HIV OUTBREAK: In tiny Austin, needle exchange is controversial


By Andi TenBarge

Until the news of the HIV outbreak in Scott County broke, the area's drug problem was "a hush, hush thing."

That's what Tammy Breeding says.

Breeding, a single mother of three, lives in the heart of Austin, a Scott County town of just 4,200 people that is ground zero for the outbreak. She said at about noon each day, intravenous drug users emerge in her neighborhood and start scouting out their next hit of Opana, a painkiller and the common drug abused in the area.

"You've got one who is walking up and down the road to this house or that house – because the busier the traffic at the house you know something's going on," Breeding said. "It's just not safe."

But the problem, she said, has grown worse since Gov. Mike Pence issued an executive order to make clean needle exchanges legal in Scott County for 30 days, an effort to stem the spread of HIV. And she and her neighbors are exasperated. She says the addicts don't want help.

"Go get a job. Get a life because there is hope for those people if they find it and they're not wanting to find it," Breeding said. "They're wanting to get that next high on whatever they can get ahold of and it's really frustrating."

Pence has concerns about needle exchange as well.

But the Centers for Disease Control & Prevention recommended the program to help battle the virus, which has spread to more than 140 people, nearly all through intravenous drug use. Typically, Scott County would see just five or fewer new HIV cases each year. That's why state officials have labeled the outbreak an "epidemic."

And it's one that has affected the entire Austin community – even all of Scott County. Kids are talking about it in schools. Parents and teachers are facing tough questions about drugs and disease. Rumors are flying.

"It's inescapable," said Tammy Davis, who teaches Spanish and provides emergency medical training at Scottsburg High School.

The needle exchange program

A one-stop shop in Austin is the home base for the needle exchange program. IV drug users who are enrolled in the program can bring their dirty needles and exchange them for clean needles. Health officials hope this will help stop the HIV virus from spreading.

Brittany Combs, the Scott County public health nurse, said the program is designed so IV users can obtain a week's worth of clean needles at a time.

"We've set it up weekly so they have to come back every week to get clean needles for the week," Combs said.

Initially, health officials underestimated how many clean needles they would need for the program. They asked users how many times a day they inject, which determines how many needles they receive.

"It was shocking to me that some of these people shoot up 10 to 15 times a day," Combs said. "We had no clue."


The program matters, she said, because the CDC reports that 90 percent of the confirmed cases of HIV have come from the area's IV drug users, who are sharing needles. And the epidemic is growing and moving into neighboring counties. Already, five cases have been confirmed in Jackson County and health officials believe the virus will spread to more neighboring counties.

"Scott County is not an island," said Dr. Shane Avery, a physician at the Scottsburg Family Healthcare. "It is surrounded by land on four sides and has an interstate down the middle."

On the street

North Church Street in Austin is the epicenter of the crisis. It's where the majority of drug traffic and prostitution can be found in this small community. Breeding, who lives at the road's intersection with Broadway Street, displays a homemade sign in her front yard saying, "No loitering and prostitution on or around these premises. Violators will be prosecuted."

Breeding isn't afraid to run people off her lawn that she suspects are dealing drugs or engaging in prostitution.

"I'm not scared," Breeding said, patting a gun holstered at her hip. "I'm not going anywhere. If you don't like it, take your drugs elsewhere."

She said before the state established the needle exchange, drug abusers were not as obvious about their usage and whether or not they were carrying the drugs and paraphernalia. Now, she said, dealers and prostitutes have gone as far as approaching her children with drugs.

The needle exchange essentially sanctions illegal drug use, she said. "'Of course, here's a free needle. Go do drugs,' that's all it's saying."

Breeding said she understands the need to keep the virus from spreading, but she thinks other routes need to be taken to battle the epidemic.

"Yeah, I know they've got an epidemic, but you know what they made a choice to stick that needle in their arm," she said. "They need to make a choice to get better."

Drug problem is not new

Health officials said Scott County has seen a growing drug problem for years.

Once doctors started noticing a rise in prescription pain killer addictions, physicians put policies in place to help curb addiction rates. Now, doctors don't prescribe Opana in Scott County unless it is "absolutely necessary."

