Health Officials Urge Broader PrEP Use After 4 More HIV Cases Found in Indiana County


An additional 4 new cases of HIV in rural Scott County -- bringing the total to 188 -- have prompted the Indiana State Department of Health to urge people at risk for infection to talk to their healthcare providers about pre-exposure prophylaxis or PrEP, according to a recent announcement.

As previously reported, in early 2015 the Indiana State Department of Health and the Centers for Disease Control and Prevention (CDC) began investigating an unusual outbreak of HIV -- as well as hepatitis C virus (HCV) -- in Scott County; a report was published in the May 1 Morbidity and Mortality Weekly Report.

At last year's International AIDS Society conference, John Brooks from the CDC's HIV Epidemiology Team described efforts to determine the source of the outbreak, trace patterns of transmission, halt further infections, and bring affected people into care. The state increased funding to expand HIV testing, care, Truvada (tenofovir/emtricitabine) PrEP, and medication-assisted addiction treatment.

At IDWeek 2015 researchers reported that an emergency syringe exchange program implemented in the wake of the outbreak had led to a decrease in risk behaviors including needle sharing.

But new HIV infections are still occurring. The Indiana outbreak will be the subject of a plenary talk at the upcoming Conference on Retroviruses and Opportunistic Infections (CROI).

Below is an edited excerpt from an Indiana State Department of Health press release describing the ongoing outbreak in more detail.

Health Officials Urge Wider Use of Preventive Medication as Number of HIV Outbreak Cases Rises by 4

Indianapolis -- February 1, 2016 -- State health officials today announced that four additional cases of HIV have been confirmed in connection with the Scott County outbreak since December 4 and urged people who engage in high-risk behaviors to talk with their physicians about preventive medications that can lower their risk of infection.

The four diagnoses bring the total number of people who have tested positive in the HIV outbreak to 188.

The outbreak has been linked to shared needles among injection drug users. All of those newly diagnosed were identified as contacts of cases previously identified in the outbreak.

"We have made tremendous progress in slowing the spread of HIV infection in Scott County, but we know more people are likely to be diagnosed as testing continues," said Indiana State Health Commissioner Jerome Adams, MD, MPH. "Stopping risky behaviors is the best defense against HIV, but pre-exposure prophylaxis can also help protect those still battling addiction. We strongly urge physicians to talk frankly with patients about their risks and whether medication is appropriate to help prevent infection with HIV."

Pre-exposure prophylaxis (PrEP) consists of a combination of two HIV medicines that are taken daily by mouth. The Centers for Disease Control and Prevention (CDC) says daily PrEP use can reduce the risk of contracting HIV through sexual contact by more than 90% and through injection drug use by more than 70%.

PrEP is recommended for people who have injected drugs in the past six months and have shared needles or works and for those who have been in drug treatment in the past six months. Federal guidelines also recommend it be considered for people who are HIV negative but are in an ongoing sexual relationship with an HIV-positive partner or others who are at high risk of contracting HIV through sexual contact. Those who take PrEP must have an HIV test before beginning the medication to ensure they aren’t already infected and be retested every three months while taking the medication.

"Anyone who engages in risky behavior needs to know how to prevent HIV, and PrEP can be a valuable tool for many people," Dr. Adams said.

To learn more about PrEP, go to For more information about ways to reduce your risk of HIV, visit the CDC’s HIV Reduction Tool at

Visit the Indiana State Department of Health at for important health and safety information, or follow us on Twitter at @StateHealthIN and on Facebook at



Indiana State Department of Health. Health Officials Urge Wider Use of Preventive Medication as Number of HIV Outbreak Cases Rises by 4. Press release. February 1, 2016.