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.
The event made international news, from The New York Times to the BBC, which called it “one of the most alarming HIV outbreaks in America in recent history.” Indiana Governor Mike Pence declared a public health emergency, and state and federal officials led a response effort to control the epidemic.
But for locals, the real work of change and recovery is just beginning. Facing the problem is always the first step, and there are signs of hope in Austin. The following series of profiles—produced by Side Effects Public Media, photographed by Seth Herald, and adapted by IM—document the lives of Austin residents coping with the unprecedented crisis firsthand.
An Addict Wakes Up
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.
After a few minutes in a dark bedroom, Kevin comes out. He combs his hair and packs some clothing in a garbage bag. He gets in the car with his father, Clyde, and heads south toward the rehab facility.
Kevin’s been to rehab before, but never by choice.
“I’ve got an anxious feeling right now,” he says. “I guess that makes sense, though.”
Kevin is 49 years old. Until recently, he lived with his dad and a collection of other drug users who cycle through the house.
Like many in Austin, Kevin’s drug of choice is a powerful prescription opioid called Opana. Across the country, heroin use is on the rise. But prescription drug abuse is still more common, and in Austin, it’s all about these pills. Most users turn to heroin only when Opana is too expensive.
Opana users here say no one’s actually getting high anymore. People are chasing the feeling they got when they first used the drug, but it doesn’t come back.
And Opana doesn’t let go.
“It’s sick, it really is,” says Kevin. “It’s a sickness. It’s really bad. I don’t get high. I can get high, but it takes hundreds of dollars to get me high. I just get what I call normal. I can’t get out of bed without a little something.”
Kevin started using drugs when he was 13. It started with drinking and marijuana, and as he got older he moved on to OxyContin, another powerful opioid. He would crush the pills and snort them.
“I was mostly ignorant to the HIV, because who thinks it’s going to happen to them? We’re in a small town. That only happens in a big city, right? Wrong.”
Kevin is 49 years old. Until recently, he lived with his dad and a series of other drug users who cycle through the house to help pay the rent.
“It went from every other day to once a day, to … every chance I got. At one time, I was injecting 10, 15 times a day, at least,” he recalls.
A few years ago, OxyContin was reformulated. The new Oxy is impossible to inject or snort. So Kevin made the switch to Opana. “When I first done the OxyContin, [I thought] there can’t possibly be anything better,” he says. “Wrong. Opana is much … ‘better’ is a bad choice of words. But stronger, I guess you’ll say. And the withdrawal is a lot worse.”
In 2012, the manufacturer of Opana tried reformulating, too, but it didn’t work. Addicts discovered that if you cook it first, you can still inject it. So Kevin stayed locked in his cycle of using, looking for a way to get his next shot, and using again.
A few months ago, Kevin got a letter in the mail. It stated that someone he knew had tested positive for an infectious disease and reported that they had shared needles.
Kevin went in the next day to the clinic and tested positive for HIV.
“It was devastating news. You’re not prepared … I was mostly ignorant to the HIV, because who thinks it’s going to happen to them? We’re in a small town. That only happens in a big city, right? Wrong.”
Even knowing he was HIV positive wasn’t enough to get Kevin to quit using. But then he got another call from his doctor and found out just how bad it was.
She told him he had liver disease, likely caused by hepatitis C. And his HIV was advanced—technically, he had AIDS. His immune system was weak. Illnesses his body would normally shrug off could kill him.
But Kevin wanted to live. His doctor told him: Get off of drugs, and get on a treatment regimen to keep the virus at bay.
Kevin decided to go to rehab.
Usually, there was a long waiting list at the rehab facility, which is located 40 miles south of Austin. Sometimes, by the time an addict got accepted into the program, they had lost their resolve to quit.
But after the outbreak, the facility began giving priority to Austin residents, especially those with HIV.
A couple days later, Kevin had a bed reserved for him. He would start in a week.
Starting rehab is the first of several hard steps Kevin will have to take if he’s going to stay clean. Soon he’ll go through withdrawals. The last shot he took is starting to wear off on the car ride down.
“I don’t feel real good right now. I got up this morning to make myself right, so to speak, but there just weren’t enough available,” he says. “I won’t be lying when I tell ’em I’m not well. I’m sure they’ll want to know the last time I used and stuff.”
For Kevin, the hardest part about rehab is being alone. That loneliness won’t necessarily go away when he gets out. His friends are all addicts, and coming home is risky.
He pulls out a list of phone numbers, basically everyone he knows.
“When I redo this list, it’ll be down to a handful of people.”
