As a nurse and manager of the only medical office in Austin, Ind., Jeanni McCarty finds herself at the heart of the state's worst-ever outbreak of HIV, so bad that on Thursday the governor declared a heath emergency.
McCarty, 42, grew up in Austin, but she scarcely recognizes it now.
"It's not what it used to be," said McCarty, who still lives in Scott County, in the southeast corner of Indiana. She described a region where many people live in poverty with limited prospects of jobs and a "very, very serious drug problem that has made us the epicenter of the HIV outbreak."
The Scott County outbreak has been linked to the illegal use of contaminated syringes. On Thursday, Gov. Mike Pence authorized a short-term exchange to fight the spread of HIV, an exception to Indiana's conservative anti-drug policy that bars needle-exchange programs that trade dirty needles for uncontaminated ones.
"This is all hands on deck. This is a very serious situation," the Republican governor said at a news conference.
"Scott County is facing an epidemic of HIV, but this is not a Scott County problem; this is an Indiana problem," Pence said, announcing the health emergency and executive order.
The order will run for 30 days but Pence can extend it. In addition to the needle exchange, the order sets up a command center to coordinate HIV and substance-abuse treatments, according to the state. The state is also establishing a public awareness program to explain safe sex and needle disposal and a hotline to get HIV testing and treatment.
Scott County, about 30 miles north of Louisville, Ky., is a rural area of about 24,000 people. Running through the area is Interstate 65, a broad highway that brings in drugs — and customers for prostitutes, who face a double danger. The human immunodeficiency virus is spread among people through blood and other bodily fluids, and is associated with risky sexual activities and the use of contaminated needles. HIV attacks an individual's immune system and eventually leads to AIDS, or acquired immunodeficiency syndrome.
Typically, Scott County sees fewer than five HIV cases a year, but 71 cases have already been confirmed since late January, and at least nine more cases have been given a preliminary positive status, according to Amanda Turney, a spokeswoman for the state Health Department. It is the worst such outbreak in the state and probably the worst in the nation, though national statistics are unavailable, she said.
The number of cases is expected to increase. Health officials say they are trying to contact as many as 100 people tied to those with confirmed HIV infections.
"We're doing more testing already and we have people here waiting on line to be tested," McCarty said in a telephone interview.
Foundations Family Medicine is the only medical office in Austin. McCarty says it has one doctor, three nurse practitioners, five nurses and two medical assistants to care for the approximately 12,000 patients who have come in.
She says the HIV outbreak had been expected.
"It's been a long time coming," McCarty said. "About three to four years ago, we noticed a big increase in the number of hepatitis C cases." Hepatitis C is also spread through blood and is associated with illegal drug use.
Since then, almost all of the confirmed HIV cases have been from Austin, a city of about 4,200. Given how quickly it has spread, more cases are expected in the coming weeks.
Some help is on the way: The area is getting its first specialist in infectious disease. Patients are being treated at no charge once they test positive for HIV.
"This has been hard to swallow," McCarty said of the outbreak.
"A lot of the problem comes from poverty," she said. "These people don't have education to get jobs. Resources are so limited."