Louisville Magazine

AUG 2015

Louisville Magazine is Louisville's city magazine, covering Louisville people, lifestyles, politics, sports, restaurants, entertainment and homes. Includes a monthly calendar of events.

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LOUISVILLE MAGAZINE 8.15 133 homeisrocksprings.com/lou positive. Te local job-training ofce distributes 650 fiers advertising free job training and help completing the high-school-equivalency test. Big plans are dreamed in silos. A treatment center in Austin. A virtual college campus. Te city of Austin hires a woman assigned to get groups talking. She led the rebuilding eforts in nearby Henryville after their 2012 tornado. She cuts ideas down to reality. No windfall of money is coming. Nor should it, says Dr. Carrie Lawrence, a postdoctoral fellow with Indiana University's Rural Center for AIDS/ STD Prevention. "It can't be top-down, here's a bunch of money, fx it, and then 10 years from now, when budgets get tight, it's gone," Lawrence says. "Tat's the norm we can't seem to get away from." (A Planned Parenthood clinic in Scott County that provided HIV testing and women's healthcare closed in 2013 when government funding decreased.) Lawrence says Indiana needs to create a culture where chasing funds for health-related issues is a constant, top priority. According to the Trust for America's Health, Indiana ranks 37th in the nation for state per-capita health investment. (Kentucky ranks 15th.) When it comes to funding for HIV treatment and prevention, Indiana lags behind. Te CDC and Health Resources and Services Administration are two major federal funding sources for HIV care. Indiana ranks 50th per-capita in funds received from those two agencies. "We have to stop being such a reactive society," Lawrence says. "And waiting for something to happen and then saying, 'Wait, we need to do something diferently.'" At least in poor urban settings there's some kind of pipeline one can enter when ready — homeless shelter to drug treatment facility to halfway house to job training site to the bus for their frst day at a new job. Most rural communities lack that structure. When he's not juggling hundreds of patients, Dr. Cooke allows his mind to get out in the weeds, those pufy, cottony ones ft for wishes. Hope, that's what's missing, he believes. "It's a very challenging area," he says. "Tis particular group has been discriminated against for a long time. . . . Tey're looked at as addicts, junkies. Tey're looked down upon." Cooke has read studies that show if people can follow a "sequence of success," they have a very low chance of living in poverty and risking the spirals that culture can bring. "Graduate high school, get a job, get married, have a kid," he explains. "Pretty simple stuf. But you have to do it in that order." B y late June, Austin seems calmer. Weekly media briefngs are over. A billboard 15 miles south of Austin encouraging HIV testing is gone. Te Indiana State Department of Health holds a press conference in Indianapolis that feels like a fnale. Reporters receive an 11-page plan. ISDH will pay for another public-health nurse in Scott County, as well as care coordinators and disease specialists. Tanks to a one-year grant from Indiana's Division of Mental Health and Addiction, an ofce with behavioral and mental-health therapists will open in Austin. LifeSpring, the company operating the ofce, hopes it can be fnancially self-sufcient once the grant expires. A few days later, I ride with Combs on the needle exchange again. She says some of her regulars are uneasy. "People keep asking, where are you going to? What's going to happen?" she says. Te Outreach Center is scaling back. It will be open one day a week instead of every day and is relocating to a building right near the police station. Some in Austin are convinced cops will spy on who's getting needles. Combs' needle exchange will continue four days a week. Right now, she operates with thousands of donated needles and a $10,000 grant. (She has dispensed more than 24,000

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