Rawstory has a comprehensive review of Scott County’s HIV epidemic, charging that Mike Pence’s negligence, belligerent refusal to assess scientific evidence, and sanctimonious grandstanding are major contributors to the County’s state of decay. It’s a long but worthwhile read. It introduces a number of extremely useful and effective public health concepts that have been governing more successful healthcare systems for decades. It also demonstrates that breaking the poverty cycle is complex and multi-faceted. Deteriorating mental health, trauma and violence, addictions, a lack of education, health complications compounded by no healthcare, teen pregnancy, epidemics–the list goes on, and it’s not a cheap list to fix.

Content Notice for brutal, sociopathic classism and ableism:

Austin, Indiana: A Perfect Storm Brewing

Mike Pence did not simply allow the HIV outbreak to happen through indifference and inaction. Every detail of his record reveals advocacy of policies that created the necessary conditions.

Average life expectancy for white working-class people without college degrees fell last year for the first time in a decade, with a surge of mortality rates for those aged 21 to 54. The main causes are overdose, liver disease and suicide—all to some degree related to drug use. This demographic is Donald Trump’s base; he leads Hillary Clinton 2:1 here in most polls.

Austin, in Scott County, Indiana, lies in America’s Rust Belt. The nation’s former industrial heartland helped lift several generations of white Americans into the middle class. The idea that the next generation would be better off than their parents became an article of faith.

By 1980, growth in productivity had plunged, coal and steel were declining, and manufacturing was being outsourced. High-paying blue-collar jobs were lost to de-industrialization, automation and globalization. Tax cuts for the rich, corporate welfare, union-busting and other Reaganomics policies accelerated the destruction of America’s great middle class.

Scott County’s children have not been better off than their parents for decades. They face high rates of high-school dropouts and teen pregnancies; one third of under-19s live in poverty.

Austin is known as the opioid capital of southeastern Indiana. I-65, a major north-south highway, runs hard by Austin, ferrying pills and heroin to Chicago dealers.

Asked by NBC News why addiction is so prevalent in Austin, William Cooke, the town’s only doctor, said, “It’s really about hopelessness. When these kids are in middle school, I’m providing them care and there’s a brightness in their eyes. They believe they can be president of the US someday. But that brightness is gone by the time they’re in ninth grade. They don’t think there’s anything waiting for them. They think there’s nothing to live for tomorrow. And the drugs are so available.”

The Rust Belt’s opioid crisis was many years in the making. As author Sam Quinoneswrites, US sales of OxyContin increased from $45 million in 1996 to $3.1 billion in 2010, and national overdose deaths quadrupled during that period. Purdue Pharma, the maker of OxyContin, deployed its sales staff to pitch physicians in regions of the US where opioid prescribing and social security/disability receipts are high. At the top of the list is Appalachia, including West Virginia, western Kentucky, southern Ohio and southeastern Indiana. By the late 2000s, pain pills were involved in more deaths than cars.

In 2011, the CDC investigated a four-year 500 percent rise in hepatitis C rates among young injecting drug users in eastern Indiana. They advised the Indiana health department to immediately consider launching syringe exchange programs in the five-county area.

In 2012, news that 31 people in Scott County had died the previous year from prescription opioid overdose was widely reported by national media. “I worry that an entire generation might be lost to drug addiction,” County Sheriff Dan McClain told NPR.

Wherever syringe possession is illegal, drug users share needles, and once hepatitis C or HIV enter the communal bloodstream, they spread rapidly. And the specific conditions of life in Austin favor maximum risk.

Most drug users live in a single neighborhood. It is not unusual for several generations of a single family living together to share needles. In addition, the primary available opioid, Opana, is expensive, so several people typically pool money for a single pill, then shoot up the liquid form together.

But these are just the proximate conditions. Austin is also one of the poorest towns in Indiana. It has a 9 percent unemployment rate, a 19 percent poverty rate and a $16,000 per capita income. It has 35 churches and one doctor.

Indiana has the nation’s sixth-highest rate of infant mortality, and Scott County has the worst health outcomes of all 92 counties in the state. In 2014, Indiana ranked 37th in state public health spending ($17.43 per person), with the bulk paying for HIP 2.0 (state Medicaid); 50th in CDC investment ($13.67 per person); 50th in HRSA investment ($12.88 per person).

Austin is 98 percent white. Although evenly split between registered Republicans and Democrats, it has voted Republican in every presidential election since 2004. Its demographics are representative of those who have fallen under the spell of the “blue-collar billionaire.” They have done so not because he has articulated a way to create decent jobs for them, but because of “hopelessness,” because “they don’t think there’s anything waiting for them,” because “they think there’s nothing to live for tomorrow.” Trump is for them what opioids are for their children.

Many Christian, conservative Republicans have a less charitable view. “The truth about these dysfunctional, downscale communities is that they deserve to die,” Kevin Williamson wrote recently in National Review. “Economically, they are negative assets. Morally, they are indefensible. Forget all your cheap theatrical Bruce Springsteen crap. Forget your sanctimony about struggling Rust Belt factory towns and your conspiracy theories about the wily Orientals stealing our jobs.…The white American underclass is in thrall to a vicious, selfish culture whose main products are misery and used heroin needles.”

Read the rest here.

-Shiv