If a town could be said to hit rock bottom, Austin, Indiana did so this year. The drug abuse problem had been out of hand for several years, but it took the worst possible outcome to make this community wake up: More than 170 newly identified cases of HIV since December, spread almost entirely by needle sharing.
State and federal officials led an emergency response to control the outbreak. 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.
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 other side of town to find Jessica.
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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.
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.”
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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 in 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.
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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.
“I know that I will be dealing with HIV in one aspect or another the rest of my career.”
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,” she 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.”
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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. She 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?”
“You can do mission work right here in your own backyard.”
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.”