Indiana HIV Outbreak Continues to Grow

By Jamie Friedlander

Southeastern Indiana health officials confirmed today an HIV outbreak there continues unabated. As of March 6 there are 44 confirmed and 11 preliminary cases of HIV. The outbreak is connected to injection of the prescription drug Opana, an opioid painkiller that contains oxymorphone, a narcotic pain reliever.

State officials first reported the outbreak Feb. 25, after identifying  26 confirmed and 4 preliminary HIV positive cases since mid-December. These cases have been reported in Scott, Clark, Jackson, Perry and Washington counties.

According to Jennifer Walthall, deputy health commissioner for the Indiana State Department of Health, the outbreak is particularly challenging because it is occurring among substance abusers.

From Jan. 1 to Dec. 31, 2014, Scott, Jackson, Perry and Washington counties each saw fewer than 5 cases of HIV, while Clark saw 12 cases. In the first few months of 2015 alone, these 5 counties combined have seen 44 confirmed positive HIV cases. (Indiana State Department of Health, Jamie Friedlander/Medill)

“As you can imagine, an outbreak of unexpected cases of HIV in and of itself is concerning,” said Walthall. “All of the cases are linked to injection drug abuse, which adds layers of additional resources that need to be provided to persons who have acquired this disease. It makes investigation of spread different and challenging.”

Some individuals also reported sexual intercourse as a possible mode of transmission, according to a press release from the Indiana State Department of Health.

An outbreak means there is an occurrence of disease in excess of what would be expected in a particular region. As of Dec. 31, 2014, Scott, Jackson, Perry and Washington counties each reported fewer than five new cases of HIV during the previous year, while Clark County reported 12. These five counties combined have already seen 44 confirmed new cases in just the last few months.

“I think what we should be paying attention to is that this could potentially have been prevented through safe needle exchange or safe access to clean needles so that people don’t need to share or reuse their needles,” said Daliah Mehdi, the chief clinical officer at the AIDS Foundation of Chicago.

In Illinois, people 18 and older must be allowed to purchase up to 20 hypodermic syringes from a pharmacy under the Hypodermic Syringes and Needles Act, which was implemented to give injection drug users a source of safe, clean needles.  In Indiana, pharmacists have discretion over whether to sell hypodermic needles to residents.

Walthall said the number of future cases is uncertain. “I can’t necessarily speculate on the parameters or perimeter of where this particular outbreak will stop,” she said. “I do know that we are being very vigilant about finding every possible contact of positive individuals.”

“HIV has not gone away. It is very much still an epidemic that we are in the middle of.”

– Daliah Mehdi, AIDS Foundation of Chicago

“HIV has not gone away,” said Mehdi. “It is very much still an epidemic that we are in the middle of. We are at the point where we have more prevention options available to us and so we need to make sure people have access to every prevention method that we know of.”

Health officials in Southeastern Indiana now report 44 confirmed cases of HIV as part of the recent outbreak there. (Steven Depolo/Creative Commons)