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Inside an epidemic: HIV outbreak brings massive cost

The largest HIV outbreak in state history includes a staggering price tag – and Hoosier taxpayers will be paying the bill for decades.
In southeast Indiana, signs of an HIV epidemic are everywhere.

The largest HIV outbreak in state history includes a staggering price tag – and Hoosier taxpayers will be paying the bill for decades.

SCOTT COUNTY, Ind. - In some southeast Indiana communities, the signs of an HIV epidemic are everywhere. Literally.Billboards along I-65 advise Hoosiers to get tested for HIV.

Posters around Scottsburg advertise the state's free testing program.

Signs along Main Street in Austin direct residents to free services and a needle exchange program at the city's community center.

Then there's the more subtle signs.

The dozens of "no trespassing" and "no loitering" signs that Austin homeowners have posted on their front porches and garages all over town are yet another troubling sign of the times in this rural Indiana community.

"The sign is there because they just wiped me clean," said Serena Deaton, pointing to a sign on her front porch. It warns: "No trespassing. Violators will be shot. Survivors will be shot again."

Deaton, a mother of four who moved to Austin six years ago, says she has been robbed several times in the past twelve months and that drug-addicted neighbors are to blame.

"I know who's doing it. They steal stuff and then they sell it to pay for their drug habit," said Deaton, who recently came home from work to find her three televisions had been stolen during a break in.

13 Investigates: Inside Indiana's HIV epidemic

She lives at the epicenter of the HIV epidemic, within blocks of the three homes where state investigators say a large number of drug users gathered and unknowingly infected each other with HIV by sharing used needles to inject the painkiller Opana. The drug users – and a growing number of prostitutes who solicit customers in Scott County – can frequently be seen roaming the streets in Austin. It's why the public park is often empty and why many parents in the town of 4,200 people don't let their kids play unattended in their own front yard.

"We don't go outside. My neighbors, we used to sit out on our porches all the time, and now we're terrified to even sit on our porches," Deaton told WTHR.

The epidemic facing the town has already taken a heavy toll. But 13 Investigates has learned the real cost is still ahead, and it's a cost Indiana taxpayers will be paying for a very long time.

A million dollars per case

Local, state and federal health agencies have mobilized a massive response to Indiana's epidemic. It includes an incredible amount of resources – both money and people – to investigate every new case of HIV, to provide services to those impacted, and to slow an outbreak that has already infected more than 150 people.

The Indiana State Department of Health says, to date, it has spent more than a half million dollars on its HIV response. $277,000 has been spent on medical supplies, contract employees and the lease on Austin's Community Outreach Center, where ISDH is operating a needle exchange program and a 1-stop service center for residents impacted by the outbreak.

"We expect this number to rise over time," said ISDH public affairs director Amy Reel, adding that the state has spent an additional $226,000 on an HIV awareness campaign in southeastern Indiana.

But those costs are relatively minor compared to the healthcare costs the state will face in the coming months and years.

"HIV is a life changing diagnosis," explained Dr. Jennifer Walthall, deputy health commissioner at the Indiana State Department of Health. "And HIV is a very expensive disease process to take care of."

A diagnosis of HIV used to mean a death sentence, with HIV soon developing into AIDS that killed patients within just a few years.

Times have drastically changed, said Beth Myerson, an HIV policy expert at the IU School of Public Health and co-director of the Rural Center for AIDS/STD Prevention.

"Now you could live many, many years which is good news. It also means you're going to have an expense piece to that," Myerson said. "Even if you're just talking about the management of HIV, just medical alone -- forget transportation to the doctor to get the medicine, anything else -- hundreds of thousands of dollars per year per person is what we're talking for antiretroviral treatment."

Those are just the initial costs of medication to suppress HIV. The longterm costs are much higher, according to Dr. Kevin Burke, the medical director of Indiana's southeast region AIDS/STD testing and detection center.

"It's an extremely expensive situation for our state government and local government. An HIV patient lives on an average 25 years, so there's about a half million dollars of cost related to their healthcare, said Burke. "And many of them will end up living on public assistance and welfare, and that takes about $400,000-500,000 to support them for 25 years. So you're looking at a cost to the state of just under a million."

That's about a million dollars for each patient diagnosed with HIV. As of Thursday night, ISDH says 160 people have been diagnosed with the disease in southeast Indiana. Over the longterm, that translates into an epidemic that will cost at least $160 million in public funds for patient healthcare alone.

And that estimate is on the low end.

Costs still rising

While reports of new HIV cases have slowed in recent weeks, the number of new HIV diagnosis is still rising. Officials at the regional HIV detection center predict as many as 180-200 Hoosiers in southeast Indiana may test HIV-positive by summer. And it is unknown how many infected Scott County residents have yet to come forward for testing.

"Not everybody wants to get tested because they're afraid what they'll find out," an intravenous drug user in Austin told 13 Investigates. She agreed to talk with WTHR on the condition that her identity not be released. "I don't want to know and a lot of the people I'm with don't want to know. I'm pretty sure there are more [cases], but it's kind of scary to get tested, you know?"

There is also a rampant increase in Hepatitis C cases in southeastern Indiana, also linked to injection drug use and needle sharing. A 3-month supply of anti-viral medication to treat that disease can cost upwards of an additional $100,000 per patient.

Looking at all aspects of the outbreak, some healthcare experts say this epidemic could ultimately cost Indiana more than a $250,000,000. They say most of that money could have been saved if the state had invested earlier in public healthcare.

"Here in Indiana, we have the most poorly funded public healthcare infrastructure in the nation," said Dr. Shane Avery, a Scottsburg physician who diagnosed the epidemic's first two HIV cases in December. "The state health department is not funded well enough to do its job properly and local health departments cannot do their job properly. If that doesn't change, I fear we may be on the verge on a much bigger epidemic."

Myerson agrees.

"I'd imagine if we were to ask Scott County in five years ‘How you doing?' I think they'll talk about serious challenges just in maintaining the health of the population that is now HIV positive," she said. "This is a really big deal. An ounce of prevention is worth much more than a pound of cure."

13 Investigates: Inside Indiana's HIV epidemic

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