As Indiana grapples with a record-breaking number of HIV infections that have devastated the state’s rural counties, public health officials are warning that the factors fueling the current outbreak — poverty, intravenous drug use, misinformation and stigma about HIV, and a lack of effective health resources — aren’t specific to that state. Other communities are also at risk for a similar tragedy.
“The conditions that led to this outbreak could happen throughout the United States,” Jerome Adams, Indiana’s state health commissioner, pointed out this week. According to USA Today, a concerning number of HIV cases have already been documented in rural areas in Alabama, Mississippi, South Carolina, North Carolina, and Idaho.
The unfolding public health crisis highlights the fact that, for decades, Congress has pursued ineffective anti-drug policies that undermine the effort to safeguard Americans from the spread of HIV. Now, as the number of HIV cases rise, some Republican lawmakers are indicating that they may finally change their minds on a matter that has frustrated medical experts for years.
Since the 1980s, conservatives in Congress have blocked federal funding from going toward needle exchange programs, which aim to help drug users avoid dirty needles that can spread infectious diseases like HIV. These programs allow drug users to receive sterilized needles without fear of prosecution; for many individuals injecting drugs, it’s the only interaction with the health system that they have.
Needle exchange programs haven’t been a controversial issue in the medical community for at least 15 years by now, largely because they have the weight of scientific evidence behind them. Expanding access to clean syringes has been proven to lower the rates of HIV without increasing the rates of drug use. Exchange programs are endorsed by all of the top medical organizations and HIV prevention groups, including the Centers for Disease Control and Prevention, the Foundation for AIDS Research, the World Health Organization, and the National Institutes of Health.
Nonetheless, social conservatives have positioned themselves as firmly against the policy, arguing that giving out clean needles represents a tacit endorsement of drug abuse that will only enable addicts.
In 1988, Sen. Jesse Helms (R-NC) — whose legacy also includes pioneering a funding ban for abortion services for some of the world’s poorest women — spearheaded the effort to yank federal dollars from needle exchange programs. Helms has had a lasting impact on drug policy. The funding ban has remained largely intact; although it was briefly lifted in 2009, when Democrats controlled the appropriations process, it was quickly reinstated by Republican leaders during a budget negotiation in 2011.
Public health officials say that states should be allowed to divert existing federal health funds toward efforts to get dirty needles off the streets. However, without federal funding, it’s been difficult to get adequate numbers of needle exchange programs off the ground. Experts have grown increasingly frustrated by the funding ban, pointing out that it’s yet another area of anti-drug policy that prioritizes a hardline criminal justice approach over an effective treatment strategy.
However, in the face of the most recent HIV outbreak, which has illustrated the enduring misinformation and stigma that’s swirled around the virus for decades, some lawmakers are starting to soften.
At the beginning of this month, Indiana Gov. Mike Pence (R) — who has long been opposed to needle exchange programs — approved a new law that allows counties to set up needle exchanges if they can prove they’re in the midst of an HIV or Hepatitis C epidemic. “This measure will save lives and give public health officials the broadest range of options to confront this and other public health emergencies in the future,” Pence said in a statement released after he signed the bill.
It’s a departure from the conservative governor’s previous positions on the topic. As recently as March, Pence said he doesn’t believe that an effective anti-drug policy “involves handing out drug paraphernalia” and vowed to veto any legislation seeking to establish a statewide exchange program.
Some of Pence’s fellow Republicans are also seeking new approaches to stem the spread of infectious diseases. “We’ve tried the war on drugs for several years. We’ve lost that battle. So we have to have a new mentality now,” Indiana Rep. Steve Davisson (R), a pharmacist who’s been attempting to change some of his state’s policies, told the Indiana Star this week.
Lawmakers in neighboring Kentucky, where health officials are expecting Indiana’s HIV outbreak to spread, also recently approved a measure allowing health departments to establish needle exchange programs, a policy that Democrats pushed through by compromising with Republicans on tougher sentences for drug traffickers.
On a national level, it’s unlikely that members of the GOP-controlled Congress would move quite so quickly to reform the longstanding federal policy on needle exchange programs. Still, several members of the House Appropriations Committee — which could choose to lift the funding ban during the next budget process — told the New York Times that they’re cautiously open to exploring the issue.
Rep. Tom Cole (R-OK), for instance, acknowledged that funding needle exchanges could be “more cost effective” than treating additional cases of HIV and Hepatitis C infections. “If the evidence is such that it really makes a difference, it is something to look at,” Cole told the New York Times this week, adding that “as Republicans, we don’t want to look like we are facilitating drug use.”
“I’m certainly willing to look at it as an option,” Sen. Shelley Moore Capito (R-WV), whose state is currently grappling with high rates of intravenous drug abuse, agreed. “Our state is really suffering from this. It’s very worrisome.”