Indiana HIV outbreak: Can a needle exchange program help?

Confronting a growing outbreak of HIV, Indiana Gov. Mike Pence has declared a public health emergency in part of his state. Public health officials have identified 79 cases of HIV in southern Indiana, mostly in Scott County.

All the recently reported cases have been tied to intravenous drug use, health officials say, with many drug users injecting the prescription painkiller Opana.

Although the Republican governor generally opposes needle-exchange programs as a policy to control drug use, on Thursday he approved a temporary program to address the growing HIV problem in Indiana.

"The people of Scott County are working hard to address this crisis, and with additional state resources and new tools provided by this emergency declaration, I am confident that together we will stop this HIV outbreak in its tracks," Governor Pence said in a press release issued ahead of a news conference.

Needle-exchange programs allow people to turn in used hypodermic needles and receive clean ones in return. They are designed to reduce the risk of spreading diseases such as HIV and hepatitis, which health officials say can be spread by sharing needles. But these programs have been controversial, with opponents saying they sustain an addiction and give the impression that drug use is acceptable.

Despite these criticisms, many states across the United States have implemented needle-exchange programs with the aim of combating infectious diseases such as HIV and hepatitis. According to the Foundation for AIDS Research, in 2010 there were 203 exchange programs operating in 34 states, the District of Columbia, the Commonwealth of Puerto Rico, and native American reservations.

In December 2009, the US repealed a 21-year ban on federal funding for needle-exchange programs. At the time, health-care advocates were confident that the move would help combat the spread of infectious diseases normally associated with intravenous drug use. "Hundreds of thousands of Americans will not get HIV/AIDS or hepatitis C, thanks to Congress repealing the federal syringe funding ban," said Bill Piper, a member of the Drug Policy Alliance, according to SFGate.

The Centers for Disease Control and Prevention has reported that injection drug use has directly or indirectly accounted for 36 percent of AIDS cases in the US.

But while needle-exchange programs have proved to decrease the likelihood that drug users will share needles, a research review in the journal Addiction found limited evidence that these programs lower disease transmission, Reuters reported in 2010. But the review’s authors said that their findings did not lead to the conclusion that the programs are entirely ineffective.

"Insufficient or weak evidence of an effect is not evidence of no effect," Norah Palmateer of Health Protection Scotland told Reuters Health in an e-mail.

In Indiana, state epidemiologist Pam Pontones said that state health officials and CDC staff agree that the outbreak "is an indicator of a larger problem," which is rampant injection drug use in the economically depressed region, the Associated Press reported.

A needle collection and distribution program was proposed in the Indiana State House last year, but it did not receive a hearing in the Senate. Now, Pence has announced that the needle-exchange program will last for 30 days and will then be subject to reevaluation. The Indiana State Department of Health will be in charge of supervising the program, and an incident command center will be established to coordinate the treatment of HIV and substance abuse.

Officials say more cases will appear, but they are confident that government measures can help limit the spread of the disease.

"I do not support needle exchanges as anti-drug policy, but this is a public health emergency," Pence said, The Indianapolis Star reported.