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For many of us, the word “outbreak” has taken a more personal meaning this year.For the people of Austin, Indiana, it’s not the first time they’ve dealt with an outbreak.“We’re an itty-bitty town, but we got big city problems,” said Austin resident Ethan Howard.By 2015, the opioid crisis had ravaged Howard’s hometown for years. People became hooked on painkillers and often used needles to take them. The same syringes would be passed from person to person.Dr. William Cooke arrived in Austin in 2004. Back then, he was the town’s only doctor. In fact, he was the town’s first doctor in a generation. He says he saw several issues in the southern Indiana community, including people’s health to poverty.As the opioid crisis started to wrap its grip across parts of the country, Dr. Cooke says he started to see another health issue spread in the community, starting around 2010.“What we saw was a really quick in dramatic rise in Hepatitis C around that time,” Dr. Cooke said. “Any community that has a high Hepatitis C rate is at high risk for an HIV outbreak.”By 2015, the opioid crisis had ravaged the city for years.“Opiates were my devil,” Howard recalled.Howard says his mom convinced him one day to go get tested, after he says he had shared a needle with his cousin.His test revealed he was positive for HIV.“I thought I was dead. I thought it was a death sentence,” Howard said.He wasn’t alone with testing positive for HIV in Austin.“In that first year, we had almost 200 cases,” Dr. Cooke said. “It was almost a quarter of the HIV cases in the state and this is a town of 4,200 people.”Austin had become home to one of the largest HIV outbreaks in rural America ever.Dr. Cooke helped convince then-Indiana Gov. Mike Pence to change his stance on needle exchanges.“It took a few months, but eventually, he signed the executive order allowing us to operate syringe service programs here,” Cooke said.That program, access to addiction recovery services and powerful HIV medicine has led to a dramatic drop in new cases.In 2015, Scott County, Indiana had 157 new HIV cases. In 2019, the county had only five, according to the Indiana Department of Health."The medications today are powerful enough and well tolerated enough that you should not spread the disease to anyone else and you should never worry about dying from HIV,” Dr. Cooke said.Dr. Cooke says Austin is still working to overcome some of the social challenges he found when he first arrived in the community in 2004.It’s been five years after the largest HIV outbreak in Indiana history. Like many communities across the world, this one is now dealing with the impacts of COVID-19.Nurse Jessica Howard is a proud native of Austin. She’s seen the challenges her community has faced over the years. She also sees the good in Austin, pointing to a local church pantry providing food and clothes to those in need.Jessica Howard in charge of coronavirus testing at Dr. Cooke’s office. She grew up in Austin and knows many of the patients that come through the door.As of early July, Scott County has not seen a large amount of coronavirus cases like other parts of the country, but the nurse worries about her patients that struggle with addiction who are now in quarantine and could relapse."These are people these are our people and we have to take care of them and protect them,” she said.Austin has come a long way from where it was in 2015, when HIV spread through a large part of the community.Last year, Dr. Cooke was named by American Academy of Family Physicians the AAFP 2019 Family Physician of the Year for his efforts to help stop the 2015 HIV outbreak.As for Howard, he says medication has made it so HIV is no longer detectable in his blood.He now travels as a musician and points to music as a source of strength that helped him through the darkest of times.“I fought and clawed my way out of a dark place,” Howard said.His fighting spirit is one this small Indiana city has used to battle through crisis before.“We’ve been through a healthcare disaster before,” Dr. Cooke said. “And there is a light on at the end of a tunnel.”It’s a mindset Dr. Cooke says we need now, as we all fight this new crisis of a coronavirus pandemic. 4221

Finding the right child care can be a frustrating -- and expensive -- process for parents around the world, from New York to Nairobi.Access to adequate child care for all has become a "global" need, said Shelley Clark, a demographer and professor of sociology at McGill University in Canada, who has studied child care and other family dynamics."We can think of iconic images like The Atlantic monthly cover of the mom carrying the kid in the briefcase to work and how absurd that's supposed to be to us, but then when we think of women in lower-income countries, you think of the mom selling goods at the market with a kid strapped to her back, and you think, 'Well, that's not a problem for her, because she can easily combine child care and work,' " Clark said."There's this perception out there that for the kinds of work that women do in lower-income countries, it's easier to combine child care and work," she said. "The fact is, it's quite challenging for these moms, also."Clark added that families in lower-income countries spend a significant chunk of their income -- about 17% of some women's average earnings -- on child care services, similar to those in wealthier countries.Families living across 30 wealthy nations in the Organisation for Economic Co-operation and Development spend on average about 15% of their net income on child care costs, according to a 2016 report from the group, an association of 35 countries founded to improve economic development and social well-being around the world.Yet the percentage of a family's income spent on child care costs varies drastically by country: Couples spend 33.8% in the United Kingdom, but in Korea, Austria, Greece and Hungary, couples spend less than 4% due to government benefits and programs. Those findings came from the OECD's database on tax and benefits across countries compared with average net income of families in those countries.Here is a sampling of what child care looks like around the world. 1984

Florida Republican Attorney General Pam Bondi issued a pair of letters Sunday taking issue with the lack of criminal investigations tied to the state's elections after the Florida Department of State said it found no allegations of criminal activity.The letters -- one issued to the Florida Department of Law Enforcement and the other to the Department of State -- came two days after the state law enforcement agency announced it had no active investigations related to the election and had been informed by the Department of State there were no allegations of criminal activity.Despite the lack of any criminal allegations referred by the Department of State, Bondi said law enforcement should look into election activities in two key counties and directed Florida Department of Law Enforcement Commissioner Rick Swearingen "to take the necessary steps to promote public safety and to ensure that our state will guarantee integrity in our elections process." 968

First Lady Melania Trump did not visit her husband, President Trump, over the weekend as he is getting treatment at Walter Reed Medical Center and has no plans to, according to multiple reports.A spokesperson for the first lady said she is remaining at the White House executive residence in quarantine after her own COVID-19 diagnosis early Friday morning."Melania is aware of the dangers of COVID-19," the official told CNN. "Potentially exposing others is not a risk she would take."In another response to the question of First Lady Trump visiting her husband at Walter Reed, an official said “that would expose the agents who would drive her there and the medical staff who would walk her up to him,” according to NBC News.The reaction from the First Lady is drawing a comparison to the president's reaction. On Sunday, President Trump and a few members of Secret Service, all wearing masks, drove around the Walter Reed facility to see supporters waiting outside. Monday morning, the First Lady tweeted she was “feeling good (and) will continue to rest at home.” 1075

Former?President George H.W. Bush is being honored with a state funeral — an official gathering that includes current and former presidents and world leaders to mark the life of the 41st President.President Donald Trump and first lady Melania Trump are at the service at Washington National Cathedral and sitting in the front row with former presidents Bill Clinton, George W. Bush and Jimmy Carter. Their wives are sitting next to each of them.PHOTOS: State funeral for George H.W. Bush  511

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