Preventing HIV outbreaks


A Wall Street Journal map based on data from the Centers for Disease Control and Prevention is telling. Large swaths of Kentucky — 54 of 120 counties — are red. Southern Indiana also is scarred by several red counties.

The red on the map identifies the counties that the CDC says are at high risk of outbreaks of HIV and hepatitis C among injection drug users. The CDC identified at-risk counties by analyzing data such as unemployment rates, overdose deaths and sales of prescription painkillers.

The CDC’s analysis is aimed at heading off another outbreak of disease such as that which afflicted the area around Scott County, Indiana, last year, leaving 181 people HIV positive. The CDC has warned Kentucky, Indiana and 24 other states to step up testing and be ready to deal with an outbreak.

As it happens, the CDC warning in June was followed last week by a New England Journal of Medicine study that said the southeastern Indiana outbreak could have been avoided. The study suggests that Indiana and other largely rural states such as Kentucky should focus on prevention measures — more HIV testing, identifying networks of intravenous drug users, increasing access to treatment, syringe-exchange programs and education. Of course, reducing addiction also would play a role.

It’s time for states to heed such calls. Most important, states need to clear the hurdles that still exist to setting up needle-exchange programs, especially now that a recent change in federal policy allows the use of federal funds to run such programs, though not to pay for the syringes.

As part of a major heroin bill that passed the Kentucky General Assembly in 2015, local jurisdictions are allowed to set up syringe exchanges at their discretion. So far, only Louisville and Lexington have done so. Others, no doubt, are held back by doubters who say handing out syringes only encourages drug abuse.

Now, some in the commonwealth are battling over whether such programs should provide only one syringe for each one turned in. The problem is that exchanging needles one-for-one assumes that the needle isn’t being shared and the clean needle isn’t just going back to being shared. Some argue that requiring a needle be turned in helps encourage users not to discard needles carelessly. Still, getting a clean needle in the hands of each drug user should be the primary goal.

In Indiana, the law passed there requires a local government to declare a public health emergency and prove that HIV, hepatitis C or overdose deaths are on the rise before it can set up a needle exchange. As the CDC warning should make clear, reacting after a scourge has taken hold is too late.

Clark County, Indiana, has been waiting almost a year since local elected officials decided a needle exchange was an appropriate part of a comprehensive approach to preventing an HIV outbreak and helping curb drug abuse. Clark County has high overdose death rates (higher than Jefferson County’s per capita) and hepatitis C has been on the rise. Yet, for some unknown reasons, Clark’s application has been held up at the state level.

In addition to the benefits of reducing the spread of disease, needle exchanges also offer an opportunity for some addicts to get connected with treatment when they come forward to get clean needles.

Now is the time to keep moving ahead on all fronts — but especially needle exchanges — to prevent the spread of disease. Kentucky and Indiana have too much at risk.

Courier-Journal, Louisville

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