As Vice President Mike Pence is charged with leading the U.S. response to coronavirus, some are calling attention to how the former Indiana governor handled a health crisis in his home state.

Critics have blamed Pence for what they say was a slow response to an HIV outbreak linked to injection drug use in 2015. The consequences of the outbreak were most evident in Austin, a small town in rural Scott County that would become the epicenter of a devastating crisis.

Where is Austin, Indiana?

Austin is located in northern Scott County about 80 miles south off Indianapolis off Interstate 65. The rural town has a population just over 4,000 people.

What happened in Austin?

In late 2014, Austin first reported an outbreak of new HIV cases linked to intravenous drug use. At its height, health officials diagnosed as many as 22 new cases a week. Around 235 cases were eventually tied to the outbreak.

At one point, the cases of new HIV infections in Scott County exceeded the number of people infected with HIV through injection drug use in New York City in the previous year.

How did it happen?

Most of the HIV cases in Scott County were believed to be caused by users injecting liquefied Opana, an opioid painkiller. The sharing of infected needles ultimately led to the spread of HIV and Hepatitis C.

Studies in medical journals have since said Indiana "could have substantially reduced the total number of HIV infections" if the state had acted faster.

A 2016 study from the New England Journal of Medicine also noted that free HIV testing had not been available in the community since a Planned Parenthood clinic closed in 2013. Federal and state funding cuts under former Gov. Mitch Daniels had prompted Planned Parenthood to close five rural clinics in Indiana.

How did Pence respond?

Health officials advocated for clean needle exchanges to slow the spread of infection, but Pence opposed doing so. The Centers for Disease Control and Prevention pushed for Indiana to remove its ban on such exchanges.

Needle exchanges allow users to trade used needles for clean ones and often link them to addiction treatment resources.

Then in March 2015, Pence declared a public health emergency for Scott County that allowed for a temporary needle exchange. In May, he signed a bill making it easier for other counties to launch needle exchange program. Later that year Pence announced the formation of the Governor’s Task Force on Drug Enforcement, Treatment and Prevention to combat drug abuse across the state.

According to the 2016 New England Journal of Medicine study, syringe exchange programs are associated with a 56 percent reduction in the risk of HIV infection. A chart shows HIV diagnoses in Scott County began tapering off within months of the emergency syringe program starting.

In 2018, Scott County reported seven new cases of HIV, down from 157 reported in 2015.

Why did Pence oppose exchanges?

Pence didn't believe exchanges could help combat drugs.

"I do not enter into this lightly," Pence said of allowing Scott County to establish a needle exchange. "I don't believe effective anti-drug policy involves handing out drug paraphernalia."

What do critics say?

Critics say Pence -- who has described himself as "a Christian, a conservative and a Republican, in that order" -- put ideology over the advice of public health experts.

Vermont Sen. Bernie Sanders, a Democratic presidential hopeful, tweeted Wednesday that President Donald Trump's coronavirus plans so far include having "VP Pence, who wanted to `pray away' HIV epidemic, oversee the response."

Leana Wen, the past head of Planned Parenthood who now teaches at George Washington School of Medicine and Health Sciences, tweeted, "As Governor of Indiana, an HIV/AIDS epidemic flourished until he allowed public health—not ideology—to direct policy & response.

"I hope he now follows the guidance of the exceptional career public health leaders @CDCgov & in the admin."

USAToday and The (Louisville) Courier Journal contributed to this story.

Contact IndyStar reporter Elizabeth DePompei at 317-444-6196 or edepompei@indystar.com. Follow her on Twitter: @edepompei.