When an outbreak of HIV hit Indiana in 2014, then-Governor Mike Pence was tasked with formulating a strategy to halt its spread. But the man known for proclaiming he's a "Christian, a conservative, and a Republican, in that order" chose his personal moral beliefs over the best course of action in stemming the tidal wave of new HIV cases.
Only after more than two months of inaction and a healthy dose of prayer did Pence come around to the idea that sparing his constituents would require setting aside his personal beliefs about addiction to enact policy that might save lives.
What was going on was unprecedented in Indiana and rare in the United States: H.I.V. was spreading with terrifying speed among intravenous drug users in this rural community near the Kentucky border. Local, state and federal health officials were urging the governor to allow clean needles to be distributed to slow the outbreak.
But Indiana law made it illegal to possess a syringe without a prescription. And Mr. Pence, a steadfast conservative, was morally opposed to needle exchanges on the grounds that they supported drug abuse.
Local, state and federal health officials worked hard to keep the virus from spreading as Pence held firm in his position, using every available resource to convince the governor to change his mind.
On March 23, more than two months after the outbreak was detected, Mr. Pence said he was going to go home and pray on it. He spoke to the sheriff the next night.
Two days later, he issued an executive order allowing syringes to be distributed in Scott County.
By the time officials were able to slow the spread, nearly 200 people in the county were infected with HIV.
Today, the needle exchange program is seen as playing a major role in halting the outbreak. From November 2014 through the next August, 181 people who lived in or used drugs in Scott County tested positive for H.I.V., according to a study of the outbreak published last month in The New England Journal of Medicine.
In September and October, not a single person tested positive.
In addition to allowing needle exchanges, Pence also opted to embrace Obamacare's Medicaid expansion:
He signed his state’s Medicaid expansion known as the Healthy Indiana Plan 2.0 in 2015 — the same year as the HIV outbreak.
His health department relied heavily on the program to respond to the HIV crisis in southern Indiana. Officials set up a “one-stop-shop,” next to a free needle exchange, in the tiny, impoverished town of Austin, and offered hot meals, HIV screenings, vaccinations and assistance to help people enroll in insurance — many for the first time — through HIP 2.0.
The expanded health care coverage proved beneficial to many people lacking access to drug abuse treatment, as well as aided the effort to test and diagnose those who had contracted HIV (some believe Pence's push to shut down Planned Parenthood clinics may have hindered timely testing and treatment).
“A lack of health insurance was one of the first barriers to testing and treatment identified in Scott County,” said Jeni O’Malley, a spokesperson for the Indiana State Department of Health. “HIP 2.0 helped address that gap and opened doors to medical care and treatment that have been life-changing for people living with HIV and hepatitis C.”
But as they say, all good things must come to an end. Inasmuch as Obamacare's Medicaid expansion assisted in his state's health crisis, Pence campaigned on Obamacare repeal with President Donald Trump and has joined other Republicans in hoping to repeal the law.
Similarly, the decision to allow needle exchanges was enacted on a temporary basis, and by late 2017 programs were beginning to shut down:
An Indiana county shut down its needle exchange program on Tuesday because of moral objections, raising the risk of increasing its number of HIV and Hepatitis C infections.
“It came down to morally, they’re breaking the law. I can’t condone that,” Lawrence County Commissioner Dustin Gabhart told Indiana Public Media. “Yes, it’s a problem. Yes, it needs to be resolved. I could not give them the tools to do it.”
Madison County’s was shut down in August—also over moral qualms.
Having thwarted an epidemic resulting in a higher incidence of HIV than "any country in sub-Saharan Africa," according to the Centers for Disease Control and Prevention, it remains to be seen what the future holds for rural Indiana.
Officials are concerned what has become a trickle of new cases will increase as needle exchanges shut down:
[Madison County Health Department administrator Stephenie] Grimes said that since the program ended in August, only seven people have been tested for hepatitis C in the county.
“People are going back to sharing needles,” she said.
Read more about Indiana's HIV outbreak, response, and current status: