TIME Addiction

Health Officials Worry as HIV Cases in Indiana Grow

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Elizabeth Renstrom for TIME

Health officials say families are using drugs together

The number of new HIV infections in Scott County, Indiana, has risen to 142, prompting local and state officials to call it a public-health emergency.

A new report released by the federal and state health officials on Friday reveals disturbing trends in injection drug use in a county of only 4,200 people. Scott County has historically reported less than five new cases of HIV each year, making the new tally of 142 all the more alarming. Health experts say the recent outbreak is reflective of a growing drug epidemic nationwide.

“There are children, and parents and grandparents who live in the same house who are injecting drugs together sort of as a community activity,” said Dr. Joan Duwve, the chief medical consultant for the Indiana State Department of Health, at a press briefing. “This community, like many rural communities, especially those along the Ohio River and Kentucky and West Virginia, has really seen a lot of prescription opioids flooding the market. With few resources [and] not a lot to do, the use and abuse has been occurring for at least a decade and probably longer.”

Health officials note that like many other rural counties in the U.S., Scott County has high unemployment, high rates of adults who have not completed high school and a large proportion of residents living in poverty with limited health care access. The report underlines the fact that the county consistently ranks among the lowest in Indiana for health and life expectancy.

“The outbreak highlights the vulnerability of many rural, resource-poor populations to drug use, misuse and addiction,” said Duwve.

The ages of the men and women diagnosed with HIV in Scott County range between ages 18 and 57. The health officials report that no infants have tested positive, though a small number of pregnant women have. Ten women in the cluster were identified to be sex workers. Around 84% of the patients have also been infected with hepatitis C. Eighty percent of the patients with HIV have reported injection drug use and among those people, all of them have reported dissolving and injecting tablets of oxymorphone. Some also reported using methamphetamine and heroin.

Dr. Jonathan Mermin, who runs the CDC’s National Center for HIV/AIDS, reminded reporters that the United States is facing an epidemic of prescription opioid abuse. “An estimated two million people are dependent on or abuse prescription opioids nationally. So while opioid pain relievers can play an important role in the management of some types of pain, the overprescribing of these powerful drugs has created a national epidemic of drug abuse and overdose,” he said.

The CDC estimates that nationwide about 3,900 new HIV infections each year are attributable to injection-drug use, which is down nearly 90% from a peak of about 35,000 in the late 1980s, says Mermin. He adds that opioid poisoning deaths in the United States have nearly quadrupled from 1999 to 2011. This epidemic has already played a major role in a growing epidemic of viral hepatitis among people who inject drugs with a 150% increase in reports of acute hepatitis C nationwide between 2010 and 2013.

State health officials and the CDC are working together to control the outbreaks of HIV and hepatitis C. The state has launched a public health campaign to notify residents of the support available to them: lab testing and treatment, referrals to addiction services and employment, and help with insurance registration. The state initially declared a 30-day public health emergency for Scott County on March 26, but expanded the executive order another 30 days. “I want to assure everyone [that] the state of Indiana will not abandon this community once the executive order is over,” said Dr. Jerome M. Adams, the Indiana State Health Commissioner.

The CDC also released a health advisory on Friday, and is asking states to look closely at their most recent data on HIV and hepatitis C diagnoses, overdose deaths, admissions for drug treatments, and drug arrests in order to help identify communities that could be at high risk for unrecognized clusters of the infections.

“We must act now to reverse this trend and to prevent this from undoing progress in HIV prevention to date,” said Mermin.

TIME Innovation

Five Best Ideas of the Day: April 20

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

1. America loves to take sides in regional conflicts. In Yemen, we shouldn’t.

By Paul R. Pillar in the National Interest

2. Here’s why Congress should drop the ban on federal funds for needle exchanges. (It’s because they work.)

By Kevin Robert Frost at CNN

3. Cheap coal is a lie.

By Al Gore and David Blood in the Guardian

4. How small-batch distilling could save family farms.

By Andrew Amelinckx in Modern Farmer

5. Can you fix city management with data? Mike Bloomberg is betting $42 million you can.

By Jim Tankersley at the Washington Post

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 health

How One Teenager Changed the Way the World Sees AIDS

Ryan White
Taro Yamasaki—The LIFE Images Collection/Getty Ryan White, 16, a hemophiliac who contracted AIDS, surrounded by mikes held out by reporters on April 21, 1988

Ryan White, who put a new face on AIDS, died 25 years ago

In 1984, when Ryan White was diagnosed with AIDS, the disease itself was still mystified medical professionals. When his name became national news, some of the only things that were well-known about it were that it was terrifying and communicable.

White — who was 18 when he died 25 years ago, on April 8, 1990 — was a hemophiliac and had acquired HIV through a blood transfusion. In and around 1985, he made headlines by trying to attend middle school in his hometown of Kokomo, Ind. Though the state’s health department declared that it was fine for him to attend school as long as he was well enough, the district superintendent decided he would have to attend class by phoning in. His parents sued in response.

As TIME remarked as the case progressed, relatively few people were directly impacted by the case: fewer than 200 school-age Americans had been diagnosed with AIDS at the time. Fear among parents, many of whom were unaware that HIV could not be transmitted through casual contact, was disproportionate.

