Indiana's HIV outbreak is a reminder the disease that took hold in the U.S. in the 1980s is still present.
Since state health officials declared the outbreak last week, the number of cases has continued to climb. The disease spreads rapidly and the only way to know if you have it is to get tested.
Health officials face a complicated task in tracking down those people who might be infected and then containing the unprecedented outbreak.
An Unusual, 'Unprecedented' Outbreak
The HIV outbreak is centered in southeastern Indiana.
"The counties that are being affected are said to have a good rate of HIV in the first place," Payal Patel-Dovlatabadi, an assistant professor and director of public health at University of Evansville says. "And those working in the counties everyday with the HIV patients are like, 'Well, we don't really see this as an outbreak. We're just seeing an increase in patients'."
But this region normally sees fewer than five new cases of HIV in an entire year.
Compare that to the latest numbers from the state department of health - which show 27 confirmed positive HIV cases and 10 more preliminary positive cases since mid-December.
"The counties that are being affected have a high percentage of those living in poverty, as well as those without health care coverage compared to the Indiana state average and U.S. averages, so they have a lot of risk factors," she says.
There are five counties involved, with the small town of Austin hit hardest. The current thought is the outbreak originated here.
"We don't have a record of an HIV outbreak like this in the state of Indiana - at least since the early 2000s," Indiana State Department of Health Deputy Commissioner Jennifer Walthall says.
In addition to sheer numbers, this outbreak is different because the virus is being predominately spread through the use of injectable drugs.
The drug at the center of this outbreak, an opioid painkiller called Opana, can be crushed, chewed, liquefied and injected. Its abuse appeared on the FDA's radar around 2010, and the drug manufacturer changed the formula to make it harder to inject.
Limited Resources Create A Specific Challenge
When the HIV epidemic began in the 1980s, the virus was primarily transmitted through sexual contact. That's begun to change over the years, but still only about a third of HIV cases nationally are attributed to needle sharing and misuse of needles.
"Sharing needles is a very risky proposition any way you look at it," Lesi Nelson, a care coordinator for AIDS Resource Group in Evansville says.
HIV can be spread by sharing the same needle with someone infected with the virus, but a lot of people don't know about the dangers of indirect needle sharing.
The water used for the product can be contaminated and so can the cotton that's used as a filter.
"They are unknowingly passing this virus on to people because they don't know they have it," Nelson says. She advocates for everyone to be tested.
Some counties – including Scott County, which is at the center of the outbreak - don't have the resources to test for HIV. The state is working to equip those counties and Walthall says the Department of Health has enhanced its own lab services.
But an outbreak like this is unprecedented in Indiana, and Walthall says the state is still exploring every possible containment option to make sure it's managed as quickly and effectively as possible.
"We are currently working on identifying all contacts of any HIV-positive individuals. If you can imagine a spider analysis of what that looks like and how each individual is connected, we can identify all of those at risk and get them connected to care coordinator services for their HIV care," Walthall says. "Additionally, the most important part in addition to that HIV care is making sure we provide really aggressive services for substance use and addiction treatment."
Walthall says trying to predict the number of people exposed to HIV in this outbreak now would be incredibly difficult, but health officials in some of the affected counties say they wouldn't be surprised to see the numbers top 100.
