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An HIV "epidemic" fueled by needle-sharing opiate addicts has infected at least 72 people in one southern Indiana county as Gov. Mike Pence plans to declare a public health emergency in that community on Thursday.
The outbreak's swift acceleration in Scott County — beginning with seven known HIV-positive patients in late January — has prompted state officials to ask the the Centers for Disease Control and Prevention to deploy investigators to test residents and to help control further spread of the virus, Pence said.
CDC staff arrived on Monday and "traveled to the community ... an epidemic 'aid team.' I met with them late Monday," Pence told reporters in Scottsburg, the county seat. "And they informed me that they had confirmed that we have an epidemic in Scott County."
Another seven residents from the area also tested "preliminary positive" for HIV — all similarly linked to opiate injections with dirty needles — bringing the possible caseload to nearly 80, Pence said.
"This is not a Scott County problem, this is an Indiana problem," he said. "People of Indiana are here to come along side our fellow Hoosiers here in Scott County and work this problem and deal with this crisis in a way that will save lives and restore health and law and order to this community," the governor added.
On Wednesday, Pence met with doctors and healthcare workers in Scott County to hear their suggestions and to start hammering out specific strategies that will accompany his health-disaster declaration, to be made formally Thursday morning.
"I don't take this action lightly. It is built upon what the Indiana State Department of Health has been doing with the very capable healthcare provider community here in Scott County," Pence said.
A group of disease-intervention specialists, testers, and care coordinators from other parts of Indiana already have started work in Scott County, Pence said. To track the spread of the virus, those experts have begun tracing all know contacts of any HIV-positive county residents.
The epidemic's true epicenter is the town of Austin, in northwestern Scott County, said Dr. William Cooke, medical director at Foundations Family Medicine. He opened the facility in Austin about 10 years and, since then, he's watched opiate abuse take a far deeper hold.
Used needles litter roadsides, ditches and yards, said Cooke, who has been publicly voicing his concerns about a brewing HIV outbreak. On Wednesday, Cooke also lobbied Indiana lawmakers to launch a clean-needle program — a strategy that, in his vision, would offer safe fresh needles and safe places to dispose of dirty needles while also connecting participating residents to addiction therapists.
"We've seen an increase in overdoses. We've identified that most of our IV drug users are hepatitis-C positive. We knew it was a only matter of time until HIV set in," Cooke said. "We've been asking for help for a long time. We identified long ago there was an undercurrent here that was very unhealthy."
Austin's population is about 4,200 people, according to the U.S. Census Bureau, and the majority of the nearly 80 known HIV cases are people who live in that town, Cooke said.
Poverty is driving the mass opiate-addiction rate — and, now, the HIV epidemic, Cooke said. He met with the governor Wednesday to pitch his ideas on how to best infuse extra state dollars into Scott County to help. In addition to his clean-needle idea, Cooke sees a dire need for infectious-disease experts, addiction counselors, cardiologists and pulmonary doctors in the area.
The CDC team also visited Cooke's clinic as well.
"We need help. But that costs money. My clinic serves the poorest people in Indiana, potentially the poorest in the country," Cooke said. "We do a sliding scale here. If they can, they may pay us 10 dollars for care. I'm hopeful this declaration provides the funding we have needed.
"It's overwhelming how much pain and suffering is going on here. We can provide a basic level of primary care. But some people can't even afford 10 dollars."
The recent HIV spread has been staggering, Cooke said: During 2014, there were about 420 new HIV cases reported throughout Indiana compared to the nearly 80 identified in just one small town during the past three months.
The dissection of Scott County by Interstate-65 is one factor in the addiction rate, Cooke said. So-called "pill mills" in Florida transport shipments of illegal oxycodone northward to street dealers in Chicago. But in many towns along that route, locals got hooked long ago. Many swallowed pills at first, then began shooting the opiates into their veins.
The other factor is deep poverty. Scott County has some of Indiana's steepest rates of high-school dropouts and teen pregnancies, Cooke said.
Geography plus economy have equalled what Cooke calls "a recipe for disaster"
"It's really about hopelessness," he said. "When these kids are in middle school, I'm providing them care and there's a brightness in their eyes. They believe they can be president of the U.S. someday. But that brightness is gone by the time they're in ninth grade. They don't think there's anything waiting for them.
"They think there's nothing to live for tomorrow. And the drugs are so available. This is what happens — here and in other towns in America. It's not unique to Austin," Cooke said. "As far as this HIV outbreak, we are the canary in the coal mine."