On March 25, Indiana’s Governor Mike Pence (R) signed a 30-day executive order temporarily suspending Indiana’s ban on needle exchange programs in response to a growing HIV epidemic in the state caused by unsafe intravenous drug use. The move—coming from a governor who recently won widespread condemnation by signing Indiana’s discriminatory Religious Freedom Restoration Act—showed a welcome willingness to prioritize the health of Indiana’s citizens over the desire for them to abstain from drug use.
Around 90 new cases of HIV were been identified in southeastern Scott County, Indiana between mid-December and early April—in a total population of about 24,000, that signifies an epidemic. Most of these new cases occurred in intravenous drug users, often injecting Opana, a powerful prescription painkiller. Following the executive order, the first needle exchange center opened at the beginning of April, available only to Scott County residents through the Community Outreach Center in the city of Austin. The center offers a week’s supply of clean needles to each participant, as well as HIV and hepatitis screening and drug treatment referrals.
Overwhelming evidence, presented by bodies such as the World Health Organization, has long supported the efficacy of needle exchange in reducing the spread of blood-borne diseases without causing an increase in intravenous drug use. And as far back as 1997, the Centers for Disease Control and Prevention issued a report to Congress recommending the inclusion of syringe exchange programs (SEPs) in community outreach initiatives. The report concluded that SEPs were able to lower the incidence of HIV more effectively than traditional drug treatment programs.
Yet many US lawmakers continue to reject SEPs on the grounds that such programs “encourage” illicit drug use. Even Governor Pence stressed that his recent executive order was “an exception” to his normal policy. A US ban on federal funding for needle exchange programs was lifted in 2009 but then reinstated in 2011. And about half of all US states retain laws that obstruct or ban syringe possession or distribution. The US thus trails over 70 other countries in implementing SEPs nationwide.
Australia, for example, implemented SEPs back in the 1980s. A government study of Australian cities then showed an 8.1% increase in the prevalence of HIV in cities without SEPs, compared with 18.6% annual decrease of HIV transmissions in cities that had them.
It’s to be hoped that Pence’s decision marks the latest step towards acknowledgement of SEPs’ proven efficacy across the US. Needle exchange should really act as a long-term, preventative measure against disease, rather than a short-term reaction to epidemics.
by Mei Schultz