By Rob Hunt and Vince Roberts
Health officials are hoping a tactic considered by most to be a “necessary evil” will help curb the growing HIV epidemic in southern Indiana that has been growing since mid-December of 2014.
On March 26, Indiana Governor Mike Pence declared a public health emergency (full text here) in Scott County due to an unusual number of HIV cases for that area. An area that sees, on average, five cases or less of HIV per year, has had a confirmed 120 cases and 10 positive preliminary tests since December. All the cases are believed to be connected to intravenous drug use in the area. In his declaration, he has authorized the Scott County Board of Health to begin a needle exchange program for 30 days, a period of time set to expire on April 25, unless it is extended.
Indiana Department of Homeland Security consultant Julie Vincent, a professor of journalism and public relations at Indiana University-Purdue University at Indianapolis, is unsure that the declaration from the governor goes far enough.
“30 days, in my opinion is not enough,” she said. “We are getting stats that the clean needle program is successful. As of April 14, we have distributed 1,516 clean needles and collected 580 used needles. That’s important because people are discarding them in open fields and abandoned houses.”
According to a report from WXIN Fox 59 in Indianapolis on April 17, that number of clean needles distributed has since risen to 5,322 and the amount of used needles collected has climbed to 1,400.
According to a 2002 CDC report to Congress, needle exchange programs reduce “risk behavior” by 80 percent and at least a 30 percent reduction in HIV transmission among intravenous drug users.
IUPUI professor and epidemiologist Thomas Duszynski said he agrees with Vincent that the program is a good place to start, but feels that the needle exchange alone isn’t going to be enough to solve the community’s long-term health concerns.
“It points to a much bigger issue in Indiana, which is funding for public health and supporting these people,” he said. “People don’t want to fund needle exchanges because they feel that money gets used on drugs. The problem is, we end up taking care of these people down the road.”
With rising health care costs, the price tag for indifference and not attacking this problem is staggering. Duszynski said he believes that from a dollars-and-sense point of view, the repercussions of inaction extend far into the future.
“The lifetime cost for a person with HIV is approaching a half-million dollars,” he said. “One needle costs 97 cents. Average that out over a person’s lifetime, and the cost is nowhere near that half million dollar mark. Prevention is always cheaper than treatment. Always has been, always will be. We’re real good at the treatment part, not so great at the prevention side of things. We need more funding for education.”
Vincent said, “About 80 percent of people who have HIV also have Hepatitis C, so that testing needs to be done.” That means, in addition to the costs of the treatments associated with HIV, in most cases, Hepatitis C treatments will have to be offered as well.
“We really have to make sure that our public health infrastructure in that area can be robust enough to provide the kinds of treatments that are necessary,” Duszynski continued. “Right now we have 120 residents that are going to require HIV and AIDS treatments for rest of their lives.”
This represents a potential cost of over $60 million to taxpayers, just for the patients that are known about now.
The historical significance of this outbreak in southern Indiana is not lost on Vincent.
“It’s the largest cluster of HIV that we know of caused by intravenous drug use,” she said. “And almost all the active cases are from intravenous drug use, which is different from other spikes of HIV. And all 120 cases are connected. In other words, friends of a friend.”
The biggest fear that health care officials have isn’t the 120 cases in front of them now, it’s the unknown. It’s the ominous belief that these cases are just scratching the surface of what is to come.
“There’s going to be testing done on the inmates in Scott County Jail,” Vincent said. “That could spike the number. I don’t know where the number will end, but the epidemiologist yesterday on the conference call said we’ve not hit the peak yet, and we don’t know what that peak is. So, on my dark days, I’m a little bleak about it.”
Duszynski said he is also concerned that, despite the narrative that this is a rural community far from civilization, the public still isn’t aware of how fast this virus can travel and that the crisis is nowhere near its conclusion.
“A lot of what I’ve heard is that this is an isolated event in that community and they’ve been able to draw lines to connect the cases,” he said. “It’s an isolated area, yes, but I can’t believe that this is going to stay right there in Scott County. There’s an interstate that runs through there and that means truck stops. It’s not far from Louisville and Cincinnati, so I think as time goes on, we’re going to see more cases elsewhere that can be linked back to Scott County.”
Despite the fears that surround the situation, there is a belief among these experts that there is hope for the residents of Scott County and other communities like it across the state.
“On the positive side, we’re all trying to do the right thing,” Vincent said. “And we’re having people come in with their needles and, after talking to us face to face, they want to quit. I haven’t seen an addict yet who wants to be one.”
Duszynski said he hopes that this situation will open the eyes of lawmakers to the need for increased funding for education about the transmission of HIV as well as the need for local communities to work toward solving the intravenous drug abuse problem that exists statewide.
“This should open the eyes of lawmakers and local health departments that this could happen in their communities as well,” he said. “We don’t necessarily like dealing with these individuals, but my biggest concern is that we’re seeing this bleed over into mainstream society. Someone doesn’t know that their husband, friend or daughter is an IV drug user, now HIV is in their home. Every case is tragic, but I hope this opens our eyes in other communities. I hope towns elsewhere realize they need to do something about the intravenous drug use in their community. There are intravenous drug users in every county. There is HIV being transmitted in every county. It just hasn’t reached the epidemic stage that we have in Scott County, but there is always that potential.”
Duszynski said he believes lawmakers need to do more in terms of funding to help with these situations, but believes if political attitudes can be set aside for the good of people, good things could happen.
“If we could raise the public health literacy there, we can raise it in other communities,” he said. “They need to know how these things work. We need to put aside our personal or religious beliefs. We can help these people. I’ve yet to meet a legislator that doesn’t want to save someone’s life.”