When an HIV outbreak—caused in large part by the use of shared needles among intravenous drug users—roiled Scott County, Indiana, in early 2015, then-Gov. Mike Pence reluctantly responded by temporarily authorizing a syringe exchange program. The allowance was for Scott County alone, though, and other counties were required to get state approval before starting exchanges of their own.
With panic around the HIV outbreak in Scott subsiding in the time since, other Indiana counties that had followed in obtaining approval for syringe exchanges are now starting to shutter their programs. Lawrence County, about 50 miles west of Scott, became the latest in mid-October when its program was suspended after one year of operation and failed to receive county commissioners’ approval to resume. That followed the closing of the syringe exchange program in Madison County, about 130 miles north of Scott. After two years of operation, Madison commissioners voted to cut off funding for the program in August.
In both cases, moral objections—i.e., the use of public money to fund illegal activities—were a major reason for shutting the programs down.
Daniel Raymond, policy director for the National Harm Reduction Coalition, says that introducing the syringe exchange programs under the duress of an HIV outbreak likely played a large role in the programs not gaining wider acceptance in the long run.
“When you start up a new program because you have the sense there’s an emergency, you may not have had a whole lot of time to have real community discussions, real education about why you’re doing this program and what the benefits are, and really talking through the issues so they don’t come back to haunt you,” Raymond says.
In Indiana, he says, the syringe exchanges were approved as a short-term solution in response to the Scott County HIV scare, and once that panic subsided, the programs had outlived their usefulness in the eyes of opponents.
“Any time a community makes the decision to close a syringe exchange program, it’s a loss to the community, but in particular, I worry about the absence of any contingency plans for people who have been benefiting from that service and no longer have the access to it,” he says. “I think there is a moral responsibility to continue to find ways to engage the population, people who are using drugs, and effectively support them. That does not seem to have been part of the deliberation in those counties.”
Beyond moral responsibilities, Raymond says the Indiana communities that have ended their needle exchanges could come to see the decision as a financial miscue. Studies cited by the Centers for Disease Control and Prevention have shown dramatic reductions in new HIV cases, thereby reducing public health costs.
“I do think that some of the people in these communities will look back on these decisions as short-sighted and hopefully reconsider at a future date because the benefits and the cost savings are so clear,” Raymond says. “The risk is the bigger picture gets lost in the emotion of today.”