Indiana: The Culpability of Politicians

— Sam Friedman

LAST YEAR THERE was extensive news media coverage of an HIV (and hepatitis C) outbreak in rural Scott County, Indiana. Rates of new HIV cases in Scott County increased from about five per year to about 30 per month in late 2014. Most of those getting infected were people who had become users of prescription pain relievers and then had changed over to heroin and to injecting their drugs — both of which reduce costs for someone with a drug problem.

Less reported were some of the political roots of this outbreak. Syringe exchange programs greatly reduce the risk of becoming infected for people who inject drugs. When New York City introduced large syringe exchange programs in the early 1990s, for example, rates of new HIV infection plummeted rapidly.

In spite of this fact, and despite many Federal review committees that recommended setting up such programs because they did no harm and did lots of good, both Congress and President Clinton (husband of the current Democratic Party candidate, Hillary Clinton) refused to allow syringe exchanges to be funded by Federal money. And in about half the states, they were and indeed in most cases remain quasi-legal or illegal. (Nonetheless, underground exchanges exist in many areas where they are illegal.)

In spite of the heroic efforts of a small group of underground exchangers in Indianapolis over two decades, syringe exchange remained illegal in Indiana. Governor Pence (now Trump’s Republican Vice-Presidential candidate) supported this prohibition before the outbreak, and although he allowed exchanges in Scott County as a temporary emergency measure, he did not act to extend it throughout the state.

Pence also caused the shutdown of Planned Parenthood in Scott County and other places in Indiana — which meant that there was no free HIV testing there. This delayed the discovery of the outbreak and made it harder for infected people to get HIV medical treatment or to get condoms to reduce their risk of transmitting HIV to sexual partners.

November-December 2016, ATC 185

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