Indiana Races to Fight H.I.V. Surge Tied to Drug Abuse

Jeanni McCarty, a nurse and native of this threadbare city of 4,200, hurried up and down Main Street in Saturday’s bright sun, handing out stacks of fliers to any business that would take them. They were announcing a hastily planned specialty clinic - FREE, they emphasized in red - that would provide H.I.V. treatment to anyone who needed it.

Quite suddenly, a lot of people around here do. And the number keeps growing.

More than 80 people in Scott County have tested positive for H.I.V. since December, mostly in the last few weeks. They range in age from 20 to 56, and health officials say almost all of them live in Austin, which sits along Interstate 65 about 80 miles south of Indianapolis, surrounded by rural space. The outbreak, the worst in Indiana’s history, stems largely from the intravenous use of the prescription painkiller Opana, which everyone from the police to pastors to the owner of the city’s sole grocery recognizes as a plague on one ragged neighborhood in particular.

Gov. Mike Pence declared a public health emergency in the county on Thursday, and against his political beliefs, he also authorized a short-term needle-exchange program last week in hopes of stopping transmission of the virus through contaminated needles.

Ms. McCarty and her boss, Dr. William Cooke, the city’s only physician, have been at the forefront of a whirlwind response effort. Dr. Cooke’s medical practice, Foundations Family Medicine, will house the new clinic, with infectious disease specialists from Indiana University coming once a week along with mental health counselors and addiction specialists.

The weekly clinic will open on Tuesday, with six of Dr. Cooke’s 15 exam rooms devoted to it. Teams of state workers from Indianapolis will be on hand to sign up uninsured patients for Medicaid, which Governor Pence, a Republican, recently expanded under the Affordable Care Act to cover most low-income adults.

The questions now are how many of the newly infected will show up - and whether the effort, which is being led by the Indiana State Department of Health and involves the federal Centers for Disease Control and Prevention, will keep the number of new cases from spiraling further.

“I really, truly don’t know what to expect,” an exhausted Ms. McCarty said after distributing the fliers. “Even if only a couple come, that’s more than we had before and then maybe they can talk others into it.” Several worried people asked for H.I.V. tests on the spot.

The outbreak here was detected because Indiana requires newly confirmed cases of H.I.V., the virus that causes AIDS, to be reported to state health officials. It is jolting not only because national rates of H.I.V. diagnosis have remained stable or even decreased in recent years, but because the virus is a largely urban problem. Only about 6 percent of new diagnoses in 2013 were in counties with fewer than 50,000 people, according to the C.D.C.

One of the only other rural outbreaks to draw national attention took place in Belle Glade, Fla., where in 1985 researchers found an infection rate higher than New York City’s or San Francisco’s.
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There is reason for urgency. The transmission rate has been about 80 percent, Dr. Cooke said, meaning that eight in 10 of those who have acknowledged sharing needles with someone who has the virus have tested positive. That indicates “a very high viral load in the community right now,” he said.

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