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INDIANAPOLIS — A poor, rural county with record numbers of drug overdoses and high levels of hepatitis C may become the next Indiana community to create a needle-exchange program.

Local leaders in Fayette County recently met with state health officials and others to devise a plan to combat the spread of the bloodborne hepatitis C virus, which is closely tied to HIV and passed among intravenous drug users who share needles.

Health indicators in Fayette County, in Southeastern Indiana, mirror those found in Scott County just before an outbreak of HIV, which causes AIDS. A state-declared health emergency there included a limited plan to give clean needles to infected IV drug users.

“Acting sooner rather than later would be best,” said state Sen. Jean Leising, R-Oldenburg, a retired nurse who represents Fayette County and took part in the meeting.

She was among lawmakers who voted in April to lift Indiana’s long ban on needle exchanges.

This spring, the U.S. Centers for Disease Control and Prevention urged county health departments in areas with high levels of hepatitis C and IV drug use to act quickly to prevent the spread of HIV. Hepatitis C rates are an indicator of needle-sharing, they warned, and can foreshadow an HIV outbreak.

In Scott County, close to 90 percent of 163 people identified as HIV-positive also have hepatitis C.

The viruses are lethal if untreated and costly. The CDC estimates that a six-month treatment for hepatitis C costs about $200,000 for one person. Lifelong treatment for the 163 people infected with HIV in Scott County could exceed $100 million total.

Beth Meyerson, co-director of the Rural Center for AIDS/STD Prevention at Indiana University, found that Fayette County had hepatitis C rates second only to Scott County in Indiana.

Last year, county health officials reported 72 cases of hepatitis C. Sixty new cases had been reported by April.

Meyerson, who took part in last week’s meeting, found that indicators of IV drug use are also significant in Fayette County.

Forty-one people overdosed on heroin in Connersville — a town of 13,232 people and the county seat — in the last three months of 2014. Eight of those people died.

Meyerson called the numbers alarming, but she said Fayette County isn’t the only rural community with a combination of drug use and hepatitis C that may prompt a needle exchange. She said she knows of nine county health departments in Indiana that are looking at what it takes to start their own programs.

“They may be next,” she said of Fayette County, “but there will be more behind them.”

Officials in Fayette County worry about barriers to responding to what they see as a public health crisis. Those challenges are similar to those found in Scott County.

Fayette County doesn’t offer HIV testing because of a lack of state funds to pay for it. A high percentage of residents lack health insurance that could cover the cost of the $70 test.

“We’re the poorest county in the state, and we have a lot of IV drug use,” said Randy White, CEO of the Fayette County Regional Hospital. “Things are bad here.”

Fayette County, with a declining population of less than 24,000, also comes last in health rankings among the state’s 92 counties. An estimated 20 percent of adults have no health insurance, though that could change if local officials enroll more people into the state’s expanded Medicaid program.

In Scott County, the state has spent more than $2 million providing HIV testing and related services — including health insurance enrollment — since the outbreak was reported in February.

However, implementing a needle exchange program isn’t easy.

The new law authorizing needle exchanges allows local health officials to begin programs to distribute and collect syringes, but only as part of a larger effort to curb the spread of hepatitis C or HIV.

No state money can be used to support the exchange. A local health department must initiate the request for an exchange and gain approval from county commissioners after a public hearing.

Local officials then seek approval from the state Public Health Commissioner, who must determine that a needle exchange is warranted.

Leising and White said educating the community about the need for a needle exchange may be a challenge, but Fayette County residents know they’re facing a crisis.

“If you don’t understand it, it can seem like you’re just helping people shoot up,” White said. “But we need to look at it from a larger public health view and realize the high cost of doing nothing.”

— Maureen Hayden covers the state for the CNHI newspapers in Indiana. Reach her at mhayden@cnhi.com. Follow her on Twitter @MaureenHayden

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