STEVE INSKEEP, HOST:
Let's visit a town managing an outbreak of HIV. It's in rural Indiana. Now, traveling in rural parts of my home state can feel like pleasantly going back in time. You still see old buildings of wood or rough cut stone. Here and there you spy a brick Victorian house beside a cornfield. But there's one way that Indiana would very much not like to go back in time. The state does not want to relive the worst moments of the AIDS epidemic. Here's Barbara Harrington of member station WFIU.
BARBARA HARRINGTON, BYLINE: There's a lot of traffic in Austin, Ind., considering it's a town of only 5,000 people. Longtime resident Clyde Polly is sitting in his front yard watching the cars go by. He says some of the people driving them are on a mission.
CLYDE POLLY: It's a town where there's always a lot of drug activity, unfortunately. A lot of people have problems. A lot of people struggle to make ends meet.
HARRINGTON: For a long time, Polly's son Kevin had an addiction problem. He's now in rehab because he got hooked on the prescription painkiller Opana. When taken orally, the pills provide pain relie, but when addicts grind them up and inject them, they say Opana can provide an almost instant feeling of euphoria.
POLLY: They do it three and four and five times a day, you know? They can't do it just one time a day.
HARRINGTON: A few weeks ago, Polly's son learned he has HIV. His case is now one of more than 140 in southeastern Indiana. The outbreak has brought so much unwelcome attention to this small town that officials here only answer questions during a weekly news conference. Austin's police chief, Donald Spicer, says opioid drug abuse has long been a problem in the community, and his department is overwhelmed.
DONALD SPICER: According to federal statistics, we have about half the personnel we should have, and, of course, that makes our job twice as hard.
HARRINGTON: Jonathan Mermin heads the CDC's Center for HIV/AIDS Prevention. He says this outbreak is unusual because it's primarily being spread through the sharing of dirty needles.
JONATHAN MERMIN: This is the first outbreak of HIV among injection drug users injecting an oral opioid in a rural community in recent years.
HARRINGTON: In March, Governor Mike Pence declared a public health emergency in Scott County, allowing for a temporary exchange where addicts can get enough clean needles for a week and then exchange them for new ones. Legislators considered a bill to expand the exchange statewide, mirroring some that exist in Indiana's neighboring states, but only a watered-down version passed. If you drive just three miles northwest of Austin, you'll cross into Jackson County. Five HIV cases were recently confirmed here. Jackson County public health coordinator Lin Montgomery says right now she can't even test people for HIV.
LIN MONTGOMERY: It costs a lot of money to set up a clinic and provide services to that population. Getting messages out to the right people is always the challenge.
HARRINGTON: The state is now expanding testing services, but that alone won't get at the drug problem. Beth Meyerson is with the Rural Center for HIV/STD Prevention and wants legislators to step up.
BETH MEYERSON: You know, when the house burns down, it's not time to just go out and buy smoke alarms. It's time to ask ourselves how did this happen? How did we let it happen? How do we need to be? And, by the way, how's the rest of the neighborhood?
HARRINGTON: But Indiana officials are at odds over just what that long-term response will look like in small towns like Austin, where there's little access to mental health or substance abuse treatment, and often only one doctor. That, state health officials say, will have to change. For NPR News, I'm Barbara Harrington.
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