Needle exchange details developing for HIV outbreak in Scott County

“I’ve noticed a lot of fear and helplessness on the part of the victims. They don’t feel like anyone cares,” Adams said. “They don’t feel like they have resources.

“We will get you tested. We will get you into treatment. We will get you coverage for treatment. There is life after HIV, and there is life after addiction, but it starts with you identifying yourself and letting us help you.”

The Scott County Board of Health unanimously agreed Thursday to request permission from Adams to implement a needle-exchange program, said Public Health Nurse Brittany Combs with the Scott County Health Department. The Indiana State Department of Health is working on developing options for how that program will work.

“We’ve already been in touch with national experts in different states and with the [Centers for Disease Control and Prevention] to envision the different ways a needle-exchange program could work,” Adams said. “But we’re going to talk to the people in Scott County and make sure and give them a range of options in terms of how to set it up, where to set it up, most importantly, and who to conduct it, and let them decide, ‘OK, this is what’s going to work for me.’”

If Adams receives Scott County’s request Friday, he said his goal is to have a needle-exchange program in place next week, and ideally by as early as Tuesday.

“We are not joking around with this outbreak,” Adams said. “We want to get things moving as quickly as possible, as long as we’re not going too fast for the locals. And so far, I would say that the locals have been pretty darn responsive.”

“We want to go as quickly as possible, so yes, that sounds like a plan,” Combs said.

Gov. Mike Pence authorized the needle-exchange program — contingent upon the approval of the Scott County Board of Health — as part of an executive order Thursday that put in place emergency measures to combat the spread of HIV in Scott County. The number of HIV-positive cases grew by two Friday — to 81 — since December. All cases related to the outbreak thus far have originated in Scott County, but officials continue to investigate contacts in Scott, Clark, Perry, Washington and Jackson counties, according to an ISDH press release.

By law, the public health disaster emergency expires 30 days after it is issued, but Adams said it’s likely that the order — and the needle exchange — will be extended at least once.

“We’ve already discussed it, and I’ll tell you, he’s optimistic and I’m optimistic after being down in Scott County,” Adams said. “But just looking at the typical course of the disease and the number of untraced contacts out there, there’s a very reasonable chance we’re going to have to extend the executive order at least once. We’d discussed making it longer in the first place, but again, we’re bound by state law.”

Pence stated Thursday he would veto legislation in the state legislature that would allow local government units to establish needle-exchange programs on their own. But experts believe that such programs need to be put in place permanently to combat the spread of disease, including Don Des Jarlais, director of research for the chemical dependency institute at Mount Sinai Beth Israel in New York.

Des Jarlais said the places most vulnerable to infections include rural and suburban communities where a new group of drug users started with prescription pain killers and moved on to injecting heroin. Without drug treatment or needle-exchange programs, these areas “are ripe for outbreaks, and we should expect more of them unless we really ramp up our HIV prevention services in those areas,” he said.

Scott County is “the canary in the coal mine,” and the problem there is emblematic of what’s going on in similar communities across the country, Adams said.

“There are communities like this all over the United States where drug use, drug abuse and untreated mental health and addiction problems are rampant,” Adams said. “HIV just happened to be the marker by which we are seeing this problem manifest. Hepatitis C, if you follow those rates we’re seeing all over the country, those rates are just booming in communities where there’s IV drug use.”

Adams touted the Healthy Indiana Plan 2.0 — the state’s version of Medicaid expansion through the Affordable Care Act — as an important tool to combat the underlying addiction and mental health issues that are helping disease to spread. HIP 2.0 can connect individuals to addiction services, behavioral health services and treatment for HIV, Adams said.

“If this outbreak were to occur in 15 or 20 other states around the country where they don’t have this option, these individuals would just be out in the cold,” Adams said. “They wouldn’t have access to these kinds of services. It’s a tremendous asset that we have here to help tackle the root of this problem, which is behavioral health concerns, addiction and lack of care and lack of options to treat those problems.”

Lack of identification documents like birth certificates and drivers’ licenses is one of the barriers to signing up for HIP 2.0. The ISDH will have a mobile vital records unit on the ground by Tuesday to help people obtain the documents they need to sign up, and HIP navigators will be on hand to help people sign up for health coverage, Adams said.

“The idea would be, go in, get your birth certificate, immediately next to you is a person that can help you get signed up, and quite literally at that point, you can go out and get services,” Adams said.

The ISDH will attempt to reach out to individuals potentially infected through a public education awareness campaign via advertising and social media called “You are not Alone.” The campaign will focus on substance abuse treatment, safe sex, needle disposal, HIV testing and HIV treatment. The campaign will encourage viewers to call hotlines for HIV and addiction services for local treatment and care resources.

The county’s 81 HIV cases represent more than half of the nearly 150 new HIV cases that have been confirmed statewide in Indiana since January, said Ken Severson, a spokesman for the ISDH. The recent surge in infections is the state’s largest-ever HIV outbreak.

— Associated Press reporter Rick Callahan contributed to this report.