MELISSA BLOCK, HOST:
The drug tied to Indiana's HIV outbreak is the opioid painkiller Opana. Health officials have reported instances of multigenerational abuse - as many as three generations of one family injecting Opana together, using the same needle. This week the state's Republican governor extended an executive order that allows for a temporary needle exchange through the end of May in Scott County, the epicenter of the HIV epidemic. Earlier I spoke with Indiana's State Health Commissioner Dr. Jerome Adams, and he told me, prior to the outbreak, there were very few doctors in the county - none of whom were comfortable treating patients with HIV.
JEROME ADAMS: A lot of the older doctors in particular have not been trained in treating HIV patients. This is not your mother or your father's HIV. I grew up in the Ryan White era. HIV was a death sentence. The prescribing was very complicated. Now we've got one-day regimens. And people, if they get promptly into treatment, have a life expectancy that can exceed 70 years of age. And so it's important that doctors understand HIV is not a death sentence, treatment is not as complicated as it once was, and we can get pretty much any doctor up to speed pretty quickly in terms of caring for patients for HIV.
BLOCK: Let me ask you a bit about the needle exchange that's in place for at least 30 days. At this point, if Indiana's governor, Mike Pence, were to come to you and say, you're a doctor. You're in charge of public health. We have an HIV epidemic. We also have a prescription drug abuse epidemic. Should the needle exchange program be made permanent to stop the vector? Would you tell him yes or no?
ADAMS: Well, one of the lessons we've learn from this is that, for as many people locally that are in favor of needle exchange, there is many people who are against it. And I'll tell you exactly what I told the governor, and he agrees with this - that anything that were to happen going forward would need to be something that empowered the locals to make that request. And anything that would happen going forward would need to happen in concert with comprehensive services.
BLOCK: Do you think you can stop the HIV outbreak there in Indiana if people are still using dirty needles, if there is no needle exchange program?
ADAMS: I think that if we do all the things that we have put in place and that we know we can do then I'm confident we can stop this HIV outbreak.
BLOCK: Help me understand that epidemiologically. If you have people in Indiana who are HIV-positive, who are sharing dirty needles, how do you keep the epidemic from spreading?
ADAMS: Well, there is a couple of components to that. One way you can keep people from spreading HIV is to get them into treatment so that their viral load is down. Another way you can stop people from spreading the disease is education about the risk of sharing dirty needles so that you lower the number of people who are using dirty needles. A third way is to get people into treatment so that you have fewer and fewer people who are actually using drugs and injecting IV drugs as a means to treat what in many cases is a mental health illness. And that leads to the other aspect is making sure we have a focus on getting people in for treatment for depression, for mental illness, so that they don't turn to those drugs. So it's not that I or the governor are against a needle exchange, but there are so many other things that have to take place to make it successful and make it sustainable that I just worry about this continual focus on needle exchange alone.
BLOCK: How much are you dealing with stigma in the community around HIV and people's willingness to come forward about both drug abuse and HIV infection?
ADAMS: Stigma is huge, particularly in a small town or in a rural area where everyone knows everyone. And again, this is not your mother or your father's HIV. HIV used to be thought of as being spread primarily through sexual transmission and, quite frankly, thought of as being spread only through homosexual men. We're finding that more and more of HIV - getting close to 50 percent - is spread through heterosexual contact, and that, again, the amount that's being spread through IV drug use is increasing.
BLOCK: I want to run a question by you that was sent to me by a doctor who has been treating what he calls a steady stream of young people who are injecting this drug, Opana - not in Indiana, but elsewhere. And he asks this, why is this drug still on the market?
ADAMS: I think that's a wonderful question. I know several people were concerned about it when it came out. But I also would say that taking it off the market doesn't necessarily fix the problem because it's like playing Whac-A-Mole. If it's not Opana it's going to be something else. I don't think going after individual drugs and taking them off the market is going to stop someone who wants to get high from getting high.
BLOCK: There's been a lot of focus on this rural county there in southern Indiana, Scott County. How worried are you about this spreading well beyond Scott County to other parts of the state and to real population centers?
ADAMS: We're extremely worried. And that's why we have disease investigation specialists from the CDC and we're bringing in specialists from other states to come in and help us. We really want to make sure we get all of our contacts traced.
BLOCK: You're talking about people who would have shared needles with people who are infected or had sex with people who are infected?
ADAMS: Either shared needles or had unprotected sex. So far we have 394 total contacts linked to the outbreak and just over 100 remaining to be contacted and investigated. But if we can quickly get to all of those contacts and make sure that we get them on the pathway to recovery and treatment, then we'll be able to contain this outbreak.
BLOCK: Well, Dr. Adams, thanks very much for talking with us today.
ADAMS: Thank you very much, Melissa. I appreciate the opportunity.
BLOCK: That's Dr. Jerome Adams. He is the state health commissioner for Indiana. Transcript provided by NPR, Copyright NPR.