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It wasn’t supposed to happen here. Not in Austin, a one-doctor-and-an-ice-cream-shop town of 4,200 in southeastern Indiana, nestled off Interstate 65 on the road from Indianapolis to Louisville, where dusty storefronts sit vacant and many residents, lacking cars, walk to the local market. Not in rural, impoverished Scott County, which had reported fewer than five new cases of HIV infection each year, and just three cases in the past six years. Not in a state where, of the 500 new cases reported annually, only 3 percent are linked to injection drug use.
But it did. And it could happen in many more backwoods towns just as unprepared as Austin.
As the largest HIV/AIDS outbreak in Indiana’s history roils this Hoosier hamlet, it reflects the changing face of the epidemic in the U.S., as a disease that once primarily afflicted gays and minorities in deep-blue cities rises in rural red states. This new evolution of HIV is also forcing a new generation of Republican policymakers to confront its orthodox opposition to remedies such as government-funded needle-exchange programs.
Over the past decade, the virus cascaded from urban cities like San Francisco, New York and Washington, D.C., into poor, rural swaths of red states in middle America—opening a new front in the national fight against the spread of HIV. “It started in the coastal states among middle-class white gay men, and then the epidemic evolved into affecting more and more minorities in the South,” says Carlos del Rio, an AIDS researcher at Emory University in Atlanta. “Obviously, now the epidemic is changed. Now, what we're seeing is it impacting the rural communities.”
In this Indiana burg, the virus is not spreading among networks of gay men, but in rapid, cluster-like fashion within jobless white families who inject prescription painkillers with dirty needles.
“This is an HIV outbreak in a rural setting that is linked to an injection drug use,” says Jennifer Walthall, Indiana’s deputy state health commissioner. “That hasn’t been seen in the U.S. to date.” Since November, Walthall’s state health department has identified 163 cases of new HIV infections, including three preliminary positives. Eighty percent also tested positive for hepatitis C. “This was not on the radar,” Walthall says.
In April, Walthall’s office, along with the Centers for Disease Control and Prevention, issued a health advisory to public health departments nationwide—a preemptive salvo to stave off similar outbreaks among injection drug users. The missive targeted health departments in rural counties east of the Mississippi River, where opioid abuse and needle-borne infections are spiking, according to the CDC.
Scott County’s outbreak was so severe that Indiana Gov. Mike Pence, long an opponent of funding needle exchanges as a member of Congress, issued an executive order in March that gave local health officials authority to establish a “limited and focused” 30-day needle exchange. Last Thursday, Jerome Adams, Indiana State Health Commissioner, declared a public health emergency in Scott County through May 2016, extending the needle exchange in Austin for another year. In Kentucky, where new HIV and hepatitis C infections are also skyrocketing, state lawmakers approved in March a law that would allow health departments and local governments to launch their own needle exchanges.
Such moves by Republican governors and legislators would have once been considered GOP heresy. A federal ban on funding such exchanges has deep roots. In 1988, during a debate over passage of the appropriations bill for the Departments of Labor, Health and Human Services, and Education, North Carolina Republican Sen. Jesse Helms introduced a rider that effectively banned federal funding of needle exchanges (specifically, the language applied to anything that “promote[d] or encourage[d] homosexual sexual activities”). A decade later, in 1998, President Bill Clinton’s administration endorsed the idea of needle exchanges—though didn’t go so far as to propose a reversal of the federal funding ban. “Well, as long as your needle is clean, what’s a little heroin or cocaine among friends?” then-House Speaker Newt Gingrich responded, sarcastically. “Your government would like to give you a free needle but doesn't have the courage to do it.”
In December of 2009, President Barack Obama, backed by congressional Democrats, overturned the ban. And two years later, in 2011, House Republicans reinstated it.
Last week, Connecticut Gov. Dannel Malloy asked Congress to repeal its ban on federal funding for syringe exchanges. In his state, such exchanges have been legal since 1992. In 2002, 40 percent of Connecticut’s new HIV infections came from injection drug use, according to Malloy. More than a decade later, that share plummeted to 8.5 percent. “The prescription opioid and heroin epidemic ravaging our country and the recent outbreak of HIV and hepatitis in the Midwest underscore a federal policy that is failing our public health system,” he wrote.
Republicans in Congress are unlikely to address that health risk anytime soon.
“The politics of trying to prevent diseases and stigmatize groups are pretty rough,” says Don Des Jarlais, who President George H.W. Bush and Congress appointed to serve as commissioner on the U.S. National Commission on AIDS in 1989. Des Jarlais, now director of research at Beth Israel Medical Center and Rothschild Chemical Dependency Institute in New York City, was appointed to his post one year after the ban began. “It’s probably going to take more cases of HIV among rural Americans before we get the federal ban change.”
Now that the disease has arrived in red states, governors like Pence who blocked the programs nationally find themselves moving forward at home—or at least more open to the idea of letting local governments shoulder the responsibility.
Earlier this month, after already extending the needle exchange by another 30 days, Pence signed into law a measure that allows the state’s 92 counties leeway to create their own needle exchanges amid public health disasters. At the Community Outreach Center in Austin, citizens can procure a fresh supply of clean needles and various public services, such as HIV testing, immunizations, ID cards and access to mental health counseling.
