIU/WFIU News

The HIV outbreak in Scott County five years ago prompted Indiana lawmakers to allow the creation of needle exchanges. The programs provide clean needles to IV drug users in an effort to stop the spread of infectious diseases such as HIV and Hepatitis C.

This year, state legislators have been debating the future of the exchanges.

Photo by: Seth Tackett, WTIU/WFIU News

Five years ago, Indiana experienced one of the nation’s worst HIV outbreaks. Mike Pence was governor then, and he approved a needle exchange to keep the problem from spreading. Now state leaders are debating whether that exchange — and others — can stay open.

Seth Herald for Side Effects

Months in prison didn’t rid Daryl of his addiction to opioids.

“Before I left the parking lot of the prison, I was shooting up getting high,” he says.

Creative Commons/Pixabay

Researchers have known for decades programs that provide clean syringes to injection drug users lower transmission rates of diseases like HIV and hepatitis C.

Now, they have personal stories to back the numbers.

Louis Arevalo holds his Truvada pills at his home in Los Angeles, California on July 17, 2015. The drug Truvada, used to halt HIV infection, has been shown to be over 90 percent effective when used correctly.
Heidi de Marco / Kaiser Health News

An analysis released Wednesday by the Centers for Disease Control and Prevention provides further links between syringe services programs and preventing HIV. 


Viral Maps Show Exactly How An HIV Outbreak Spread

Jan 24, 2018

Epidemiologists traditionally have depended on what people say to discover how disease spreads. But in investigating Indiana's recent HIV outbreak, the CDC tracked what the virus says — by looking at its DNA.


Seth Herald / for Side Effects Public Media

On a recent morning in downtown Tippecanoe County Indiana, a standing-room-only crowd showed up for a county commissioners meeting. The issue at hand? Renewing the county’s syringe exchange program.


Barbara Brosher / WTIU

Health officials in Indiana's Scott County--the epicenter of Indiana's HIV outbreak--aren’t confident a recent move by the FDA to pull a powerful painkiller from market will have an effect on addiction in the historically drug-ravaged county.

This story is part of NPR's podcast Embedded, which digs deep into the stories behind the news.

Sitting on a dresser in the back bedroom of a house in Austin, Ind., is the bottom of a soda can. A woman places a sliver of a pill, a powerful prescription opioid called Opana, on the jagged half-can. She begins to heat the pill with a cigarette lighter, melting its hard white coating and turning it the color of whiskey.

Her name is Joy.

Seth Herald/Side Effects

Four days a week, public health nurse Brittany Combs drives her SUV around the small town of Austin, Indiana, handing out clean needles to injection drug users and talking to people about going to rehab.

It’s a task that can be rewarding—when one of her customers finally wants help to get off drugs—and a bit agonizing, because there’s often not a rehab bed ready for them.


This story is part of NPR's podcast Embedded, which digs deep into the stories behind the news.

In the spring of 2015, something was unfolding in Austin, Ind.

Seth Herald / Side Effects Public Media

Amid fears that providing free, clean needles would promote illegal drug use, Congress passed a law prohibiting the use of federal funds to support needle exchange programs in 1988. But at the end of last year, lawmakers effectively ended that ban.

What Have We Learned From The Indiana HIV Outbreak?

Oct 2, 2015
Scott County public health nurse Brittany Combs distributes clean syringes from the back of a van in June 2015
Seth Herald

When an outbreak of HIV among injection drug users was declared in rural Scott County, Indiana, in February, it made national headlines. HIV was supposed to be an urban problem, and AIDS had been in steady decline among IV drug users since the early 90s. 

Daniel Raymond, policy director at the national Harm Reduction Coalition, says the Scott County outbreak, which infected 181 people, was a “wake up call” for communities around the country who are dealing with rising rates of hepatitis C, ongoing prescription opioid addiction, and increasing abuse of heroin.

Seth Herald/Side Effects

This episode of Sick, a new podcast from Side Effects Public Media, tells the story of Kevin Polly, a man who has to leave his town behind in order to save his own life. 

In February, the Indiana State Department of Health announced an HIV outbreak in rural Scott County. Thirty people had tested positive just since December, and most of the cases were linked to injection drug abuse of a potent prescription opioid called Opana. Since then, the number of cases has grown to more than 170.

Seth Herald

If a town could be said to hit rock bottom, Austin, Indiana, did so this year. Drug abuse has been out of hand there for some time, but it took the worst possible outcome to make the Southern Indiana community of 4,200 wake up to the problem: more than 170 newly identified cases of HIV since December 2014, spread almost entirely by needle-sharing.


Seth Herald

Getting Right, Part 2

Read our entire Getting Right series.

Heading out into the field, public health nurse Brittany Combs is a little angry, and in a hurry. Driving the county’s mobile needle exchange through Austin, Indiana can be hectic. Today she’s on a mission to find Jessica, a young mother who wants to go to rehab. But Brittany keeps getting interrupted.

“I’m supposed to be going to get Jessica right now,” she says as she pulls out of the community center, where the needle exchange is based. ”I told her I’d be there at three. Well, that’s not gonna happen.”


Seth Herald

Getting Right, Part 3

Read the whole Getting Right series.

On a recent Thursday afternoon, Police Chief Don Spicer is on patrol in Austin, Indiana. He drives through the northern part of town, where dilapidated houses are interspersed among tidy ones with manicured lawns.


Seth Herald

Getting Right, Part 4: A Person Struggling With Addiction Wakes Up

Read the entire Getting Right series.

It’s early in the morning, and Kevin Polly is getting ready to go. His daughter has called to wish him well, and when he gets off the phone, he excuses himself. Before he leaves, he has to get right.

One last shot—that’s the hope, anyway.


Seth Herald

Ravaged by one of the worst outbreaks of HIV in recent history and an underlying epidemic of injection drug addiction,  a small rural community is changing fast as it grapples with the fallout of the crisis. In this 4-part series, reporter Jake Harper and photojournalist Seth Herald tell the story of shifting attitudes, new thinking, and signs of recovery.

RCAP

A new initiative known as Project Cultivate aims to connect counties with the resources they need to start a needle exchange program from scratch.

Seth Herald / Side Effects Public Media

On a recent afternoon, Brittany Combs drove a white SUV through a neighborhood at the northern end of Austin, Indiana. In the back of her vehicle, there were hundreds of sterile syringes, each in a plastic wrapper.


Indiana Passes Needle Exchange Bill

May 1, 2015
needle exchange
Joe Mabel/Wikimedia Commons

The Indiana General Assembly took action Wednesday on a bill that would allow needle exchanges in some counties. Needle exchanges allow drug users to trade dirty syringes for clean ones, in order to reduce transmission of infections such as HIV. The number of people infected with HIV has continued to grow in rural Scott County, Indiana since the state health department declared an outbreak there in late February.

A temporary needle exchange program is set up at a Community Outreach Center in Austin, Ind.
Barbara Harrington / WFIU/WTIU

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.


Melissa Johnson/Flickr

Legislation that would allow needle exchanges in some Indiana counties cleared the House Public Health Committee on Monday. 

Last week, Gov. Mike Pence declared a public health emergency in Scott County, which has seen about 80 new HIV cases in just the last few months. Though Pence has allowed a needle exchange to operate in the county for 30 days, he has maintained his opposition to allowing needle exchanges statewide.

Shane Avery practices family medicine in Scott County, Ind. In December, a patient came to his office who was pregnant, and an injection drug user.

After running some routine tests, Avery found out that she was positive for HIV. She was the second case he had seen in just a few weeks.

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