Tuesday, May 5, 2015

Rural drug abuse in Indiana makes it onto the NYT front page

Abby Goodnough reported a few days ago in the New York Times under the headline, "Rural Indiana Struggles to Contend with H.I.V. Outbreak."  The dateline is Austin, Indiana, population 4,295, where more than 140 residents have tested positive for H.I.V. in this "largely rural region just north of the Kentucky border."  Austin is in Scott County, which is 98% white and has a poverty rate of 19%, just short of the "high poverty" designation.

One of the women who has tested positive hasn't yet started treatment because she does not want to be seen entering the clinic on Main Street.  She comments:
I thought it was just a homosexual disease. I didn’t ever think it would be in my small hometown.
Goodnough explains that this crisis "would test even a large metropolis" and Austin is especially ill-equipped to handle it, even with help from the Center for Disease Control and Prevention, along with non profit groups and the state.

In fact, it seems that the state may be part of the problem:  
Gov. Mike Pence reluctantly authorized a needle exchange program last month, but local officials are not running it according to best practices, outside experts say. Austin residents still must wait for addiction treatment, even though they have been given priority. And getting those who are H.I.V.-positive on medication, and making sure they adhere to the protocol, has been difficult. 
Officials here say the need for education is urgent and deep; even local health workers are learning as they go. 
Specifically, the local officials have become aware of local discomfort at visiting a needle distribution center, so they are taking needles directly to users in a van.  One local public health nurse commented:
If you would have asked me last year if I was for a needle exchange program, I would have said you’re nuts.  I thought, just like a lot of people do, that it’s enabling — that you’re just giving needles out and assisting them in their drug habit. But then I did the research on it, and there’s 28 years of research to prove that it actually works.
Austin lies not far from the I-65 corridor, which has led to an educational campaign "encouraging truck drivers and travelers along I-65 between Indianapolis and Louisville to avoid prostitutes, use condoms and limit their sex partners."

An earlier story about the southern Indiana crisis, this one on NBC, is here.  Other New York Times coverage is here, here, here, here, and here.

One of those stories included this quote from Austin's police chief regarding the crisis and it's broader impact on the community:
It's done a lot. It's probably hurt our economy. It's hurt the people, maybe kept away some people who come here and spend money. There's a lot of negatives that can come with something like this.
And this quote—very depressing indeed, especially if it is correct in associating this epidemic with rural America--is from Jennifer Walthall, the Indiana Deputy Health Commissioner:
There's nothing that makes Scott County different than any other rural county in America. It just happens to be the first that brought our attention to this constellation of events. There is an opiate epidemic across the United States.

1 comment:

Dakota Sinclair said...

It's striking that the first comment I see is that the one person thought HIV is a homosexual disease. It's a moment of complete and utter ignorance coupled with tragic life consequences.

It is interesting that the local community is trying to move the needles around in a van. I would think that there would be a reluctance by opiate users to give the government your address for the purely logical reason of one day it's the needle exchange van, the next day it's the police van. But I would imagine that the state, in its reluctant agreement to participate in a needle exchange, has some form of immunity from police reprisals.

It seems tragic that an epidemic that, as stated in the original post, would challenge a major metropolis, would occur in rural Indiana. The combination of poor education, poverty, and isolation forms the ultimate breeding ground for disease. Imagine how many would have been able to avoid contracting the disease had they been better educated or had neighbors who were educated and could tell them the dangers/risks of their actions.

It appears that a needle exchange, and providing advice on sexual activities, is a basic start to a greater problem throughout the country. Perhaps including materials on the dangers of drug use with the needles would help some addicts try to ease back on their usage?