“This measure will save lives and give public health officials the broadest range of options to confront this and other public health emergencies in the future,” Pence said of the law, which took effect immediately, in a statement. “Hoosiers may be assured that our administration will continue to work tirelessly to confront the crisis in Scott County in a compassionate and focused way until public health and public safety are restored.”
But it did. And it could happen in many more backwoods towns just as unprepared as Austin.
As the largest HIV/AIDS outbreak in Indiana’s history roils this Hoosier hamlet, it reflects the changing face of the epidemic in the U.S., as a disease that once primarily afflicted gays and minorities in deep-blue cities rises in rural red states. This new evolution of HIV is also forcing a new generation of Republican policymakers to confront its orthodox opposition to remedies such as government-funded needle-exchange programs.
Over the past decade, the virus cascaded from urban cities like San Francisco, New York and Washington, D.C., into poor, rural swaths of red states in middle America—opening a new front in the national fight against the spread of HIV. “It started in the coastal states among middle-class white gay men, and then the epidemic evolved into affecting more and more minorities in the South,” says Carlos del Rio, an AIDS researcher at Emory University in Atlanta. “Obviously, now the epidemic is changed. Now, what we're seeing is it impacting the rural communities.”
In this Indiana burg, the virus is not spreading among networks of gay men, but in rapid, cluster-like fashion within jobless white families who inject prescription painkillers with dirty needles.
“This is an HIV outbreak in a rural setting that is linked to an injection drug use,” says Jennifer Walthall, Indiana’s deputy state health commissioner. “That hasn’t been seen in the U.S. to date.” Since November, Walthall’s state health department has identified 163 cases of new HIV infections, including three preliminary positives. Eighty percent also tested positive for hepatitis C. “This was not on the radar,” Walthall says.
In April, Walthall’s office, along with the Centers for Disease Control and Prevention, issued a health advisory to public health departments nationwide—a preemptive salvo to stave off similar outbreaks among injection drug users. The missive targeted health departments in rural counties east of the Mississippi River, where opioid abuse and needle-borne infections are spiking, according to the CDC.
Scott County’s outbreak was so severe that Indiana Gov. Mike Pence, long an opponent of funding needle exchanges as a member of Congress, issued an executive order in March that gave local health officials authority to establish a “limited and focused” 30-day needle exchange. Last Thursday, Jerome Adams, Indiana State Health Commissioner, declared a public health emergency in Scott County through May 2016, extending the needle exchange in Austin for another year. In Kentucky, where new HIV and hepatitis C infections are also skyrocketing, state lawmakers approved in March a law that would allow health departments and local governments to launch their own needle exchanges.
Such moves by Republican governors and legislators would have once been considered GOP heresy. A federal ban on funding such exchanges has deep roots. In 1988, during a debate over passage of the appropriations bill for the Departments of Labor, Health and Human Services, and Education, North Carolina Republican Sen. Jesse Helms introduced a rider that effectively banned federal funding of needle exchanges (specifically, the language applied to anything that “promote[d] or encourage[d] homosexual sexual activities”). A decade later, in 1998, President Bill Clinton’s administration endorsed the idea of needle exchanges—though didn’t go so far as to propose a reversal of the federal funding ban. “Well, as long as your needle is clean, what’s a little heroin or cocaine among friends?” then-House Speaker Newt Gingrich responded, sarcastically. “Your government would like to give you a free needle but doesn't have the courage to do it.”
In December of 2009, President Barack Obama, backed by congressional Democrats, overturned the ban. And two years later, in 2011, House Republicans reinstated it.
Last week, Connecticut Gov. Dannel Malloy asked Congress to repeal its ban on federal funding for syringe exchanges. In his state, such exchanges have been legal since 1992. In 2002, 40 percent of Connecticut’s new HIV infections came from injection drug use, according to Malloy. More than a decade later, that share plummeted to 8.5 percent. “The prescription opioid and heroin epidemic ravaging our country and the recent outbreak of HIV and hepatitis in the Midwest underscore a federal policy that is failing our public health system,” he wrote.
Republicans in Congress are unlikely to address that health risk anytime soon.
“The politics of trying to prevent diseases and stigmatize groups are pretty rough,” says Don Des Jarlais, who President George H.W. Bush and Congress appointed to serve as commissioner on the U.S. National Commission on AIDS in 1989. Des Jarlais, now director of research at Beth Israel Medical Center and Rothschild Chemical Dependency Institute in New York City, was appointed to his post one year after the ban began. “It’s probably going to take more cases of HIV among rural Americans before we get the federal ban change.”
Now that the disease has arrived in red states, governors like Pence who blocked the programs nationally find themselves moving forward at home—or at least more open to the idea of letting local governments shoulder the responsibility.
Earlier this month, after already extending the needle exchange by another 30 days, Pence signed into law a measure that allows the state’s 92 counties leeway to create their own needle exchanges amid public health disasters. At the Community Outreach Center in Austin, citizens can procure a fresh supply of clean needles and various public services, such as HIV testing, immunizations, ID cards and access to mental health counseling.
“This measure will save lives and give public health officials the broadest range of options to confront this and other public health emergencies in the future,” Pence said of the law, which took effect immediately, in a statement. “Hoosiers may be assured that our administration will continue to work tirelessly to confront the crisis in Scott County in a compassionate and focused way until public health and public safety are restored.”
Nice work, Republicans
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