SCOTTSBURG, Ind. — On the same day the nation acknowledged National Youth HIV/AIDS Awareness Day, officials with the Indiana Joint Information Center announced Friday that the number of confirmed HIV cases in Scott County, Indiana now stands at 106, up from 81 on March 27.

The increase in confirmed cases came as no surprise to Dr. Kevin Burke, health officer with the Clark County Health Department, which initially detected the Scott County HIV outbreak. 

More cases are likely to be detected, but the question is, how many?

“My gut feeling is that it’s close to its peak, but that remains to be seen,” Burke said. 

Officials with the health departments in Scott and Clark counties are still working with representatives from the federal Centers for Disease Control and Prevention to track down and test known associates of the previously detected positive results. Most of the people in the highest risk category have already been tested, Burke said. 

“Now we have to concentrate on the sort of medium-risk and low-risk individuals,” Burke said. “Even though some of those will be positives, the percentage of positive results is going to be much lower than what we found initially. 

“When we were at 75 positives, basically, we were finding that 80 percent of everybody we tested ... turned out to be positive, but again, those are the highest-risk individuals that we focused on first.” 

The virus is believed to have been transmitted through needles shared among intravenous drug users. Gov. Mike Pence issued an executive order March 25 that declared a public health emergency and authorized the Scott County Health Department to create a needle-exchange program. That program has been implemented, but it’s off to a slow start, said Scott County Public Health Nurse Brittany Combs. 

“I think fear is one of the biggest barriers that we’re fighting,” Combs said. “People have started rumors in the community that we have cops there waiting for them, or we have cameras and we’re going to video them or we’re going to get their information in order to track them after the needle exchange is done — none of which are true.

“It’s just getting the correct information out there, and we’ve really been pushing the people that have been coming to the exchange program to spread the word that this was super-easy for them to do, and that we don’t have cops and we’re not trying to hurt people. We’re there to help them.” 

So far, 19 individuals have taken advantage of the needle-exchange program, and 820 needles have been distributed, Combs said. The number of needles given to a person is dependent upon the number of times that person injects intravenous drugs per day, and Combs is hopeful that more people will utilize the program as the health department builds trust in the community. 

One way Scott County plans to do that is through outreach. They hope to get a mobile unit in operation soon that will likely include needle-exchange services. The exact scope of services the mobile unit will provide is still in discussion, Combs said. 

Other services available in Scott County through a “one-stop shop,” including mental health and addiction services, Healthy Indiana Plan 2.0 enrollment, HIV testing and vital records replacements have been more popular, and the availability of services has been a plus, Combs said. 

“We’ve had several people that came in that talked to the LifeSpring [Health Systems] mental health experts about substance abuse,” Combs said. “... There are people that are actively trying to stop the IV drug use.” 

Pence’s executive order authorizing the needle-exchange program is set to expire April 24. Burke called for Pence to renew the order. 

“It needs to be 90 days at least,” Burke said. “Some of these people have a long, slow transition from IV drug use to drug rehab [and] drug addiction therapy.” 

HIV cases directly related to the IV drug use in Scott County have not yet been reported in Clark or Floyd counties, said Clark County Health Department Administrator Mike Meyer.

While Burke is calling for the needle-exchange program to be extended by three months at minimum, what he’d rather see is the state allow communities to implement needle exchanges where they’re needed for as long as they’re needed. 

A bill authored by Rep. Ed Clere, R-New Albany, would do just that in the 23 counties most at risk of outbreaks of bloodborne diseases spread by intravenous drug use. The bill passed through the House this week by a narrow 52-39 vote, and is now on its way to conference.

“We can’t afford to wait for the next crisis and continue to be reactive,” Clere said. “We need to put policies in place that will allow us to get in front of the next potential crisis and keep it becoming from a crisis.” 

But earlier this week, representatives of Pence’s administration told Clere that Pence intends to veto the bill if it allows needle-exchange programs. 

“I think that’s a mistake, because there have been extensive studies previously that show you do decrease infection risk [and] disease risk in patients who are in the program,” Burke said. “You actually increase the probability that they will enter drug rehab because the needle-exchange process gives you the opportunity to give them literature, give them information, encourage them to seek help with their addiction. So that interaction is more than just, ‘Give me your dirty needles and here’s clean ones.’” 

Clere said that Pence’s administration has communicated to him that they have “policy concerns,” but have not yet elaborated on what those policy concerns are. 

“If it’s a good strategy for Scott County, then why not allow it in other areas to help keep them from becoming the next Scott County?” Clere asked. 

Koesters writes for the News and Tribune