Threading the Needle — How to Stop the HIV Outbreak in Rural Indiana

An HIV outbreak in rural Indiana provides a cautionary tale. An aggressive, multipronged strategy is needed to prevent similar outbreaks, and it requires permanently lifting the ban on using federal funds to support needle-exchange programs. Many observers were surprised when Indiana Governor Mike Pence issued an executive order on March 26, 2015, declaring a public health emergency after a rapidly escalating outbreak of human immunodeficiency virus (HIV) was identified in Scott County, a rural region on the Kentucky border. 1 Others, however, had seen it coming. Over the years, a growing number of young people in Scott County — like those in surrounding counties and states — had begun abusing opiates such as oxymorphone, an opioid analgesic prescribed by local medical providers, until a more tamper-resistant formulation and policy reform began limiting its abuse. Facing the . . .