SCOTT SIMON, HOST:
Scott County, Ind., had what's been called rural America's worst HIV outbreak in 2015. The cause was IV drug abuse, and the county fought it by accepting a needle exchange program. Now, with HIV cases dropping dramatically, Scott County's commissioners are likely to close the exchange. From member station WFIU, Mitch Legan reports.
MITCH LEGAN, BYLINE: The small manufacturing county found itself in the national spotlight when IV drug use led to hundreds of new cases of HIV. Mike Pence was Indiana's governor then and approved Scott County's needle exchange as an emergency measure.
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MIKE PENCE: I will tell you that I do not support needle exchange as anti-drug policy. But this is a public health emergency.
LEGAN: Since then, health administrator Michelle Matern has been trying to help residents get comfortable with the needle exchange.
MICHELLE MATERN: I think a lot of people forgot kind of what 2015 was like and what we went through as a community.
LEGAN: At the outbreak's worst, the county saw 22 new HIV cases in a week. It had one in all of last year. Health officials credit the needle exchange. But two of three county commissioners say it's leading to overdoses and enables drug use. Neither would grant interviews to NPR, but here's Mike Jones at a recent meeting.
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MIKE JONES: One of the things that I really struggle with is that there's no accountability. I don't know where - how do you get to somebody to say, enough's enough?
LEGAN: Those who work at the county's needle exchange say it's been difficult when many see the exchange as a starter kit for drug users. Kelly Hans was struggling with addiction before the outbreak and now works as an HIV tester for the county.
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KELLY HANS: These are our cottons. And that's used for injection, you know, to filter through as they're trying to pull up. A lot of people back in the - back in my day, you cut off a cigarette filter, and you put it in there and pulled through the cigarette filter.
LEGAN: About 170 drug users use the needle exchange each month. Hans says it may be their only access to testing, health care and recovery services.
HANS: I didn't know what any resources were in 2015. And if I walked in and said, I'm struggling, I'm in active addiction, somebody help me, like, I was scared of that judgment.
LEGAN: There are over 300 needle exchanges operating across the country. Research from the Centers for Disease Control and Prevention shows they help reduce the spread of infectious diseases like HIV and can help people overcome substance abuse. Jerrica Hall says that's exactly what the program did for her.
JERRICA HALL: It's not just about the needle exchange. It's also about people treating you like a human being.
LEGAN: Former U.S. Surgeon General Dr. Jerome Adams attended that same meeting and praised Scott County's needle exchange as the gold standard.
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JEROME ADAMS: I've seen syringe service programs all over the nation. I've been to Canada and seen how they do it over there. And the way you're doing it here is the way it's supposed to be done.
LEGAN: But the commissioners say there are treatments for HIV and are frustrated they don't see more people in recovery.
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JONES: And it's aggravating for a first responder to Narcan somebody, and they walk out of the ER. There's no - nothing happens.
LEGAN: Health officials have warned of what's happening in West Virginia. HIV cases are spiking there as elected officials crack down on needle exchanges. In Scott County, Ind., Matern says they can transition to a harm reduction program without needles, but she doubts it will be as effective. She expects rising HIV cases to follow suit.
For NPR News, I'm Mitch Legan in Bloomington.
(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.