TIME Infectious Disease

How an HIV Outbreak Hit the Heartland

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Elizabeth Renstrom—TIME

Drug abuse combined with a spotty public health system are to blame for Indiana's public health emergency

Indiana Governor Mike Pence on Thursday declared a public health emergency in a rural Indiana county after 79 cases of HIV were confirmed there in the last several months.

An outbreak of HIV may seem odd in such a remote part of the country. The dozens of confirmed cases, described as an epidemic, are centered in Scott County, about a half-hour north of Louisville with a population of about 25,000.

But the spike has been fueled by growing heroin and drug use in rural counties like this one. A number of Midwestern states have struggled with a recent uptick in drug and needle use, and Indiana specifically has seen an increase in the use of a powerful painkiller called Opana, which can be altered and injected. The number of deaths related to opioids like Opana rose from 200 a year in 2002 to 700 in 2012, according to the Indiana State Department of Health.

In this area of the state, there’s relatively weak public health infrastructure to prevent the infection from spreading. Scott County is just one of five counties serviced by a single HIV testing clinic, and the county’s relative isolation from a sufficient public health system can help explain the virus’s rapid growth, says Beth Meyerson, an Indiana University health professor and co-director of the Rural Center for AIDS/STD Prevention.

“The system isn’t working and isn’t strong enough from a public health perspective,” Meyerson says.

In a 2013 study by the non-partisan organization Trust for America’s Health, Indiana ranked last in federal funding per capita from the Centers for Disease Control. The national average spent per capita was $19.54. In Indiana, $13.72 was spent on each Hoosier.

Indiana has also seen an increase in Hepatitis C in many rural communities, says Meyerson, another warning sign that HIV may be spreading. According to the U.S. Department of Health & Human Services, about 25% of people who have HIV in the U.S. are co-infected with Hepatitis C.

On Thursday, state authorities stepped in. Gov. Pence allowed local officials to start a 30-day needle-exchange program in Scott County as a way to stop the outbreak. “I do not enter this lightly,” Pence said, according to the Indianapolis Star. “In response to a public health emergency, I’m prepared to make an exception to my long-standing opposition to needle exchange programs.”

MORE: This Contraceptive is Linked to a Higher Risk of HIV

While dozens of cases have been reported, it’s likely that there are many more still unconfirmed. “I don’t expect these counties will remain the center of the epidemic,” Meyerson says. “I’m sure it’s going to be in other parts of southern Indiana, wherever our system is the weakest. We don’t know what we don’t know right now.”

TIME HIV/AIDS

HIV Triggers a Public Health Emergency in Indiana

Indiana Gov. Mike Pence responds to a question during a news conference, March 25, 2015, in Scottsburg, Ind.
Darron Cummings—AP Indiana Gov. Mike Pence responds to a question during a news conference, March 25, 2015, in Scottsburg, Ind.

Intravenous drug use identified as the source of infections

Gov. Mike Pence declared a public health emergency Thursday in south Indiana’s Scott County, which has seen a large HIV flare-up from intravenous drug use.

At least 79 HIV confirmed cases have been tied to the southern Indiana country since January, up from fewer than five new cases in a typical year, and the state expects that figure to rise as officials scramble to alert up to 100 people linked to those newly infected. Intravenous drug use has been named as the primary infection source in every confirmed case.

“This is all-hands-on-deck. This is a very serious situation,” Pence said at a news conference on Thursday.

The emergency order will set up a command center to coordinate HIV and substance abuse treatment. Pence also authorized a temporary needle-exchange program, on recommendation from the Centers for Disease Control and Prevention, after the governor had previously said he opposed the practice.

“Scott County is facing an epidemic of HIV, but this is not a Scott County problem; this is an Indiana problem,” the Governor said in a statement. “ I am confident that together we will stop this HIV outbreak in its tracks.”

Read next: This Map Shows the Deadliest Counties in the U.S.

Listen to the most important stories of the day.

TIME Innovation

Five Best Ideas of the Day: March 9

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. Take a data dive to see how a ring of suburban poverty is appearing around America’s revived cities.

