The New York Times ran an article 5/5/15 about a small town in rural Indiana that is facing a relative epidemic of new cases of HIV.
Austin, Indiana, a town of only 4200, has more than 140 people just diagnosed with HIV. The town is struggling to understand what to do about this epidemic, since the area has had a low HIV rate in the past.
The new cases of HIV were intravenous opioid addicts, and Opana was specifically mentioned by the opioid addicts in the article.
As in many small towns, needle exchange has been met with resistance from citizens who feel giving free needles to addicts only serves to encourage them to use more drugs.
Fortunately, the Indiana governor has authorized a needle exchange program for the area where addicts were sometimes using the same needle as many as three hundred times. Unfortunately, the needle exchange is not being run according to best practices. People must sign up for the service. Obviously, many opioid addicts who could benefit from free new needles are hesitant to register with anyone, due to the shame and stigma associated with addiction in this country.
To add to the difficulty, local police still arrest any addict found with needles, unless they are enrolled with the needle exchange. In other words, if one addict signs up for needle exchange and distributes these new needles to other drug users, those users could still get arrested if the police find their needles. Police say they are doing this to force addicts to register with the needle exchange.
We already know, from decades of studies, that actions like these by the police erode trust in the whole needle exchange program. Studies show needle exchange works best when people aren’t asked to register, and are allowed to procure free needles for other people who won’t come to a needle exchange. These type programs are very effective at halting the spread of HIV
The article only tangentially mentions treatment; it says some intravenous drug users have gone to a residential treatment center about 30 miles away, and others remain on a waiting list.
Sadly, no mention is made of medication-assisted treatment of opioid addiction with buprenorphine and methadone.
I did my own research: residents of Austin can drive to an opioid addiction treatment center less than a half hour away, in Charlestown, Indiana Also, there are at least two OTPs in Louisville,, only a few minutes farther, in Kentucky.
I hope someone is telling all the opioid addicts about this option. We know that after an opioid-addicted person enters medication-assisted treatment, the risk of contracting HIV drops at least three-fold. Thankfully HIV can now be treated, and is more like a chronic disease than the death sentence it was twenty-five years ago, but wouldn’t it be better to prevent HIV in the first place?
I fear Austin, Indiana is a harbinger of things to come in other small towns in our nation. Let’s stop with the politics, and get patients into medication-assisted treatment. Let’s do unrestricted needle exchange, and let’s hand out naloxone kits!
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