The exchange became the first of its kind in Indiana following the HIV outbreak in Scott County. Leaders there want to continue the exchange because they say it's helping slow the spread of HIV.
But much of the community remains divided over the program's effectiveness.
Slowing The Spread Or Fueling The Problem?
When you drive through the neighborhood at the center of Indiana's HIV outbreak, there's something that jumps out at you. House after house, block after block, there are dozens of ‘no trespassing' signs posted in people's front yards. Some houses have video cameras staring out at the street, others have their driveways roped off.
We knocked on a lot of doors here, wanting to talk to people living in Austin about how things are going.
More than 190 people in Scott County are living with HIV – an outbreak sparked by drug users sharing needles.
We talked to several people who are unhappy with the exchange. They say they're still finding used needles in their yards and on public property. That's one of the reasons you see all of those no trespassing signs around here. Some think the exchange enables the users and contributes to the problem.
But we also spoke to a couple of people who are hooked on the prescription painkiller Opana. They call the needle exchange a lifesaver – one that allows them to save their money for food, transportation or healthcare.
Austin, in many ways, is a town that remains divided over whether the needle exchange is doing more harm than good. And no one is willing to do an interview with us, out of fear they would become some sort of target.
Except Austin resident Michael Steele.
"I don't feel that the needle exchange is exactly a good thing," Steele says while looking out at his neighborhood. "I think that the state should check into having a rehabilitation center."
That's a sentiment many of his neighbors share.
But Scott County's Health Department says you can't dispute the numbers.
Governor Mike Pence declared a public health emergency last March, allowing the county to setup a temporary needle exchange program to help control the HIVoutbreak. At the time, there were 79 cases of HIV.
We've got our weekend planned and they're not sure what's going to happen at 12 o'clock, so the idea of treating this lifelong disease is impossible.
By May of last year, the number of cases reached 164 and the outbreak was slowing. Since then, health officials have diagnosed fewer than 30 new HIV cases.
"The needle exchange is a vital piece of prevention," says Dr. William Cooke. "The most potent way to prevent the spread of HIV is to treat HIV. If the viral load is undetectable, you can't spread it."
But health officials say the community needs to look beyond prevention and think about the long-term implications of the outbreak.
Cooke says he's treated about 130 of the more than 190 people diagnosed with HIV. He's prescribed Antiretroviral therapy to about 100. He says there are still people coming to him for the first time who were diagnosed last year.
"They live rather day-to-day, desperation," he says. "It's more about surviving this day or getting to that next fix, getting through till noon. We've got our weekend planned and they're not sure what's going to happen at 12 o'clock, so the idea of treating this lifelong disease is impossible."
Lack Of Substance Abuse Treatment Remains Biggest Barrier
Substance abuse treatment remains difficult for many of the people hooked on Opana.
But there are more resources in Austin as a result of the outbreak. LifeSpring Health Systems now has an office across the hall from the county's needle exchange program.
"Here we provide behavioral health treatment," says Senior Vice President of Community Care Initiatives Beth Keeney. "So we've got everything from individual therapy to group therapy as well as psychiatric services and case management services."
The state recently awarded LifeSpring a grant to expand its detoxification services, which includes medically-assisted treatment.
But need doesn't always translate to demand.
Many people here can't afford to go to an in-patient facility for treatment, which requires them to leave their homes, jobs, families for at least 30 days.
It's a slow process, everything takes time. And you're like, ‘We're at a year now' and that's still one of the things that we're still really lacking in.
And the wait to get into those facilities is worse than it was this time last year – when Scott County residents were bumped to the top of the list because of the outbreak.
"At the height of the outbreak, for Scott County residents we were looking at anywhere from one to two weeks," Keeney says. "Right now I think the average is five to six weeks."
People who do get into those facilities often find themselves in a tough situation once they get out. There's no transitional housing in Austin. And the community lacks the social support many people need to stay clean.
"That is the one thing that I wish was going better, too," says Scott County Public Health Nurse Brittany Combs. "It's a slow process, everything takes time. And you're like, ‘We're at a year now' and that's still one of the things that we're still really lacking in. And there's things in place that are working to try to help us through that but it's just such a slow process."
The pace is frustrating for many people in the community who see rehab as the only way to address the ongoing problems here.
But IV drug use in Austin has been going on for years. And health officials say it will likely take just as long to correct the problem as it did to create it.