He says at first it doesn’t bother him, that they weren’t really his friends in the first place. Then he backtracks. Obviously, it bothers him. That’s why he’s talking about it.
But staying away from his friends to stay clean—it’s a necessary change.
For now, as he arrives at the rehab facility, he’s resolved to put his life of addiction behind him. “I’m looking forward to it. It’s gotta be better,” he says. ”The lifestyle, I’m over it.”
The Other Side
A Cop Struggles to Save His Neighbors from Drugs
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.
After moving through some of the busier neighborhood streets, he heads west across the interstate. Next stop: Spicertown, a part of Austin named after Don’s family, which has owned land here for four generations. He slows down where his childhood home used to stand and looks at the two trees he used as a teen to practice parallel parking.
“I spent a lot of time on this street as a kid,” he recalls.
This connection he has to the town determines how he does his job as police chief. “It gives me a drive to do things that other people might not want to do to make it a better place to live,” he says. “You want it to be safer. You don’t want the drugs here. You work harder to eliminate those things.”
Austin has become a mecca for illegal drug use and crime. The problem was painfully highlighted by the HIV outbreak that hit this spring.
As grim as the HIV situation is, Don says he sees a ray of hope in the fact that the rest of the community is waking up to the problems he’s been struggling with for years.
“I think the people just want things to get back to normal,” he says. “Normal now is going to be different than it used to be.”
“I’ve come to the conclusion that the world is on fire and all I have is a garden hose.”
Don’s own views on Austin’s addiction problem have evolved since the crisis broke. For one thing, he understands now that addicts are trapped in a cycle of craving and withdrawal pains.
“I’ve learned that people don’t just take drugs to get high,” he says. “I’m learning that a lot of the users are just doing it to stop the sickness.”
His new views helped him embrace a controversial program: the needle exchange that started in April. Drug users in Scott County can now get free, sterile syringes every week, and the police can no longer arrest them for carrying drug paraphernalia.
At first, Don was against the idea, since it limits what he can do to combat drug use. But the needle exchange also connects users to treatment, and now Don is all for it.
“I was seeing one side of it, I guess,” he says. “Now I’m able to see some of it from [the users’] perspective. I think that’ll make us better policemen at the end of the day, because we’ll have a little more compassion for the user.”
When Don became a police officer 20 years ago, substance abuse was mostly limited to alcohol and marijuana. But then came OxyContin in the late 1990s, and several years later, an even more addictive opioid, Opana.
The problem for Don Spicer isn’t just the drugs; it’s everything that comes with them. At $160 a pill, Opana use is an expensive habit. Petty crime and prostitution are rampant as users try to pay for their next hit. And the high street price means there’s a strong incentive to sell, too. The pills are rarely hard to find.
All this means a lot of work for the police. But Don’s department is small.
“We should really have a 12-man staff,” he says. “But we only have six. What can I do? I do as much as I can.”
Most of the time, there’s only one officer on patrol. Some volunteers help fill in gaps, but Don still doesn’t think it’s enough to police a city of 4,200 people. He says with the calls he gets regarding the street crime, there’s little time to tackle the drugs.
“I’ve come to the conclusion that the world is on fire and all I have is a garden hose. So I can only put out a few fires,” he says. “I can’t put ’em all out.”
There’s not much police can do to intervene before addiction sets in. Don says he often sees young people succumb to addiction who were exposed to drug use in their homes when they were little kids.
“They can’t seem to break that cycle,” he says. “Some of them, you think, ‘Man, this kid don’t have a chance.’ And in all honesty, they don’t. If they grow up watching these things happen, they tend to want to follow that same path.”
Still, Don tries to help where he can. When he visits homes in Austin, he talks to kids, sometimes bringing them stickers or stuffed animals, so they’ll think of the police as friends. You never know what might put a kid on a different path.
“We can make positive impacts on a few people,” he says. “There are some results you see from time to time.”
Don has requested additional funds from the county and is looking for grants to be able to pay for more officers. He’s hopeful about Austin’s future. In the long run, he says the HIV outbreak may be what turns Austin around, as the community is finally waking up to the problems his department’s been grappling with for years.
“I see this as a golden opportunity to exploit some resources that we would have not had available had this not happened,” he says. “It’s a very bad thing that’s going on with the disease, the health issues, but so much good’s going to come from it.”
At the end of his shift, Don pulls up to a curb by the police station, and a man walks up to the window of his squad car. Chuckie Bowling was a drug user for years until an arrest by Don brought him to a turning point.
