December 1st, 2016
The international calendar marks today—World AIDS Day—as an annual reminder of how punitive, stigmatizing policies have wreaked tragic consequences. Worldwide, one in five injecting drug users and and a total of nearly 37 million people are living with HIV. More than 1.2 million of them live in the US.
This is the first World AIDS Day following the election victory of Donald Trump and the appointment of his troublingly racist and anti-LGBTQ administration. And Trump’s second in command, Vice President-elect and Governor of Indiana Mike Pence, has a uniquely vicious recent history of policymaking around HIV.
Pence, preparing to assume the second highest office in the land, has a disturbing inclination to impose medical punishments on the very populations that have long been disproportionately affected by HIV—populations viewed as sinful by his fundamentalist Christian belief system.
For example, he has a record of opposing LGBTQ rights. He is strongly associated (though he denies it) with support for the condemned abuse tactic known as “conversion therapy”—attempts to, for example, electro-shock the queer out of people.
And his targeting of people who use drugs has been even more obvious. On Pence’s watch, Indiana (where Trump began his “victory tour” of the US today) experienced an HIV outbreak so startling it became a national news scandal, raising fears that the disease, once thought to be slowly petering out in the US, could make a brutal large-scale comeback.
Splashed across the front pages in early 2014, the alarming increase in new HIV diagnoses in Scott County, Indiana was linked to a rise in opioid use and sharing of syringes. The Center for Disease Control and local sheriffs explained to Pence that the clearest solution to the problem was access to clean syringes—a policy implemented across the world to stop the spread of contagious disease.
Yet Pence made his lack of interest in protecting drug users from misery and death painfully clear. First he simply delayed, said he’d have to “pray on it.” Then, when Congress suggested legalizing syringe exchange in the state, he said he’d veto it. When he was finally pressured into writing an executive order allowing one syringe exchange in Scott County, it soon proved to be insufficient. Yet again, Pence sat idly by as drug users paid the price. Ultimately, he decided he would be okay with legal syringe exchange programs—but only after a county had already proved a state of emergency due to Hepatitis C or HIV rates.
This proved an ineffective prevention strategy, as Pence could easily anticipate. Hepatitis C states of emergency have popped up in in county after rural county in Indiana over the past two years. And while they were then legally allowed to distribute syringes, Pence would not allow the state to fund these lifesaving and cost-effective programs. Instead, NGOs bore the burden of finding funding to protect the health of people he was elected to protect.
Pence’s syringe-exchange rules might have been designed to fail to protect drug users’ health. Rural and impoverished areas, in which a public health department might include just a couple of staffers, are often incapable of dealing with the red tape required to prove a state of emergency and initiate syringe exchange. They often don’t even have the resources to diagnose HIV or hepatitis C en masse. Medical services are lacking. And these are the very places where syringes will already be scarce, making sharing more likely.
Simply put? We don’t know how many people in Indiana have HIV or Hepatitis C, because Pence did not care enough about them to look for them.
When Scott County declared its HIV crisis in 2014, patients were experiencing the flu-like symptoms associated with the early stages of virus, two to four weeks after infection. If other parts of the state followed a similar timeline in terms of new HIV transmissions, patients in other rural areas would now be in the latency stage of HIV—typically asymptomatic for up to 10 years.
If Scott County is not an outlier—and hepatitis C outbreaks elsewhere suggest it is not—then there could be many more HIV-positive people using drugs and sharing syringes in rural Indiana. By the time we know the full extent of the crisis, some of these infected people may be dying early, painful deaths. Preventable deaths.
Like US leaders in the 1980s, Pence chose in 2014 to punish people whose lifestyles he found immoral.
And now, amid a national crisis of opioid-related deaths, this man is about to enter the White House.