Indiana Gov. Mike Pence considering needle-exchange plan to combat HIV spike

Faced with a growing HIV outbreak tied to intravenous drug use, Indiana Gov. Mike Pence said Wednesday he's considering a needle-exchange program as part of a public health emergency he's preparing to declare in a county that's at the epicentre of the cases.

Pence, a Republican, said he opposes needle exchanges as part of drug-control policy but is listening to health officials to determine the best way to stop the outbreak in Scott County in southern Indiana. Health officials say 72 cases of HIV have been confirmed in southern Indiana and seven other people have preliminary positive HIV infections. All of those infected either live in Scott County or have ties to the county.

Pence, who plans to issue an executive order Thursday morning outlining a range of state actions, noted that Scott County typically sees five HIV cases each year.

"This is a public health emergency and I'm listening to my health department, I'm listening to the Centers for Disease Control and I'll make my decision based on the best science and the best way we can stop this virus and stop this outbreak in its tracks," Pence said after meeting with local officials in Scottsburg, the county's seat.

Indiana's confirmed HIV cases have risen from 26 a month ago when state officials announced the outbreak to 72 now. IV drug use has been determined as the mode of infection in nearly all of the cases, said state epidemiologist Pam Pontones.

Needle-exchange programs allow people to turn in used hypodermic needles and get clean ones in an effort to keep diseases such as HIV and hepatitis from spreading. Such programs are illegal in Indiana, but a measure being debated in the Legislature would allow them on a limited basis.

The number of HIV cases is expected to rise. Officials are trying to contact as many as 100 people tied to those with confirmed infections of the virus that causes AIDS.

Indiana has launched an awareness campaign that includes billboards and social media. State health commissioner Dr. Jerome Adams said a mobile unit will be sent to Scott County with resources to help combat the outbreak.

Pontones said state health officials and staff from the Centers for Disease Control and Prevention who arrived in the county about 50 kilometres north of Louisville, Kentucky, on Monday agree that the outbreak "is an indicator of a larger problem," which is rampant IV drug use in the economically depressed region.

"With the amount of drug use that's happening and the intravenous needle-sharing that's going on, if someone who's highly infectious becomes part of that sharing network, that infection can transmit very rapidly," Pontones said.

She said the vast majority of the people who've become infected during the outbreak shared a syringe with someone else while injecting a liquid form of the prescription painkiller Opana.

Republican Rep. Ed Clere of New Albany, who proposed the needle distribution and collection program Wednesday at the Statehouse, said a House panel considered similar legislation last year, but it didn't receive a hearing in the Senate.

"Unfortunately we're back here, not just with needle exchange as a hypothetical theory, but with a real situation where a needle exchange [program] could make a difference," he said.

The program would require participating agencies to register with state and local health departments and provide information on treatment for drug addiction.

Dr. Jennifer Walthall, deputy state health commissioner, told lawmakers that despite Pence's opposition to a needle-exchange program, the department must look at every option.

"We have never encountered this type of situation before and we need to consider it differently," Walthall said.