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HIV/HCV Outbreak: Scott County, Indiana

Back in March, 2015, national media reported that an epidemic of HIV had broken out in rural Scott County, Indiana. 46 cases were discovered within a three-week period, more than double the usual yearly infection rate. A few weeks later, that number had climbed to 142, and continues to climb to this day. The source of infection: injection drug use. According to an article in the New York Times, people who had formerly used Oxycontin, which is usually crushed and snorted, had switched to the prescription opiate, Opana, a more potent drug, which they cooked into a liquid and injected. Needles were passed around and used until they broke off in people’s arms. Some needles were used more than 300 times. With the national blood supply now cleared of hepatitis C, injection drug use has become the number one cause of all new HCV infections.

Brittany Combs, the health nurse of the Scott County Health Department, and in my opinion, the reluctant hero of this epidemic, told me the HIV infections were discovered through the Scott County STD office, when a single patient reported early symptoms of HIV. Upon further investigation, the health department found that everyone in the patient’s household was infected with the virus. Since hepatitis C is not classified as a STD, those infections were found later, and the outbreak turned out to be one of co-morbidity. Everyone who tested positive for HIV were also infected with HCV. People who shared needles were infected with both viruses in a single injection.

In need of a way to achieve control over the co-infection epidemic, Brittany Combs began looking into needle exchange, a controversial program in which new syringes are traded for dirty ones. Like many people, Ms. Combs believed the distribution of clean syringes would lead to an increase in drug abuse. She decided to research the issue for herself, and found statistics showing that needle exchange programs markedly reduced infection with HIV/HCV. Indiana Governor Mike Pence, also on record against needle exchange, (in fact, needle exchange is illegal in Indiana), declared a state of emergency in the region of the epidemic, allowing the institution of a time-limited needle exchange program.

Now, a white minivan cruises the Scott County neighborhoods most affected by this potentially deadly outbreak, looking for people in need of testing or clean syringes. Often an occupant of the van, Ms. Combs herself urges folks to take advantage of mobile services, allowing patients to avoid being seen going in and out of the county health department.

The thing that makes Indiana’s response to the epidemic a possible resounding success: access to treatment. So far, everyone infected in this outbreak has qualified for the HIP-2 insurance program, an extension of Indiana Medicaid. According to Ms. Combs, this insurance covers treatment for both HIV and HCV. All bases have been covered here: testing, treatment, education, and prevention. Will Indiana continue its offense against this growing public health crisis? Will its principals inspire similar responses in other states? We’ll soon know the answers to these questions, as those in emerging pockets of infection look for ways to control rates of infection in what may very well become a national epidemic.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.