Donald Spicer slowed his police car to a crawl as he pointed out “shooting galleries” — paint-chipped houses with broken windows and rotting wood, where addicts inject liquid painkillers and lose all sense of time.Used needles often lie in plain sight, in the cracked streets, in the garbage-filled gutters, on patchy lawns.“This is a common problem,” the police chief said.Austin, founded in 1853, was once best known as an important rail stop between Indianapolis and Louisville, Ky.

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Davis was a divorcee who met and married a “nice man from the church.” While on their honeymoon, Davis says, she started to feel ill with symptoms she could not shake.

Later, “I found his HIV test results hidden in his Bible,” she says, adding that the date of the test “told me that he knew he was HIV positive well before we got married, but he never said anything.” (MORE: HIV/AIDS and People Over 50) Women over 50 make up 10 percent of all women living with HIV.

“This isn’t anything new to us.”Spicer now finds his rural hometown at the core of the state’s worst-ever outbreak of HIV, one so grave that Gov. Pence also authorized a short-term needle exchange to fight the virus’ spread, an exception to Indiana’s conservative anti-drug policy that bars programs to trade dirty needles for clean ones.

But for Austin’s lifelong residents, the rash of infections making the headlines is a symptom of a deep-rooted problem dating back decades.

Gilead developed an oral form of tenofovir in the late 1990s, and co-bought the rights to emtricitibine from Emory for more than half a billion dollars in 2005. But even with this profit potential, Gilead has said that it “does not view Pr EP as a commercial opportunity,” and only began promoting Truvada as Pr EP earlier this year.

Tenofovir is the bedrock molecule in the company’s four HIV medicines—Truvada, Atripla, Complera, and Stribild—which together comprise a -billion HIV franchise. And while Pr EP is championed by public-health organizations like the Centers for Disease Control and Prevention and the World Health Organization, others in the field approach Pr EP with trepidation, concerned it might spur a decline in condom use and fuel an increase in other STIs.For men in America with access to health care, HIV isn’t usually fatal. I’d been taking Truvada, also known as Pr EP—short for Pre-Exposure Prophylaxis—a daily, two-drug regimen that prevents the transmission of HIV. We waited a moment in the silent room for the results. After arranging a lunch date the following day with one of their counselors, I exited the clinic into the street. It’s not a forgiving place to be sad.* * *Truvada, made by the pharmaceutical company Gilead Sciences, was approved by the Food and Drug Administration in 2012 to prevent HIV in those at high risk for infection.Early studies found it to be somewhere between 92 and 99 percent effective.People with HIV have been sentenced to years or even decades in prison for having sex without telling their partners they’re infected, even when they practiced safe sex.Are these laws a deterrent to spreading the virus or could they actually fuel the epidemic?His words, while well-intentioned, only served to amplify the generational difference between us: Gay Millennials, when they think of HIV, think more about dating than about death. When I’d gone to the AIDS Healthcare Foundation clinic near my home in South Beach, I wasn’t intending to take an HIV test—I’d been taking Pr EP for months, but knew I was still at risk for other sexually transmitted infections.