AUSTIN, Ind. — She became addicted to painkillers over a decade ago, when a car wreck left her with a broken back and doctors prescribed OxyContin during her recovery. Then came a new prescription opiate, Opana, easily obtained on the street and more potent when crushed, dissolved in water and injected. She did just that, many times a day, sometimes sharing needles with other addicts.
Last month, the thin, 45-year-old woman learned the unforgiving consequences. She tested positive for H.I.V., one of nearly 150 cases in this socially conservative, largely rural region just north of the Kentucky border. Now a life long hobbled by addiction is, like so many others here, consumed by fear.
She is afraid to start antiretroviral therapy because she does not want to be spotted entering the clinic on Main Street, she says, and afraid to learn her prognosis after hearing a rumor — false, it turns out — that someone else with the virus was given six months to live. Other drug users have refused to be tested at all.
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For now, the program here is giving out a maximum of 140 clean needles per user per week to whoever goes to the outreach center or accepts them from the roaming minivan. Ms. Combs said some people told her they injected as often as 15 times a day, and the exchange is erring on the side of providing slightly more than people need. She has passed out needles at a house where the owner, an older woman known as Momma, sits on the porch while a steady stream of visitors comes to shoot up inside. She has knocked on the door of a trailer where, she said, “multiple family members live and the daughters all prostitute themselves out and everyone is doing drugs.” One recent afternoon, on a street fragrant with lilacs, a young woman on a bicycle declined Ms. Combs’s offer of clean needles, saying she already had some — and H.I.V.
“I know I need the medicine to slow it down,” she murmured.
At a run-down house with a wheelchair on the porch, Tiffany Prater, 27, walked out to greet the van, saying, “The needles ain’t lasting me long enough.” She beckoned two men out of the house to get some, too.
“This little boy right here needs a card,” she told Ms. Combs, gesturing toward an expressionless friend whose eyes kept slipping shut. “You got some extra Neosporin and stuff? Because look how bad his arms is.”
The van moved on, stopping as someone yelled from a white house with a broad lawn. A woman in a pink tank top emerged, saying a neighbor had taken some of her clean needles and her daughter’s, too.
The daughter could not come out of the house — she had just injected and “can’t get up from the kitchen table,” the mother said. Ms. Combs gave the woman needles for her and her daughter.
“Spread the word that this white vehicle is a friendly mobile,” she said.
Opana remains easy to get, he added, a quarter of a pill selling for $40 — enough of a dose to ease his withdrawal symptoms and enable him to get out of bed.
One unexpected benefit of the H.I.V. outbreak, according to the woman who tested positive and fears starting treatment, is that the men who used to stream into town daily, seeking young female addicts who would prostitute themselves in exchange for drug money, have all but disappeared.
“It took H.I.V. to change our town,” she said. “Those of us who are affected are devastated, but I’m glad H.I.V. is here.”
