Scott County health official: HIV-prevention measures don't go far enough

However, the leader of the agency that first detected the outbreak believes one aspect of the order is insufficient.

Clark County Health Officer Dr. Kevin Burke’s staff first realized that something was wrong when it was clear that new cases of HIV would far exceed Scott County’s typical average of five per year.

“I think we’ve had very good support from the state,” Burke said. “I believe that they will get more involved. They already have provided and facilitated enhancing the number of people who can do the testing and do the care coordination.”

Burke believes that the implementation of a needle-exchange program is an important tool that health officials can use to combat the spread of disease among intravenous drug users, which is why he’s disappointed that Pence’s order only authorizes such a program to exist for 30 days.

Pence noted that, by law, he can only authorize emergency action for 30 days. He could issue another order after the current one expires.

“I think communities that have a problem with this, especially if the infection issue rears its ugly head, need to use all proven, scientifically valid options and therapies to help mitigate and control the problem,” Burke said. “And definitely, needle exchange is proven to decrease infections, so I’m disappointed that he’s taken that position.”

Burke hopes to dispel the notion that a needle exchange will contribute to rising levels of IV drug use.

“Some people have concerns that if you make the needles readily available, then there’s a greater chance that the individual may start using IV drugs, and that has not been proven by a lot of different studies that have been done over the years,” Burke said. “So my only concern about a small-scale or limited program is that it won’t reach enough people that need the needle exchange option, and it won’t last long enough to help facilitate their transition from being an IV drug abuser to someone who’s in a drug rehab program.”

The needle-exchange program’s 30-day window opened Thursday, but it’s not known how long the program will take to implement. Scott County Health Department Public Health Nurse Brittany Combs said the Indiana State Department of Health is going to implement the program, but had no details on how it would work.

“I was just told [Thursday] morning that they have been working on it, so we will know as soon as possible how that program’s going to work,” Combs said.

Pence’s executive order notes that Scott County will come up with a plan the state will have to approve and supervise. Messages left with the Indiana State Department of Health were not returned as of press time.

Combs was uncertain about how effective the program could be working within the time constraints allowed by Pence’s executive order.

“I don’t know. We’ll see,” Combs said. “The main goal is to stop the spread of HIV, and so that’s what we’re going to do initially. I’m not sure if it’s going to be long enough or not.”

Pence made clear Thursday when he announced his executive order that he generally opposes needle-exchange programs, and intends to veto a bill making its way through the state legislature that would allow local governments to establish their own needle exchanges.

Burke believes that’s a mistake.

“I do think that needle exchange decreases the risk of spread of infection,” Burke said. “It actually increases somebody’s chances of getting into rehab because the exchange process allows the people distributing the syringes the opportunity to give some education to the individual about options they might have if and when they decide to quit. It does not increase the risk of IV drug use.”

A typical needle-exchange program would provide addicts with one to two weeks’ worth of needles, Burke said, with addicts then bringing back the used needles in exchange for new ones. That would also ensure that needles are safely discarded, he said.

Restricting the needle-exchange program to Scott County could be problematic, as it’s likely that the HIV outbreak will reach outside of the county’s borders. Between 75 and 100 people still need to be tested, and it’s likely that interviews with HIV-positive individuals from that group could yield another list of people who are at risk, Burke said.

“We feel that some future cases in surrounding counties will likely occur,” Burke said.

Of the 79 HIV-positive cases, about 75 percent of the individuals also tested positive for hepatitis C, Burke said.