What we know about Austin, Indiana's struggles with drugs and HIV
Nearly four years ago, a public health disaster struck Austin, Indiana, a Southern Indiana town 37 miles from Louisville.
In February 2015, health officials became alarmed about 26 confirmed and four preliminary positive HIV cases in an area that previously saw only a handful. The cases were linked to needles used to inject painkillers.
The number of cases more than doubled the first month. By mid-May 2015, they'd risen to 153.
Dr. Tom Frieden, former director of the U.S. Centers for Disease Control and Prevention, said that gave Austin, with a population of around 4,200, a higher incidence of HIV than "any country in sub-Saharan Africa," and "more people infected with HIV through injection drug use than in all of New York City last year."
He estimated that treating those infected would cost $100 million. And his agency issued a nationwide health advisory to be on the lookout for clusters of HIV and hepatitis C among intravenous drug users and to take steps to prevent them.
The Courier Journal chronicled the outbreak and the initial response. We also looked at ways the community struggled to deal with the crisis. In our current four-day series, we're showing you signs of hope as the community recovers — and some of the people nurturing that hope.
Here's some of what we've learned:
It was unprecedented yet predictable
Poverty, despair, addiction and lack of access to health care created perfect conditions for an HIV outbreak.
Austin, a working-class manufacturing town, was weakened by a series of economic blows. The American Can plant shut its doors in 1986. A supermarket closed. Poverty crept up and drug use festered.
Eventually, so did hepatitis C, a liver disease that can also be spread by shooting up drugs. Experts consider it a harbinger for HIV.
But places to get help were scarce. Austin had one doctor and no drug-treatment centers.
Dwindling government funding in 2013 led Planned Parenthood in nearby Scottsburg to close after years of providing HIV education, testing and referrals. The nearest regular HIV testing and case management was in Jeffersonville, about 35 miles away.
The ingredients for similar outbreaks are everywhere. After Austin's outbreak, CDC researchers identified 220 counties nationally that they consider especially vulnerable to becoming the next Austin. Fifty-four are in Kentucky.
The initial response was slow
Many public health advocates argue officials should have foreseen the possibility of an HIV outbreak and done more to prevent it. The state wasn’t ready for all the HIV testing needed when the outbreak hit. Less than a month in, a state STD prevention specialist told local health workers there were only five volunteer testers available from agencies across Indiana, with limited time to help.
Many public health experts also criticize former Republican Gov. Mike Pence, who opposed syringe services programs. Indiana law banned them at the time, with critics arguing they enable addicts to keep using drugs.
Pence eventually signed a 30-day executive order declaring a public health emergency in Scott County and allowing it to run a state-supervised syringe program.
By then, HIV cases had more than tripled, reaching 79.
Many people have pitched in to help heal Austin from within. We spent more than six months looking at the outbreak and response through the lens of its only physician, Dr. Will Cooke, who treated most of the HIV patients and worked with community groups fighting poverty and addiction. Churches also played a big role.
Austin has begun to recover in many ways: Most cases of HIV are well-controlled.
In 76 percent of Scott County's HIV patients, the virus is so well controlled by medication that it's undetectable. That compares with 49 percent nationally.
According to the Scott County Health Department, 383 participants used the county’s syringe services program through late November this year. People can get 140 clean needles per visit, and overall the program has given out about 139,000 clean needles so far this year and has taken back 118,000 dirty ones.
While federal officials expected 26 new cases of HIV a year after 2015, there were only 12 in 2017, the last full year for which data is available.
High school graduation rates are up, now exceeding 90 percent. The number of recovery groups has risen from three before the outbreak to 18 today, and membership in these groups has risen more than tenfold.
Slowly, a culture of recovery is taking hold.
People are spreading hope
They're in every part of the community — Austin's schools, recovery groups, churches and elsewhere.
They are people like Kathy Risk-Sego, a choir teacher determined to raise up all of her students; Jacob Howell, a pastor who found his way out of addiction and now serves others; and Laura Nowling, a former teacher who struggled with meth and now helps spread the gospel of recovery.
Behind each of these people are others who have helped them.