A year later, in the fall of 1986, White started eighth grade, thanks to a court order — and, then and in the years that followed, he put a familiar face on a disease that had seemed to many Americans to be distant or foreign. The sympathetic story of a young boy who just wanted to go to school ended up helping all AIDS sufferers get a fairer shake; in 1990, for example, shortly after he died, Congress passed his namesake act, which helps Americans get medical care for the disease. As Rev. Ray Probasco, a family friend of the Whites’ who eulogized Ryan, put it:

”Not much was known about the disease back then. So very quickly a great deal of fear permeated Ryan’s community. At first, Ryan and the disease were perceived as one and the same. In time, we saw the boy and the disease, and they were not the same. It was Ryan who first humanized the disease called AIDS. He allowed us to see the boy who just wanted, more than anything else, to be like other children and to be able to go to school.

”And children began asking Ryan, ‘Are you afraid to die?’ And Ryan responded, ‘Everyone’s going to die. If I die, I know I’m going to a better place.’ I believe that God gave us [a] miracle in Ryan. He healed a wounded spirit in the world and made it whole.”

Read TIME’s original 1985 coverage of White’s attempt to attend school, here in the TIME Vault: The AIDS Issue Hits the Schools

TIME portfolio

A Powerful Look Inside Austerity-Hit Greece

This is a humbling, often intense, meditation on the fragility of social cohesion

When the European sovereign debt crisis hit in 2008, media commentary often focused on the fate of the so-called “PIIGS“. Namely, Portugal, Italy, Ireland, Greece and Spain. These were the countries saddled with the largest debt and slowest economic growth, and were the ones — excepting Spain and Italy — that received multi-billion dollar bailouts from the E.U. and International Monetary Fund. These emergency plans, it was said, would keep their economies afloat, but came with a caveat: governments would have to massively reduce spending in an effort to rein in their out-of-control finances.

The move was deeply unpopular. In Greece, austerity measures became associated with public sector layoffs, welfare cuts and later, to the rise of far right and far left political parties. In Ireland, large scale emigration and a collapsed property market dominated the national conversation, while Portugal dealt with mass youth unemployment.

Today, things have changed — at least for some. On paper, Lisbon and Dublin seem to be recovering, with their gradually rising credit ratings. But the situation in Athens often looks like it’s getting worse. Today, it is estimated that close to one million Greeks do not have access to healthcare — which has been linked to a rise in HIV infection, infant mortality and suicide rates — while 40 percent of Greek children live below the poverty line.

It is this Greece that photographer Angelos Tzortzinis set out to capture. Over the course of six years, he has documented the effects of austerity measures in his native country, one he says he no longer recognizes.

The images that have emerged are as powerful as they are shocking. The photographer shows us everything from charged Golden Dawn rallies to women working as prostitutes, and from immigrants seeking shelter to drug addicts in their bedrooms. This is a humbling, often intense, meditation on the fragility of apparent social cohesion and on the very real impact that political and economic policies can have on everyday life.

Angelos Tzortzinis is a photographer based in Athens

Richard Conway is a contributor for TIME LightBox

 

TIME Budget

Texas Measure Cuts HIV Funds, Boosts Abstinence Education

A Republican-sponsored measure has been tucked into the Texas budget to supplant funding for HIV prevention with abstinence education

(AUSTIN) — Texas would cut $3 million from programs to prevent HIV and other sexually transmitted diseases and spend that money instead on abstinence education under a contentious Republican-sponsored measure tucked into the state budget Tuesday night.

The GOP-controlled House overwhelmingly approved the budget amendment, but not before a tense exchange with Democrats that veered into the unusually personal.

Republican state Rep. Stuart Spitzer, a doctor and the amendment’s sponsor, at one point defended the change by telling the Texas House that he practiced abstinence until marriage. The first-term lawmaker said he hopes schoolchildren follow his example, saying, “What’s good for me is good for a lot of people.”

Democrat state Rep. Harold Dutton asked Spitzer if abstinence worked for him.

Shouts of “Decorum!” soon echoed on the House floor as Spitzer responded and the back-and-forth intensified. Efforts by Democrats to put the debate in writing for the record — usually a perfunctory request — failed.

The measure is a long way from final approval. It must still survive budget negotiations with the Senate, although that chamber is equally dominated by conservatives.

Texas in 2013 had the third-highest number of HIV diagnoses in the country, according to the federal Centers for Disease Control. Texas also has one of the highest teen birth rates, and its public schools are not required to teach sex education.

Another Republican-sponsored amendment that passed Tuesday night would prevent schools from distributing sex education materials from abortion providers.

TIME Infectious Disease

How an HIV Outbreak Hit the Heartland

TIME.com stock photos Health Syringe Needle
Elizabeth Renstrom—TIME

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

The number of HIV cases found in a remote Indiana county has grown to 120, according to numbers released Friday by the state’s health department, after 79 cases were confirmed there over the last few months. Ten additional cases are awaiting confirmation.

The dozens of cases, described as an epidemic, are centered in Scott County, about a half-hour north of Louisville with a population of about 25,000. Indiana Governor Mike Pence declared a public health emergency there in March after dozens of cases of HIV were discovered.

An outbreak of HIV may seem odd in such a remote part of the country, but it’s 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.”

Read next: At Least 120 Now Infected In Indiana HIV Outbreak

Listen to the most important stories of the day.

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

475180273
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.

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