The first HIV clinic in a rural, midwestern community grappling with an abrupt HIV epidemic is set to open on Tuesday in Austin, Indiana — the outbreak's apparent epicenter.
Dr. William Cooke says he’ll staff a weekly HIV clinic at an existing center called Foundations Family Medicine. Two infectious disease doctors will commute each Tuesday from Indianapolis, Cooke said. Addiction counselors will be on hand, too.
But some people are frightened by the planned launch, Cooke told NBC News. Some of his patients failed to show up for appointments on Thursday, more phoned to cancel future exams, and several locals verbally threatened the facility — all apparently due to Cooke's public vow to help HIV-positive residents in the area, he said.
Cooke's office manager texted him on Thursday afternoon: "We have been yelled at, cussed at and told off because of what we are doing, getting harassing and threatening phone calls." Cooke was driving back from Indianapolis at the time.
"I need my office to stay open to provide any of this care that is planned. I know what I'm doing is right," Cooke said. "But it is the most destructive business decision I could be making."
Indiana health officials reported Thursday there are 71 confirmed cases of HIV plus nine people with "preliminary positive" HIV results — almost all of them living in Scott County, near the Kentucky border. All 80 cases have been linked to dirty IV needles shared by opioid addicts. That count is expected to rise.
On Thursday, Indiana Gov. Mike Pence declared a public health emergency in Scott County, freeing healthcare resources to help the community. Staffers from the Centers for Disease Control and Prevention arrived Monday, assessed the number of HIV diagnoses and told Pence "we have an epidemic," the governor said.
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That spurred Cooke to huddle with two infectious disease doctors in Indianapolis Wednesday night to prepare for the launch of an HIV clinic at his office. Despite the local pushback, that plan remains in place.
"We’re going to contact each one of those individuals, bring them into the clinic starting on Tuesday to initiate treatment to try to get a handle on this and get them the antiviral medication they need," Cooke said.
"Right now, we’re just identifying who's positive, who's negative but then they’re just kind of left there," Cooke said, adding there are no drugs available locally to reduce the odds of additional HIV infections, no methods in place "to keep the negatives from turning positive, and no treatment for the ones that are positive."
Cooke also contacted two pharmacies in Austin, informing them of standard HIV-treatment protocols so both will have the medications in stock next week.
HIV cannot be cured, but drugs can keep patients healthy, can help reduce the risk that patients will infect others and can prevent infection if people at high risk take them.
Cooke's clinic will also be equipped with DMV and other vital records to help new patients obtain the official IDs needed to register for Medicaid or HIP 2.0, a state health insurance program for uninsured adult residents.
And Cooke will offer clean needles to his drug-using patients and send them home with safe containers to collect and return dirty needles — part of a now-legal but temporary needle-exchange program Pence authorized through his emergency declaration.
Before the epidemic, Cooke had five HIV-positive patients, he said. He doesn't know how many more have since been exposed to the virus that causes AIDS. In Scott County, nearly 20 percent of the 24,000 residents live below the poverty line. Given that, Scott allows some patients to pay $10 per exam.
That's why he's determined, he said, to help them acquire low-cost health insurance — along with any anti-HIV drugs. He estimated the co-pays for some antivirals to be $3 or less, if patients are on HIP 2.0.
"The bigger concern is that these patients follow through with treatment by getting those medications. Because if they can’t afford them they’re not going to take them," Cooke said.
"We've got to reduce this viral load that’s just running rampant through the community."
How will Cooke pay for the new HIV clinic? He's not sure. He's not even sure, he said, how much operating the clinic will cost. His office manager met with a local attorney Thursday to establish a 501 (c)(3) to make the clinic a nonprofit, eligible for tax-deductible donations.
"We can use help. ... I'm doing this on faith," Cooke said. "Yes, we need to get paid as a clinic [to offer] all of this. But that’s not the number one concern now. The number one concern is getting these people into treatment."
Cooke has asked state health authorities to help fund the clinic, and they've agreed to kick in some money, he said. Amanda Turney, a spokeswoman for that agency, confirmed "the Indiana State Department of Health is assisting with operations, coordination and technical assistance. Details will be forthcoming."
Gov. Pence also has committed to provide state personnel and resources to Scott County.
“The people of Scott County are working hard to address this crisis, and with additional state resources and new tools provided by this emergency declaration," Pence said, "I am confident that together we will stop this HIV outbreak in its tracks.”