Indiana OKs clean needle exchange amid HIV outbreak

Shari Rudavsky | The Indianapolis Star

Show Caption Hide Caption Public health emergency for Indiana HIV outbreak Indiana Gov. Mike Pence has authorized a short-term needle exchange program to help contain an outbreak of HIV in a county with 79 confirmed new infections since January. (March 26)

INDIANAPOLIS — Gov. Mike Pence on Thursday declared a health emergency in southeastern Indiana where an HIV outbreak is underway and announced the state would sanction a short-term needle-exchange program.

Pence, who declared the situation an "epidemic," said the needle-exchange program would last for 30 days and then would be re-evaluated. Its "sole purpose," he said, would be to stop the spread of the disease.

However, the governor said he did not want needle exchanges to become an "anti-drug policy" and said that if the legislature sent him a broad-based needle exchange program, he would veto it.

State health officials have recorded 79 HIV cases linked to IV drug use in Scott County. Pence said there normally were about five annual cases in the county.

Pence said he did not support needle exchange programs in general, but added "This is a public health emergency."

"This is not a Scott County problem. This is an Indiana problem," he said.

The state will set up an incident command center to coordinate HIV treatment and substance abuse treatment.

The Indiana State Department of Health will supervise a "short-term needle exchange program for the sole purpose of containing the epidemic," according to the press release.

"The people of Scott County are working hard to address this crisis, and with additional state resources and new tools provided by this emergency declaration, I am confident that together we will stop this HIV outbreak in its tracks," Pence said in a release issued ahead of a news conference.

A House panel on Wednesday embarked on a three-hour hearing on whether to pass an emergency amendment opening the door to needle exchange programs, which many medical experts believe are critical to curbing this outbreak and any others.

Since the middle of December, when the first case was identified, 72 people in five counties in the area — most of them from Scott County — have tested positive for HIV. HIV causes AIDS, a disease that weakens the immune system, gradually destroying the body's ability to fight infections and certain cancers.

All the cases are linked to intravenous drug use, many with the prescription painkiller Opana. State health officials say they expect to see still more cases appear in the coming weeks.

Some have called for Indiana to make needle exchange programs legal. Many states and municipalities have already done so. Kentucky Gov. Steve Beshear signed a bill Wednesday that included a provision for needle exchange programs.

Pence, however, stopped short Wednesday of endorsing the practice wholeheartedly.

Many of those on the front lines of the outbreak said a 30-day response, while better than nothing, would provide only a Band-Aid for a gaping wound. As Pence drove south to visit Scottsburg, many of the doctors from the area were driving north to testify at a House Public Health Committee hearing to pass an amendment allowing for needle exchange programs statewide.

Dr. Kevin Burke, Clark County public health officer, said he hopes that even if the governor institutes a temporary needle exchange program, the Legislature will act.

"A 30-day program would be much too short," he said. "You're not going to help those people long-term."

Nor will a needle exchange limited to one county do much to curb the spread of HIV, others argue. Jeanni McCarty, office manager for Foundations Family Medicine in Austin, which has seen many of the local HIV cases, described one patient, who has been seen there for most of her life. The young woman came to her recently and confessed that not only did she use intravenous drugs and share needles with those around her, but she helped fund her habit with prostitution. She said she tested positive in January and since then, she estimated, she has had sexual relations with about 75 truck drivers passing through the area.

Dr. Deepak Azad, an internist in Scottsburg, agreed that containing a needle exchange program to the area makes little public health sense. "65 goes from south to north," he said. "Keeping a needle exchange program only in Scott County is not going to solve the problem."

But Dr. Jennifer Walthall, deputy state health commissioner who testified at the hearing, said Pence has little interest now in supporting needle exchange programs for the entire state. Instead, she said, he's considering it only to help solve the public health emergency.

"What we're considering is a surgical strike for the areas affected," she said. "He's opposed to it as a systematic 92-county solution."

Others, however, warned that could prove to be short-sighted. While the current efforts focus mainly on a temporary fix for the problem in southeastern Indiana, Dr. Shane Avery, a Scottsburg family medicine doctor, said it might not be long before the outbreak spreads. The number of hepatitis C cases, which often goes hand in hand with HIV, has already increased in recent years, he said.

"This could explode everywhere in Indiana," he said. "It just started in Scott County."