Comments on: One rural American town is in the grip of a dramatic outbreak of HIV

One rural American town is in the grip of a dramatic outbreak of HIV

andoatnp — Tue, 05 May 2015 12:59:34 -0800

How an HIV outbreak hit rural Indiana — and why we should be paying attention [Washington Post]
Rural Indiana Struggles to Contend With H.I.V. Outbreak [New York Times]
The Drug That's Infecting Indiana [Medium]
The Best Way To Stop Indiana's Outbreak Is The Most Unpopular [Medium]
Small Town America: This Is Your War On Drugs [Medium]

By: nevercalm

nevercalm — Tue, 05 May 2015 13:10:39 -0800

I read the Times article this morning, and gave myself a concussion from smacking my forehead. It's truly frightening.

By: xingcat

xingcat — Tue, 05 May 2015 13:11:14 -0800

It amazes me that there are still people in this world who think that needle exchange programs (or just having needles/syringes available over the counter and not being illegal to have in your possession) are a bad idea. I can't understand even the basis of "Drugs are bad," because sure, if you believe that, it's fine, but "Diseases are worse, and many can't be cured."

By: zachlipton

zachlipton — Tue, 05 May 2015 13:12:08 -0800

Other things I almost spray her with saliva-infused coffee over: The fact that the health department does not offer pregnancy tests or STI screenings; that community members regularly come into one HIV testing centers [sic] with no practical or useable knowledge of the virus; that any money an organization receives from the State of Indiana cannot be used to purchase condoms. ... According to a public health nurse with the Scott County health department, it is not uncommon for a single needle to be used upwards of 300 times, until it literally breaks off in someone's arm.

While they get a slight bit of credit for begrudgingly permitting a needle exchange program just now that the outbreak is in full swing, this seems like an utterly foreseeable situation caused by moralizing busybodies and a lack of reproductive health services and education.

By: sciatrix

sciatrix — Tue, 05 May 2015 13:15:21 -0800

"If they've got one needle and they're not in the program, they're going to jail,'" Sheriff McClain said. Oh my god, how on earth did it not occur to them that people who do not trust authority--like, say, IV users--are not going to respond well to attempts to force them to sign up for something? This push is going to exacerbate any paranoia at all in that community and make it that much harder for the needle exchange to actually work. What the fuck, is there no one with an even basic understanding of group psychology or public health in the entire county?

By: Thorzdad

Thorzdad — Tue, 05 May 2015 13:17:27 -0800

I was wondering when this would make it to the Blue. It's sort of been a story that's been flying under the radar, even here in Indiana. Most of the press about it has mostly been about Pence authorizing a temporary needle exchange program, limited to just that county. It's a fucking mess, and the press here is doing their best to keep it as quiet as possible. Indiana: the Florida of the North. Pffft. Indiana exported stupid to Florida. It's our #1 crop after corn.

By: leotrotsky

leotrotsky — Tue, 05 May 2015 13:23:17 -0800

It's sort of been a story that's been flying under the radar, even here in Indiana. Most of the press about it has mostly been about Pence authorizing a temporary needle exchange program, limited to just that county. It's a fucking mess, and the press here is doing their best to keep it as quiet as possible. No kidding. I live in Indiana. This is the first I've heard of this.

By: the man of twists and turns

the man of twists and turns — Tue, 05 May 2015 13:24:07 -0800

Painkiller Abuse, a Cyclical Challenge - "As this third United States opioid epidemic continues, we can look back on its predecessors. The first peaked around the end of the 19th century, when opioid products were unregulated." Next up, heroin. This new gilded age is starting to look a lot like the old one.

By: zachlipton

zachlipton — Tue, 05 May 2015 13:25:37 -0800

Why do most of these links point to the same place? Three of them point to three different articles by Leigh Cowart, who is on the ground in Scott County reporting on this story. They are all in the same publication, but are different articles.

By: ostro

ostro — Tue, 05 May 2015 13:26:21 -0800

They did not arrest the man, Sheriff Dan McClain said, although they confiscated a number of clean needles he had received from a volunteer group that was not part of the official program.

By: Thorzdad

Thorzdad — Tue, 05 May 2015 13:27:43 -0800

What the fuck, is there no one with an even basic understanding of group psychology or public health in the entire county? Sure there are. But they have to operate within the confines set by our legislators and law enforcement. Look...Pence absolutely did not want to authorize the needle exchange. It violates everything he believes in. But, he was backed into a corner by cold reality. But, he still made it very limited, which probably makes it only doomed to fail.

By: Holy Zarquon's Singing Fish

Holy Zarquon's Singing Fish — Tue, 05 May 2015 13:40:10 -0800

[P]olice are arresting anyone found with needles but no card, saying it will prod more people to participate This is where my desk acquired a forehead-shaped indentation.