“I got arrested and got ten years,” Chuckie recalls. “And I woke up and said, ‘Look, you gonna live here the rest of your life or you gonna watch your kids grow up?’”
Now, Chuckie has been clean for nine years and counts Don as a friend. He’ll stop him in the street to chat, or swing by the bait shop Don runs in his off hours.
“I can get out and do whatever I want to, and just, I mean, live my life the way I wanna live it,” Chuckie says.
As Chuckie walks back toward his apartment, the two make a plan to go fishing before Don rolls up his window. “That’s really why we do what we do,” Don says. “You wanna make a difference.”
A Nurse Finds Her Calling
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.”
Jessica wasn’t home when the addiction treatment facility called a few days earlier. With the long list of people waiting to get in, she missed her chance. But if Brittany finds her and gets her to the community center, Jessica can get back on the list.
But first, a last-minute errand is pulling Brittany to the other side of town. Another young woman needs an HIV test fast, before anyone else comes home, and there’s just time to get it done. Just barely, if she hurries.
Brittany finally finds the house and heads inside with some other health workers to administer the test. A few minutes later, she’s speeding to the other side of town to find Jessica.
Brittany has been running the needle exchange since April. After the initial shock of this spring’s HIV outbreak in Scott County, Indiana, the state approved a clean needle exchange, the first to operate in the state. That program’s mobile unit, a roaming SUV carrying health workers in front, and thousands of needles in back, has become an important tool for building trust with drug addicts.
“This one prostitute I keep seeing, she frustrates me. She doesn’t wanna change, she doesn’t want help.”
Like a lot of people in town, Brittany was skeptical at first about the program. How could giving syringes to drug users possibly help the problem? But she looked into it, and found that access to clean needles reduces the spread of disease. Even better, it draws members of the secretive addict community out of their homes and connects them to addiction treatment and other health services.
She has seen it work. “Just yesterday, two guys told me that they’re going to rehab,” she says. “I swear, when they first started the program, I thought there’s no way they will ever get off drugs. So that’s amazing.”
Brittany grew up in Scott County. When she was in school, her teachers used to tell her she would make a good nurse, but she didn’t listen.
After high school, she studied occupational therapy. She hated it and dropped out, and worked for a few years at a veterinary clinic. Then, finally, she went back to school for nursing. “When I did my community health rotation, I absolutely fell in love with it.”
Then six years ago, she was hired as the county’s public health nurse. There was plenty of work to do dealing with the town’s problems. Even before the outbreak, Scott County’s health indicators put it dead last among Indiana’s 92 counties. Brittany knew about the drug problem—large numbers of people abusing prescription painkillers, but she didn’t see it a lot in her work until the HIV outbreak hit.
After a short drive, Brittany pulls up to the house where Jessica lives with her mother. She’s not home, so Brittany drives on to look for her on another side of town.
Since the outbreak was discovered, Brittany’s job has become a lot more demanding. She works long hours, often well into the evening. It’s exhausting, and it sometimes keeps her from the things she would rather be doing.
The other night, she stopped by her son’s baseball game but could only stay for twenty minutes before she had to go to a health-board meeting.
Brittany says she can handle the demands on her time and energy. The hardest part is seeing all the people who refuse help.
“This one prostitute I keep seeing, she frustrates me. She doesn’t wanna change, she doesn’t want help,” Brittany says. ”It’s frustrating.”
She’s committed, though. “I know that I will be dealing with HIV in one aspect or another the rest of my career,” she says. “That kinda seems overwhelming at times, because it’s not anything I would ever have to deal with before. But this is public health. This is what we do. We adapt and we learn as we go.”
Stopped at an intersection, Brittany recognizes a car from a distance. It’s Jessica, riding around the neighborhood. She has the hood of her jacket pulled up.
Brittany follows, trying to catch her before she makes it to the main road, but Jessica is too far ahead. Jessica turns to head south, and Brittany follows again. Then Jessica stops at the Dairy Queen a few hundred yards away.
“Hey, girlfriend!” Brittany pulls alongside Jessica’s car and shouts through her window. “I was supposed to pick you up, remember?”
Jessica says she forgot, and that she’ll head over to the community center after she gets ice cream for her son. It’s hard to tell if she’s lying. She might just want Brittany to stop following her.
But if Jessica doesn’t end up going, Brittany will track her down again, just like she did today. Because despite the frustration and the long hours, helping this community is just something she wants to do.
“Before all this started, I was feeling a really strong calling to do mission work and go overseas … and then all this broke,” she says. “I don’t have that calling to go to Africa anymore. You don’t have to. You can do mission work right here in your own backyard.”
