HIV crisis in Austin, Ind., is a sign 'we failed,' its lone doctor says

It's been 17 days since "D" shot up. The 45-year-old drug addict is sitting on the front porch of her home in Austin, Indiana. She rocks back and forth as she watches her two young granddaughters, blonde and laughing, play in front of homes with boarded-up windows and garbage-strewn yards.

Seventeen days ago, D found out she was HIV positive. We aren't using her name to protect her privacy.

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"It's been very stressful, scary, devastating for me and my children and my grandkids all," she said.

"When I wake up in the morning, it's not about the addiction anymore. It's like survival mode. It's about the HIV. It's about staying healthy and living long enough to see them be raised safely, happy."

Since December, 150 people in and near Scott County, Indiana, have tested positive for HIV, most of them in 4,200-person Austin. Health experts blame dirty needles shared among IV drug users.

Drugs have long been a problem here. But things got especially bad when the prescription painkiller Opana, an opioid, became widely available a few years ago. Addicts crush the pills, boil away the coating in water, then inject themselves.

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Indiana Gov. Mike Pence declared a public health emergency on March 16. This allowed the county to do something controversial: set up a needle exchange. It has since been extended another 30 days, expiring May 24. Many states don't allow addicts to swap dirty needles for clean ones, because of laws making it illegal to possess drug paraphernalia.

At the same outreach centre where they can exchange needles, addicts get information about health insurance and treatment. Nurses go door to door administering HIV tests on the spot. With the help of officials from the Centers for Disease Control, the only clinic in Austin is offering HIV treatment.

Countrywide alert

William Cooke is Austin's lone doctor. After years of calling for help to deal with the drug problem in the community, he's grateful for the extra resources.

"If there is a silver lining to the HIV crisis," he says, "it's that it's brought attention to the underlying problems of addiction, lack of economic development and opportunity for people."

"I worry about the surrounding people across North America that are living similar lives as here. Are we doing enough? My guess is we're not, and we are failing those communities just as we failed Austin."

Concern that what's happening in Indiana could happen elsewhere in the U.S. is shared by the Centres for Disease Control. Last month, the federal public health authority put out a countrywide alert. It urged health departments to track HIV and hepatitis C cases in order to detect any similar outbreaks.

At a weekly news conference to provide an update on the health crisis, Indiana's state health commissioner described what's happening in Scott County as the canary in the coal mine.

"We know the factors that predispose this community to this outbreak exist throughout Indiana and throughout the country," he said. "And quite frankly, I don't expect this will be the last time we see an outbreak like this."

Succour through prayer

Austin is an incredibly religious community. There are about 35 churches here, or roughly one for every 120 people.

Since the outbreak, the Christian community has come together to try to help addicts. Every Monday night, more than 100 people hold hands and walk through the worst affected neighbourhoods. A woman wheels a cart with a large speaker playing Christian music. The group approaches glassy-eyed addicts. They all hold hands and pray together.

Linda Thomas pushes her young son in a stroller with the group. She used to be on the other side: an addict for most of her teenage years. She got clean after getting pregnant, going to jail and meeting her husband, Jeremy, who is also a recovering addict.

"I love the prayer walk," she said. "It's amazing what they're doing. Being together because they cannot do it themselves. They can't. I couldn't do it, and that's why God gave me Jeremy."

The prayer walk happens not far from where D lives. After 20 years of drug use, she says staying off the needle since her HIV diagnosis hasn't been as hard as she expected.

"It took HIV to change my life for the better," she said.

And she says, in some ways, it's been good for the community, too. Some, like her, are trying to keep clean. There are fewer prostitutes on the street. She feels safe letting her granddaughters play outside.

"I've probably only got 10 or 15 years anyway. Why not make it my best 10 or 15 years."