Donald Spicer slowed his police car to a crawl as he pointed out “shooting galleries” — paint-chipped houses with broken windows and rotting wood, where addicts inject liquid painkillers and lose all sense of time.
Used needles often lie in plain sight, in the cracked streets, in the garbage-filled gutters, on patchy lawns.
“This is a common problem,” the police chief said. “This isn’t anything new to us.”
Spicer now finds his rural hometown at the core of the state’s worst-ever outbreak of HIV, one so grave that Gov. Mike Pence declared a health emergency last week. Pence also authorized a short-term needle exchange to fight the virus’ spread, an exception to Indiana’s conservative anti-drug policy that bars programs to trade dirty needles for clean ones.
But for Austin’s lifelong residents, the rash of infections making the headlines is a symptom of a deep-rooted problem dating back decades. There is a lack of opportunity here, Spicer said, few jobs, few resources and even few things to do.
“We’ve always been a step behind and struggling to keep our heads above water,” he said.
He paused for a moment at a faded, single-story home that once knew better days. The empty house could be razed, he said, as part of a city program to remove blight.
“That’s my grandmother’s house,” he said.
Austin, founded in 1853, was once best known as an important rail stop between Indianapolis and Louisville, Ky. A city of 4,200 residents, it’s surrounded by farmland but also home to four large manufacturing plants. As semi trucks drive products up and down nearby Interstate 65, drug deals, addiction and prostitution have found their way here as well.
This year, Spicer said, the police department has made 59 drug-related arrests.
“I can’t say that’s not normal,” he said.
The state declared an emergency after health officials reported a total of 81 HIV positive tests last week, including 74 confirmed and seven preliminary cases related to the outbreak in southeastern Indiana. Almost all of the confirmed HIV cases have been from Austin, Cooke said. That number is expected to rise.
A new HIV clinic, backed by health officials, opened at Cooke’s office Tuesday. The average patient here with HIV, the virus that causes AIDS, is 20 to 30 years old with no insurance or access to medical care; many lack Social Security numbers and birth certificates. In addition to offering the needle exchange program and counseling, the clinic will help patients secure such documents.
Some addicts don’t bother trying to hide. On the corner of Rural and Church streets, an intersection with heavy drug use, a man dressed in a red jacket waved in Spicer’s direction. The man is a known user, Spicer said. The chief waved back.
Opiate addiction cropped up here in the late 1990s, Spicer said, when Oxycontin made its way down I-65 and into Scott County. But when the formula for Oxycontin changed, so did addicts’ habits. They chased a different high: Opana, a pill that's also injected and is tied to the current HIV outbreak.
One-quarter of an Opana pill sells for $60 to $80 on the streets. Although he is grateful for the governor’s assistance and the influx of resources poured into Austin, Spicer worries about the long-term impact.
“Don’t come in here for 30 days and think you’ve got it fixed and leave,” he said. “We’ll still be here 10 years from now dealing with it.”
The median household income in Austin is about $33,000, less than the statewide figure of $48,000. The poverty level is about 26% and 19% in surrounding Scott County, according to census figures. Statewide it’s 15.4%.
Dr. William Cooke, medical director at Foundations Family Medicine, said he noticed an unhealthy environment years ago, as the county’s overdose rate continued to rise. It was only a matter of time, he thought then, until HIV set in.
Like Spicer, Cooke knows the key to controlling the city’s HIV epidemic is long-term care. Infectious-disease doctors will be helping at the clinic indefinitely, he said. Once the outbreak is under control — which could take up to six months — then “we can transition to a primary care model for HIV,” Cooke said.
Even then, he would like to have infectious-disease doctors come to Austin once a month.
“It would be detrimental to come in, do something independent, meet their goals and leave,” Cooke said. “We were here before this hit, and we will be here long after it goes away.”
Many Austin residents are concerned that dealing with the HIV outbreak does not address the city’s root issues. The city is resistant to change, they said, and has lost development opportunities to Scottsburg, its neighboring city.
Harry Amic recalled the Austin of his youth — a city with a Greyhound bus station and restaurants lining the downtown promenade.
“We had businesses here — merchants, a movie show,” Amic, 70, said. The bus station and theater closed long ago, he said, as did many restaurants. “I don’t want to be around this. Austin fell apart.”
Samantha Collins grew up strolling around Austin with her friends; she would walk to school. But now, Collins said, she would never let her son walk alone the way she used to because “you have to check the ditches and yards for needles.”
The HIV crisis, many residents say, could serve as a wake-up call to the county and state. Residents from all over southeastern Indiana are fed up with the opiate addiction tearing their communities apart. On Saturday afternoon, a group of protesters marched through Austin’s streets, passing the dilapidated buildings the police chief drove by a day earlier — areas with empty orange prescription bottles strewn on front lawns.
The neon-clad activists, about 20 in all, called for an end to drug abuse.
“Just say no!” they chanted.
“Not even once!” they continued, holding signs that read “itune out drugs” and “nope to dope.”
The group, members of the nonprofit organization Walking for Wellness, marches through a different city in Southern Indiana each week.
Among the crowd was Portia Moreillon, whose daughter died of a heroin overdose last year. Moreillon said her daughter was diagnosed with cervical cancer, and when her insurance stopped paying for her pain medication she turned to heroin. She died three months later.
Moreillon joined Walking for Wellness to deter others from abusing drugs. “If we can get even one person help, then I feel like my daughter’s death is not in vain,” she said.
There are similar problems in nearby counties, Moreillon said, including Clark County, Floyd County and Washington County.
“Addiction is not something someone chooses,” she said with tears in her eyes. “Somebody’s got to do something. It’s everywhere.”