It's almost 8 o'clock in the morning. Most people are just getting to work, but Dr. Will Cooke has already put in a full day.
He just finished an emergency room night shift, and there's still plenty of work to be done.
Cooke and his team at Foundations Family Medicine in Austin are preparing for what will become a weekly HIV clinic.
When patients walk in the door, a nurse asks some basic questions about drug use and sexual behaviors. Then the nurse administers a preliminary drug test. It takes about 20 minutes to get the results and it's 99 percent accurate.
Whether people test positive or negative, they talk with a nurse about HIV, addiction treatment options, the county's new needle-sharing program and safe-sex practices.
The clinic is possible because of an executive order the governor signed last week.
In some ways we've forgotten rural America, and we look the other way."
- Dr. Will Cooke
The order comes after more than 80 people near Scott County have contracted the virus. It authorizes a needle-sharing program in Scott County and allocates State Department of Health resources to the area.
Those resources are something local officials have been requesting for more than a decade.
"Ever since I opened my practice in 2004, it was obvious there was a problem with drug use here. I've been asking for help for a long time," Cooke says. "In some ways we've forgotten rural America, and we look the other way."
Cooke and other health coalitions applied for multiple grants and tried to get the attention of state officials, but they were consistently denied funding.
"We knew it was only a matter of time before we saw HIV, but we never thought it would be as bad as it is - to the extent that it is that we would be in the middle of an epidemic," Cooke says.
Local agencies haven't sat idle, though. In 2011, the county got a wakeup call when 19 people overdosed on Opana, the prescription opioid that's been linked to the recent HIV cases.
"We did do a lot of environmental strategies that did address this," says Lori Croasdell, the coordinator for the Coalition to Eliminate the Abuse of Substance in Scott County.
They started making local doctors aware of the problem and developed a system so doctors could track how much Opana they were prescribing to any given patient.
The number of overdoses dropped, but the drug use continued.
"People who used to get a lot of Opana through our local pharmacies, that was curtailed, but they're getting it from somewhere," Croasdell says.
Austin sits right off Interstate 65, which has been identified as an easy way for drugs to be transported into Indiana. Some of those drugs come from as far south as Mexico.
There's also the fact that Opana is a prescription drug. It doesn't have to come from Mexico. It can be obtained from nearly any local pharmacy.
...a legal substance that only becomes illegal when you sell it, that's much harder to fight."
- Dan McClain, Scott County Sheriff
"It's a lot easier for us to fight methamphetamines, which we've kept down, heroin, which we've kept down, but when you're talking about a legal substance that only becomes illegal when you sell it, that's much harder to fight," says Scott County Sheriff Dan McClain.
Scott County law enforcement plans to continue cracking down on Opana use, but they're also hoping to do more on the treatment side.
"We are looking now at treating everyone that's HIV positive in the jail, testing and then offering treatment for that," McClain says. "There's a funding mechanism we're hoping to get from the state with the tremendous expense of these medications."
Back at Foundations Family Medicine, Dr. Cooke says his clinic is finally getting the resources it needs. But the governor's executive order is only effective for 30 days.
Health officials warn more resources need to be allocated to other counties where the virus is spreading.
"It's all across Indiana and in many ways because of the concentrated issues that we have here in Austin with IV drug use and poverty and now this infection coming in, this HIV virus, we may just be the canary in the coalmine," Cooke warns. "Hopefully, maybe this will be a wake up call that we can't forget any American."
