Stopping the HIV Outbreak in Rural Indiana

‘On March 26, 2015, Indiana Governor Mike Pence issued an executive order declaring a public health emergency in several counties across Indiana due to a rapidly escalating outbreak of human immunodeficiency virus (HIV).

In just a few short years, there has been a large increase in the number of young people abusing opiates. This increase in injection-drug use and the high rate of HIV and HCV transmission through drug injection means that needles are in short supply, and injection-drug users are turning to sharing needles.

Indiana is one of 25 states in the U.S. where it’s illegal to purchase syringes without a prescription and where state law does not authorize needle-exchange programs. Thus why Governor Pence declared a state of emergency, which enabled him to temporarily suspend the law and introduce a temporary needle-exchange program.

However, this needle-exchange program deters many people from participating because it requires that injection-drug users register with their initials and date of birth and unregistered injection-drug users are subject to prosecution for carrying syringes. (Using needles for non-medical purposes is a felony punishable by up to 3 years in prison.)

In order to prevent further HIV outbreaks among substance users, aggressive implementation of evidence-based practices for HIV prevention must be put in place. Permanently lifting the ban on using federal funds to support needle-exchange programs will be a critical component of HIV prevention, since these programs reduce HIV incidence.  The federal funding ban limits these programs scalability and quality of services, including their ability to provide on-site HIV and HCV testing and referrals for drug treatment.’

Synopsis of Threading the Needle — How to Stop the HIV Outbreak in Rural Indiana by Steffanie A. Strathdee, Ph.D., and Chris Beyrer, M.D., M.P.H.