HIV outbreak only part of health crisis

INDIANAPOLIS — Weeks after sounding an early alarm on the HIV outbreak in his community, Dr. Shane Avery, a Scott County physician, was relieved to see Gov. Mike Pence finally act to contain the virus.

Avery applauded Pence’s decision to temporarily set aside his personal objections to programs that give clean needles to intravenous drug users. Pence’s authorization March 26 of a temporary needle exchange for Scott County was part of package of efforts that include directing more public resources to a community in crisis.

But before Avery went to bed that night, he emailed a passionate argument for why such programs shouldn’t be confined to Scott County. Among the recipients of his message were top doctors at the Indiana State Department of Health.

The thrust of his case: As bad as it is, the HIV outbreak in southeastern Indiana may be masking the deadlier problem of hepatitis C, a virus also transmitted through blood and contaminated needles.

The liver-attacking disease kills more people annually than AIDS because it so often goes undetected and untreated.

A full course of treatment for a single patient exceeds $100,000.

Four years ago, the U.S. Centers for Disease Control and Prevention noted an alarming spike of hepatitis C cases in five rural counties in southeastern Indiana — Wayne, Fayette, Dearborn, Henry and Decatur.

The overwhelming number involved people in their 20s who were intravenous drug users.

In the previous four years, the CDC saw a 500 percent increase of hepatitis C in those counties. It identified the spread of the virus as an “emerging epidemic” and advised the state to employ a needle exchange to quell it.

Yet, no such program has been put into place. Indiana forbids needle exchanges with a law that makes it a felony to possess a hypodermic needle with the intent to inject an illegal drug.

In the meantime, the CDC continues to track the rise of hepatitis among young IV drug users. Last year it reported the highest number of cases in Indiana, Kentucky, Tennessee, Georgia and Florida.

“So, in the midst of what the (state) describes as the largest outbreak of HIV in state history, the CDC has reported that Indiana has one of the fastest growing numbers of individuals infected with hepatitis C,” wrote Avery, “and it is occurring in a rural, young, white population that shares dirty needles in a state that makes it illegal to possess a clean syringe without a doctor’s prescription …”

Avery confessed that he and health officials embraced the “war on prescription drugs” aimed at curbing the illegal injection of opiate-based painkillers.

He was glad to see a crackdown on loose rules governing prescription painkillers, he said, as well as the closing of so-called “pill mills” run by doctors handing out scrips too freely.

His Scott County community, after all, had the highest incidence of prescription drug abuse in the state — including an disproportionate number of overdose deaths.

But, Avery said, the next piece never came — resources for treatment or medically guided prevention and education programs.

Now, he argues, “Rural Indiana, Scott County included, lacks the ability to serve the needs of the hundreds of thousands of people who need help.”

For Scott County, that started to change last week with Pence’s declaration of an emergency order, which overrides for Scott County the law prohibiting needle exchanges, as HIV cases rose toward 80 and beyond.

For a county where the state didn’t even have an HIV testing center until last week, that was a big move forward.

But Avery worries that it still falls short of recognizing that any rural county in Indiana could be the next Scott County.

“I don’t wish to be alarmist,” he wrote. “But this is our new normal.”

Maureen Hayden is statehouse bureau chief for CNHI newspapers. Send comments to