The epidemic's true epicenter is the town of Austin, in northwestern Scott County, said Dr. William Cooke, medical director at Foundations Family Medicine. He opened the facility in Austin about 10 years and, since then, he's watched opiate abuse take a far deeper hold.
Used needles litter roadsides, ditches and yards, said Cooke, who has been publicly voicing his concerns about a brewing HIV outbreak. On Wednesday, Cooke also lobbied Indiana lawmakers to launch a clean-needle program — a strategy that, in his vision, would offer safe fresh needles and safe places to dispose of dirty needles while also connecting participating residents to addiction therapists.
Austin's population is about 4,200 people, according to the U.S. Census Bureau, and the majority of the nearly 80 known HIV cases are people who live in that town, Cooke said. Poverty is driving the mass opiate-addiction rate — and, now, the HIV epidemic, Cooke said. “We need help. But that costs money. My clinic serves the poorest people in Indiana, potentially the poorest in the country," Cooke said. "We do a sliding scale here. If they can, they may pay us 10 dollars for care. I'm hopeful this declaration provides the funding we have needed.”
CMDA Member and Assistant Professor at Indiana Wesleyan University Reginald Finger, MD, MPH: “The HIV infection outbreak in Scott County, Indiana, straddling I-65 between Indianapolis and Louisville, occurred because at least three unfortunate factors came together at once. Lying astride a heavily traveled north-to-south transportation corridor in the Eastern U.S., it unfortunately acts as a pipeline for illegal drugs. The county struggles with poverty and poor health, ranking last among Indiana counties for health indices by the Robert Wood Johnson Foundation. Many communities nationally, however, are just as much at risk. Any one of them has enough people injecting illegal drugs with shared needles to fuel a lethal epidemic if the right virus were introduced, as it was to Scott County. Even in this age of anti-retroviral medications, HIV still makes a mess of human lives, while piling up millions of dollars in healthcare costs onto a community already struggling to make ends meet.
“What is the lesson for healthcare professionals in similar communities across the country? First: one needs a high index of suspicion not only for HIV infection itself but for any of the associated risk factors and conditions. Hepatitis C infection is often seen first. Not every injecting drug user fits a ‘stereotypical’ profile. I have decided never to be offended when a doctor, pastor or counselor asks me a blunt question about lifestyle choices, even ones that may be far from my experience. My response is ‘No, sir, but thank you for asking.’ By the question, I know that this professional is on the ball, interested not only in whatever may affect my health—as important as that is—but on protecting my community as well. Next, be well connected to social, legal and spiritual resources in your community. You may be the only human services professional that your patient has seen in a long time, especially if the person has low regard for ‘the system’ and came to you only because their need is acute. “Finally, each clinician must remember that better health for our nation depends on community and environmental factors, yes, but also on individual decisions and interventions that can only occur one patient or family at a time. The person whose life you touched in the office today may be the index case of the epidemic that did not happen—because you were there!”
Professionalism in Peril – Part 5: Our Obligation to the Poor
Healthcare for the Poor