State on alert after HIV outbreak in Indiana

DES MOINES — An outbreak of HIV cases in rural Indiana delivers a dire warning to states with similar rural pockets, such as Iowa, even as the number of newly diagnosed Iowans fell sharply last year.

Roughly 170 people this year in one Indiana county have tested positive for HIV. It is the largest outbreak in the state's history.

The outbreak is believed to have spread by drug users in rural southern Indiana sharing needles.

The number of new HIV diagnoses in Iowa dropped 19 percent from 2013 to 2014. But Randy Mayer, the state's HIV/AIDS/STD bureau chief, cautioned that number could rebound slightly next year while continuing a general downward trend.

Mayer also said the state is on full alert for breakouts such as Indiana's.

'I think there's a possibility for something like that in any state that has any rural community with large injection drug use,' Mayer said.

Drops and Shake-ups

In 2013, there were 122 new HIV diagnoses in Iowa. That fell in 2014 to 99, the lowest in at least a decade.

Mayer believes there is a gradual trend of fewer new diagnoses in Iowa each year, but he suspects the drop between 2013 and 2014 will prove to be abnormally large.

There was a similarly steep drop from 2007 to 2008, but Mayer said that was due to a significant percentage of the population not getting tested due to the floods in Cedar Rapids.

Mayer was not sure how to explain the dramatic drop in new diagnoses in 2014. He said one possibility is the shake-up of medical care under the new federal health care law.

'In 2014 you had the Affordable Care Act implemented at its peak, so you have to wonder, might there have been some influence with people changing medical providers …

or medical providers not testing,' Mayer said.

Mayer believes it is likely the number of HIV diagnoses will increase from 2014 to 2015, but remain on an overall downward trend. He noted the long-term trend has shown fewer diagnoses since peaking at more than 120 in 2009.

'We saw a (near) 20 percent decrease in diagnoses (in 2014). That's way too much. We're already seeing some evidence it will come back up closer to where it was,' Mayer said.

'I expect them to come up, but hopefully not as high as in the past.'

Sharing Needles

The hardest-hit area by the HIV outbreak in Indiana was Scott County, near the state's southern border, just 40 miles north of Louisville, Ky.

The area previously had never reported more than five HIV cases in a single year.

The culprit: drug users sharing needles.

Mayer said there are known pockets of injection drug users in Iowa, and his department closely is monitoring those areas for warnings signs of a similar outbreak here.

'We have some anecdotal evidence of drug use and increased positive (testing) for hepatitis C in parts of the state,' Mayer said. 'And we've been hearing from substance abuse treatment providers that they've seen an increase in the use of heroin and other opiate drugs.'

Mayer said whenever an injection drug user is diagnosed with hepatitis C — which can be transmitted similarly to and sometimes at the same time as HIV — 'my staff's alarm bells go off we monitor the situation.'

'Hopefully we have the services provided and we are being vigilant so we would be able to contain an epidemic that could start among that population,' Mayer added.

Vigilance could help stem an outbreak before it gets started, he said.

'Especially with injection drug users, just watching that population closely. When we get one injection drug user gets diagnosed, getting to them quickly, making sure (he or she) gets tested, making sure we get all the (sexual) partners tested,' Mayer said.

If Iowa can avoid an outbreak similar to what happened in Indiana, Mayer hopes the state will continue on that downward trend of new diagnoses. He said the federal government's analysis suggests Iowa has passed its 'tipping point' of new diagnoses, and that those numbers should continue to drop over the long-term.

'We've been containing things. We've been expecting or hoping we'd see some decreases in diagnoses,' Mayer said. 'I think we're actually there.'