By: Sangermaine

Sangermaine — Tue, 05 May 2015 13:40:57 -0800

This new gilded age is starting to look a lot like the old one. the man of twists and turns If it's any consolation, the first Gilded Age was followed by a brief progressive period of labor and health reforms. Though it seems like the robber barons of today have learned that particular lesson and are doing pretty well at holding it back.

By: resurrexit

resurrexit — Tue, 05 May 2015 13:41:15 -0800

The Best Way To Stop Indiana's Outbreak Is The Most Unpopular To be fair, this could be the title of a "conservative" or "liberal" article. Depending on your approach, either needle exchanges and condoms or 'don't do drugs' and abstinence are "the best way" to stop HIV. Where is the "all of the above" response if it's truly about stopping a horrible disease?

By: Eyebrows McGee

Eyebrows McGee — Tue, 05 May 2015 13:41:30 -0800

xingcat: "I can't understand even the basis of "Drugs are bad," because sure, if you believe that, it's fine, but "Diseases are worse, and many can't be cured."" You have to explicitly ask them, "Is your goal here to make a moral point about drugs/extramarital sex being bad or to reduce HIV?" You will be surprised by how many carefully consider it and then answer, "To make a moral point. It's their own fault they're sick." I'm serious, try it. You'll convince some people to actually consider their beliefs and whether they're pursuing the outcome they actually want, or just they're lazily conflating things because of rhetoric and shortcuts in thinking. But you'll also be shocked by how many people actually have zero practical goal in mind when creating/supporting laws or programs; they are literally just interested in legislating morality and handing out the rewards and punishments that God hasn't got around to dealing with yet. Not only do they not want to alleviate suffering or mitigate consequences, but even if they know we can reasonably prevent some number of people from making bad ("immoral") decisions, they don't want to do anything that might prevent those bad decisions and the accompanying suffering -- they just want to make sure people are punished for them afterwards by suffering as many consequences as possible. It's some pretty twisted quasi-Calvinist predestinationary bullshit.

By: Ferreous

Ferreous — Tue, 05 May 2015 13:43:20 -0800

Up here in north Indiana I've heard talk from people that boils down to "let them all get aids and die, that's what they get for using drugs" and "needle exchanges take away the fear of aids, so even more people will do drugs"

By: Melismata

Melismata — Tue, 05 May 2015 13:46:06 -0800

"I thought it was just a homosexual disease," the woman said one recent evening In 2015, people still think this? *headdesk*

By: roomthreeseventeen

roomthreeseventeen — Tue, 05 May 2015 13:46:45 -0800

By: witchen

witchen — Tue, 05 May 2015 13:47:00 -0800

Depending on your approach, either needle exchanges and condoms or 'don't do drugs' and abstinence are "the best way" to stop HIV. Where is the "all of the above" response if it's truly about stopping a horrible disease? It doesn't need to be said. The sky is blue, water is wet, etc. But also: it doesn't work. Telling people not to have sex and not to be addicted to things is basically wasted air. You have to meet people where they are, not from where you think they should be according to your personal beliefs about sex and substance (ab)use.

By: Eyebrows McGee

Eyebrows McGee — Tue, 05 May 2015 13:47:26 -0800

Melismata: "In 2015, people still think this?" In Ryan White's home state, for God's sake!

By: poffin boffin

poffin boffin — Tue, 05 May 2015 13:48:38 -0800

in 2015 people still think an invisible man cares who you marry.

By: Maias

Maias — Tue, 05 May 2015 13:48:50 -0800

Here's what I wrote about this and the "needle exchange sends the wrong message" trope. (In the same special section in Medium).

By: OnTheLastCastle

OnTheLastCastle — Tue, 05 May 2015 13:54:53 -0800

"I thought it was just a homosexual disease," the woman said one recent evening In 2015, people still think this? *headdesk* I just came here to post that exact same thing. I... don't understand how it is possible for our educational system (both formal schooling and public health education) to have failed so many people so utterly.

By: downtohisturtles

downtohisturtles — Tue, 05 May 2015 13:55:54 -0800

Until it happens to their little son or daughter. And then what? Don't you see? That could never happen to them or their family. That's for bad people.

By: Joey Michaels

Joey Michaels — Tue, 05 May 2015 13:57:21 -0800

I... don't understand how it is possible for our educational system (both formal schooling and public health education) to have failed so many people so utterly. Well, see, it didn't fail people. It just doesn't cover any of that information. So it succeeded in keeping them ignorant, which is the goal.

By: rankfreudlite

rankfreudlite — Tue, 05 May 2015 14:02:35 -0800

Per the NYT article: Opioids now cause more deaths than any other drug, more than 16,000 in 2010. That year, the combination of hydrocodone and acetaminophen became the most prescribed medication in the United States. The problem lies, not in the opioid. It lies in the acetaminophen.

