INDIANAPOLIS — An Indiana doctor in the heart of the state’s HIV epidemic says the virus has likely expanded beyond the outbreak’s epicenter, transmitted by infected drug users and commercial sex workers.

“There is no doubt in my mind that this has spread beyond the borders of Scott County,” said Dr. Shane Avery, a family physician treating some of the infected patients. “Scott County is not an island.”

At a legislative hearing Monday, Avery called on state health officials to begin systematically testing drug users in neighboring counties as part of a larger response to contain the worst outbreak of the AIDS-causing virus in Indiana history.

As of Friday, there were 130 confirmed HIV cases tied to Scott County. There’s been at least one death of an HIV-positive resident, a pregnant teenager, attributed to a drug overdose.

Avery told lawmakers he knows of infected drug users and prostitutes who’ve admitted they’ve shared needles and engaged in unprotected sex — two prevalent means of spreading the virus — after the outbreak erupted.

The Indiana State Department of Health currently offers HIV testing in only 24 of Indiana’s 92 counties. Up until late March, after the HIV outbreak was into its third month, there was no HIV testing in Scott County; residents had to travel about 30 miles to be tested in neighboring Clark County.

The Scott County doctor was among a lineup of health advocates who testified in favor of a proposed legislative measure that would allow other high-risk communities to implement a needle exchange program like the one authorized in Scott County under an emergency order issued by Gov. Mike Pence in March.

On Monday, Pence extended his executive order for another 30 days, allowing a temporary needle-exchange program there, in response to the rapidly growing numbers of HIV-positive cases tied to intravenous drug use in Scott County.

The original executive action ordered state organizations to coordinate a multi-agency response to the epidemic, but that response is limited to Scott County.

Avery and others testified much more is needed, given at least 23 Indiana counties have high rates of IV drug use and Hepatitis C — a potentially lethal blood-borne disease considered a marker for HIV.

Beth Meyerson, co-director of the Rural Center for AIDS/STD Prevention at Indiana University, said 90 percent of those who’ve tested positive for HIV in Scott County have also tested positive for Hepatitis C.

Avery harshly criticized Pence’s stated “longstanding” opposition to needle exchange programs and the governor’s threat to veto legislation that would expand it outside Scott County.

“It is the governor’s refusal to address this situation that will result in Indiana’s most historic failure in public health,” Avery said.

Needle exchange programs to curb the spread of infectious disease have been endorsed by the Centers for Disease Control, the American Medical Association, the World Health Organization and other public-health agencies.

But it’s been met with resistance in Indiana, where possession of a needle without a prescription can be a crime.

Still, some key Republican legislators seem willing to consider a measure that could go beyond Pence’s emergency order.

House Public Health Chairman Ed Clere, R-New Albany, authored the language that would allow local health departments in high-risk communities to adopt their own emergency needle programs.

At Monday’s hearing on the measure, Senate Public Health Chairwoman Patricia Miller, R-Indianapolis, said she, like the governor, has long opposed needle exchange programs, but she’s now open to the idea because of the crisis in Scott County.

Miller said any measure, if passed, would have to have a “sunset” provision, meaning the Legislature would have to re-approve the law in 2017 to keep the programs in place.

“Indiana is in a terrible position,” Miller said, after two hours of emotional testimony on the measure. “I’m heartsick about the disease and the epidemic we have in Scott County. I’m just sorry we have that here in Indiana. But we need to address it.”

Miller noted the pending end of the current legislative session April 30 in highlighting the need for quick action by lawmakers. She also pointed to the limited nature of the governor’s health emergency declaration, which can only waive enforcement of the state’s needle paraphernalia laws for 30 days at a time.

Miller wants to see some changes, though, to the language in Clere’s bill, including a more detailed plan for the collection of contaminated needles, before she presents it to fellow members of the super-majority Senate Republican caucus.

“We have not had one word in my caucus yet about needle exchange,” Miller said.

Two GOP senators, Erin Houchin of Salem, and Liz Brown of Fort Wayne, both questioned the effectiveness of needle exchange programs without other measures, including drug treatment programs, in place.

Houchin said she feared “putting the cart before the horse” by authorizing a needle exchange program, given Indiana has so few mental health and addiction services available, especially in rural areas.

David Powell, head of the Indiana Prosecuting Attorneys Council, shares that concern.

Powell said prosecutors can’t support a program where the state provides needles to illegal drug users, without more assurances that there will be resources in place to treat drug addictions.

“If you don’t have treatment programs, what are you going to fix?” Powell said.

Maureen Hayden is the CNHI state reporter in Indiana. Reach her at mhayden@cnhi.com. Follow her on Twitter @MaureenHayden.