One year after an HIV outbreak in southern Indiana made national headlines, nearly 200 people in Scott County are living with the virus.
Hundreds of people here were injecting a prescription painkiller called Opana and sharing their needles.
So HIV spread quickly among drug users, resulting in the largest outbreak the country's seen in decades.
A lot's changed in the year since then, but Austin still has a long way to go.
Change Creeps Into Austin
When HIV came to Austin last year, it didn't come quietly.
It tore through the community, starting with five cases, exploding to 30, eventually multiplying until now more than 190 people are infected. All in a town of less than 5,000. Small, sleepy Austin got the most brutal of wake up calls.
It's gotten a lot better in the past year. The police are doing more patrols, which I'm glad to see.
But over the past year, change has slowly crept into this community.
Michael Steele lives within the ten-block radius considered the heart of the outbreak. He sees a difference compared to last April. Back then, the streets in his neighborhood were a whole lot busier.
"I'd see prostitution, drug dealing going on," Steele says.
In the middle of the day. All day long. Certainly you still see people, he says, just not nearly as many.
"It's gotten a lot better in the past year," Steele says. "The police are doing more patrols, which I'm glad to see. Trying to cut down on the drugs and the crime here."
Community Confronting New Challenges
Most of the users here are hooked on the potent painkiller Opana. They melt off its plastic coating then inject the liquid – providing a high different than any other painkiller.
Police made it their mission to crack down on the people bringing the drugs to Austin. And that's making it a lot harder for the people who are dependent on the drug – which raises a new problem.
"A lot of people tell me it's not like some of the older pain medicines they were addicted to because with this one they can't withdrawal from it," Combs says. "Because with this one the withdrawal symptoms are so severe that they feel like they're going to die."
So users are turning to what they can get off the streets – first that was methamphetamine, now heroin.
"Totally changed the whole dynamic," Combs says. "And with the heroin we don't know what they're getting or what it's laced with or what's in it, so they don't even know. So our chances of overdose are going up."
And that's just one of the many realities Combs grapples with every day.
"We have 300 some odd labs that we have to go through now," she says.
She's unsure what the county's current Hepatitis C rate is because there's hardly enough time to keep up with all of the testing. Combs is busy running what became the state's first syringe exchange program after the outbreak last year.
More than 380 people signed up and about half of them are still actively using the program.
Underlying Issues That Contributed To Outbreak Remain
Combs says the situation in Austin is improving, but there's still what seems like a never-ending list of issues to address.
"We need dental care, I mean their teeth are a nightmare," she says. "And, you know how it is when you have a bad tooth – it hurts. And, so when all their teeth hurt, can you imagine living like that everyday? So we need dental care, we need a lot of things. But we've come a long way in one year but we still have a long way to go."
There are so many layers to the story in Austin – so many examples of how the community feels it was failed.
Before the outbreak happened, Scott County ranked dead last in an annual report of the state's health outcomes for several years in a row.
Its rate of premature death is the worst in the state and has increased every year since 2007.
The take home message from this is our system's broken and we can expect then bad health outcomes unless we really want to invest in it.
Nearly 15 percent of the people in the county are living in poverty.
And those are problems that can't be solved without more time – and money.
"Really for drug use, or sexual health, or public health, generally all of those things depend on investment," says Beth Meyerson, Co-Director of the Rural Center for AIDS/STD Prevention. "And in our state we invest 13 cents per person [per year] on public health. That includes Medicaid. I spent that last week at Starbucks."
One year after the HIV outbreak, change has crept into Austin.
But crisis hasn't left.
"The take home message from this is our system's broken and we can expect then bad health outcomes unless we really want to invest in it," Meyerson says.
