Scott County, health department working on needle exchange program

Updated, Friday, March 27, 4:01 p.m. The Scott County Board of Health and the Indiana State Department of Health are working to coordinate a needle exchange program to address an epidemic of HIV in that county linked to intravenous drug use, state health officials say.

Scott County officials unanimously approved a request for a needle exchange Thursday night to help in the outbreak of 81 HIV cases in that county, which in a typical year sees about five such cases.

The following story appeared online March 26:

Gov. Mike Pence Thursday declared the HIV epidemic in southeastern Indiana a public health emergency and gave local authorities the OK to begin a short-term needle-exchange program to help fight an outbreak that now includes 79 cases all linked to intravenous drug use.

But Pence made it clear that allowing for a temporary needle exchange program does not reverse his long-held opposition to needle exchange programs.

"I do not enter into this lightly," he said. "In response to a public health emergency, I'm prepared to make an exception to my long-standing opposition to needle exchange programs."

His order applies only to Scott County, and it remains up to local authorities there to decide whether they wish to establish such a program under the supervision of the Indiana State Department of Health. The order will last for 30 days, after which the governor would re-evaluate whether to issue another temporary order.

Scott County Sheriff Dan McClain said he would like to see a needle exchange program in his area, particularly one that includes testing, education, and treatment for those who require it. His jail is housing 11 HIV positive inmates.

"I think if you're just flat out giving out needles, you're not going to do much good," he said.

Scott County Health Department officials did not return calls placed to the office Thursday.

Others criticized the governor's plan, saying that it would not get at the root problems in the area, which include a paucity of medical care, HIV testing sites, and other public health resources.

The Robert Wood Johnson annual County Health Rankings, released earlier this week, placed Scott County last in the state on health outcomes.

Many services beyond the ones the governor has allocated will be needed to have an impact, said Beth Meyerson, co-director of the Rural Center for AIDS/STD Prevention at Indiana University. Nor will a 30-day needle exchange program do much good.

"There's zero evidence to support the governor's proposition. His solution is not based on public health science," Meyerson said. "I appreciate the governor's flexibility, but it's not even close to being an appropriate response."

The state's emergency response also involves sending resources to Scott County to help people register for the state's Healthy Indiana Plan, which covers HIV testing and treatment. A mobile unit will assist people with getting the vital records they need to enroll and also offer vaccinations for preventable diseases associated with IV drug use, such as hepatitis and tetanus.

Indiana State Health Commissioner Dr. Jerome Adams said that other measures to help halt the spread of HIV could also follow.

"Everything's on the table. We're going to look at what works best," he said.

Earlier this week, the Centers for Disease Control and Prevention sent a team of seven to the region to help combat the outbreak, considered an epidemic since the numbers far exceed the area's norm of HIV cases a year. Between five and 10 state health officials have been traveling to the area daily to help with the effort to spread the word to get tested and, if positive, be treated.

Indiana University School of Medicine infectious disease specialist Diane Janowicz welcomed the governor's multipronged approach to fighting the outbreak. Janowicz added that solving the problem will not be easy.

"This is a very large HIV epidemic that we have not seen before, particularly in an underserved rural setting where resources are more limited than in a large urban area, and there are going to be social and economic obstacles that we will have to overcome in order to make sure that we're providing the best care for these patients," said Janowicz, also medical director for the Midwest AIDS Training and Education Center, which is helping state health officials in Scott County.

But Meyerson warned that the Scott County outbreak might be just the first salvo of a more widespread problem for Indiana. Noting that many other rural areas also lack HIV testing resources and that 20 percent of people who are positive do not know it, Meyerson said she would not be surprised if in coming months the situation spreads.

"You have to have a testing system to know, we don't know what we don't know because we don't have a testing system," she said. "We have no idea and we have to be honest about that."

Other counties such as Lake and Marion that have been harder hit by HIV in recent years could also benefit from some of the measures Pence has approved for Scott County, State Rep. Charlie Brown (D-Gary) said in a news release.

The House Public Health Committee is currently considering an amendment that would remove the state's stricture on needle exchange programs. Kentucky Gov. Steve Beshear signed into a law Wednesday a bill that included provisions for needle exchanges in that state.

Pence said, however, that his actions Thursday did not change his overall view of needle exchange programs, which have been endorsed by the CDC as an effective way to halt the spread of diseases such as HIV and hepatitis B and C.

"I don't believe effective anti-drug policy involves handing out drug paraphernalia," Pence said, adding that if the legislature sends him a broad-based needle exchange program bill, he will veto it.

Call Star reporter Shari Rudavsky at (317) 444-6354. Follow her on Twitter: @srudavsky.