With the exception of a brief detour into Indiana Gov. Mike Pence’s (R) anti-abortion beliefs during the vice presidential debate on Oct. 4, the night centered around foreign policy, not public health.
It’s a shame, since lackluster public health efforts are what led to the defining moment of Pence’s one-term Indiana governorship: a massive HIV outbreak spurred by public health funding cuts and Pence’s moralistic stance against needle exchanges.
A timeline of the HIV outbreak, the worst in state history, reads like a roadmap of what to do if you want to create a public health crisis.
Pence slashed state health spending.
Pence first laid the groundwork for Indiana’s HIV outbreak as a congressman back in 2011, when the House passed his amendment to defund Planned Parenthood. Then in 2013, Pence’s first year as governor of Indiana, Scott County’s one Planned Parenthood closed in the wake of public health spending cuts. Since that particular Planned Parenthood was also the county’s only HIV testing center, there was no longer a place for the county’s 24,000 residents to get tested.
Nearly 20 percent of Scott County residents live below the poverty line. Injection drug use there is a major problem, increasing the risk of HIV outbreak.
Fast-forward to 2015. Local health officials began to report HIV cases linked to intravenous prescription opioid use in Scott County. Scott County residents were sharing needles to inject their opioids, and nobody was getting tested.
The situation quickly spiraled out of control. At the height of the outbreak, 20 new cases of HIV were being diagnosed each week, reaching a total of nearly 200 cases by the time the outbreak was finally under control.
Pence was dangerously wrong about needle exchanges.
During that time, Pence dragged his feet. Although the outbreak was identified in late January of 2015, it took Pence until April of that year to allow a temporary needle exchange in Scott County. It was a big shift for the governor, who was morally opposed to needle exchanges and believed they promoted drug use.
This position is dead wrong, according to health experts.
“People think that if you give someone a syringe, it means they’re going to go out and inject drugs, and if don’t give them syringes, they won’t inject drugs,” Robert Childs, executive director of the North Carolina Harm Reduction Coalition, told HuffPost in 2015.
“But the thing is that if you don’t give them syringes, they share them, and then people will start getting HIV and viral hepatitis C.”
And beyond humanitarian or public health reasons, opposing harm reduction isn’t fiscally sound policy. “These are extremely costly diseases, and there’s no reason to get them if people can get access to clean syringes — an incredibly cheap product,” Childs said.
Pence reversed his needle exchange stance — for now.
After Pence finally reversed his stance and instituted Scott County’s temporary exchange, four other Indiana counties followed suit, according to the Indianapolis Star.
The program has largely been a success. “Over the past year, the syringe exchange program in Scott County has had a tremendously positive and dramatic impact,” Dr. R. Kevin Rogers, Scott County’s health officer, told the Star. The county will extend the program through May 2017.
But a temporary needle exchange focuses too much on solving this specific outbreak, instead of instituting a permanent public health fix for those who are going to use drugs, Hannah Cooper, an associate professor at Rollins School of Public Health at Emory University, told HuffPost in 2015. Instead, she said, the county needs a permanent program.
“This is not a closed environment,” Cooper said of Scott County. “People can move freely. New infections will come in, and people need to be able to protect themselves.”
Pence’s public health record in Indiana seems to be out of the election spotlight ― a frustrating oversight, considering nearly 200 people contracted HIV while Pence twiddled his thumbs over harm reduction and de-emphasized public health spending.
So the question remains: Do we really want to see Pence’s public health judgement replicated on the national stage? Our collective health may depend on that answer.