In December of 2014, the Indiana State Department of Health (ISDH) began documenting an alarmingly high number of new and suspected cases of HIV in rural Scott County. By April 2015 the number of new confirmed HIV infections had risen to epidemic proportions from 30 
in late 2014 to 135. Governor Mike Pence declared a public health emergency, which allowed the county to establish a temporary syringe exchange program (SEP). Interviews with affected persons revealed the majority (80%) of infected individuals were abusing the powerful prescription opioid analgesic oxymorphone (Opana-ER) through dissolving and injecting it; some were also injecting other drugs, such as heroin or methamphetamine. 
Of the 135 persons found to be HIV+, 114 (84.4%) were co-infected with the HCV. Each affected person typically reported nine other individuals he
/she had shared needles with, had sexual contact with, or knew might be at risk for HIV. ISDH reports that the total number of new HIV cases is now 188 within and around the Scott County city of Austin, population 4200. Austin now has a higher incidence of HIV than “any country in sub-Saharan Africa,” says CDC Director Thomas Frieden. According to the CDC, 10% of the Austin population is chronic intravenous drug users. Detox and treatment services are limited and primarily associated with serving jail time.

Scott County struggles with many challenges, such as low educational outcomes and a historically high poverty rate. These are both causes and symptoms of substance abuse problems. A percentage of the population is mired in a “culture of generational poverty” and has strong links to the Appalachian communities of eastern Kentucky. Scott County is a rural community with a population of 23,712, located 30 miles north of Louisville, Kentucky, the closest metropolitan area. It has 190.4 square miles in land area and a population density of 127 persons per square mile. From 2009-2013, the median household income was $42,898 and the percentage of persons below the poverty level was 19%. Over 41% of premature deaths in Scott County could be avoided if Scott residents had the opportunities of those in healthier counties. The poverty rate among children under 18 was 24.5% in 2013. The 2014 population was 97.7% white, 1.8% Hispanic/Latino, .4% Black, .6% Asian, and .9% two or more races. There are two school districts within the county. According to 2014 data, 80.6% of adults have a high school diploma and only 13.2% have a Bachelor’s or higher. Scott County has 1404 Preschool (0-4) age youth, 4040 school age (5-17) youth, 1910 college age 18-24), 5833 young adult (25-44), 6784 older adult (45-64), and 3741 seniors (65+). In 2014, the county reported that 926 Scott County residents were receiving disability, of those 138 were under age 18, and 673 were aged 18-64.

Use of tobacco, alcohol, and marijuana is prevalent at disturbingly young ages and prescription painkiller mis-use is rapidly growing among youth. This has a negative effect on the health and well-being of our citizens, which adversely impacts our work force. Scott County ranks 92 of 92 counties in morbidity/mortality, which means people in Scott County die younger than the rest of the state and report higher incidence of ill health as reported in the Robert Wood Johnson Foundation county health rankings. Substance abuse pervades the economic and social fabric and the community has been desperately trying to impact this through coalition efforts. Scott County has a strong need for early intervention and secondary prevention activities among at-risk youth, particularly as engagement in and support for positive activities and skill building.