By: Agave

Agave — Tue, 05 May 2015 14:10:13 -0800

I'll remember your phrase, Eyebrows McGee: "some pretty twisted quasi-Calvinist predestinationary bullshit" This phrase could be useful in a variety of situations!

By: CBrachyrhynchos

CBrachyrhynchos — Tue, 05 May 2015 14:12:36 -0800

It doesn't need to be said. The sky is blue, water is wet, etc. But also: it doesn't work. Telling people not to have sex and not to be addicted to things is basically wasted air. You have to meet people where they are, not from where you think they should be according to your personal beliefs about sex and substance (ab)use. Actually, it's an interesting paradox. It turns out that if you provide comprehensive sexuality education covering all the options for safer sex, people are more likely to say "no" than if you tell them, "just say no." A similar pattern is true for drug abuse provided there are treatment options.

By: Lemurrhea

Lemurrhea — Tue, 05 May 2015 14:13:17 -0800

This paragraph from the NYT, gave me some hope: If you would have asked me last year if I was for a needle exchange program, I would have said you're nuts," Ms. Combs [public health nurse] said. "I thought, just like a lot of people do, that it's enabling — that you're just giving needles out and assisting them in their drug habit. But then I did the research on it, and there's 28 years of research to prove that it actually works. Right? Yes yes, public health nurse doesn't know about needle exchanges. Whatever. But she learns the facts, accepts the scientific consensus, and then starts doing personal outreach because the drop-in centre has problems. That is fucking winning.

By: futz

futz — Tue, 05 May 2015 14:17:25 -0800

Aaaaand stories like this are causing Indiana politicians and others to pass even tougher fucking laws that make it even harder for people who NEED pain medication to get it. I do not abuse my meds but they are almost impossible to get. I am treated like a junkie at every turn. All the hoops that I have to jump though is demoralizing. You can't even be totally honest with your doctor (or feel like you can't) because you don't want to look like a drug seeker. My doc couldn't believe that morphine wasn't working for me. So, I continue to take strong meds that help a little bit in order not to rock the boat while my life falls apart around me. I even have a genetic condition that explains all the pain. Fuck this.

By: sebastienbailard

sebastienbailard — Tue, 05 May 2015 14:18:35 -0800

I... don't understand how it is possible for our educational system (both formal schooling and public health education) to have failed so many people so utterly. The schools are legally required to fail to teach safe sex. INDIANA Indiana Sexuality Education Law and Policy Indiana requires that schools teach sexuality education. This instruction must: • Teach abstinence from sexual activity outside of marriage as the expected standard for all school age children; • Include that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases (STDs), and other associated health problems; and • Include that the best way to avoid sexually transmitted diseases and other associated health problems is to establish a mutually faithful monogamous relationship in the context of marriage. Each school must include instruction about HIV/AIDS and "integrate this effort to the extent possible with instruction on other dangerous communicable diseases." This instruction must stress abstinence-until-marriage. School boards must also establish an AIDS advisory council, consisting of 13 people. This council must consist of "parents, students, teachers, administrators, and representatives of the state department of health" and must review all curricula and materials for HIV/AIDS instruction to ensure that they "reflect the standards of the community." This council must also work in consultation with the Indiana Department of Health. Furthermore, Indiana Code states that: The state board of education shall provide information stressing the moral aspects of abstinence from sexual activity in any literature that it distributes to schoolchildren and young adults concerning available methods for the prevention of acquired immune deficiency syndrome (AIDS). Such literature must state that the best way to avoid AIDS is for young people to refrain from sexual activity until they are ready as adults to establish, in the context of marriage, a mutually faithful monogamous relationship. See Indiana Code 20-10.1-4-10, 20-10.1-4-11, and 20-8.1-11-3. Recent News November 10, 2010 Class focus runs beyond abstinence, EVSC says "This month Plaza Park Middle School students are being offered a sex education curriculum that stresses relationship building and abstinence." Read full article. source: http://abstinenceworks.org/what-about-my-state-mainmenu-90

By: Pope Guilty

Pope Guilty — Tue, 05 May 2015 14:19:51 -0800

This is a thing that is the inevitable, inescapable, and 100% predictable outcome of a state being run by the filth who run this place. This is happening because we demand it. God damn us.

By: clockzero

clockzero — Tue, 05 May 2015 14:20:01 -0800

Actually, it's an interesting paradox. It turns out that if you provide comprehensive sexuality education covering all the options for safer sex, people are more likely to say "no" than if you tell them, "just say no." A similar pattern is true for drug abuse provided there are treatment options. On the other hand, this probably seems more paradoxical if one feels that everyone should listen to self-appointed father figures about what the public should and shouldn't be doing.