"If you come into the ER, they don't give you a prescription for pain medicine, they give enough for 3 or 4 days until you can get to your primary care physician instead of giving you a whole script," Combs said.

Because doctors in the county do not prescribe the drug, those who are addicted have to find it on the streets.

"Since we are on the I-65 corridor, it can come from anywhere," Combs said. Users "have told me that (the drug trade) runs all the way from Canada to all the way to Florida."

Combs said Opana is highly addictive – to the point that it consumes the users' lives and finances.

"All they think about is when they're going to get that next hit," Combs said. "One 40 gram pill of Opana can go for upwards of $160."

Experts say the county drug problem can be linked to socioeconomic factors. Scott County is one of the state's poorest. Residents earn an average of just $30,000, compared with a state average of $38,600.

About 17 percent of residents live in poverty, ranking the county 21st out of 92.


And its unemployment rate is also higher than the state's rate. About 6.8 percent of its residents were unemployed last month, nearly 1 percentage point higher than in the rest of Indiana.

"Some major factories left and you know the economics in the whole country have been bad for years," Combs said. When drug abuse takes hold, "it just grows and it's circular. So kids see how their parents live and we're trying to stop that cycle."

The community impact

Five miles down the road from Austin is Scottsburg High School, where some students are anxious.

Mark Slaton, superintendent of Scott County School District 2, said he and his colleagues felt it was their responsibility given the outbreak to educate students about needle safety and how the virus is transmitted.

"I want them to have facts first and foremost," Slaton said.

Students at Scottsburg High School filled the cafeteria just days after the confirmed count of HIV cases broke 100 to listen to a presentation by the Indiana Social Health Association. As the presentation began, soft giggles and whispers flooded the cafeteria.

Awkwardness could be felt among the crowd as the spokes person from the Social Health Association began to speak. Students learned about how the disease is transmitted from person to person and what steps to take to stop it from spreading.

A few anxious students and parents raised questions about the program in advance, given the topic's sensitive nature. Slaton said most of the anxiety could be linked to a lack of knowledge about HIV in the area.

But originally, the program was to include students in grades 5 through 12 at both Scottsburg high and middle schools. Community pressure prompted the district to cancel the 5th grade presentation.

"We have a very conservative community even though we have a very liberal problem," Slaton said. "A lot of our folks couldn't come to grips with the fact that we were going to be talking about certain subjects with 10 and 11 year olds."

Slaton and his administration felt the issue could be addressed at a better time in the spring when the 5th graders have lessons about puberty.

Teachers at Scottsburg High School also saw the presentation as an opportunity to clear up misconceptions about how the virus is transmitted from person to person.

Davis, the emergency medical teacher, said when the news broke, her students had a mixture of emotions. Some were complacent about the outbreak because they figured it was miles down the road in Austin, while others were concerned about how the rest of the world would look at Scott County.

"There are so many good things in our county that could be advertised, and with this being what is advertised, it's a lot of shock and disappointment," said senior Brandon Boswell.

And not only is embarrassment swirling around the student body – but also fear. Teachers and students said they've heard multiple "outrageous" rumors passed along via social media.

"We've had rumors that there are people sneaking into Walmart and the grocery stores and injecting blood into food and that they're putting needles under the gas pump handles," Davis said. "There's so much that they need to know and I think that this is going to address that really well in mass."

Some of the questions – including "Can I sit on a toilet seat?" or "Can I go the same restaurant as someone with HIV?" – harkened to a time when HIV was a new disease and fear came from ignorance about the illness.

"I think there were a lot of things people knew going into it, but then there's a lot that we were able to learn," Boswell said. "Hopefully everyone feels safer about the decisions being made."

But Davis has another fear related to the virus. She described Scott County as a small county with approximately 24,000 people. She is afraid students have become bombarded with the drug abuse and HIV news because it's in the media constantly and has become the main topic of conversation within the community.

"It's going to become so saturated for these kids that they end up tuning it out," Davis said. "You don't want that to happen, but at the same time you realize they can only take so much."

"Good things are happening too."


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