HIV in Scott County, Indiana

This story is part of NPR's podcast Embedded, which digs deep into the stories behind the news.

Sitting on a dresser in the back bedroom of a house in Austin, Ind., is the bottom of a soda can. A woman places a sliver of a pill, a powerful prescription opioid called Opana, on the jagged half-can. She begins to heat the pill with a cigarette lighter, melting its hard white coating and turning it the color of whiskey.

Her name is Joy.

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Four days a week, public health nurse Brittany Combs drives her SUV around the small town of Austin, Indiana, handing out clean needles to injection drug users and talking to people about going to rehab.

It’s a task that can be rewarding—when one of her customers finally wants help to get off drugs—and a bit agonizing, because there’s often not a rehab bed ready for them.


This story is part of NPR's podcast Embedded, which digs deep into the stories behind the news.

In the spring of 2015, something was unfolding in Austin, Ind.

Seth Herald / Side Effects Public Media

Amid fears that providing free, clean needles would promote illegal drug use, Congress passed a law prohibiting the use of federal funds to support needle exchange programs in 1988. But at the end of last year, lawmakers effectively ended that ban.

What Have We Learned From The Indiana HIV Outbreak?

Oct 2, 2015
Scott County public health nurse Brittany Combs distributes clean syringes from the back of a van in June 2015
Seth Herald

When an outbreak of HIV among injection drug users was declared in rural Scott County, Indiana, in February, it made national headlines. HIV was supposed to be an urban problem, and AIDS had been in steady decline among IV drug users since the early 90s. 

Daniel Raymond, policy director at the national Harm Reduction Coalition, says the Scott County outbreak, which infected 181 people, was a “wake up call” for communities around the country who are dealing with rising rates of hepatitis C, ongoing prescription opioid addiction, and increasing abuse of heroin.

Seth Herald/Side Effects

This episode of Sick, a new podcast from Side Effects Public Media, tells the story of Kevin Polly, a man who has to leave his town behind in order to save his own life. 

In February, the Indiana State Department of Health announced an HIV outbreak in rural Scott County. Thirty people had tested positive just since December, and most of the cases were linked to injection drug abuse of a potent prescription opioid called Opana. Since then, the number of cases has grown to more than 170.

Seth Herald

If a town could be said to hit rock bottom, Austin, Indiana, did so this year. Drug abuse has been out of hand there for some time, but it took the worst possible outcome to make the Southern Indiana community of 4,200 wake up to the problem: more than 170 newly identified cases of HIV since December 2014, spread almost entirely by needle-sharing.


Seth Herald

Getting Right, Part 2

Read our entire Getting Right series.

Heading out into the field, public health nurse Brittany Combs is a little angry, and in a hurry. Driving the county’s mobile needle exchange through Austin, Indiana can be hectic. Today she’s on a mission to find Jessica, a young mother who wants to go to rehab. But Brittany keeps getting interrupted.

“I’m supposed to be going to get Jessica right now,” she says as she pulls out of the community center, where the needle exchange is based. ”I told her I’d be there at three. Well, that’s not gonna happen.”


Seth Herald

Getting Right, Part 3

Read the whole Getting Right series.

On a recent Thursday afternoon, Police Chief Don Spicer is on patrol in Austin, Indiana. He drives through the northern part of town, where dilapidated houses are interspersed among tidy ones with manicured lawns.


Seth Herald

Getting Right, Part 4: An Addict Wakes Up

Read the entire Getting Right series.

It’s early in the morning, and Kevin Polly is getting ready to go. His daughter has called to wish him well, and when he gets off the phone, he excuses himself. Before he leaves, he has to get right.

One last shot—that’s the hope, anyway.


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