By: zachlipton

zachlipton — Tue, 05 May 2015 14:27:13 -0800

It's interesting to me how the same people who believe so passionately in the power of the free market, that ordinary Americans will inevitably make the right choices for themselves when presented with an unrestricted set of options also believe so passionately in restricting the personal choices available to us based on moralistic reasoning. Somehow, payday loans are totally cool, because it's your choice whether to take one out or not, but every damn syringe in the state has to be accounted for? If consumers can pick a cell phone plan, they can learn about STIs, birth control, and protection and decide what's right for them.

By: el io

el io — Tue, 05 May 2015 14:35:10 -0800

source: http://abstinenceworks.org/what-about-my-state-mainmenu-90 Abstinence does work. Teaching abstinence in lieu of comprehensive sex-ed does NOT work.

By: resurrexit

resurrexit — Tue, 05 May 2015 14:39:05 -0800

You have to explicitly ask them, "Is your goal here to make a moral point about drugs/extramarital sex being bad or to reduce HIV?" You will be surprised by how many carefully consider [this false dichotomy] and then answer, "To make a moral point. It's their own fault they're sick." Eyebrows, that's exactly what you're doing. If you don't believe me, just explicitly ask yourself, "Is your goal here to make a moral point about [not compromising cultural gains in the sexual revolution or more-permissive drug use] or to reduce HIV?" I'm serious, try it. You'll be shocked by how many people actually have zero practical goal in mind when creating/supporting laws or programs; they are literally just interested in legislating morality....

By: blucevalo

blucevalo — Tue, 05 May 2015 14:45:24 -0800

Holy mackerel ..... actually, the "homosexual disease" quotes do not surprise me one iota, living as I do in the good ol' state of Tennessee. What does surprise me is that people in this thread are surprised that this sort of thing is still believed "in 2015." In many ways, HIV education and awareness are more invisible than they were 15 or 20 years ago. I'd be willing to bet large sums of money that most people who are not health care professionals or HIV activists even know/remember who Ryan White was. The belligerent and willful ignorance about HIV among legislators and other political elites makes matters still worse. It's incredibly Pollyannaish for anyone to believe that the same morons of the political class who insist that there is such a thing as "legitimate rape" or who pass laws mandating transvaginal ultrasounds for women seeking abortions would give a rat's ass about going on the hunt for any actual facts about HIV.

By: librosegretti

librosegretti — Tue, 05 May 2015 14:56:29 -0800

The problem with abstinence as a "method" is that what is actually being used is "intending to be abstinent". The failure rate for this is very high.

By: zachlipton

zachlipton — Tue, 05 May 2015 15:05:19 -0800

To be fair, this could be the title of a "conservative" or "liberal" article. Depending on your approach, either needle exchanges and condoms or 'don't do drugs' and abstinence are "the best way" to stop HIV. This has been well studied. There's no "depending on your approach" here because we've spent a lot of time trying both and we have some idea what strategies prevent transmission of infections. Similarly, you cannot say that "depending on your approach," either antibiotics or rain dances are "the best way" to treat bacterial infections. Telling people not to do drugs and not to have sex is not generally considered effective. Have you ever met someone addicted to drugs? Why would you think saying "um, don't do drugs; drugs are bad for you" would be very helpful? Harm reduction strategies work, especially when combined with a network of other services and education. And that's what the best programs do. They use needle exchange and safe injection sites to get people in the door, build up trust with clients, and then trained nurses and social workers can offer services to further help. It meets clients where they are right now and takes immediate steps to prevent the harm that comes from IV drug use without requiring 100% successful treatment first.

By: rtha

rtha — Tue, 05 May 2015 15:06:46 -0800

In a story about this from a couple weeks ago, a local (health department? can't remember) official was interviewed, and they said they'd made appointments for some people at the nearest HIV clinic, but they hadn't gone. Because the clinic is three hours away. In a different state. And a lot of people don't have reliable access to cars. Pence has blood on his hands. His refusal to institute actual science-based public health policies is directly responsible for this epidemic. I hope he burns in the hell he believes in. > Where is the "all of the above" response if it's truly about stopping a horrible disease? Because we have actual evidence, almost 30 years' worth, showing that needle exchange works, and until now in Indiana they have chosen to ignore that evidence in favor of unfounded and ineffective moralizing. How do we know it's ineffective? Because hundreds of people HUNDREDS OF PEOPLE have gotten a totally preventable disease. They had the gall to be poor and use drugs and so were sentenced to death by stupid, ignorant, hateful policies like Pence's. And it's going to cost Indiana taxpayers a shitload more to treat their HIV for the next umpteen years than it would have to prevent it in the first place. I might be a little incandescently angry about this.

