CDC: Indiana has 'one of the worst' HIV outbreaks

Shari Rudavsky | The Indianapolis Star

INDIANAPOLIS — A team of high-ranking federal officials will visit Indiana on Tuesday to get a firsthand look at the response to an HIV outbreak of more than 140 cases, one of the largest in recent years, in the hope of learning ways to prevent similar occurrences.

"This is one of the worst documented outbreaks of HIV among IV users in the past two decades," said Dr. Jonathan Mermin, director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention at the Centers for Disease Control and Prevention in Atlanta. "It's of import to the CDC as well as the people of Indiana."

The Scott County outbreak, which was first noted in December, has yet to be controlled. Officials from the CDC and health departments from three other states have been assisting Indiana State Department of Health workers in responding to the HIV spread.

With no end date in sight, CDC officials will remain in Indiana, participating in the ongoing effort to track people who could have contracted HIV, either through sharing needles or having sexual contact with those already known to be infected.

"This is still an active investigation," Mermin said. "We are here as long as we are needed."

Nor is it clear how large the outbreak could be once the investigation has concluded.

The State Department of Health has alerted health care providers in other parts of Indiana to be aware of the outbreak and to do HIV testing of their patients who use intravenous drugs.

"We're under no illusion that there's a magic line around Scott County that's going to prevent the spread," said Dr. Jerome Adams, Indiana State Health commissioner.

In this instance, the outbreak came to light because of an "astute" public health nurse who noted 11 recently diagnosed HIV cases, far from the area's norm of fewer than five a year. As the number of cases soared far beyond the normal rate, health officials declared it an epidemic.

Drug use, often of the prescription painkiller Opana, is a "multigenerational activity, with as many as three generations of a family and multiple community members injecting together," state health officials wrote in an article published Friday in the CDC's Morbidity and Mortality Weekly Report. Some pregnant women have been infected, and nearly 85% of those who tested positive for HIV were positive for hepatitis C as well.

Having HIV spread through a community like this is not an everyday occurrence. Since the peak of the HIV/AIDS epidemic in the late 1980s, health officials have seen almost a 90% decrease in the number of new infections among people who use drugs.

"It's the population among which we have had the most success in HIV prevention in the United States," Mermin said.

But drug users in urban areas may be more aware of the risks associated with needle sharing and other practices that can lead to infection, Adams said. In addition, they also might know that HIV these days is not necessarily a death sentence but can be controlled with medications.

Communicating these messages to the people of Scott County has been a key part of the response to the HIV outbreak, along with providing immunizations, substance abuse and job counseling and other services to area residents. Local officials also instituted a temporary needle exchange program, made legal by Indiana Gov. Mike Pence's public health emergency order.

Now, state health officials will look to see whether they need additional resources in other areas at risk of an HIV outbreak. They will look to Scott County to see what worked and what did not. And they will take into account local needs and resources already in place, Adams said.

"It's not one size fits all," he said.

The frustrating thing with implementing such programs, Mermin said, is that failures often garner more attention than successes.

"The paradox to public health is if you do a very good job, no one knows it was done," Mermin said.