Rural Indiana ends needle swaps that helped struggle HIV and raises fears of one other outbreak
A parade of law enforcement, health workers, and community members had made the same point to county commissioners in rural Indiana: the needle-exchange program for drug users was working.
It helped contain the historic HIV outbreak and made Scott County, which is half an hour north of Louisville, a model for the rest of the country, they said. It put addicts in a “one-stop shop” with medical supplies, tests, and people to guide them to recovery. It had the support of former US surgeon general Jerome Adams, who appeared for a public meeting last month.
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But district officials this week voted 2-1 to end the program, telling a crowded and passionate room in Scottsburg, Indiana that they don’t want to encourage dangerous behavior. One commissioner questioned the extent to which the syringe swap itself had resulted in a dramatic HIV reversal against the backdrop of increasing public awareness. Another said he wouldn’t want to deliver the needle someone overdosed with.
“I know people who are alcoholics and I don’t buy them a bottle of whiskey,” Commissioner Mike Jones said at a Wednesday meeting where some lined the drab walls and stood in the hallway because the chairs were full. “And I know people [who] want to kill themselves and I won’t buy them a bullet for their gun. “
Michelle Matern, administrator of the county health department, is now concerned that she will see another HIV outbreak that once swept through the area and made headlines across the country in 2015. Before this surge, fewer than five residents of the county had tested positive for the virus, which is devastating the immune system and requiring lifelong treatment.
Now, Matern said, more than 150 are infected with HIV, which makes the community of around 24,000 seem even more vulnerable to her. In an interview on Friday, she struggled to explain why a “Dream Team” chorus of support for the syringe program was not enough – reflecting the frustration of health officials across the country in a year of highly politicized responses to the coronavirus pandemic.
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Decades of studies have shown that syringe exchange reduces infection by collecting used, potentially contaminated needles and issuing clean ones. But many still resist the idea that public funds are used for drug use. Some states are trying to restrict exchange programs and people disagree on how overdoses skyrocketed during the economic and social upheaval of the pandemic.
“That is the extremely disappointing thing that these decisions are being made by people who are not experts in health or public health,” said Matern.
Scott County’s exchange program was approved in response to the state’s worst HIV outbreak, believed to have spread through split-needle injections of opioid drugs, particularly the addictive pain reliever Opana. The diagnoses reached three digits in the small community with the latest poverty rates and insurance coverage.
Some – including former Vice President Mike Pence (R), then governor of Indiana – were against syringe swaps. At the time, the programs were illegal. But as the public health crisis worsened and pressures mounted, Pence allowed exchanges in Scott County and later approved programs nationwide in times of public health emergency.
Infections and syringe exchanges in Scott County have decreased, and there has been a single HIV case in the county in the past year, according to authorities.
The Austin, Indiana needle change station that welcomes people with colorful reminders of “Wearing Naloxone” and “TESTED” has become a way for public health officials to reach vulnerable and addicts with all kinds of help, from meals to friendly check-in for medication to reverse an overdose. Last year, according to Matern, around 350 people took part.
“The actual replacement part is very easy and quick,” says Matern. “It is this 25- to 45-minute conversation that our employees have with the participants that is really changing people’s lives.”
“For some people, this may be the only healthy non-toxic relationship they have had and are likely to have, especially with the health care provider,” she added.
The two district commissioners who voted to end syringe swaps said they take HIV seriously but are most interested in preventing overdose deaths, which official figures say have increased over the past year. Worried about contributing to drug use, they argued the county could continue to provide other addiction control services.
Kelly Hans, a county HIV prevention coordinator, wonders how they can attract people to help.
As a lifelong resident who used to struggle with addiction, Hans believes that exchanging a needle could have saved her from hepatitis C if it had existed sooner. Following the vote on Wednesday, the 44-year-old said in an interview, was “devastating”.
“We will miss all of the population that we need to find,” she said.
Officials elsewhere are pursuing new restrictions on syringe exchanges, with supporters citing litter and the need for more guard rails and opponents saying they will force shutdowns of valuable programs.
In West Virginia, Governor Jim Justice, R, signed one of those bills this spring against the urging of many health professionals and a state medical association.
“It prevents the problems we had with needles everywhere that could be causing all sorts of problems in communities,” Justice said.
Critics say the closure of some resources has already contributed to an increase in HIV cases in Kanawha County. A 2019 study found that losing an injection program increased the risk of HIV spread and overdose in people who inject drugs.
“We will really regret it. There will be people who will die,” warned Del. Barbara Fleischauer, D, before the measure was passed from 67 to 32 years, according to the Associated Press.
North Carolina legislature tabled another bill this year that would create new restrictions and spark a heated debate.
“Any single provision in the bill would close numerous locations across the state,” wrote a former Charlotte police chief and former drug sergeant in a letter to the editor published in the Raleigh News and Observer last month.
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