How Discriminatory Public Health Policies Created Indiana's HIV Outbreak
Last month, amidst the economic and ethical disaster that was unfolding around Indiana Governor Mike Pence's asinine and discriminatory anti-LGBT "religious freedom" bill, another story was unfolding in Southeastern Indiana that illustrated the potentially fatal consequences of stigmatizing marginalized populations for political gain. As of the writing of this article, there have been 89 cases of HIV infection recognized among residents of Scott County, Indiana, since mid-December of 2014, a number that dwarfs the average of five cases that is usually diagnosed in the county annually. It constitutes the largest HIV outbreak the state has ever experienced.
Why Scott County, Indiana? Well, like most epidemics, it isn't one thing so much as it is a confluence of a number of different factors that created the epidemiological perfect storm necessary for the disease to flourish. One wouldn't pick out a rural, Midwestern county with fewer than 25,000 residents as the likeliest place for an HIV outbreak, but there were a number of unique factors that made it susceptible. For instance, Scott County's geography and size make it a perfect landing spot for HIV to be transmitted through injection drug use, as I-65 -- a major drug trafficking route that runs from the Gulf of Mexico to Chicago and intersects in Louisville with two other major interstates -- runs through the county's two biggest cities and the insular nature of the injection drug using community helps to amplify the chances of one or two positive people spreading the virus to those around them.
Other contributors like high unemployment, poverty and sex work have helped to create the environment that has fueled this epidemic. But the two biggest factors have been a series of poor policy decisions by the Indiana state government regarding HIV/AIDS care and injection drug use that were implemented out of prejudice and ignorance.
Well, we don't want to encourage them, do we? Ask any opponents of needle exchanges to justify their position and you will usually hear some variation on that theme. Don't encourage them, they say, treating IV drug users like petulant children who need to be taught a lesson and sent to bed early without their dessert. Don't encourage them, they tell you, as if they had forgotten that we tried prohibition in this country before and that it was such an unmitigated failure we abandoned it almost as soon we had adopted it. Don't encourage them, they proclaim as they labor under the gross misapprehension that a dirty needle and all of its attendant dangers makes a damn bit of difference to a dope sick addict who needs to get well.
Don't encourage them -- it's a sentiment that is all too familiar to reproductive health advocates and the HIV/AIDS community writ large. It is the principle that states that knowledge is corrosive and that teaching children how to use a condom is tantamount to forcing them into premarital intercourse at gunpoint. It is the institutionalized ignorance that leads to sex ed classes where the teachers aren't allowed to talk about sex and have to explain sexually transmitted infections using M&Ms and a couple of Dixie cups. Ultimately, just as is the case with prevailing attitudes about IV drug use in America, it is the moralizing of medical matters in which the worst aspects of religion and prejudice eclipse science and compassion as the guiding force in shaping public health policy.
After riding the now-crested Tea Party wave to large gains in the 2010 midterm elections, the Indiana state government went on a crusade against Planned Parenthood and Roe v. Wade, becoming the first state to pass legislation defunding Planned Parenthood. Fortunately, a federal judge nixed the law, but in the four years since then, Planned Parenthood funding in the Hoosier state has been slashed to the point that five of the state's clinics had to close. One of those five happened to be in Scott County.
The wretched irony of the situation is that the Scott County Planned Parenthood center did not perform abortions -- so the state government shut down the county's only HIV testing facility not for anything it did, but for what it supposedly represented.
At the same time that Planned Parenthood was under attack, Washington's brief, four-year rendezvous with sane injection drug use policy ended when the ban on federal funding for needle exchanges that had been instituted by President Obama in 2009 was reinstated by Congress, leaving it once again to states and localities to fund such programs. Unsurprisingly, given the opposition of Governor Pence and the right-wing Indiana legislature to needle exchanges and the fact that Indiana spends the least amount of money per capita on public health of any state, the need for such programs was ignored.
And in the wake of the discovery of the outbreak, it's easy to become discouraged with only a cursory glance at the recent government response. Much of the news coming out of Indiana has focused on Governor Pence's decision to sign an emergency executive order lifting the ban on needle exchanges in Scott County for 30 days, a measure that makes about as much sense as taking two days' worth of a two-week antibiotic therapy and expecting to get better.
However, while Pence has been thumbing his nose at the well-being of his constituents, the Indiana House has passed a piece of legislation with much more promise. The bill, which was introduced by Republican Representative Ed Clere, would allow for the establishment of needle exchanges in counties that have been deemed high risk based on the rates of hepatitis C infection. The legislation, which is currently being considered by the state senate, would allow a quarter to a half of the counties with the highest rates of new hepatitis C infection to create needle exchanges, a development that is extraordinary given where the discussion on exchanges was even a few weeks ago.
Don't look now, but the Indiana legislature might be poised to pull off that rarest of feats in politics: to learn from its mistakes.