When Sherry Lawson was hired five years ago as a public health nurse in Lawrence County, she said she was surprised to learn the health department didn’t give away free condoms as part of its effort to prevent the spread of human immunodeficiency virus and sexually transmitted disease.
“Condoms are one of the types of things that need to be offered, but we’re a very conservative county,” Lawson said.
But soon, some residents will have access to free condoms through the county’s syringe-exchange program.
The Indiana State Department of Health earlier this month declared a public health emergency in Lawrence County, allowing its health department to establish a needle-exchange program in an effort to reduce the spread of hepatitis C.
The Indiana Recovery Alliance, a Bloomington-based nonprofit that operates Monroe County's needle-exchange program, will provide the same services in neighboring Lawrence County, including distributing free condoms.
“We are trying to follow all the best practices for harm reduction,” Lawson said. “I feel like if we’re trying to protect these folks against anything we can protect them against, then providing condoms is a good option.”
It’s the same story in the seven other Indiana counties that have so far been approved to operate syringe-exchange programs.
Although the state doesn’t require or offer any guidelines to counties on providing condoms as part of a needle-exchange, county health departments are distributing condoms as part of a larger effort to prevent the spread of HIV and hepatitis C.
In Madison County, which began operating its exchange in June 2015, each syringe kit not only includes clean needles, cotton swabs and other supplies to ensure a clean injection, but also two condoms.
Stephanie Grimes, the county’s public-health coordinator and needle-exchange organizer, said it’s a common-sense practice that can go a long way in preventing the sexual transmission of HIV and other diseases.
“It all goes hand in hand,” she said. “It’s not just about the needle. One risky behavior can lead to another.”
Fayette County Health Nurse Paula Maupin said health officials there put up to six condoms in each of their needle kits. The county health department also provides condoms in bags or envelopes for free at its office in downtown Connersville.
“We take every opportunity to put them wherever we can,” Maupin said.
She said the county has made a concerted effort to make it easy for people to get condoms because of the alarming pervasiveness there of people trading sex for drugs.
“When you’re under the influence, you’re a little more uninhibited,” Maupin said. “Hopefully they won’t be so uninhibited that they won’t practice safe sex, but we want them to have the opportunity to have condoms if they need them.”
According to the Centers for Disease Control and Prevention, more than 92 percent of new HIV cases in Indiana in 2014 were transmitted sexually. Transmission through injection-drug use was just 2.8 percent in men and 5.6 percent in women.
Kristin Adams, president and CEO of the Indiana Family Health Council, said distributing condoms is one of the simplest ways to prevent the spread of disease, but a lack of funding could jeopardize counties’ ability to get them into the hands of people who need them.
The state does not fund county syringe-exchange programs, and it doesn’t offer health departments any money or programs to buy or receive condoms.
Adams said the Indiana Family Health Council has tried to fill that gap by using some of its federal grant money to buy and distribute condoms to health departments, college campuses and other social-service agencies.
She said her organization has given free condoms to six of the eight counties that are currently approved to run a needle exchange, but looming cuts to the agency's grant funding may force the non-profit to do away with its condom-distribution program.
Budget cuts have already taken a toll. Adams said the Indiana Family Health Council spent $75,000 to buy and ship 1.5 million condoms around the state last year. This year, that was cut to $50,000 and 1 million condoms.
Adams said potential cuts next year could force the organization to totally eliminate its funding to distribute condoms.
“We have to look critically at whether we’re going to be able to sustain this,” she said. “At the end of the day, we try to do what we can with whom we can without duplicating our services.”
Fayette County nurse Maupin said all the condoms the health department gives away come from the Indiana Family Health Council, and losing access to free condoms to include as part of its needle exchange could have a big impact on the program.
“It would certainly put us in somewhat of a bind,” she said. “If the state isn’t able to provide them, we’d have to use grant funds to get condoms, which would take away from all the other supplies we need to get.”
Carrie Lawrence, director of Project Cultivate, a program in Indiana University’s Rural Center for AIDS/STD Prevention, said many county health departments already are strapped for cash, and the extra financial burden of buying condoms only would add to their budget problems.
“It would be amazing if we were given the funding and tools to use all the harm-reduction tools out there,” she said. “I think we could be more than just ‘Poor Indiana with their HIV outbreak.’ We could set the precedent for what serious prevention efforts look like.”
But that isn’t the case now, Lawrence said, and the fact counties with needle exchanges are finding ways to provide condoms outside of state funding is a testament to local health officials’ dedication to curbing the spread of HIV and hepatitis C.
“I think it shows how much Hoosiers really do value public health,” she said. “It’d be nice to see that reflected in how the state funds public health, and see these counties rewarded for their efforts that don’t have a lot of resources to begin with.”