Human Immunodeficiency Virus (HIV) graphic courtesy of the Public Health Image Library from CDC

100+ Cases of HIV in Indiana, or how to close barn doors once the horses get out

There is an outbreak of HIV going on in Indiana right now, with most cases associated with most of the cases being associated with intravenous (injected) drug use. The Governor of Indiana has even declared a state of emergency and asked for the Centers for Disease Control and Prevention to go in and help stop the epidemic.

The thing is… We know how to prevent these things.

HIV infections only happen via a limited number of ways. You don’t catch it from shaking hands, kissing, or breathing in the air that someone with HIV has breathed. You need full-on exchange of body fluids that are high in content of HIV. This could happen in one or more of several ways: through unprotected sex, blood transfusions, organ transplants, and sharing infected needles. It was the last way that the outbreak in Indiana happened.

We know to prevent these kinds of outbreaks with sensible public health interventions. There are needle exchange programs where people who use (and abuse) injected drugs can take their used needles and have them disposed in a safe way. They then get clean needles to use so they don’t have to borrow needles from someone who is potentially infected. This intervention works, but it was not in place in Indiana. Why?

Because the state — like the Federal Government — has a law prohibiting the use of public funds to fund needle exchange programs, despite all the evidence that needle exchange programs are cheap alternatives to the scores of people who have to be treated for HIV and other infections acquired through the sharing of needles.

Now that the horse is out of the barn, so to speak, Governor Mark Pence has suspended the enforcement of the law and a whopping 29 people are taking part in it (as of April 11, 2015).

Think about it for a second. At one point, the policymakers of the Hoosier State debated whether or not to allow public funds to have needle exchange programs. At one point, they were told about the benefits. At one point, they voted against it. And now they have over a hundred people who will pay for it with a lifetime of health problems.

So what changed from when that discussion was had to today? How are the people who were denied clean needles then different than the people who are being offered them now? The answers are clear. Nothing changed, and the people denied then are just human as the people being helped now. Check that… Something did change. The Governor — and/or his advisors — listened to reason. Only that they did it a little too late.

This is just another one of those situations that happen much too often where politicians are allowed to make public health decisions. They confuse simple concepts like “no dirty needles, no infections” with confused pseudo-moral arguments like “no dirty needles, more heroin addicts.” Or they confuse “safe sex with condoms” with “all-out orgies, with condoms.” In essence, if they make a decision by not sticking to the science, the decision is very likely to be wrong, to backfire, and to get people killed.