In early 2015, news began to spread about an outbreak of HIV infections
in rural Scott County in Indiana, eventually becoming an international story.
Dozens of intravenous drug users in the county's tiny city of Austin
(population 2,500) became infected with HIV, primarily from sharing and reusing
dirty needles to inject opiates. Since the start of the outbreak, over 210 in
the county have been diagnosed with HIV, most in Austin. Moreover, almost 95
percent of those infected with HIV were also infected with Hepatitis C. Prior
to the outbreak, Scott County had fewer than five new cases of HIV each year.
The IV drug use did not come as a surprise to public health officials. Hep C
rates had been on the rise in Scott County for years and it was widely assumed
that it was linked to IV drugs.
The outbreak was fanned by the flames of ignorance. Former Governor (now Vice President) Mike Pence's policies helped degrade the public health capacity to prevent and respond to this growing epidemic through limited funding and an actual shutdown of Planned Parenthood offices that offered HIV and Hep C testing. Eventually, with more than a little nudging from the Indiana Health Commissioner (and now US Surgeon General) Dr. Jerome Adams, and a lot of pressure from the CDC, Pence grudgingly declared a public health emergency and authorized a short-term needle exchange program as a part of a multi-pronged approach to contain the outbreak.
Now, just two years later and despite demonstrated progress in reducing new HIV and Hep C infection, some of the Indiana counties are closing their needle exchange programs. Some of the politicians voting to close the programs defined it as a "moral" issue. Other complained that not enough users actually entered treatment programs. Bottom line: the programs worked. But now, despite lower rates of HIV and Hep C, it’s easy to declare victory and close the programs.
There is an important lesson to be learned from this situation. It seems clear that this was never about addressing a public health crisis as much as it was about saving face. Having HIV infection rates in a predominately white, rural town in a predominately white state that mirrored and, in some cases exceeded, some areas of Sub Saharan Africa just looked bad! Rather than merely being reactive, it was an opportunity to learn more about the intersections of opioid addiction, poverty and HIV/Hep C infection. It was also an opportunity to develop an infrastructure of prevention and treatment programs that would, over time, lesson the economic burden and human toll extracted by these twin epidemics. Without that infrastructure (which should also include safe injection sites) we will see more of these outbreaks, and not just in small rust belt towns.
The outbreak was fanned by the flames of ignorance. Former Governor (now Vice President) Mike Pence's policies helped degrade the public health capacity to prevent and respond to this growing epidemic through limited funding and an actual shutdown of Planned Parenthood offices that offered HIV and Hep C testing. Eventually, with more than a little nudging from the Indiana Health Commissioner (and now US Surgeon General) Dr. Jerome Adams, and a lot of pressure from the CDC, Pence grudgingly declared a public health emergency and authorized a short-term needle exchange program as a part of a multi-pronged approach to contain the outbreak.
Now, just two years later and despite demonstrated progress in reducing new HIV and Hep C infection, some of the Indiana counties are closing their needle exchange programs. Some of the politicians voting to close the programs defined it as a "moral" issue. Other complained that not enough users actually entered treatment programs. Bottom line: the programs worked. But now, despite lower rates of HIV and Hep C, it’s easy to declare victory and close the programs.
There is an important lesson to be learned from this situation. It seems clear that this was never about addressing a public health crisis as much as it was about saving face. Having HIV infection rates in a predominately white, rural town in a predominately white state that mirrored and, in some cases exceeded, some areas of Sub Saharan Africa just looked bad! Rather than merely being reactive, it was an opportunity to learn more about the intersections of opioid addiction, poverty and HIV/Hep C infection. It was also an opportunity to develop an infrastructure of prevention and treatment programs that would, over time, lesson the economic burden and human toll extracted by these twin epidemics. Without that infrastructure (which should also include safe injection sites) we will see more of these outbreaks, and not just in small rust belt towns.
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