Indiana is in the midst of “one of the worst documented outbreaks of HIV among IV users in the past two decades,” said Dr. Jonathan Mermin, director of the National Center for HIV/AIDs, Viral Hepatitis, STD and TB Prevention at the U.S. Centers for Disease Control and Prevention. Since December, more than 140 cases have been reported in an area that previously reported no more than five cases a year.. The outbreak is tied to intravenous injection of the prescription opioid, oxymorphone (brand name: Opana).
To combat the epidemic, Mike Pence, governor of Indiana, declared a state of emergency and temporarily authorized a needle exchange program.
Gov. Pence should be commended for listening to public health officials, despite his own reservations about needle exchange programs. While stopping injection drug use is the best way to reduce a user’s risk of HIV infection, addiction may prevent many from taking this step. Accordingly, providing clean needles and syringes through syringe exchange programs is the next best option. Because most programs provide other health services, they can also help some addicts stop using.
Numerous studies have shown the effectives of syringe exchange programs in reducing HIV risk behaviors and infection. Nevertheless, SEPs have been controversial. Critics fear that making injection equipment easy to get will increase drug use. They are also concerned that the programs will increase crime and discarded needles and syringes in surrounding neighborhoods.
However, studies have shown that syringe exchange programs neither increase drug use among existing users or new users, nor increase crime or discarded injection equipment where they operate. With evidence of significant benefit, and few harmful effects, public health organizations, from the CDC to the World Health Organization, recommend syringe exchange programs as an essential component to HIV prevention programs.
Despite the evidence supporting the effectiveness of SEPs for HIV prevention, they remain illegal in most states because of drug paraphernalia laws and the long-standing federal ban on funding. Drug paraphernalia laws were adopted as part of Nixon’s “War on Drugs’ (before the AIDS epidemic) and prohibit possession or distribution of injection equipment.
Although some state and local governments and nongovernmental organizations have funded syringe exchange programs, these entities lack the financial stability that federal programs have, and some groups have been reluctant to support them given the federal government’s perceived disapproval.
The Indiana outbreak has brought renewed attention to the need to use the best-proven methods for HIV prevention, which includes syringe exchange programs, even if politically unpalatable. States should adopt laws that permit the programs, and the federal government should affirmatively support funding of them as part of its prevention efforts. If governments do not act, Indiana will not be alone in facing HIV outbreaks.
Leslie Wolf is the director of the Center for Law, Health & Society and a professor of law at Georgia State University College of Law. She conducts research in a variety of areas in health and public health law and ethics, including law and policy related to HIV/Aids.