In late 2014, health officials belatedly became aware of an HIV outbreak in Scott County, Indiana. With fewer than 24,000 people, this rural county rarely saw a single new case in a year, according to The New York Times. But by the time government agencies tried to stop the transmission of the virus a few months later, some 215 people had tested positive.
One man seemed responsible for needlessly letting the situation get out of control: Indiana’s then-Governor Mike Pence. In 2015, when the virus was seeming to rapidly move through networks of people who use intravenous drugs, even the reluctant local sheriff encouraged the governor to authorize a clean-needle exchange, a proven tool to reduce such an outbreak.
But, as the Times reported when he became Donald Trump’s running mate, “Mr. Pence, a steadfast conservative, was morally opposed to needle exchanges on the grounds that they supported drug abuse.” His opposition was based on an incorrect belief; while research has long shown that needle exchanges do reduce HIV and hepatitis, it has also shown that they do not encourage drug use.
Pence went home to “pray on it” before he decided to approve a limited needle exchange. Many observers believed that the program acted as a kind of public-health Hail Mary pass, staunching a catastrophic wound that would have gotten much worse.
But as new research from the Yale School of Public Health published in the British medical journal The Lancet HIV shows, even that was marred by chaos and disorder, and the program likely had little effect on the outbreak. Indiana’s needle program began “with police officers initially confiscating syringes,” and it went into effect the same day the Pence “signed a bill that upgraded possession of a syringe with intent to commit an offence with a controlled substance from a misdemeanor to a felony charge, subject to imprisonment for up to 2.5 years.” This law began immediately after the 30-day exchange.
The study was co-authored by Yale assistant professor of epidemiology (and one-time ACT UP activist) Gregg S. Gonsalves and associate professor of biostatistics, ecology, and evolutionary biology Forrest W. Crawford. And while it projects that the worst of the HIV outbreak in Indiana was avoidable, this was because of reasons not previously understood. Gonsalves and Crawford write that the needle program began well after the peak of the epidemic: “The number of undiagnosed HIV infections had already fallen substantially by the time a public health emergency was declared and syringe-exchange programmes implemented.” Using mathematical modeling, the researchers estimate that the HIV infections had been rising since 2011 and had actually peaked in January 2015, “over 2 months before the Governor of Indiana declared a public health emergency.”