AUSTIN, Ind. (AP) — Main Street in this southern Indiana city is lined with blooming dogwood and redbud trees and punctuated by a short stretch of well-kept storefronts. It's a tidy appearance that masks a darker side of the community — the worst HIV outbreak in state history, which health officials warn hasn't yet peaked.

The outbreak is tied to needle-sharing among drug users who are mostly shooting up a liquefied prescription painkiller called Opana. A Scott County health department nurse described the desperate measures some users took before the recent emergency needle-exchange program, saying they'd told her they used the same needle hundreds of times.

Austin residents say the last 15 years have seen a steady growth in drug use, prostitution and drug-related crime, particularly in low-income areas with shabby rental homes. They fear the outbreak, which is up to 135 cases since the beginning of the year, will make times even harder in the 4,200-resident community that's 30 miles north of Louisville, Kentucky.

"A lot of people are scared, scared for their children, scared for their children to be outside because of the carelessness of the users discarding their needles," said Teresa White, who along with her husband, John, has found used syringes in the parking lot of their West Side Auto & Service Center.

Indiana sees about 500 new HIV cases each year, state statistics show, so 135 in one community is far beyond normal. State health officials said Tuesday they've enlisted specialists from Virginia, Colorado, Missouri and other states to help track down about 130 people who may have shared needles or had unprotected sex with those who have already tested positive for the virus that causes AIDS.

Indiana accepted the added help because it "is absolutely essential" in containing the public health emergency, Deputy State Health Commissioner Jennifer Walthall said.

Residents say drug use has long plagued the community not far from Interstate 65, where the main employers including a large canning factory that opened in the late 19th century and a Pepsi plant. The outbreak is hurting the city's image in ways local officials don't yet fully appreciate, Austin Police Chief Donald Spicer said.

"It's done a lot. It's probably hurt our economy. It's hurt the people, maybe kept away some people who come here and spend money. There's a lot of negatives that can come with something like this," he said.

Gov. Mike Pence approved a monthlong needle-exchange program for Scott County on March 26 and extended it on Monday for another 30 days.

Ninety-five people are participating in the program, according to Brittany Combs, the public health nurse for the Scott County Health Department. They get a week's worth of clean syringes in a small paper sack that includes pamphlets on drug use, rehabilitation options and a small plastic bag with condoms, bandages and cotton balls.

Before the program started, Scott County had only one pharmacy where people could buy syringes, Combs said, and a requirement to sign a registry drove many drug users away out of fear of arrest. Combs said some users have described re-using and sharing needles so many times that dosage numbers were rubbed off the plastic tube, she said.

"It's been staggering to see the number of times that people have used the same needle — I mean upward of 300 times. They will use the same needle until it literally breaks off in their arm. I've heard that multiple times. They'll take a file and they'll file it to make it sharper so they can keep using it," she said.

Walthall said the current crisis is a reflection of the drug abuse problems that are a scourge in many parts of the nation.

"There's nothing that makes Scott County different than any other rural county in America. It just happens to be the first that brought out attention to this constellation of events. There is an opiate epidemic across the United States," she said.

That's little comfort to residents seeing the outbreak in real time.

Samantha Collins, who works at one of the town's only eateries, Marko's Pizza and Subs, said people in adjacent communities are looking down on Austin, an attitude that's surfaced at school athletic events.

"My stepdaughter is in sixth grade and different schools come in for sports, for games, and they're like, 'I hope we don't have to use Austin's balls,' she said. "This has nothing to do with our children."