Indiana HIV outbreak's original source still elusive

As of Thursday, efforts to identify those infected with HIV had turned up 166 confirmed cases in and around the Scott County town.

More work is being done to reveal harder-to-find cases, including the person who first brought the virus to the community where it quickly spread.

“We don’t know who that person is,” said state Public Health Commissioner Dr. Jerome Adams. “There are so many rumors as to who it could be. The thing is, just when you think you’ve got it, you find out there was one more person before them.”

Sex or drugs could have been the route for the initial infection. At least 10 people infected with HIV in the current outbreak have identified themselves as commercial sex workers who meet most of their customers at truck stops along Interstate 65.

Most of the people infected are drug users who’ve shared contaminated needles.

The risk of HIV transmission is higher among IV drug users. “It’s like injecting yourself with the virus right into your bloodstream,” Adams said.

Finding the initial case is important because it will help health officials finally understand the scope of the outbreak.

Tests conducted by the U.S. Centers for Disease Control and Prevention have found almost all those infected in Scott County have the same strain of HIV with high viral loads — meaning they were highly infectious and recently infected.

As important as finding the source is identifying, testing and treating others who may have been exposed.

“If we stop the outbreak tomorrow, you’re still going to have HIV in this community for the next 40 years,” Adams said. “If people aren’t treated, it’s going to keep popping up over and over.”

State health officials expanded HIV testing and treatment efforts in Scott County after declaring a public health emergency in March. About half of $2 million in emergency funds that were set aside have been spent.

They’re now reaching out to nearby physicians and hospitals to ask them to offer HIV testing to anyone who comes through the door. State and county health departments can’t afford to test everyone. But doctor-ordered tests are typically covered by insurance or the Healthy Indiana Plan, which is the state’s expanded Medicaid program.

Health officials also are pushing to get more eligible people — especially in rural areas with high rates of IV drug use — enrolled in Healthy Indiana so they can be tested and treated for HIV and Hepatitis C, another blood-borne disease spread through unprotected sex and contaminated needles.

“It just takes one infected person to come into a community of people engaging in high-risk behavior, and it’ll be Scott County all over again,” said Dr. Kevin Burke, who oversees HIV testing for Indiana’s southeast region. “We’ll see an explosion of HIV cases.”

Convincing people to get tested remains a challenge.

Adams recommends that everyone be tested at least once in their lifetime – more if they engage in high-risk behavior.

“There are a lot of things that happen in life that either we don’t want to own up to, or quite frankly we’ve blanked out or forgotten,” he said. “You can have HIV for years before it becomes AIDS, but we want people to know before they are passing it along.”

Public health workers assigned to track down people who’ve had sex or shared dirty needles with people known to be infected with HIV have found some who refuse to be tested — even though treatment is available and could be paid for by the state.

“There is a fatalism for some, a sense of, ‘I’m a dead man walking,’ as one man said to me,” Adams said.