A parade of law enforcement, health workers and community members had all made the same case to county commissioners in rural Indiana: The needle exchange program for drug users worked.
It helped contain historic outbreak of HIV and made Scott County, which is half an hour north of Louisville, a model for the rest of the country, they said. It brought addicts into a "one-stop shop" with medical care, testing and people who could guide them toward recovery. It had the support of former U.S. Surgeon General Jerome Adams, who showed up to a public meeting last month.
But county officials voted 2 to 1 this week to end the program, telling a packed and passionate room in Scottsburg, Ind. that they do not want to enable dangerous behavior. One commissioner questioned the extent to which the syringe swap itself drove a dramatic HIV turnaround amid increasing public awareness. Another said he would not want to supply the needle that someone used to overdose.
"I know people who are alcoholics, and I don't buy them a bottle of whiskey," Commissioner Mike Jones said at a Wednesday meeting, where some lined the drab walls and stood in the hall because the chairs were full. "And I know people [who] want to kill themselves, and I don't buy them a bullet for their gun."
Michelle Matern, administrator of the county's health department, now worries that she will see another HIV outbreak like the one that once ripped through the area and made national headlines in 2015. Before that surge, she said, fewer than five county residents had tested positive for the virus that ravages the immune system and requires lifelong treatment.
Now, Matern said, more than 150 have HIV, making the community of about 24,000 seem to her even more vulnerable. In an interview Friday, she struggled to explain why a "dream team" chorus of support for the syringe program was not enough - echoing the frustrations of health officials around the country who have felt sidelined or overruled during a year of highly politicized responses to the coronavirus pandemic.
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Decades of studies have found that syringe exchanges reduce infections by collecting used, potentially contaminated needles and giving out clean ones. But many still balk at the idea of public resources going toward drug use. Some states are moving to restrict exchange programs, and people disagree about the best way forward as overdoses soar during the pandemic's economic and societal upheaval.
"That's what's so extremely disappointing, is that these decisions are being made by people who are not experts in the health field or public health field," Matern said.
Scott County's exchange program was authorized in response to the state's worst-ever outbreak of HIV - believed to have spread through shared-needle injections of opioid drugs, specifically the addictive painkiller Opana. Diagnoses reached the triple digits in the small community with last-in-the-state rates of poverty and insurance coverage.
Some - including former vice president Mike Pence (R), then governor of Indiana - were against syringe swaps. At the time, the programs were illegal. But as the public health crisis worsened and pressure mounted, Pence allowed exchanges in Scott County and later gave statewide sanction to the programs in times of public health emergency.
Infections and syringe-sharing in Scott County plummeted, and by last year, authorities said, the county saw a single case of HIV.
The needle-exchange stop in Austin, Ind. - which welcomes people with colorful reminders to "Carry Naloxone" and "GET TESTED" - became a way for public health officials to reach the vulnerable and addicted with all kinds of aid, from meals to friendly check-ins to handouts of medication for reversing an overdose. Last year, Matern said, about 350 people participated.
"The actual exchange part is very simple and quick," Matern said. "It's that 25-to-45-minute conversation that our staff has with those participants that really make a difference in people's lives."
"For some people that may be the only healthy nontoxic relationship that they've had and probably have, especially with the health-care provider," she added.
The two county commissioners who voted to end the syringe-swap said they take HIV seriously but are most concerned with preventing overdose deaths, which rose last year according to officials. They worried about contributing to drug use and argued the county could continue to provide other services meant to address addiction.
Kelly Hans, an HIV prevention outreach coordinator with the county, wonders how they will lure people in for help.
A lifelong resident who used to struggle with addiction, Hans said she believes that a needle exchange could have kept her from getting hepatitis C if it existed earlier. Watching Wednesday's vote, the 44-year-old said in an interview, was "devastating."
"We're going to miss the whole population that we need to find," she said.
Officials elsewhere are pursuing new restrictions on syringe exchanges, with supporters citing litter and a need for more guardrails and opponents saying they will force valuable programs to close.
In West Virginia, Gov. Jim Justice, R, this spring signed one of these bills against the urgings of many health professionals and a state medical association.
"It prevents the problems that we were having with needles all over the place that could cause all kinds of different problems in communities," Justice said.
Critics say that the shuttering of some resources has already contributed to a spike in HIV cases in Kanawha County. A 2019 study found the loss of a syringe program heightened the risk of HIV spread and overdoses among people who inject drugs.
"We are really going to regret this. There are going to be people that are going to die," warned state Del. Barbara Fleischauer, D, before the measure passed 67 to 32, according to the Associated Press.
North Carolina lawmakers this year introduced another bill that would create new restrictions, sparking passionate debate.
"Any singular provision in the bill would close numerous sites throughout the state," wrote a former Charlotte police chief and ex-narcotics division sergeant in a letter to the editor published last month in the Raleigh News and Observer.