As Indiana is grappling with the worst HIV outbreak in its history — a public health crisis that has intensified over the past month — its conservative governor has been forced to go against his own drug policy to effectively combat the virus.
The number of HIV infections in southeastern Indiana has surpassed 70 since mid-December, with additional cases currently under investigation. Health officials have traced the cases back to intravenous drug use in a rural part of the state, which fits into a larger pattern of opioid abuse that’s been on the rise across the country.
HIV is most commonly spread through sexual activity. But the virus can also be transmitted through using dirty needles that have come into contact with blood. In Scott County, an impoverished community in Indiana that’s north of Louisville, Kentucky, health officials believe that HIV is being spread rapidly because residents are sharing needles to inject a liquefied form of a prescription painkiller.
Gov. Mike Pence (R) declared a health emergency on Thursday, and announced he would override state law to expand access to sterile needles among drug users. The governor authorized a short-term needle exchange program limited to Scott Country, and will decide whether to renew it after 30 days have passed.
Pence, like many of his Republican colleagues, has previously been opposed to needle exchange programs, a public health effort that intends to prevent drug users from sharing contaminated syringes. Conservatives typically say that handing out clean needles will only encourage drug users to keep using illicit substances.
But this week, he said he was heeding advice from health officials despite his “reservations” about the policy. “I don’t take this action lightly. It is built upon what the Indiana State Department of Health has been doing with the very capable healthcare provider community here in Scott County,” the governor said.
Needle exchanges are endorsed by a wide range of public health experts and HIV prevention groups — including the Centers for Disease Control and Prevention, the World Health Organization, AIDS United, the National Institutes of Health, and the Foundation for AIDS Research — as an effective means of containing the spread of infectious diseases. Federally funded studies have found that providing access to clean syringes can help lower the rates of HIV without increasing the rates of drug use. Advocates who work in the field say these programs are effective because they’re often the only way to connect high-risk populations with the health care sector, where drug users are often stigmatized.
Nonetheless, it’s been difficult to get these programs off the ground because the federal government has imposed a funding ban on needle exchanges for decades. Although the 21-year-old ban was finally lifted in 2009, it was quickly reinstated by Republican leaders in Congress during a budget negotiation in 2011. AIDS activists have continually decried it as an example of enacting policy that contradicts the scientific evidence in the field.
Proponents of the policy are encouraged by Pence’s move this week, which seems to signal that GOP leaders might reverse course on this issue if they’re presented with evidence that needle exchanges are necessary. At one point, Pence acknowledged, “I’m going to put the lives of the people of Indiana first.”
“It’s very exciting. Great to see Gov. Pence showing leadership on this,” Bill Piper, the director of national affairs for the Drug Policy Alliance, an organization that supports the harm reduction model of addressing drug users that includes helping them use safer needles, told The Daily Beast. “His actions stand out as being more influential — he has the ability to influence others.”
However, Pence was careful to emphasize that his temporary order doesn’t mean he’s changed his mind about needle exchanges altogether. “I don’t believe effective anti-drug policy involves handing out drug paraphernalia,” the governor said, adding that he is prepared to veto legislation that seeks to implement a broader needle exchange program throughout Indiana.
Health experts say the factors that led to Indiana’s current outbreak have been building for quite some time, and they’re frustrated that Pence won’t commit to more long-term solutions. Dr. William Cooke, who runs the only doctor’s office in Scott County — and is currently working to open the first HIV clinic there — believes that the rates of poverty and drug addiction in the region signaled the need for a different HIV prevention strategy years ago.
“We’ve seen an increase in overdoses. We’ve identified that most of our IV drug users are hepatitis-C positive. We knew it was a only matter of time until HIV set in,” Cooke told NBC News this week. “We’ve been asking for help for a long time. We identified long ago there was an undercurrent here that was very unhealthy.”
Don Des Jarlais, a leading researcher on needle exchange programs who works at Mount Sinai Beth Israel in New York, told the Associated Press that rural areas where new drug users start injecting opioids are particularly vulnerable to HIV outbreaks, and “we should expect more of them unless we really ramp up our HIV-prevention services in those areas.”