By: Marcus J. Hopkins, Blogger
In early 2015, Scott County, Indiana was thrust into the global spotlight for an HIV outbreak among injection drug users abusing opioid prescription drugs and heroin (Hopkins, 2015). In a county that averaged a total of 5 new HIV infections each year, even doubling that number would’ve been a statistical anomaly. By the end of 2016, the county had 216 new HIV infections in the span of just two years, and of those, 95% were co-infected with Hepatitis C (HCV). So rare was the disease that county health department officials had never handled HIV cases, instead sending them all to the regional Sexually Transmitted Diseases Department in Clark County (May, 2016).
The outbreak in Scott County was, and still is, both instructive and reflective of several concurrent health crises faced by most of rural America. In one county, virtually every major health risk met in the middle: a prescription opioid addiction problem, the resultant heroin usage problem, and an access to comprehensive healthcare problem all walked into a bar, and out came one of the worst concentrated HIV epidemics in the U.S. in the past decade. Throw in a paucity of drug addiction, recovery, and Syringe Services Programs (SSPs), and you had the perfect case study for how outbreaks occur.
To be fair to Indiana’s legislature and then-Governor Mike Pence, the state responded intelligently to the crisis by legalizing for the first time SSPs…under certain previsions. Counties had to apply for approval, had to show that they had funding, and had to be located in a high-risk zone. Since Mike Pence’s departure from the state to swampier D.C. pastures, his replacement has actively attempted to ease those restrictions. Earlier this year, the Indiana General Assembly passed a bill allowing local governments to establish syringe or needle exchange programs without having to receive state approval (Rudavsky, 2017). His efforts have not, however, managed to convince everyone.
Madison County, for example, recently voted to remove all funding from their SSP, run by the county’s health department, and prohibited appropriations of funds for paying for both supplies and labor (Fentem, 2017). The ordinance, approved by five of the seven-person council, immediately shuttered the only operating SSP in the county, and was largely driven by stigma-based fears: discarded syringes were going to litter front lawns and public parks; drug addicts were going to wander over from neighboring counties, bringing their drug problems with them; “What about the innocent children?!” These well-worn excuses and arguments against the establishment and funding of SSPs have plagued the proven Harm Reduction measure since its inception. The fears are also unsupported by anything other than anecdotal evidence and hearsay, few assertions of which are backed up by any credible research or quantifiable proof.
Worse, still, is that the council members did nothing on their part to allay these fears. Council member Fred Reese is quoted as saying the following:
Some say if you don’t do the needle exchange, you’re going to have a spread of HIV, you’re going to have a spread of hepatitis C, but my concern is the innocents. I don’t want these needles out (Fentem).
This kind of statement on the part of an elected officials shows cowardice, rather than leadership. Part of the job of county councils is to do what’s in the best interests for everyone, rather than kowtowing to fear-based arguments that bear little resemblance to reality.
Clark County – where Scott County once sent its HIV cases for management – recently renewed their SSP for one year, after which it will be up for renewal in August 2018. About half of the program’s 150 participants have HCV, many of whom were diagnosed through the program (Beilman, 2017). Their hopes for the program include seeing a more balanced rate of return on needle collection. Of the nearly 16,000 needles distributed, the exchange collected almost 8,000 (Beilman).
In Boone County, where no SSP currently exists, Prosecutor Todd Meyer sent the following communique to county leaders:
A needle exchange program does not help in fighting the demand side, in fact, it will do the exact opposite by providing the users/addicts with the tools they need to continue to abuse illicit drugs…(Davis, 2017).
That this opinion was issued by a prosecutor should shock no one. Meyer’s position, however, is reflective of those espoused by [mostly Conservative] voters, legislators, and law enforcement officials, but again, bear little resemblance to reality. Instead, they rely upon fear and stigmatization, along with two terrifyingly short-sighted sentiments: “Not in my back yard!” and “It can’t happen here!” While Meyer contends that Boone County doesn’t have an HIV problem, now, let’s see if it has one in two years.
Back in Scott County, the SSP, run by the Scott County Health Department (SCHD), has another issue: it doesn’t keep track of HCV cases (de la Bastide & Filchak, 2017). For some reason, SCHD officials are only worried about their HIV problem. If that seems counterintuitive, that’s because it is. It was, in fact, a spike in new HCV cases that led to the discovery of the HIV epidemic. Additionally, with a 95% co-infection rate in the 216 HIV cases identified in the initial outbreak, as well as the more aggressive spread of HCV in the U.S. compared to HIV, it makes no sense, whatsoever, for the SCHD to fail to keep track of HCV.
The concurrent HIV and HCV outbreaks in Scott County, Indiana were just the beginning. Already, rural states and counties are beginning to see an uptick in new infections of both diseases as a result of Injection Drug Use (IDU). More concerning is the fact that most of those counties are deeply Conservative, which creates significant challenges for those hoping for proactive healthcare policies, rather than reactive cleanup measures. As for Scott County, there are several families with multiple generations infected with HIV, and very likely with HCV, as a result of prescription opioid and heroin abuse. Unfortunately for them, their county’s health department doesn’t see fit to track their issues.
- Beilman, E. (2017, August 10). Clark County Commissioners renew syringe exchange for one year. Jeffersonville, IN: News and Tribune. Retrieved from: http://www.newsandtribune.com/news/clark-county-commissioners-renew-syringe-exchange-for-one-year/article_4a43988e-7e25-11e7-9cb7-07d78f1cfbf6.html
- Davis, V.T. (2017, August 11). Boone County prosecutor wants to tackle opioid problem without needle exchange program. Indianapolis, IN: Scripps Media, Inc.: WRTV. Retrieved from: http://www.theindychannel.com/news/local-news/boone-county/boone-county-prosecutor-wants-to-tackle-opioid-problem-without-needle-exchange-program
- de la Bastide, K. & Filchak, D. (2017, August 08). Needle exchange a sticky debate – Health official: ‘You don’t want to be the next Scott County’. Anderson, IN: The Herald Bulletin. Retrieved from: http://www.heraldbulletin.com/news/local_news/needle-exchange-a-sticky-debate/article_7c909c35-985f-5678-9a24-d029168f825c.html
- Fentem, S. (2017, August 10). Residents’ Fears Drive First Closure of An Indiana Needle Exchange. Indianapolis, IN: WFYI Indianapolis. Retrieved from; http://www.wfyi.org/news/articles/residents-fears-drive-first-closure-of-an-indiana-needle-exchange
- Hopkins, M. (2015, April 08). Scott County & the Case for Needle Exchange. Washington, DC: Community Access National Network: HEAL Blog. Retrieved from: https://communityaccessnationalnetwork.wordpress.com/2015/04/08/scott-county-the-case-for-needle-exchange/
- May, L. (2016, December 09). Scott County HIV outbreak: How did it happen and where does it stand?. Indianapolis, IN: Scripps Media, Inc.: WRTV. Retrieved from: http://www.theindychannel.com/news/local-news/scott-county-hiv-outbreak-how-did-it-happen-and-where-does-it-stand
- Rudavsky, S. (2017, April 16). Why Indiana needle exchanges don’t have equal success reaching drug users. Indianapolis, IN: The Indiana Star. Retrieved from: http://www.indystar.com/story/news/2017/04/16/why-indiana-needle-exchanges-dont-have-equal-success-reaching-drug-users/100369270/
Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.