HIV epidemic means decades of care, Indiana health official says

Even as new HIV cases reported each week have dropped into single digits, Health Commissioner Jerome Adams warned that the problem isn’t going away.

“Cases of HIV in this community will remain there for the next 40 to 50 years,” Adams said, warning of a recurrence of the outbreak without long-term care and intervention.

Health officials have confirmed 170 cases of the AIDS-causing virus linked to an outbreak detected in late November among drug users sharing dirty needles. In the previous five years, only three HIV cases had been reported in the county.

The number of newly detected cases has slowed with the introduction of a needle-exchange program and an infusion of state help, including rapidly expanded testing and treatment, at an estimated cost of about $2 million.

Adams said during a press conference Wednesday that public health workers have been unable to locate at least 46 people who may have been exposed to a highly infectious strain of the virus through contact with infected drug-users and commercial sex workers. Some are known only by first names or aliases, making it difficult to track them.

Another 21 people who engaged in drug use or sex with infected persons refuse testing. The state cannot force anyone to be tested for the virus.

Adams’ warning of “continuing vigilance” came as the state pulls back some resources and shifts more responsibility to local officials. The state’s one-stop outreach center, where Scott County residents can go for a range of services from HIV testing to clean needles, is closing at the end of June at its current location. It will re-open one day a week in a new location to be determined.

“We’re not leaving Scott County,” Adams said. “We’re not passing the baton, we’re trying to figure out how to run together.”

Adams has pulled in public and private resources to help Scott County create a long-term plan to care for ill residents. For example, Indiana University Health has agreed to coordinate health care for the estimated dozen county jail inmates infected with HIV. The state will pick up the costs for that care, which is yet to be determined, marking a significant departure from current policy that requires counties to pay for inmate health care.

The national AIDS Healthcare Foundation, meanwhile, is working with a local physician, Dr. William Cooke in Austin, to expand HIV treatment and other services.

And LifeSpring Health Systems, a drug treatment program in neighboring Clark County, is opening a satellite facility in Scott County, which until now had no addiction treatment services. LifeSpring has accelerated access to its services, reducing wait times for its program from up to 10 weeks to 10 days.

Coordinating services among providers that don’t typically work in rural communities has been a challenge, said deputy state health commissioner Jennifer Walthall.

But Adams said private-public partnerships are critical given the limited dollars spent on public health care in Indiana, which ranks near the bottom in per-capita spending on public health care.

“We are in a resource-limited world in a resource-limited state,” he said.

The state’s decision to ramp down efforts in Scott County comes as other communities worry about the next potential HIV outbreak.

At least nine counties with high IV drug use and high levels of Hepatitis C are looking at rules that would allow them to request a declaration of a public health emergency. Hepatitis C, a potentially lethal blood-borne disease, often accompanies HIV.

Madison County health officials have taken steps toward that declaration, which would allow that county to launch a needle exchange like the one in Scott County. Hepatitis C cases there have nearly doubled in the last two years.