Five years ago, Indiana experienced one of the nation’s worst HIV outbreaks. Mike Pence was governor then, and he approved a needle exchange to keep the problem from spreading. Now state leaders are debating whether that exchange — and others — can stay open.
The epicenter of the outbreak was the Scott Co. town of Austin, where the number of positive cases made its HIV infection rate comparable to sub-Saharan Africa.
“About 95% of the cases were also co-infected with hepatitis C,” county health administrator Michelle Matern says. “And so, all those cases back then relate to injection drug use – sharing syringes with each other.”
As the crisis deepened, Pence signed an executive order allowing the county to operate a needle exchange program.
“I will tell you that I do not support needle exchange as anti-drug policy,” he said during a 2015 visit to Scott Co. “But this is a public health emergency. And I’m evaluating all of the issues and all of the tools that may be available to local health officials in light of a public health emergency.”
Since then, HIV cases in the county have been dropping steadily.
“We’re expected to have around 25 new HIV cases every year, just based on our population size and the number of positive cases that live in our county,” Matern says. “And the most we’ve seen in the past three years is 12 cases. Last year, I believe we had seven. So every year we’re trending downward.”
She credits the county’s needle exchange for the drop in cases. Since Scott Co. started its exchange, eight other counties have followed suit – including Clark Co.
But without legislative action, all of the Indiana exchanges will have to shut down next year. Legislators are debating whether to let that happen, or extend the exchanges for at least another year.
State Sen. Ron Grooms, who represents Clark Co., opposes extending the expiration date. “It was intended to be an exchange. It became a giveaway program in which hundreds of syringes were being given away at any time at any given location at multiple locations.”
Clark Co. felt the effects of the HIV outbreak, too, as Scott Co. residents came for treatment. Eric Yazel was an emergency room doctor at the time.
“If you came in and told me that ‘I’m using heroin and I need some help,’ I’d hand you a paper that had a phone number on it for a place that had a couple month wait,” he says. “And that’s literally all that we had to offer.”
Yazel, who is now the county’s health administrator, says overdose deaths have dropped by 50%.
“Downstairs right now," Yazel says, "if you come in and say, ‘I'm ready to stop and ready to go into recovery,’ we have a recovery coach that'll walk right in the room and say, ‘Alright, here's your options in the community, let's go get you some help.'
“We offer medical care, we do tons of hepatitis and HIV testing. We've diagnosed over 100 cases of hepatitis C through testing specifically done at our syringe service program, which obviously has a huge public health benefit for the community.”
Paul LaKosky, executive director of the North America Syringe Exchange Network, has been working in HIV prevention for nearly 25 years. Last year, the network provided needles and harm reduction supplies to 435 syringe service programs across the country.
“I think that if you spend some time with folks at a syringe exchange, handing out clean syringes and harm reduction supplies is the least of what happens,” he says.
LaKosky says exchanges provide counseling and are a healthcare access point for those who are unlikely to seek it out. He says many want to do even more but are hampered by insufficient funds or manpower, or by uncertain legal situations like the one in Indiana.
“We are very, very resource tight,” he says.
State Sen. Chris Garten, who represents Scott Co., also has voted against extending syringe service programs. And County Commissioner Mike Jones has been an outspoken opponent of needle exchanges, saying they facilitate drug use.
LaKosky disagrees. “When you’re starting to succeed, you don’t stop, you keep going. So when you’re successfully reducing the number of transmissions, that’s not the time to say, ‘Oh, we can go back to our old practices,’ because the old practices were what got you into trouble in the first place."
The Scott Co. Board of Commissioners is set to vote on the exchange in May. Matern says it’s difficult to face resistance from local officials, especially when the progress is happening right in their backyard.
“It’s unfortunate they see these programs – all syringe exchange programs – as just giving a drug addict a weapon or another needle because it’s a lot more than that,” she says. “I would encourage all political leaders to – if your county has a syringe exchange, go there and talk to the staff that works them.”
Research from the Centers for Disease Control and Prevention shows needle exchanges help reduce the spread of infectious diseases like HIV and can help people overcome substance abuse. And they don’t lead to more needles on the street. Indiana has an average syringe return rate of 82 percent.
“People will continue to use – just because there aren’t clean syringes available, they will go back to using and sharing dirty syringes,” Matern says. “And so we’re going to see disease spread again. It may not be the first year, it may not be the second year, but eventually we’re going to see the increase of disease start again.”
Matern says the cost of an HIV outbreak pales in comparison to that of a syringe exchange program.
“I think sometimes it gets lost that what works here for our small community may not work for Clark, or Tippecanoe or Lafayette County,” Matern says. “Individually, this is what works for our county. We know it works. And so, I think the opportunity should be given to everybody.”
This story was produced by Side Effects Public Media, a news collaborative covering public health.