The Best Way To Stop Indiana’s Outbreak Is The Most Unpopular
Stifling an explosion in HIV cases may require approaches that communities really, really hate.
By Leigh Cowart
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The man working at the gas station won’t shop at WalMart anymore. He tells me that there were three local people caught on camera injecting meat with human blood, and that only one of them was apprehended. He tells me it was on the news. He lives 20 miles away and commutes into Scottsburg, Indiana to work. He used to drive all the way here to buy groceries at WalMart as well, but since the recent HIV outbreak — and the talk of contaminated meat — he won’t any more.
Whether or not this is true isn’t the point. (For the record, I haven’t found any evidence as of yet to substantiate this claim.)
The point is, he believes it.
The point is, he’s scared.
And why wouldn’t he be? Scott County is in the middle of an HIV explosion big enough to bring in the Big Guns. Case in point: Tuesday’s media briefing featured two special guests — Jonathan Mermin, the director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB prevention, and Jerome Adams, the Indiana State Health Commissioner.
My morning gets off to a rough start. After catching up on the response to racist police brutality in Baltimore, I go down to the hotel lobby for breakfast, only to find a room full of white people nodding along to Fox News propaganda about the problems with black children. (Dear reader, let me assure you that it took an inordinate amount of composure not to put the waffle iron through that flat screen.) But, dedicated reporter that I try to be, I simply snarl with my yet-unbrushed teeth, grab a fucking chocolate milk, and leave. I had a press conference to attend.
The media in attendance are crammed into a small room in the small building that is the Austin City Hall. Outside, a broken clock stands ominously; inside, a cluster of cameras and bossy reporters jostle for prime position to be catch the attention of Amy Reel, the Director of Public Affairs for the Indiana State Department of Public Health. She’s an icy and formidable moderator. PBS is there, alongside NPR, as well as a reporter from the Associated Press and a bevy of local journalists.
Dr. Jennifer Walthall, a deputy commissioner in the state’s health department, opens the briefing. In a white suit, she stands tall, all bright eyes and the kind of cool animation one wants to see in a motivated guardian of the public’s health. Standing before the room, she starts with a quote from The Phantom Tollbooth: “the only thing you can do easily is be wrong.”
Okay.
Maybe not the most traditional or organic start to a pep talk, but it works. The point is that what Scott County is trying to do is outrageously difficult, but worth it. Multi-generational levels of drug abuse and a dangerous HIV outbreak are formidable foes, but there is a team of locals, Indiana workers, and out-of-state experts standing between the members of this small, rural community and the frothing outbreak at their door.
Current data holds that there are 143 total cases of HIV involved in this situation, with a foreboding 120 contacts left to trace. Disease detectives from the CDC are here, tracking down people who cannot be named, only described: Red hair, met him at a gas station; lanky brown-haired fellow who I think lives across town; a relative of a friend of a friend who they only saw once. They are even working with truck stops around the area, attempting to set up education campaigns for the drivers who slip through and in and out of local sex workers, some of whom have tested positive for the virus. It’s a game in which you grap at every straw in sight, trusting that eventually, you’ll grab the long one.
This media briefing was an exercise in pathological optimism, with the participants engaged in a kind of political dressage, prancing around the issues of the needle exchange. It’s a temporary stay put into effect by Governor Mike Pence, because, in Indiana, it’s illegal to be in possession of a needle or syringe without a prescription (though, notably, you can buy them over the counter, so long as you sign a log.)
It was clear, based on the rather leading questions of one local reporter that the needle exchange program is not exactly a welcome service here in Scott County. The reporter at one point referred to the outbreak as a “blessing” for the community, since it has shined a light on the scourge of drug abuse and, presumably, is cleaning up the sleepy lattice of streets that scratch across the county.
Harm reduction programs for unpopular populations can be a surprisingly tough sell. But that doesn’t mean it’s not worth the fight. Meticulous research has shown that needle exchange programs actually work for reducing HIV transmission, and are not associated with an increase in drug use in the areas served. The argument against them is that they support or condone illegal drug habits; the argument for is that they save lives and don’t actually do any harm. Only one of these arguments is backed by science.
I asked Dr. Walthall if it would be sustainable for a community with such a high percentage of HIV positive individuals to exist without a needle exchange, given that the outbreak is directly linked to intravenous drug use.
“Our hope is that, um, well, let me answer that question in two phases,” she began. Walthall is a direct, precise talker; the “um” is loaded.
“The first answer is that we are very pleased — I generally don’t venture into the policy arena, I’m the lady on the ground — we are pleased with the collaboration that is going on currently in session in the state of Indiana. We are thrilled to be under a renewal of the executive order of the governor to have the needle exchange program in place right now and to allow the local health department to continue their extraordinary work in making that occur. So there is progress being made on that front, and we’re very pleased to be in this space at this particular point in time.
“The second, is really to echo the response from Dr. Mermin before in that the response to an HIV/Hepatitis C outbreak such as this requires a comprehensive response. Our hope is that what we do put in place that’s sustainable will make the practice in this community of injection drug use and sharing needles obsolete sooner, rather than later.”
Which means stopping this outbreak is going to rely on getting this pool of IV drug users into treatment and recovery and keeping them from relapsing back into oxymorphone or, failing that, getting them to use clean syringes and stop needle sharing. The “abstinence-only” approach isn’t winning any awards in the sexual health arena. It’s not hard to say that relying on curing opiate addiction in order to stop an outbreak of HIV is a risky bet.
Might as well ban condoms too, while we’re at it.
Leigh Cowart is reporting live from Indiana all week. Leave a response to this post below, or use the tag HIVOutbreak on Medium or #HIVoutbreak on Twitter.
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