INDIANAPOLIS — An Indiana county at the heart of an HIV outbreak has seen a "significant increase" in the number of cases more than two weeks into a short-term needle exchange program approved by Gov. Mike Pence, state health officials said Friday.
The Indiana State Department of Health said there are now 120 confirmed HIV cases and 10 preliminary positive cases tied to Scott County, about 30 miles north of Louisville, Kentucky. That's up from 106 last week.
Health officials who declared an epidemic last month have said they expect the number of cases to rise as more people are tested. But the growing number could put pressure on Pence to extend the 30-day needle exchange program that he approved March 26.
Spokeswoman Kara Brooks said Friday that Pence is reviewing reports and recommendations from health officials and will make a decision early next week about extending the program beyond April 25.
The Scott County outbreak has occurred among intravenous drug users and primarily involves the use of the high-powered painkiller Opana, health officials have said. The county typically sees about five HIV cases each year.
Since Pence approved the temporary needle exchange, 5,322 clean syringes have been provided to 86 participants, health officials said Friday. About 1,400 used syringes have been returned.
Brittany Combs, public health nurse for the Scott County Health Department, said the needle-exchange program had "really picked up a lot this week," in large part because a mobile unit has been traveling around neighborhoods seeking to get more IV drug users into the program.
"It's that trust factor. You have to gain that trust, and I think we're slowly starting to do that," Combs said.
But the future of the Scott County program, as well as the fate of legislation that would allow needle-exchange programs in other counties, isn't clear.
Pence opposes needle exchanges as an anti-drug policy. Senate President Pro Tem David Long said Thursday that the emergency exchange for Scott County was "the right reaction" but wasn't sure if it is the correct approach long-term. Nor was he sure whether the Senate would support legislation sponsored by House Public Health Committee Chairman Ed Clere, R-New Albany, that would allow the 23 Indiana counties with the highest rate-per-population of hepatitis C to establish their own needle-exchange programs.
The Centers for Disease Control and Prevention reports that between 50 percent and 90 percent of people with hepatitis C are also infected with HIV. Health officials say because of this, high rates of hepatitis C are a key indicator of needle-sharing and a potential HIV outbreak.
The House approved the bill on April 7 in a 54-39 vote, and the measure is scheduled for a hearing Monday in a House-Senate conference committee, which will try to work out a final version for lawmakers to consider before the Legislature's April 29 adjournment deadline.
Long said Pence isn't alone in his concerns that needle exchanges could promote drug use instead of prevent it.
"At the same time, you adapt and you evolve based on the world we live in, so we're going to have to see if that requires a pivot for us," Long said.
Clere said he appreciates Pence's approval of the short-term needle exchange but that "it doesn't help in other areas of the state that are at risk for a similar outbreak. It's just not enough."
He said the association between needle exchanges and illegal drug activity makes many people, including lawmakers, uncomfortable. But he thinks the exchange program shouldn't be viewed as anti-drug policy, but as "a proven and effective harm-reduction policy."
"We simply can't afford to view this as a short-term problem," Clere said.
Money could also be an issue as lawmakers weigh their options. Since 1989, the federal government has banned public funding of needle exchange programs. Pence's executive order didn't include money for the Scott County program.
"They asked the state agencies to find their own money. How sustainable is that?" said Dr. Beth Meyerson, co-director of the Rural Center for AIDS/STD Prevention at Indiana University. "There's no evidence that the Pence administration is thinking about this in the long term at all."
Associated Press writers Rick Callahan and Tom Davies contributed to this report.