INDIANAPOLIS — A rural southern Indiana county that was the epicenter of the state’s worst-ever HIV outbreak driven by intravenous drug use is poised to end its needle exchange program despite warnings that doing so could lead to increased disease risk.
Health officials, including the Centers for Disease Control and Prevention, have called Scott County’s program that started in 2015 a success in drastically reducing the spread of infectious diseases by providing IV users with clean syringes to discourage needle sharing.
But the continuation of such programs there and elsewhere have faced opponents who argue they enable drug abuse and lead to more needles being left in public places.
Those arguments have swayed Scott County Commissioner Randy Julian, who was elected in November to his first term on the three-member body, to side with commissioners President Mike Jones, a longtime opponent of the exchange. They could vote Wednesday against renewing the program, which would lose its authorization in May 2022.
Julian said in an interview that six years after the HIV outbreak, the area’s drug users are aware of the risks from sharing needles and it is time for them to take responsibility for their actions.
“There’s no end game to it,” Julian told The Associated Press. “It was brought in here and it did its job on what it should have done, but now it’s time to move on and fight it in a different way and get people off the addiction instead of handing them needles. That just doesn’t do it.”
Scott County’s needle exchange began in 2015 after then-Gov. Mike Pence, amid mounting HIV cases driven by users of a liquefied form of the painkiller Opana, overcame his objections to such programs and authorized the state’s first-ever effort to provide addicts with clean needles.
The area’s HIV outbreak eventually grew to about 235 people infected — with nearly 200 of them in 24,000-person Scott County and centered in the small town of Austin about 40 miles north of Louisville, Kentucky.
State health department reports show Scott County had fewer than five new HIV cases during 2020 and that its rate of hepatitis C infections had fallen by about two-thirds since 2015, even though it remained the third highest among Indiana’s 92 counties during 2019.
Indiana’s state health commissioner, Dr. Kristina Box, and her predecessor, Dr. Jerome Adams, who was U.S. surgeon general under President Donald Trump, attended a county commissioners meeting in early May to urge them to continue the program. Box said that jettisoning it would inevitably lead to rising HIV and hepatitis C cases.
“We may not see it immediately, but there’s no question in my mind we would see increasing rates of hepatitis C, we’d see increasing rates of HIV, we’d see individuals coming back to the emergency room,” Box told reporters at the meeting.
Julian, the county commissioner, argued that the exchange program’s treatment referrals, testing and overdose-reversal drugs should remain available. Julian conceded that HIV cases could rise again if the exchange ends, but he said if that happens, the program could be reinstated.
Indiana began allowing the exchanges in 2015, but only with state approval, after Scott County’s HIV outbreak. State lawmakers in 2017 backed allowing counties and cities to create their own programs.
Indiana’s authorization for the exchanges had been set to expire in 2022, but earlier this year legislators approved extending that permission until July 2026.
Eight other counties now have needle programs, including Clark County just south of Scott County. Others are those with the cities of Indianapolis, Fort Wayne, Lafayette, Bloomington, Anderson, Richmond and Connersville.
Julian said the exchange has not ended needle sharing while Scott County had more than 70 opioid overdoses last year, including nearly two dozen fatal ones. He said he’s troubled by the items that the program provides participants along with syringes, including what he said was a tourniquet, metal cooker, cotton balls and alcohol.
“That’s a little hard to swallow,” Julian said. “The people here are tired with it. They’re tired of the needle exchange.”
Reporter Tom Davies contributed.