--- description: Drug abuse combined with a spotty public health system are to blame for Indiana's public health emergency title: How an HIV Outbreak Hit the Heartland image: https://static.time.com/v3/assets/bltea6093859af6183b/blt72d574357b555cac/6987789b3c1639079745105c/health-syringe-needle-6.jpg?branch=production&width=3840&quality=75&auto=webp&crop=16:9 ---  * [Health](/section/health/) ## Health Update your preferences in [Account Settings](/account/preferences/) Close * [Infectious Disease](/tag/infectious-disease/) ## Infectious Disease Update your preferences in [Account Settings](/account/preferences/) Close # How an HIV Outbreak Hit the Heartland by [Josh Sanburn](/author/josh-sanburn/) ## Josh Sanburn Update your preferences in [Account Settings](/account/preferences/) Close Updated: Dec 13, 2023 2:19 PM CUTPublished: Mar 27, 2015 3:48 PM CUT  Elizabeth Renstrom—TIME by [Josh Sanburn](/author/josh-sanburn/) ## Josh Sanburn Update your preferences in [Account Settings](/account/preferences/) Close Updated: Dec 13, 2023 2:19 PM CUTPublished: Mar 27, 2015 3:48 PM CUT The number of HIV cases found in a remote Indiana county has grown to 120, according to [numbers released Friday](http://time.com/3826336/indiana-hiv-outbreak-grows/ "undefined") 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](http://time.com/3759280/indiana-hiv-public-health-emergency-drugs/ "undefined") 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](http://time.com/wp-content/uploads/2015/03/ser%5Fdrug%5Fdeaths%5Findiana.pdf "undefined") 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](http://time.com/wp-content/uploads/2014/08/tfah2013invstgamrcshlth05%5Ffinal.pdf "undefined") 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](https://www.aids.gov/hiv-aids-basics/staying-healthy-with-hiv-aids/potential-related-health-problems/hepatitis/ "undefined"). 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_](http://www.indystar.com/story/news/politics/2015/03/25/gov-pence-visit-indiana-county-hiv-outbreak/70427432/ "undefined"). “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](http://time.com/3660564/contraceptives-hiv-risk/?iid=time%5Fspeed "undefined") 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_](http://time.com/3826336/indiana-hiv-outbreak-grows/?iid=time%5Freadnext "undefined") ### The Photo That Changed the Face of AIDS  David Kirby on his deathbed, Ohio, 1990. Therese Frare  In another of Therese Frare's photos taken in the final moments of David Kirby's life, his caregiver and friend, Peta; David's father; and David's sister, Susan, say goodbye. Therese Frare  Bill Kirby tries to comfort his dying son, David, 1990. Therese Frare  A nurse at Pater Noster House in Ohio holds David Kirby's hands not long before he died, spring 1990. Therese Frare  David Kirby, Ohio, 1990. Therese Frare  David Kirby's mother, Kay, holds a photograph of her son -- taken by Ohio photographer Art Smith -- before AIDS took its toll. Therese Frare  Peta, a volunteer at Pater Noster House in Ohio, cares for a dying David Kirby, 1990. Therese Frare  Peta lies on a couch in a home rented by Pater Noster House, 1991\. After the infamous ad ran, Benetton donated money to Pater Noster, some of which was used to furnish the house where Peta and other patients stayed. Therese Frare  Peta on the Pine Ridge Indian Reservation, July 1991\. "Peta could be a handful at times," Therese Frare told LIFE.com, "but there was a great deal of joy in our relationship. He wasn't like anyone I'd ever met." Therese Frare  Peta swims in a lake on the Pine Ridge (Lakota) Indian Reservation in South Dakota, during a trip home with photographer Therese Frare in July 1991. Therese Frare  Peta at the Pine Ridge (Lakota) Indian Reservation in South Dakota, during a trip home with Therese Frare in July 1991. Therese Frare  Peta in Ohio, 1991. Therese Frare  Peta in bed at Pater Noster House, 1992. Therese Frare  Scene at Pater Noster House, Ohio, 1991. Therese Frare  Peta at Pater Noster House, 1992. Therese Frare  Peta with Bill and Kay Kirby at Pater Noster House, 1992\. "I made up my mind," Kay Kirby said, "when David was dying and Peta was helping to care for him, that when Peta's time came -- and we all knew it would come -- that we would care for him. There was never any question. We were going to take care of Peta. That was that." Therese Frare  Kay Kirby administers medicine to Peta via an IV, 1992. Therese Frare  Peta and Bill Kirby share a quiet moment together in Peta's room, Ohio, 1992. Therese Frare  Peta in hospice, Columbus, Ohio, 1992. Therese Frare  Bill and Kay Kirby, 1992. Therese Frare [_Listen to the most important stories of the day._](http://time.com/newsletter/the-brief/autoplay/?xid=spl-fullbrief-article "undefined") ```json [{"@context":"https://schema.org","@type":"NewsArticle","@id":"https://time.com/3761476/indiana-hiv-outbreak-epidemic-mike-pence/","mainEntityOfPage":{"@type":"WebPage","@id":"https://time.com/3761476/indiana-hiv-outbreak-epidemic-mike-pence/"},"headline":"How an HIV Outbreak Hit the Heartland","datePublished":"2015-03-27T15:48:18.000Z","dateModified":"2023-12-13T14:19:01.000Z","description":"Drug abuse combined with a spotty public health system are to blame for Indiana's public health emergency","url":"https://time.com/3761476/indiana-hiv-outbreak-epidemic-mike-pence/","keywords":["Infectious Disease","Heroin","health","HIV","Aids","Indiana","outbreak","epidemic"],"thumbnailUrl":"https://static.time.com/v3/assets/bltea6093859af6183b/blt72d574357b555cac/6987789b3c1639079745105c/health-syringe-needle-6.jpg?branch=production&width=1200&quality=75&auto=webp&crop=1200:675&height=675","author":[{"@type":"Person","name":"Josh Sanburn","jobTitle":null,"url":"https://time.com/author/josh-sanburn/"}],"articleSection":"Health","image":[{"@type":"ImageObject","url":"https://static.time.com/v3/assets/bltea6093859af6183b/blt72d574357b555cac/6987789b3c1639079745105c/health-syringe-needle-6.jpg?branch=production&width=1200&quality=75&auto=webp&crop=1200:675&height=675","width":1200,"height":675,"headline":"TIME.com stock photos Health Syringe Needle","caption":"TIME.com stock photos Health Syringe Needle","creditText":"Elizabeth Renstrom—TIME","representativeOfPage":true}],"publisher":{"@type":"Organization","name":"Time","url":"https://time.com/","logo":{"@type":"ImageObject","url":"https://time.com/images/logo.png","width":528,"height":156},"foundingDate":"March 3, 1923","sameAs":["https://www.facebook.com/time","https://www.instagram.com/time/?hl=en","https://twitter.com/time","https://www.pinterest.com/timemagazine"]}},{"@context":"https://schema.org","@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"item":{"@id":"/section/health/","name":"Health"}},{"@type":"ListItem","position":2,"item":{"@id":"/tag/infectious-disease/","name":"Infectious Disease"}},{"@type":"ListItem","position":3,"item":{"@id":"https://time.com/3761476/indiana-hiv-outbreak-epidemic-mike-pence/","name":"How an HIV Outbreak Hit the Heartland"}}]}] ```