By: KathrynT

KathrynT — Tue, 05 May 2015 15:08:27 -0800

Eyebrows, that's exactly what you're doing. If you don't believe me, just explicitly ask yourself, "Is your goal here to make a moral point about [not compromising cultural gains in the sexual revolution or more-permissive drug use] or to reduce HIV?" Wait, what? We KNOW what actually works to reduce HIV. Needle exchanges and fully informative sex education: that's what works. Are you trying to argue from ParallelUniverseLand, where Obama has a goatee and facts work backwards?

By: sonic meat machine

sonic meat machine — Tue, 05 May 2015 15:08:40 -0800

Eyebrows, that's exactly what you're doing. If you don't believe me, just explicitly ask yourself, "Is your goal here to make a moral point about [not compromising cultural gains in the sexual revolution or more-permissive drug use] or to reduce HIV?" People had premarital sex and used drugs prior to the sexual revolution. It's just that at that time, it was kept very quiet (and HIV didn't exist). It's not that unwanted children, STIs, and overdoses didn't happen—they just didn't get the same amount of attention that they do today. If you want to really prevent HIV, you use needle exchanges and distribute condoms. “If only they would stop having sex...” is not a strategy, it is just the denial of reality.

By: sciatrix

sciatrix — Tue, 05 May 2015 15:08:59 -0800

You will be surprised by how many carefully consider [this false dichotomy] and then answer, "To make a moral point. It's their own fault they're sick." Eyebrows, that's exactly what you're doing. If you don't believe me, just explicitly ask yourself, "Is your goal here to make a moral point about [not compromising cultural gains in the sexual revolution or more-permissive drug use] or to reduce HIV?" What? Seriously, what? I don't remotely think this question about needle exchanges and their efficacy--or whether we should pay for condoms--is as cut and dried about culture as you seem to think it is. In Eyebrows' example, let's say we're talking about needle exchanges, the people who are arguing for needle exchanges are arguing for them because needle exchanges demonstrably slow the spread of HIV. On the other hand, the people arguing to take needle exchanges away in case it encourages drug use are doing so in direct contradiction of evidence that needle exchanges do no such thing. Sure, you can argue that both people have political or moral reasoning underlying their points, but only one of them is actually looking at the evidence and backing policies designed to alleviate a social issue based on that evidence. Saying that "everyone does it" is to ignore the question of whether policies will actually do the thing they are ostensibly intended to do, which was Eyebrows' entire point about asking the question in the first place.

By: ArbitraryAndCapricious

ArbitraryAndCapricious — Tue, 05 May 2015 15:11:45 -0800

Anyway, I don't think that a lot of people are saying "do drugs! Drugs are awesome! As long as you have clean needles, everything will be swell!" I suspect everyone is in agreement that opiate abuse is not a life path that one should pursue. The issue is what you do to help people who already have a problem, and telling them not to do drugs is kind of clearly not a workable strategy. Neither is throwing them in jail, which seems to be the only other strategy that some people are comfortable pursuing.

By: zachlipton

zachlipton — Tue, 05 May 2015 15:16:49 -0800

Exactly ArbitraryAndCapricious. I'm also guessing that a rural Indiana county that didn't even offer HIV testing until now is unlikely to have much in the way of free and low-cost drug treatment services. And even if drug treatment was plentiful, it can only be so effective. Needle exchange and other harm reduction services bridge that gap by providing immediate health benefits. The research shows that harm reduction works best when coupled with other services like drug treatment, physical and mental health care, housing for the homeless, etc...

By: juiceCake

juiceCake — Tue, 05 May 2015 15:23:37 -0800

Until it happens to their little son or daughter. And then what? My son or daughter made a mistake. Treat them but don't treat the "real" junkies. That's what, most likely.

By: AlexiaSky

AlexiaSky — Tue, 05 May 2015 15:35:05 -0800

What I hate about this most Is the costs. If these people really really want to be able to save budgetary money, keeping mostly young abled-bodied men and women from getting HIV is a great way to do that. Because they have HIV Ryan White laws require them to be taken care of REGARDLESS OF THEIR ABILITY TO BE ON MEDICAID. And if you haven't heard medication for HIV is long term and expensive(sarcasm).People don't die from AIDS most of the time unless they actively avoid, are denied services, or simply are unaware they have it. Needle exchanges work! They save costs! They keep people from getting a chronic illness! They provide a place for people who are in need to get information and receive care.

By: AlexiaSky

AlexiaSky — Tue, 05 May 2015 15:40:47 -0800

It I'd more like: my daughter has HIV... Pay the copays for her medicine under Ryan White... Provide her anonymous labels on everything and make sure she had access to PrEP and PEP services for her good future husband and children...But don't let the druggies get these services they don't need them!

