Indiana is in the midst of a horrific spike in HIV cases—79 cases have been recorded in one county alone—and Governor Mike Pence is breaking with party tradition in his search for a solution. He has announced that the state will initiate an HIV and substance abuse treatment center that will include a short-term needle exchange program “for the sole purpose of containing the epidemic.”
The governor’s decision to sanction a short-term needle-exchange program is a major step forward in drug reform—and not just for the Hoosier State. Support from Pence, the former congressman and staunch conservative, could mean the tipping point in a debate that’s plagued the U.S. for two decades.
Despite mounting scientific evidence that needle exchange programs are effective at reducing HIV among drug users, the federal ban on funding has been in place since 1980. If Pence can help sway others in his party to support the issue, there’s a good chance the ban may be lifted all together.
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“It’s very exciting. Great to show Gov. Pence showing leadership on this,” Bill Piper, director of national affairs for the Drug Policy Alliance, told The Daily Beast. “His actions stand out as being more influential—he has the ability to influence others.”
At present, Pence’s plan only allows the needle exchange to remain open for 30 days. If prior studies are any indication, Pence may want to extend it.
Experts estimate that IV drug use accounts for 14 percent of cases of HIV among women and up to 11 percent among men—an epidemic that newly infects 50,000 Americans every year. Needles, used to inject drugs into the bloodstream, make an ideal vehicle for HIV. The blood-borne infection can cling either to the needle itself or the drug inside of it. The result puts the 15.9 million people who inject drugs worldwide, 3 million of whom already have it, at great risk of infection.
But there is a simple remedy: clean needles.
The first federally funded evaluation of the efficacy of needle-exchange programs took place in New Haven, Connecticut, in late 1998. Using mathematical and statistical data (rather than self-reporting), the researchers found a 33 percent drop in the rate of HIV infections among participants. Since then, more than four dozen studies have been released showing similar results.
The list of agencies that support the practice is extensive. It includes the Centers for Disease Control and Prevention, the World Health Organization, the American Medical Association, the National Institutes of Health, and the National Academy of Sciences.
But still, the ban on federal funding for needle-exchange programs lives on. First introduced amid AIDS panic of the 1980s, it was repealed once in 2009 by Democrats, but then quickly reinstated when Republicans took the House in 2011.
Critics of the ban argue that needle-exchange programs not only promote drug use, but increase the likelihood that people will use drugs. Science begs to differ. Multiple reports from the CDC and the National Institute on Drug Abuse have concluded that syringe exchange programs do not increase the incidence of drug use. In 2008, the Surgeon General released a statement confirming this.
Kaiser Health estimates that there are at least 221 sterile syringe exchange programs nationwide across 33 states. The programs themselves are simple, providing a place for users to dispose of contaminated needles and obtain sterile syringes for later use.
“No one is going to run out and do heroin just because they have a syringe,” Piper says. “The reality is people who are going to use heroin are going to use it. These services are meant to keep people alive.”
