What happens when you shut down health centers that provide HIV testing and ban programs that encourage drug users not to share needles during a spike in opioid use? In rural Indiana, the result was a surge in HIV infections. More than 80 people have tested positive for HIV in Scott County since mid-December, with most cases linked to intravenous use of Opana, a prescription painkiller.
The warning signs were there: Four years ago the Centers for Disease Control and Prevention advised of the rapid spread of Hepatitis C—which often accompanies HIV—among young drug users in Indiana, many of whom shared needles and other injection equipment. Indiana has the lowest per capita spending on public health of any state, while Scott County “has high rates of poverty and despair,” wrote Shane Avery, a local family physician. “Add to this a high rate of uninsured, low rates of completing a high school education, and insufficient access to public health services such as testing for sexually transmitted infections and mental services,” and you get conditions ripe for an addiction-fueled epidemic. The only clinic to offer HIV testing in the county, run by Planned Parenthood, closed in 2013, after state legislators pushed through a series of ideologically driven funding cuts.
Now, Governor Mike Pence has declared a state of emergency and is rushing in resources that should have been there all along. He’s also done something the CDC recommended four years ago, which is to suspend the state’s ban on making clean syringes and needles available to drug users. “In response to a public health emergency, I’m prepared to make an exception to my long-standing opposition to needle exchange programs,” he explained. It’s a very narrow exception, applying only for thirty days, and only in Scott County. “I don’t believe that effective anti-drug policy involves handing out paraphernalia to drug users by government officials,” Pence elaborated.
This is an incoherent position, and one that frustrates health workers and advocates. If needle exchanges are bad policy, why use them in an emergency? And if they are effective enough to warrant use now, why ban them otherwise? “Governor Pence will have to renew the emergency declaration for another 30 days, and keep renewing it indefinitely, until Indiana passes a permanent syringe exchange law,” Daniel Raymond, policy director for the Harm Reduction Coalition, wrote in an email. “There’s no medical, scientific or public health basis for a 30-day needle exchange program—it’s unrealistic to expect that within a month you can find everyone at risk and somehow get them to stop injecting.”