By: Eyebrows McGee

Eyebrows McGee — Tue, 05 May 2015 15:56:20 -0800

resurrexit: ". If you don't believe me, just explicitly ask yourself, "Is your goal here to make a moral point about [not compromising cultural gains in the sexual revolution or more-permissive drug use] or to reduce HIV?"" I may not be totally following your point because I have a head cold, but I'm serious that it's a very interesting question to ask people. To use a less-charged example, putting people in jail for murder actually does very little to reduce the murder rate, but it makes a strong moral point about murder. Most of us agree that we WANT to make that moral point that murder is bad by punishing people for it, even if the punishment is not particularly effective in reducing murder rates. (Presumably we will also pursue other policies to reduce murder rates.) Or, to use an example with liberals, liberals may object to government-sponsored gun ownership classes because they normalize and legitimize gun ownership, which is fine if your goal is making a moral point about gun ownership, but if your goal is the practical one of reducing gun violence and studies show that gun ownership classes reduce gun violence (by, say, encouraging people to store their guns more safely), it is helpful to stop and untangle those two goals and be explicit about which one you want to actually pursue. These aren't necessarily simple questions with easy endpoints -- maybe gun safety classes decrease gun violence in the short term by encouraging safer storage but increase it in the long term by encouraging and normalizing gun ownership -- but needle exchanges are pretty well-attested as both a short- and long-term harm mitigation strategy that also helps reduce drug usage rates. Objecting to needle exchanges because you find drug use so immoral that drug users aren't deserving of help is a legitimate political position, but be honest that that is your political position. Don't pretend that needle exchanges increase drug use, when you know they don't, and you object to them for that reason. If your goal is "reduce HIV transmission," then be honest about reducing HIV transmission, and be honest about opposing measures that reduce HIV transmission. Don't say "condoms don't reduce HIV transmission" -- say "condoms do reduce HIV transmission, but the government shouldn't be in the business of providing them to people having extramarital sex because of the moral implications." In this particular case, you will find if you ask people (as I frequently did when I taught philosophy) you will uncover some seriously quasi-Calvinist predestinationary bullshit. (And I'm pretty involved in state and local politics, and when I have a strong, gut-level moral reaction to a political question, I actually do take that as a signal to stop and ask myself, "Wait, what am I reacting to here, and is this an actual coherent moral position?" I have come to the conclusion, for example, that my moral opposition to fur is actually pretty incoherent as long as I continue to wear leather and eat meat. This does not actually make me feel any better about fur; I still feel that it's gross and wrong, while hardly worrying about leather and meat. I understand this is absurd. But I also recognize that my feeling is not actually a logical or moral argument, and that if a law regulating the sale of fur in my state is up for debate, I shouldn't let my moral gut reaction override my actual moral reasoning abilities. As I understand myself to be human and therefore fallible, I don't require total philosophical coherence of myself ... just that I work hard at interrogating the parts where I discover I'm incoherent, until I understand my incoherence as well as I can and I'll remember it's there. Right now, in fact, my state is considering a gambling expansion and I'm trying to weigh my first impulse that gambling is a terrible, immoral way to raise revenue with my second impulse that if people want to gamble they really should have that freedom, and consider its objective pros and cons to the state as well as my conflicting moral positions about predatory revenue raising and personal freedom. I've been at it for several days and haven't yet worked out my opinion on the proposal.)

By: ArbitraryAndCapricious

ArbitraryAndCapricious — Tue, 05 May 2015 17:03:54 -0800

Meanwhile in Gloucester, MA, they're taking a different approach. Essentially, they're saying that if you walk in to the police station with your drugs or drug equipment, they will not charge you. Instead, they will immediately assign you an "angel" to help you get into treatment. They are also making nasal narcan available without a prescription to anyone, and they'll pay for it for people who can't afford it. Finally, they're going to lobby their representatives in D.C. to get them to pursue better strategies for dealing with drug addiction. The police chief ends his open letter:

I have been on both sides of this issue, having spent 7 years as a plainclothes narcotics detective. I have arrested or charged many addicts and dealers. I've never arrested a tobacco addict, nor have I ever seen one turned down for help when they develop lung cancer, whether or not they have insurance. The reasons for the difference in care between a tobacco addict and an opiate addict is stigma and money. Petty reasons to lose a life.

So yeah. That's a different approach.

By: futz

futz — Tue, 05 May 2015 17:06:28 -0800

Wow.

