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The Unexpected Public Health Emergency

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Jenna Tyler
September 18, 2015


Emergency managers and public health administrators are charged with identifying and predicting the threats and hazards that have the greatest probability of affecting their local jurisdiction. However, despite their education and experience, very few might have predicted that a localized drug abuse problem would escalate to a declared public health emergency that called for executive orders, the suspension of existing laws and a complex multiagency response. Yet a growing HIV outbreak turned this unexpected threat into a reality as a rural county in southeastern Indiana experienced more than 180 confirmed HIV cases in less than nine months.

The Event

TylerAccording to the Center for Disease Control and Prevention (CDC), the Indiana State Department of Health (ISDH) opened an ongoing investigation Jan. 23, 2015 after disease intervention specialists linked 11 confirmed HIV cases to Scott County, Indiana. With a population of less than 25,000 and a historical average of 5 HIV cases per year, the initial response by ISDH focused on interviewing the newly diagnosed individuals about their sexual behaviors and past drug abuse. These interviews led ISDH to conclude that a majority of the cases were caused by syringe –sharing partners injecting a prescription opioid called Opana.

By mid-March, the outbreak showed no end in sight. The ISDH reported 55 confirmed HIV cases. This prompted the Governor of Indiana to declare a public health emergency and sign Executive Order 15-05, which suspended current Indiana Code and legalized a short-term needle exchange program. This needle exchange program allowed injecting drug users to register with the local health department to obtain enough needles to last for one week and then required the injecting drug user to return their used needles in order to acquire new needles for the following week. Despite the controversial debate of the effectiveness of needle exchange programs, empirical studies  have found needle exchange programs to be quite effective in limiting the spread of blood-borne illnesses such as HIV.

The needle exchange program was housed within the Community Outreach Center which provided community members free HIV testing and vaccinations, as well as guidance on HIV prevention and treatment. Personnel from local health departments and ISDH staffed the Community Outreach Center while personnel from the CDC focused on patient tracing. Together, these entities strived to contain the outbreak and provide treatment for the individuals who tested positive for HIV.

Best Practices

The Scott County HIV outbreak is not simply a warning to the State of Indiana, but a warning to the entire nation. In fact, state health officials argue there is no distinct reason why the HIV outbreak occurred in Scott County, Indiana and claim it is only a matter of time before similar incidents develop across the country.

In the interest of this prediction, the following three actions should be considered best practices for similar public health emergencies.

1.      Establishing a Community Outreach Center 

The Community Outreach Center offered a centralized location for managing the incident and provided critical public services to community members all free of cost. In an effort to attract more community members, supporting state agencies were also stationed in the Community Outreach Center to help people obtain state-issued ID cards, birth certificates and enroll in a health insurance plan. This approach enabled a more coordinated and collaborative multiagency response.

2.      Engaging the Public

In order to stop the spread of HIV, response agencies had to ensure the public was aware of the incident and the consequences of not getting tested. As such, ISDH launched the You Are Not Alone campaign focusing on substance abuse, safe sex, needle disposal and HIV testing treatment. Additionally, the local health department identified many members did not have a means of transportation to participate in the needle-exchange program. As such, the local health department began operating a mobile needle-exchange program.

3.      Creating a Culture of Acceptance

From the start of this public health emergency, it was clear that in order to stop the spread of HIV, response organizations would have to create a culture of acceptance and attend to the needs of the public. Moreover, it was absolutely critical to establish a cooperative relationship built upon trust with community members. This meant proving that community members could openly admit to abusing prescription drugs without fear of arrest.


Indiana state health officials believe the Scott County HIV outbreak has reached its peak with the response efforts slowly dwindling. Now, it is up to the locals to recover to a community that fosters social resiliency. Keck and Sakdapolrak describe social resilience as the ability of communities to cope with and overcome adversities by learning from experiences to make adjustments that minimize the chances of reoccurrence. In the case of Scott County, building a socially resilient community rests in the hands of community members—not response agencies—who will have to decide if they will let this incident define them or transform them. 

Author: Jenna Tyler is a graduate student enrolled in the criminal justice and public safety program at Indiana University-Purdue University Indianapolis. Tyler can be reached at [email protected].

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