Showing Kids Another Way
In a church basement off of Main Street in Austin, four teenagers are huddled around a sink, debating how to strain water from pasta. They’re trying to make a large pot of mac ’n’ cheese, but somebody forgot the colander.
Seventeen younger kids sit just outside the kitchen, finger painting and gluing things to colorful paper.
The kids gathered at the church are part of a new group, called Stand Up, started recently by some enterprising high school seniors. The teens know from experience that there’s not much to do in Austin, and that drug addiction can be passed down from parent to child.
In the wake of Austin’s drug-fueled HIV epidemic, the students didn’t think enough was being done.
“It was very frustrating to me, to see the adults not doing anything about it, that the kids had to make the first step, “ says Holli Reynolds, one of the group’s founders. “Nothing was being said. Everyone just went on with their day.”
Stand Up was born out of her frustrations, and those of her classmates. They thought that with an outlet and some role models, younger kids might be able to resist the drugs that are so easy to find in town.
“It sucks that they have to be here at all,” says Chandler Bowman, another Stand Up leader. “I mean, we’re helping these kids, but it sucks at all that this is even a problem. It’s ridiculous that this is a problem.”
“If [we] teach a child the right way to go or have a child look up to one of us and know that we are going to be there for them, then I accomplished my goal.”
Holli and Chandler make an unlikely pair. Holli is a jock. She plays basketball. Chandler plays trumpet in the band. They live in different areas and are going to different colleges after the summer’s over.
But they have something in common. They love Austin, and they want to make it a better place to grow up.
To do that, they need to reach a lot of kids. They spend hours passing out fliers and explaining their mission to parents. They also count on the kids to recruit their friends, and it seems to be working. Today’s group is the largest yet.
“It’s nice—we didn’t expect to have this many kids,” says Chandler. “We didn’t expect to have the support we have. We couldn’t really do it without these kids coming back every week. We enjoy having them, and they enjoy being here and playing and learning what they’re learning.”
The volunteers finally serve the mac ’n’ cheese, and when everyone’s done eating, the volunteers divide the kids into different age groups for short lessons. For the past couple of weeks, they’ve been learning about disease—a difficult topic, especially when there’s one disease in particular you have to confront.
A junior named Jakeb Watts is teaching the youngest group. “Who remembers last week when we talked about viruses?” he asks. “What is a virus?”
One little girl says, “HIV.”
As the kids get restless, Holli jumps in to help out. If someone in the room had AIDS, she says, “You won’t be able to get AIDS from just sitting next to her. It’s very hard to get AIDS.” She trails off. “Later on you will understand how to get it, but I don’t feel comfortable telling you.”
The volunteers are still learning how to talk about drugs and disease with such young kids, but they do it anyway. With everything going on in town, those topics are already in the kids’ lives.
It’s the kids that keep Chandler invested in his town, when he might otherwise check out. “I’m uplifted by what we’re doing,” he says. “Without all those kids smiling, saying they have a good time and coming back, this would just be exposing myself to more sadness that I don’t need.”
Chandler and Holli know it might be hard for Stand Up to live on after they go to college this fall, especially without a stable source of funding. But for now at least, the community is pitching in with small donations of money or snacks for the kids. And the seniors are recruiting younger volunteers like Jakeb to keep the effort alive.
The HIV crisis in Austin has been the subject of national media coverage and the focus of an intense emergency response. But people in this town know that changing the underlying problems in the long term needs to be a sustained, local effort. The volunteers with Stand Up want to be part of that.
“If [we] teach a child the right way to go or have a child look up to one of us,” says Holli, “and know that we are going to be there for them, then I accomplished my goal, because they’re the next generation. And if we spark hope for them, then we’re doing our jobs. That’s what the whole group was made for.”
As the evening draws to a close, the kids gather in a circle for a game of duck, duck, goose. Holli joins in. Round after round, they circle, tapping each other on the head, giving chase and giggling. Round after round, until it’s time to go.
The kids don’t want to leave.
This project is also part of Images & Voices of Hope’s Restorative Narrative Fellowship, which gives journalists across the U.S. a stipend to spend six months telling stories of resilience and recovery. Jake Harper was named one of five inaugural IVOH fellows last year. The Kevin Polly audio above is from Harper’s podcast, Sick. Additional audio originally aired on WFYI 90.1 FM.
The HIV outbreak caused many in Austin to come together. Dozens, sometimes hundreds of people gather for weekly prayer walks (photographed above by Seth Herald), hoping to inspire change among the area’s drug users.