By: Ephelump Jockey

Ephelump Jockey — Tue, 05 May 2015 18:19:41 -0800

I never thought the blue would find itself so close to my home. I wondered how long it would take for this to come up. I'm glad it did. I'm from Scottsburg, grew up there. It's five minutes from Austin. Opiates have been big here for a long time. Shit, my sister's an addict. Pills, fortunately. Never thought I would say that. This place is a wasteland. Politically, these people have been abandoned. They're full of wrong-headed viewpoints and get trapped here without any recourse due to financial uncertainty, or they choose this place because they can't conceive of a better life for themselves. I came here to visit before I move to a new city. I've been here for a couple months. The first thing I heard about when I got back in early March was the HIV outbreak. You know your home is fucked when all anyone can muster is a defeated shrug in response to that kind of news. It's treated with the same dead-eyed half-fascination as someone you know getting arrested and seeing the local PD post it on facebook. Fuck this state. Fuck the governor for having no sympathy for his constituents. Fuck the local government for selling us out to big business and providing no community initiatives to give kids here a better opportunity for a life beyond drugs and booze and screwing to forget that the place where they live is a shithole. Fuck the drug dealers for their complicity in providing that escape knowing full-well where it leads. Fuck the lack of public health options available to get addicts the help they need. Fuck the well-to-do locals for turning their noses up at their neighbors. Fuck the tiny rural health clinics that treat every patient with severe pain like a drug seeker. Fuck the chatter and fuck this place. I'm overwhelmed with a bursting wellspring of raw pity for those diagnosed. I know one of them personally, and I'm sure if I invested the time, I could find other people I know that have positive diagnoses. But honestly, I'm glad to turn my back on this place. Anywhere that can't muster the tiniest bit of compassion to care for its own should burn. I wish I could pick every person with a diagnosis up in an oversized jet and take them somewhere where they aren't demonized for just trying to get by. I move in a week. I hope someone learns something from this catastrophe. Goodbye, and good luck, Indiana.

By: Dip Flash

Dip Flash — Tue, 05 May 2015 18:24:31 -0800

[P]olice are arresting anyone found with needles but no card, saying it will prod more people to participate That is so angering, because one of the ways that needle distribution works in the real world is that because of poverty or shame or any of a million other reasons, most people won't go into the needle exchanges themselves, and instead a lot of the distribution happens by a small number of people coming in, picking up large numbers of needles (and other supplies for harm reduction) and then handing them out. It might be one person in an extended family, it might be a network of friends or neighbors, or it might even be a dealer who offers clean works along with selling drugs -- but regardless, it gets the clean needles out to the people who need them. There is a special place in hell for people who use their power to harm people, and this is a great example of someone doing that.

By: gingerbeer

gingerbeer — Tue, 05 May 2015 18:38:50 -0800

Al Jazeera has been providing good coverage of this. On the upside, the state Attorney General issued a powerful statement in FAVOR of the state bill. And the bill passed in decent shape and is now law. The Rural Center for AIDS/STD Prevention has produced a couple of good fact sheets (both pdfs) on the need in Indiana. On the downside, while doing research on this for work, I discovered that the Scott County jail provides photos and charges for everyone held there, and the vast majority are there for drug charges, with a disturbing number there just for syringe or paraphernalia possession. If you're feeling inspired to take action, here's an action alert from AIDS United asking Congress to lift the ban on federal funding. The federal ban means that when the CDC went to Indiana earlier this year, they could not provide funding for syringe access there. It doesn't prevent states and cities from having a program, but it means they can't use federal grants to pay for it.

By: emjaybee

emjaybee — Tue, 05 May 2015 18:57:22 -0800

It's the same line of thinking that got people to agitate against a shot (HPV) for children that could prevent cancer. A particularly nasty, often fatal form of cancer, at that. Because the virus that might trigger the cancer happens to be spread by sexual contact, usually. Therefore, protecting your child from dying of cancer became a bad thing, because it had something to do with having more than one sexual partner. I mean. If you cannot be bothered to imagine your own child dying of cancer because you refused to get them a shot, and find that horrifying enough to want them to get the shot, I don't know what to say to you. Sure, delude yourself that your child will avoid the virus by being abstinent and only have sex with someone who did the same (never mind getting raped), pray to Jeebus that your child won't get cancer. But you're playing a numbers game with your child's life. How will you comfort yourself when your child is dying from cervical cancer; on her deathbed will you look at her emaciated face and feel not a twinge of guilt about how you could have prevented it? I have had to accept that there are lots of people that can do that. Who can see their own loved ones dying of AIDS or addiction and shrug and keep voting against needle exchanges and drug rehab and medical care for all.

By: double block and bleed

double block and bleed — Tue, 05 May 2015 19:51:58 -0800

rtha: "Pence has blood on his hands. His refusal to institute actual science-based public health policies is directly responsible for this epidemic. I hope he burns in the hell he believes in." Mike Pence is the biggest tool in the toolbox. A toolbox, I might add, that contains only the dullest of tools. He's an unfortunate combination of mean-spiritedness and idiocy. He can be relied upon without fail to do the dumbest or worst possible thing in any given situation. He's an embarrassment to our state who almost makes me miss Mitch Daniels. (shudder) I voted against Pence, and I'll continue to do do, but voting here is often like trying to piss into a hurricane.

