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Indiana Governor Extends Public Health Emergency To Fight HIV Outbreak

MELISSA BLOCK, HOST:

A small rural county in Indiana is dealing with a dramatic spike in cases of HIV. Typically, Scott County sees five new HIV cases each year. Already in 2015, they have seen 128. And today the governor of Indiana, Mike Pence, extended a public health emergency in Scott County. This allows a temporary needle exchange program to continue there. State lawmakers are now considering a bill that would let other counties run needle exchange programs of their own. Beth Meyerson testified at the state capitol today in support of needle exchange. She's co-director of the Rural Center for AIDS/STD Prevention at Indiana University and joins me now. Welcome to the program.

BETH MEYERSON: Thank you.

BLOCK: As I understand it, the spike in HIV infection in Scott County, which is in southern Indiana, is tied to injection, drug abuse, and in particular to a drug called Opana which is a potent opioid painkiller which is altered and then injected. What can you tell us about that drug?

MEYERSON: So Opana is an opioid. Apparently the form that they're using is a prior iteration of it because the current iteration of Opana doesn't allow for cooking and shooting very easily. So they do that - requires a little larger gauge of needle as well, so you can imagine some of the tissue damage involved, and you have to inject it 10 times a day compared to, say, heroin twice a day.

BLOCK: Well, based on your experience working with rural populations and AIDS and STD prevention, how surprising was it for you to see an outbreak of this size happen in a county like Scott County?

MEYERSON: Well, if you ask people in Scott County, they wouldn't be surprised because they have known for years that they have had an injection drug use issue with Opana. And then when you fold onto that the fact that the public health system is almost nonexistent in that area, it would not be surprising then if HIV enters that drug-using network and hepatitis C also. They come co-occurring often - that it wouldn't be such a surprise that we wouldn't know about it.

BLOCK: Here's one of the things that I don't understand. The public health emergency in Indiana is just for Scott County. I would assume that this problem of Opana injection, drug abuse and HIV rates is not limited to Scott County.

MEYERSON: Well, the governor and the state health department are saying that the outbreak is limited to a 10-block area, but we also know from clinicians, actually, that testified today, and information from the community that, in fact, people's sexual networks are outside of that. The using population comes and goes, so that is probably not realistic. And frankly, we wouldn't know because it's not like we're doing any massive screening around Scott County. Remember, Melissa, the resources are very, very low. In fact, if you look at a map of southern Indiana, you would see that the HIV testing site that's the closest to Scott County prior to the outbreak was in Clark County. That's far away.

BLOCK: Let's talk about the needle exchange program. The state of Indiana reported last week that about 5,000 clean syringes had been given out to 86 participants in Scott County. Does that sound like enough to curb the outbreak that you're seeing?

MEYERSON: Well, it's just the beginning. This is a trust building situation that - in fact, it did not begin until April 9. It's just initiating its process. It just went to mobile. Initially people had to come in to the health department to get syringes and exchange them. And so you can imagine the fear that people experience in trying to do that, of course knowing full well that this is temporary. When they come out of the woods, there's all sorts of issues that accompany, structurally, a needle exchange that's a temporary gig. I am, though, happy to see that 86 people have trusted enough to get engaged in the syringe exchange because that clean syringe could mean the difference between hepatitis C or HIV infection.

BLOCK: Beth Meyerson, thanks very much for talking with us.

MEYERSON: Thank you so much.

BLOCK: Beth Meyerson is assistant professor at Indiana University's School of Public Health in Bloomington. She's also co-director of the Rural Center for AIDS/STD Prevention. Transcript provided by NPR, Copyright NPR.