The number of reported HIV cases continues to creep upward in a rural Indiana county as state health and government officials seek to contain an outbreak that has received national attention. In a study of contrasts, a report from Minnesota health officials that HIV cases increased statewide last year garnered little attention.
The Indiana State Department of Health released new numbers May 7 indicating that there were 149 confirmed cases of HIV related to the outbreak in Scott County and one preliminary positive case. Typically, there are fewer than five cases a year in the community which has an 8.9% unemployment rate and where 19% of the population lives in poverty.
The department opened a community outreach center on March 30 which has since tested 206 individuals for HIV, provided 184 immunizations against tetanus and Hepatitis A and B, collected about 9,200 used needles and distributed almost 10,500 sterile needles.
Needle exchanges were against the law in Indiana, but Gov. Mike Pence—a Republican who has stated his opposition to the practice—signed a bill May 5 allowing exchanges to operate in public health emergencies. The Scott County exchange was allowed under a 30-day public health-emergency executive order issued by Pence on March 26 and renewed on April 20.
The new law took effect immediately. It allows for needle exchanges to operate after a county or municipality declares an HIV or hepatitis C epidemic that is being spread primarily through intravenous drug use. Once an exchange is operating, it must also provide education on drug-overdose response and treatment, provide drug-addiction treatment information and service referrals, and provide needles without collecting personally identifiable information. The law also prohibits police from using an individual's visit to an exchange as probable cause to “stop, search or seize” the person.
Last week the state also distributed posters, flyers, door decals and digital Wi-Fi messages to rest stops along Interstate 65 between Indianapolis and Louisville encouraging travelers and truck drivers to practice safe sex and to be tested for HIV.
“We have evidence that over-the-road truck drivers are particularly susceptible to HIV-infected persons," Indiana Health Commissioner Dr. Jerome Adams, said in a news release. "When you factor in that Interstate-65 passes right through the epicenter of the current outbreak, the risk is even greater.”
While the 150 cases in Scott County represent a huge spike in HIV cases there, the 307 cases recently reported for 2014 by the Minnesota Department of Health represent only a 2% increase statewide. The Indiana outbreak has been mostly confined to a rural area and has been tied to intravenous use of the drug oxymorphone, sold under the name Opana. The increase in Minnesota has been mostly among urban residents and spread by sexual contact.
In Minnesota, 144 (62%) of the new HIV cases in 2014 were believed to be sexually transmitted among gay men with most living in the seven-county Minneapolis-St. Paul area. Only five cases were directly linked to intravenous drug use but 12 cases were linked to someone having sex with an intravenous drug user. Eighty-six cases are listed as “unspecified.”
The new cases included 234 men and 73 women, with 32% being residents of Minneapolis, 14% residents of St. Paul, and 40% living in their suburbs—leaving only 14% of new cases to be distributed among the other 80 counties of “Greater Minnesota,” according to the Minnesota Department of Health. It also reported that almost one in five of the new cases involved people born outside the U.S.
Minnesota had an HIV infection rate of seven cases per 100,000 people, which is the 17th lowest among the 50 states. The MDH reported that Vermont had the lowest rate, 2.5 per 100,000; while Maryland had the highest, 43.7. The national rate is 18 per 100,000 residents.
Although Minnesota compares well nationally, the Minnesota AIDS Project called 307 news HIV cases “completely unacceptable” and called on political leaders to commit more resources to fight the disease.
“We have the tools and the knowledge to cut new infections in half but we lack the political will and funding to make it happen,” Matt Toburen, the organization's director of public policy, said in a news release. “Funding for HIV prevention in Minnesota is at the lowest levels since the 1990s.”