By: HiroProtagonist

HiroProtagonist — Tue, 05 May 2015 20:37:11 -0800

The schools are legally required to fail to teach safe sex. Well having read that list, there's a lot of requirements to teach "the best way is dontdosex", and "the only certain way is dontdosex", but I didn't see a single thing in there that prohibited the teaching of safe sex.

By: bendy

bendy — Wed, 06 May 2015 00:27:23 -0800

Every vacation my family took from the seventies well into the eighties was to visit my grandad in his nursing home in a tiny town in Fayette county, Indiana. The reason we were there was so his sister could take a once-a-year cruise as a break from visiting her brother. My grandad died in 1986 and we stopped visting the tiny town for awhile. In the early 2-zeroes my great aunt got less able to take care of herself. My mom and I visited and schemed ways to get care for her. Eventually we found caretakers - surprisingly they were willing to work for $7/hour! We didn't put that together with the fact that all of the businesses in town had closed except the Sonic and the catalog counter at the Montgomery Ward. Each time we talked to great-aunt's bff - her next door neighbor - he told us that the caretakers had stolen stuff, that caretakers had let their relatives (with rap sheets) in, that since she was blind, her caretakers deceived her all the time. Eventually we found out that the woman we had hired - with great recommendations - was one of the most thorough thieves. We kept visiting her, but when we did we found that her jewelry and posessions had been stolen. The last time we visited, just after her death, I found a few pieces of furniture that I wanted and had them shipped to myself. At her funeral, none of her caretakers were there, just her friends from church and the country club. Last time we were there, my mom and I looked at each other and realized that we would never go back to that town again. It had been part of her childhood and part of mine, but now that all of our relatives were dead we'd never go there again. Her aunt left her house (3-bdrm, 2-bath ranch on an acre, probably valued around $26,000) to her bff, and her money to us. Every once in a while I check property values in that tiny town and can rarely find any home whose asking price is more than $50K. Even the last time I was there, that town was so quiet and so depressed. There was one steakhouse that served overcooked steaks in a dining room choked with cigarette smoke and a breakfast place where, if they didn't know you, you got the stink eye. tl;dr - Rural Indiana seems so incredibly depressing to me that distraction with drugs seems inevitable. Any town would be irresponsible to not provide a needle exchange.

By: sonic meat machine

sonic meat machine — Wed, 06 May 2015 03:57:47 -0800

bendy, that's not rural Indiana, it's rural America. The topography of an Appalachian village or a low-country tobacco town might be different from the old farming towns of Indiana, but the malaise is the same.

By: entropone

entropone — Wed, 06 May 2015 06:31:35 -0800

Here's what I wrote about this and the "needle exchange sends the wrong message" trope. Just quoting this again so that people in this thread make sure to read it because it's terrific and important and it hit me right in the feels.

By: Sophie1

Sophie1 — Wed, 06 May 2015 07:20:05 -0800

If every HIV-negative person in town hasn't been offered education and unfettered access to PrEP, there will continue to be more infections for years to come.

By: biggreenplant

biggreenplant — Wed, 06 May 2015 10:15:14 -0800

It's horrific how drug users are treated. I so agree with what Sophie1 says. Get everyone access to education and treatment (as in PrEP). One point that seems to recur on Metafilter though is that HIV is a death sentence. NO it is not. For the drug addicts it likely is a very big extra nail in the coffin because health care and services and humane treatment to addicts is so low to begin with. However, I worked for years in ASOs and still maintain ties with the HIV community (and via HIV+ family and friends) and treatment has greatly advanced. Life expectancy of someone *treated* early with modern HIV drugs is about the same as for someone who is HIV negative. Also, people on HIV treatment are not very infectious. Again, being HIV+ is not something to encourage and for the group of marginalized people struggling with addiction it will be a huge health hit but please, HIV and HIV+ people don't need to be seen as toxic diseased pariahs. And on that topic, similarly HPV shots are great and I plan to get my sons vaccinated but for crying out loud, no one in the Western world who gets tested and treated for cervical dysplasia will *die of cancer* because they didn't get the shot. Here's a CDC cite for noting that cervical cancer is one of the most preventable cancers link I've been treated for all manner of HPV and really wish the shot had been around in my day, but I am not worried about dying of cervical cancer. I get tested. I have been treated. I've had normal paps for years. Okay rant over. The ridiculous horrible situation in Indiana doesn't need more hyperbole to make it a tragedy for the people affected.

By: biggreenplant

biggreenplant — Wed, 06 May 2015 10:29:05 -0800

Also, the CDC report first posted April 24th.

By: gingerbeer

gingerbeer — Fri, 08 May 2015 08:44:28 -0800

Infographic from amfAR.

By: andoatnp

andoatnp — Tue, 19 May 2015 02:24:37 -0800

Surge in Cases of H.I.V. Tests U.S. Policy on Needle Exchanges