INDIANAPOLIS - Half of Indiana's 92 counties, now at risk for an HIV outbreak like the one that's hit Scott County, could launch emergency programs that give needles to drug users under a measure advancing in the Indiana House.
But the proposal, aimed as a pro-active measure to curb the spread of the virus that causes AIDS, faces a veto threat from Republican Gov. Mike Pence.
The measure, crafted by the Republican Public Health Committee Chairman Ed Clere, New Albany, would let local health officials adopt a needle exchange program like the one that Pence authorized last week when he declared a health emergency in Scott County.
The bill is limited in scope: The trigger that would allow local health departments to implement such programs is their rate of hepatitis C, a potentially lethal blood-borne virus that, like HIV, is commonly transmitted through sharing of contaminated needles and through sexual contact.
“We have an opportunity in these communities to keep them from becoming the next Scott County," Clere said.
Health experts consider hepatitis C to be a key indicator of increased risk for HIV and the two viruses are closely linked. Scott County had one of the biggest increases in hepatitis C cases in Indiana in the three years preceding the current outbreak of HIV that's been linked to intravenous drug use.
Since late December, more than 80 Scott County residents have tested positive for HIV in a community that typically sees only five HIV cases a year; almost all have also been diagnosed with hepatitis C.
A 2014 study by the Centers for Disease Control found Indiana's rural communities had some of the highest rates of new hepatitis C cases in the nation.
Current law in Indiana bars needle exchanges for illegal drug users; it's a crime to possess a hypodermic needle with intent to inject an illegal drug.
Clere's measure would allow local health departments to work around that law in the event of a health emergency. Under the measure, the local health departments in 23 counties with the worst hepatitis C rates would be allowed to launch emergency needle programs as soon as the legislation is passed if their local doctors determine it's needed to curb the spread of hepatitis C and HIV.
An additional 23 counties with high hepatitis C rates could also start such programs, after meeting additional conditions, including first holding a public hearing on the issue.
No state funding could be used to finance such a program and only non-profit organizations approved by local health departments could dispense the needles to drug users.
The measure was passed by the Public Health Committee Monday, with support from Republicans with high-risk counties in their districts.
"This puts the decision-making in the hands of local health officials, which is where it needs to be," said Rep. Steve Davisson of Salem.
Davisson acknowledged that needle exchange programs are controversial. Though endorsed by the American Medical Association and the Centers for Disease Control as an effective tool to slow the spread of disease, some critics see handing out clean needles as an enabling drug users.
But Davisson, who grew up in Scott County, said too many Indiana counties are in peril.
"We're just trying to get ahead of this, so communities can be proactive instead of reactive like we are now," he said.
Rep. Ron Bacon, R-Boonville, tried to get legislators to study the issue of needle exchange last year, after seeing rising numbers of hepatitis C cases in rural counties around in Indiana. But it was met with skepticism from legislative leaders.
"Now we've got a real problem," Bacon said.
Clere's measure would take away Pence's exclusive power to allow a needle exchange program and it would put more control into the hands of local health officials.
In the weeks leading up to Pence's emergency order, local doctors in Scott County had pleaded with Pence to allow them to start such a program. He relented after CDC experts advised him that such a program was critical to stopping HIV from spreading.
But Clere's measure now faces a veto threat from Pence, who's had a long-standing opposition to needle exchange programs that currently exist in 33 states. Pence has said he opposes them as a part of his "anti-drug" policy but so far has declined to explain why.
Last week, in announcing his decision to allow Scott County to implement a needle exchange program under his 30-day emergency order, Pence also threatened to kill any legislative measure that would expand such a program statewide.
In response to the threat, Clere narrowed his proposal to apply only to counties that face the highest risk of an HIV outbreak like the one in Scott County. But even the narrower proposal would face resistance from Pence, according to Joey Fox, Pence's legislative liaison at the Indiana State Department of Health.
Clere's frustration was evident Monday. "I'm not sure where the goal post is now. It seems to keep moving," he said.
Maureen Hayden is the CNHI state reporter in Indiana. Reach her at firstname.lastname@example.org. Follow her on Twitter @MaureenHayden.