By Luke Juday at the Weldon Cooper Center for Public Service at the University of Virginia

2. Don’t worry about Russia giving up on nuclear cooperation and the International Space Station.

By Lisa Saum-Manning in U.S. News & World Report

3. Scientists reverse-engineered social networks to learn how to fight HIV among homeless youth by word of mouth.

By Jessica Leber in Fast Co.Exist

4. A Pyrenees pipeline could weaken Putin’s grip on European energy.

By Paul Ames in Global Post

5. For developmentally disabled kids, the benefits of organized sports are huge.

By Darrin Steele in Quartz

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME HIV/AIDS

Scientists Find a Way to Block HIV from Infecting Healthy Cells

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Getty Images HIV viruses infecting a human immune cell

Researchers overcome a major hurdle in developing the ultimate protection against HIV

Reporting in the journal Nature, scientists describe a new way to potentially block HIV from infiltrating healthy cells. Such interference is key to protecting people from HIV infection, but most efforts so far haven’t been successful.

This time, however, may be different. Michael Farzan, professor of infectious diseases at Scripps Research Institute, and his team used a gene therapy technique to introduce a specific HIV disruptor that acted like gum on HIV’s keys. Once stuck on the virus’s surface, the peptide complex prevents HIV from slipping into the molecular locks on healthy cells. Because the gum isn’t picky about which HIV strain it sticks to—as long as it’s HIV—the strategy works against all of the strains Farzan’s group tested in the lab, including both HIV-1 and HIV-2 versions that transmit among people, as well as simian versions that infect monkeys. In lab dishes containing the virus and human and animal cells, the disruptor managed to neutralize 100% of the virus, meaning it protected the cells from getting infected at all.

MORE: The End of AIDS

The strategy is based on what HIV experts know about how the virus infects healthy cells. HIV looks for a protein, or receptor on immune cells called CD4, which serves as the lock, and uses a specially designed portion of its own viral coat made up of three proteins as the key. Once HIV finds its target and the match is made, the virus changes its shape to better slip inside the healthy cell, where it takes over the cell’s machinery and churns out more copies of itself. Farzan’s gum, called eCD4-Ig, not only seeks out these parts of the key and renders them useless, but by glomming onto the key, also causes the virus to morph prematurely in search of its lock. Once in lock-finding mode, the virus can’t return to its previous state and therefore is no longer infectious.

The encouraging results suggest that eCD4-Ig could provide long-term protection against HIV infection, like a vaccine; in four monkeys treated with gene therapy to receive eCD4-Ig, none became infected with HIV even after several attempts to infect them with the virus. The protection also seems to be long-lasting. So far, the treated monkeys have survived more than a year despite being exposed to HIV, while untreated control monkeys have died after getting infected.

MORE: This Contraceptive Is Linked to a Higher Risk of HIV

The strategy, while promising, is still many steps away from being tested in people. Farzan used a cold virus to introduce the eCD4-Ig complex directly into the muscle of the animals, and it’s not clear whether this will be best strategy for people. Previous gene therapy methods have led to safety issues, and concerns have been raised about controlling where and how much of the introduced material gets deposited in the body. It may also be possible to give the peptide as an injection every few years to maintain its anti-HIV effect.

MORE: HIV Treatment Works, Says CDC

Farzan anticipates that if proven safe, the strategy could help both infected patients keep levels of HIV down, as well as protect uninfected, high-risk individuals from getting infected. But many more tests will need to be done before we might see those results. Four monkeys can provide valuable information, but can’t answer questions about safety and efficacy with any confidence. “Things change when we get to humans and when we get to larger numbers,” he says. “But the data in monkeys are as encouraging as one could hope.”

TIME Innovation

Five Best Ideas of the Day: February 9

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. A humanitarian intervention for Aleppo could provide a glimmer of hope in Syria.

By Ana Palacio in Project Syndicate

2. The U.S. needs a new Church Committee to strengthen oversight of our intelligence services.

By Michael German at the Brennan Center for Justice

3. A regional force is the wrong approach to fight Boko Haram — and might make things worse.

By Hilary Matfess in Al Jazeera America

4. The mystery of autism might be unlocked by studying the microorganisms in children’s stomachs.

By Ruth Ann Luna at the Baylor College of Medicine

5. Test for HIV and syphilis with an iPhone.

By Tasbeeh Herwees in Good

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Venezuela

A 36-Pack of Condoms In Venezuela Now Costs $755 at Official Rates

Because of a near-defaulting economy, consumer goods such as condoms are scarce and hugely marked up

In Venezuela, a 36-pack of Trojan condoms now costs $755 at the official exchange rate. That’s the price being asked on the MercadoLibre website, where Venezuelans go to buy goods in short supply.

Compare that to a box in the U.S., which goes for $21.

The huge markup is due to the collapse in oil prices, which has had disastrous consequences in Venezuela, Bloomberg reports.

The South American country relies on crude-oil exports for 95% of its foreign-currency earnings and has seen a 60% fall in those exports over the past seven months.

As a result of the government’s policy of slashing imports to make up for the deficit, consumer goods have become scarce and expensive, and people are forced to queue for hours to get basic products such as meat, sugar, medicine and now contraceptives.

For those with access to American dollars, condoms can be bought on the black market for around $25. But this is only the lucky few.

The lack of access to contraceptives could deepen the country’s social problems. Venezuela has one of South America’s highest rates of HIV infection and teenage pregnancy. Because abortion is illegal, the disappearance of condoms and other forms of birth control like the pill may force more women to clandestine abortion clinics, increasing the risk of maternal deaths.

[Bloomberg]

TIME Research

There’s a Smartphone Attachment That Will Test for HIV in 15 Minutes

Blood testing for HIV
Getty Images

The device has the potential to save millions of lives

A team of researchers from Columbia University have developed a device that can be plugged into a smartphone and used to quickly test for HIV and syphilis.

The mobile device tests for three infectious-disease markers in just 15 minutes by using a finger-prick of blood, and draws all the power it needs from the smartphone, Science Daily reports.

The accessory costs an estimated $34 to make and is capable of replicating tests done in a laboratory using equipment that costs many thousands of dollars.

Samuel K. Sia, head researcher and associate professor of biomedical engineering at Columbia, described the smartphone accessory as “full laboratory quality.”

Because it can be easily used in remote and impoverished areas, like rural Africa, it is hoped the small but effective smartphone accessory will save millions of lives from sexually transmitted diseases.

[Science Daily]

TIME Innovation

Five Best Ideas of the Day: February 3

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. “Even from a libertarian point of view, vaccination is a matter of rational self-interest.”

By Ben Boychuk in the Orange County Register

2. ‘Doubt everything:’ Ukrainian students are warning their Russian counterparts not to trust Putin.

By Arslan Saidov and Claire Bigg in the Guardian

3. To reach kids where they are, provide teens crisis counseling by text.

By Alice Gregory in the New Yorker

4. Is the secret to a cure for HIV lurking in dormant pools of the virus?

By Catharine Paddock in Medical News Today

5. 3D-printed ‘cool bricks’ can naturally air condition a room.

By Whitney Hipolite in 3DPrint.com

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Davos

Bill Gates: HIV Vaccine a Reality by 2030

Bill Gates, Co-Chair of the Bill & Melinda Gates Foundation gestures next to his wife Melinda French Gates during the session 'Sustainable Development: A Vision for the Future' in the Swiss mountain resort of Davos
Ruben Sprich—Reuters Bill and Melinda Gates at the World Economic Forum in Davos, Switzerland on Jan. 23, 2015.

New drugs would significantly impact the global struggle against the virus which has claimed the lives on millions over the past 30 years

Philanthropist and Microsoft founder Bill Gates believes an HIV vaccine, as well as new intensive drugs to combat the disease, will be available by 2030. That would significantly impact the global struggle against the virus which has claimed the lives of millions over the past 30 years.

Speaking the World Economic Forum in Davos, the billionaire founder of the Bill & Melinda Gates Foundation said the two “miracles” were within reach. “We’re pretty optimistic in this 15-year period we will get those two new tools,” he said. The Gates Foundation, founded fifteen years ago, spends tens of millions of dollars on medical research.

A vaccine is seen as pivotal in preventing new infections, while drug treatments would do away with the need for life-long treatment, he added.

[The Guardian]

TIME Infectious Disease

Unlicensed Cambodian Medic Charged With Murder After Allegedly Spreading HIV

212 HIV cases were found in the community where he practiced

An unlicensed medic is being charged with murder after Cambodian medical authorities found 212 cases of HIV in the district where he had been treating patients, allegedly with contaminated equipment.

Yem Chrin treated poor patients and was believed to have healing powers, Reuters reports. However, he did not have a medical license and was allegedly delivering injections and blood transfusions using unclean equipment. Authorities tested 1,940 people in the northwestern province where Yem Chrin worked, and 212 tested positive for HIV. Some children as young as 6 years old tested positive for the virus, according to al-Jazeera.

Yem Chrin allegedly told police that he sometimes used the same syringe on two or three patients before disposing of it.

The World Health Organization and UNAIDS found that “the percentage of people that reported receiving an injection or intravenous infusion as part of their health treatment was significantly higher among the people who tested positive for HIV than the people who were HIV negative,” in the area in which Yem Chrin treated patients, Reuters reports.

The development is a setback in Cambodia’s largely successful efforts to eradicate the virus since it first spread through the country in the 1990s.

[Reuters]

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