Crisis in Austin, Indiana

If It Can Happen Here, ...

If a town could be said to hit rock bottom, Austin, Indiana, did so in 2015. Drug abuse has been out of hand there for some time, but it took the worst possible outcome to make the Southern Indiana community of 4,200 wake up to the problem: in just a few months more than 150 newly identified cases of HIV since December 2014, spread almost entirely by needle-sharing. News coverage, from The New York Times to the BBC, called it “one of the most alarming HIV outbreaks in America in recent history.” Indiana Governor Mike Pence declared a public health emergency, and state and federal officials led a response effort to control the epidemic.

One might think of an HIV epidemic in large cities or in under-developed areas around the world. But Austin is like many other rural communities in America. A few downtown businesses line Main Street, while farmland and forest stretch out in all directions. Austin appears to have had much better, but still modest times. Unemployment is 3.5 percent higher than the national average and the annual per capita income is $16,000. The median age is 35. How many other towns across the US may be facing the same risk?

An Alarming HIV Epidemic

1,422% - That's the increase in new HIV / AIDS cases in Austin. Where historically there have been less than 5 cases reported annually, the Indiana State Department of Health (ISDH) found 11 in three months. That number grew to 135 in the next three and 157 for 2015.

Source: CDC Health Advisory - Outbreak of Recent HIV and HCV Infections among Persons Who Inject Drugs

Opana and Needle-Sharing Accelerate Epidemic

Among 112 persons interviewed by the Centers for Disease Control and Prevention (CDC), 108 (96%) injected drugs. And 100% of these cases reported dissolving and injecting tablets of the prescription-type opioid oxymorphone (OPANA® ER) using shared drug preparation and injection equipment.

In Austin, it is thought that the number of injections per day can be as many as 15 per person. The CDC investigated the outbreak and found up to six “injection partners” were present at a single “injection event.” Among those confirmed HIV positive, an average of nine high-risk contacts per person were reported. In some families, three generations have been found sharing syringes and injection preparation materials.

Austin's Large Share of Statewide HIV Issue

It is remarkable to note the disproportionate share Austin represents of Indiana's statewide issue. This small town of 4,200 people reflecting less than one-tenth of one percent of the state's population contains 25% of the entire state's new cases of HIV / AIDS.

Source: IN.gov - Spotlight on HIV/STD/Viral Hepatitis, 2015 Indiana Annual Report, February 8, 2016

It's Everyone's Problem

Austin has an epidemic. Indiana has as trend it cannot ignore, as seen here, nor is it. But it doesn't stop there. Deputy Commissioner Dr. Walthall said, “There’s nothing that makes Scott County different than any other rural county in America... There is an opiate epidemic across the United States. The sharing of needles for injected drug use is not limited to Austin. It’s Indiana’s problem. It’s the United States’ problem.”

What's Being Done

Governor Declares Public Health Emergency

Indiana Allows Needle Exchange Program

Aside from declaring a public health emergency bringing much needed state and federal support, Governor Mike Pence issued an executive order to begin a needle exchange program in Scott County. Additional services to combat the epidemic included:

A One Stop Shop offering sterile syringes, HIV testing, condoms, hepatitis immunizations, harm reduction and addiction education, and help securing identification in order to apply for healthcare and other benefits
Medication for reducing the HIV viral load
Mobile outreach
Referrals to addiction treatment facilities
Transportation assistance to services
Additional staff for direct care, state-level interventions and oversight
Outpatient addiction counseling
Public awareness campaigns

The Crossroads of America

As its welcome signs suggest, Indiana identifies itself as the Crossroads of America. Interstate 65 is busy with U.S. travel, commerce and for decades now, drug trafficking. It connects many other similar corridors that criss-cross America.

The tragedy in Austin has many stories and lessons for all of us. Chief among them seems to be that if it can happen in Austin, a rural town not dissimilar to countless others in the U.S., it can happen anywhere. It has also become apparent that we can mobilize prevention, containment and treatment swiftly.

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