XPost: alt.politics, alt.homosexual, alt.politics.obama   
   XPost: seattle.business   
   From: murray@seattle.gov   
      
   White alone - 4,124 (96.0%)   
      
   Union worker white trash pieces of shit.  Real smart.  That's   
   what they're doing with the union payoff money they got for   
   voting Obama.  You stupid fucks are dead meat.   
      
   AUSTIN, Ind. — Jeanni McCarty, a nurse and native of this   
   threadbare city of 4,200, hurried up and down Main Street in   
   Saturday’s bright sun, handing out stacks of fliers to any   
   business that would take them. They were announcing a hastily   
   planned specialty clinic — FREE, they emphasized in red — that   
   would provide H.I.V. treatment to anyone who needed it.   
      
   Quite suddenly, a lot of people around here do. And the number   
   keeps growing.   
      
   More than 80 people in Scott County have tested positive for   
   H.I.V. since December, mostly in the last few weeks. They range   
   in age from 20 to 56, and health officials say almost all of   
   them live in Austin, which sits along Interstate 65 about 80   
   miles south of Indianapolis, surrounded by rural space. The   
   outbreak, the worst in Indiana’s history, stems largely from the   
   intravenous use of the prescription painkiller Opana, which   
   everyone from the police to pastors to the owner of the city’s   
   sole grocery recognizes as a plague on one ragged neighborhood   
   in particular.   
      
   Gov. Mike Pence declared a public health emergency in the county   
   on Thursday, and against his political beliefs, he also   
   authorized a short-term needle-exchange program last week in   
   hopes of stopping transmission of the virus through contaminated   
   needles.   
      
   Ms. McCarty and her boss, Dr. William Cooke, the city’s only   
   physician, have been at the forefront of a whirlwind response   
   effort. Dr. Cooke’s medical practice, Foundations Family   
   Medicine, will house the new clinic, with infectious disease   
   specialists from Indiana University coming once a week along   
   with mental health counselors and addiction specialists.   
      
   The weekly clinic will open on Tuesday, with six of Dr. Cooke’s   
   15 exam rooms devoted to it. Teams of state workers from   
   Indianapolis will be on hand to sign up uninsured patients for   
   Medicaid, which Governor Pence, a Republican, recently expanded   
   under the Affordable Care Act to cover most low-income adults.   
      
   The questions now are how many of the newly infected will show   
   up — and whether the effort, which is being led by the Indiana   
   State Department of Health and involves the federal Centers for   
   Disease Control and Prevention, will keep the number of new   
   cases from spiraling further.   
      
   “I really, truly don’t know what to expect,” an exhausted Ms.   
   McCarty said after distributing the fliers. “Even if only a   
   couple come, that’s more than we had before and then maybe they   
   can talk others into it.” Several worried people asked for   
   H.I.V. tests on the spot.   
      
   The outbreak here was detected because Indiana requires newly   
   confirmed cases of H.I.V., the virus that causes AIDS, to be   
   reported to state health officials. It is jolting not only   
   because national rates of H.I.V. diagnosis have remained stable   
   or even decreased in recent years, but because the virus is a   
   largely urban problem. Only about 6 percent of new diagnoses in   
   2013 were in counties with fewer than 50,000 people, according   
   to the C.D.C.   
      
   One of the only other rural outbreaks to draw national attention   
   took place in Belle Glade, Fla., where in 1985 researchers found   
   an infection rate higher than New York City’s or San Francisco’s.   
      
   There is reason for urgency. The transmission rate has been   
   about 80 percent, Dr. Cooke said, meaning that eight in 10 of   
   those who have acknowledged sharing needles with someone who has   
   the virus have tested positive. That indicates “a very high   
   viral load in the community right now,” he said.   
      
   Health officials from nearby Clark County, which handles H.I.V.   
   testing in 11 counties, have been going out since February to   
   test people at their homes, using oral swabs that deliver   
   preliminary results in 20 minutes and asking those who are   
   tested to disclose any needle-sharing and sexual partners.   
      
   For the last week, a team from the C.D.C. has been helping with   
   that work; a spokeswoman for the agency said it was not aware of   
   any other jurisdiction’s ever declaring a public health   
   emergency because of an H.I.V. outbreak.   
      
   For those who are H.I.V. positive, case managers have been   
   assigned on the spot to help arrange counseling and treatment.   
   But most have not started treatment yet, partly because the   
   closest H.I.V. clinic is in Louisville, Ky., about 35 miles   
   south of here.   
      
   “Our first three, we had appointments for them at the Louisville   
   clinic, and to a person, none of them showed up,” said Dr. Kevin   
   Burke, the public health officer who oversees H.I.V. testing in   
   the region. “That may be fatalism. But at the same time, this   
   population doesn’t have reliable transportation.”   
      
   Some will not be coming to the clinic for now because they are   
   in the Scott County jail. Sheriff Dan McClain said that 11 of   
   his 120 inmates had tested positive so far, but that they had   
   not started treatment because the cost is so high — upward of   
   $20,000 a year per patient, according to Dr. Burke — and he   
   wants a guarantee of financing first.   
      
   “That’s a discussion I’ve had with the governor,” Sheriff   
   McClain said. “Once we get that support, we’ll screen whoever   
   comes through our doors, medicate them, educate them and   
   eventually refer them over to Dr. Cooke.”   
      
   For now, only inmates identified as having shared needles or   
   having had sex with someone who has tested positive are being   
   screened, he said.   
      
   “Most of them take it no differently from somebody telling them   
   they have a cold,” the sheriff added. “They’re resigned to the   
   addiction.”   
      
   That is where the needle exchange may prove crucial to the   
   containment effort, he and others said, although many believe   
   that 30 days — the length of time Governor Pence authorized it   
   for — will not be nearly long enough. The clinic will also help   
   those who are willing get into detoxification and addiction   
   treatment programs, Dr. Cooke said.   
      
   To understand how this could happen in Austin, or perhaps any   
   small, poor, insular American town, is to take a drive with   
   Donald Spicer, the city’s longtime police chief, through a   
   neighborhood known as the North End. There, people in their 20s   
   wandered the streets one afternoon last week, alone or in small   
   groups, often averting their eyes as the police cruiser passed.   
   “No trespassing” signs were posted in most yards, and many were   
   strewn with ragtag furniture and trash. As many as two-thirds of   
   the modest homes are rented out, Chief Spicer said, and they are   
   often neglected to the point of crumbling.   
      
   “We have houses I like to refer to as shooting galleries, where   
   they all lay around and get high all day,” he said.   
      
   Addicts have long crushed narcotic pills and combined them with   
   liquid to inject directly into their veins. And while the makers   
   of Opana reformulated it in 2012 to make it harder to abuse,   
   many addicts still manage to do so.   
      
      
   [continued in next message]   
      
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