Kelly Hans holds a box of Narcan nasal spray at the county's One-Stop Shop in Austin. Mitch Legan/WTIU/WFIU News
In 2015, rural Scott County, Indiana, found itself in the national spotlight when intravenous drug use and sharing needles led to an outbreak of HIV.
Mike Pence, who was Indiana's governor at the time, approved the state's first syringe exchange program in the small manufacturing community 30 minutes north of Louisville, as part of an emergency measure.
"I will tell you that I do not support needle exchange as anti-drug policy," he said during a 2015 visit to the county. "But this is a public health emergency."
In all, 235 people became infected with HIV over the course of the outbreak, most of them within the first year. In all of last year, there was one new case. Health officials credit the needle exchange for the dramatic drop-off in cases.
But with cases the lowest in years, Scott County's commissioners are considering shutting the program down. Two of three commissioners have said they plan to vote to end the program during their meeting June 2, arguing it enables drug use. (Neither would grant interviews to NPR.)
Needle exchanges provide intravenous drug users with clean syringes and a place to dispose of used ones. Research shows they help reduce the spread of infectious diseases like HIV and can help people overcome substance abuse by acting as an access point to health services for those who are unlikely to seek them out.
Michelle Matern, Scott County's health administrator, doesn't want to see the syringe program end.
"I think a lot of people forgot kind of what 2015 was like, and what we went through as a community," says Matern.
Hans goes through the contents of one of the kits the exchange provides intravenous drug users. Mitch Legan/WTIU/WFIU News
Residents have testified to the effectiveness of the exchange during recent meetings. Former U.S. Surgeon General Dr. Jerome Adams attended a commissioners' meeting in early May and praised Scott County's exchange as the gold standard.
"I've seen syringe service programs all over the nation; I've been to Canada and seen how they do it over there," Adams said. "And the way you're doing it here is the way it's supposed to be done."
The county's One-Stop Shop in Austin, Ind., provides testing for HIV, hepatitis C or sexually transmitted infections. There's food and the people who work there can connect users with health insurance, housing and recovery opportunities. It serves around 170 people a month.
"We don't call it a needle exchange anymore," Matern says. "We call it a 'syringe service program,' because we realize that it's a lot more than just exchanging us syringes for new ones."
The two commissioners who are against the program say it enables drug users by providing supplies needed to inject drugs and is leading to overdoses.
"It's aggravating for a first responder to Narcan somebody, and this is one of the things I really struggle with is that there's no accountability," commissioner Mike Jones said during a recent meeting. "They walk out of the ER, there's no – nothing happens. I mean, nothing happens."
In a since-deleted Facebook post, commissioner Randy Julian referred to the program as "a welfare program for addicts."
Carrie Lawrence, associate director of the Rural Center for AIDS/STD Prevention at Indiana University says eliminating the supply of clean syringes is not going to help people who are struggling with addiction stop injecting drugs. They're likely to continue even with dirty needles. "That's how Indiana got known for our HIV outbreak," she says.
Closing the syringe exchange she says, "is putting more people at risk."
Kelly Hans was struggling with addiction before the outbreak and now works at the needle exchange as its HIV prevention outreach coordinator. She says getting rid of the program would be a huge blow to the county's recovery system.
"I wish there would have been some place like this prior to the outbreak in 2015, when I was using and when I was a mess," she says. "There was nowhere for me to go to ask for help. Recovery wasn't very loud here in Scott County. So, I didn't even know who to go to."
At THRIVE Recovery Community Organization in Scottsburg, 1,885 people from around the area reached out for help last year. Over a quarter of them were referred there by the county's needle exchange.
The exchange provides Narcan and information to help people use drugs safely, both to prevent disease and avoid overdoses.
Lawrence began researching the situation in Scott County from the start. She says the trust that has been built between the exchange and IV drug using community is what has made it effective.
"You can't just throw up a tent in the middle of the parking lot to do this," she says.
But the commissioners say there are treatments for HIV and are frustrated they don't see more people in recovery from drug use.
"I don't know how you get to someone to say, 'Enough's enough,'" Mike Jones said at a recent meeting.
Health officials have warned of what's happening in West Virginia, where cases of HIV and hepatitis C are spiking as elected officials crack down on needle exchanges.
In Scott County, Matern says they could transition to a harm reduction program without needles – sharing addiction resources and STD and HIV testing services. But she doubts it will be as effective, because what gets people in the door is the needles. If the needle exchange is halted, she expects a rise in HIV cases to follow.
Carrie Lawrence agrees. "Given the history of the Scott County outbreak, another one could happen," she says.
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