Social Determinants of Medicine and Health

HIV Epidemic in Southern Indiana: Why the social aspects of disease need to be addressed

Last week, the CDC declared a HIV epidemic in Scott County Indiana. As early as January, there were seven noted cases of HIV in an area that suffers from high levels of poverty and injection drug use. Both poverty and drug use as social factors are very commonly seen in many populations and drive HIV rates. It has been known for many years that sharing needles with someone who is HIV positive is one major means of contracting the virus. What we have not done as a society is to address head on the issues that drive infection rates. Why have we not established needle exchanges to provide clean needles for addicts?

Gov. Mike Pence (R-Indiana) with advice from the CDC team in Scott County agreed to allow temporary needle exchanges to slow the infection rates. What Gov. Pence is not doing is allowing for the establishment of exchanges for a longer term. For Gov. Pence and many on the political right, needle exchanges are a problematic issue. Saying “needle exchange” in politically right leaning circles in akin to saying that you support illicit dug use. The British government during the term of Margaret Thatcher instituted needle exchange programs for the good of the health of the United Kingdom. The decision although politically divisive, saved lives and it helped to reduce HIV infection rates among IV drug users dramatically. To me, this issue is a no brainer. Short-term needle exchange programs will be helpful in Scott County, but in order to not repeat an epidemic of this magnitude or worse in an area where poverty drives a culture where sexual networks can form and the drug culture is rampant. Political views override the best interests of many in this country.

Needle exchanges, while allowing for addicts to stay safe and reduce the chances of contracting HIV doesn’t halt the use of drugs. What if we could offer rehabilitation while these exchanges operate? It would stand to reason that there are factors which lead individuals to drug use, during an exchange while we are offering them protection against reusing/sharing used needles we could also ┬ádevelop and expand resources to help individuals break the addiction cycle. But if we break teh cycle of addiction by dealing with all of the underlying factors associated with a particular person’s addictions, then how do they continue on a clean path when poverty continues to be prevalent and pathological in their community. I do not have the answers on how poverty can be conquered, but it starts with opportunity. So many of our politicians say that they are pro-USA for jobs and manufacturing but they continue to sanction loopholes for corporations that ship jobs to other countries. Poverty persists because those who want to work and want to make a LIVING WAGE cannot do so because of the lack of semi-skilled work. Not every job should require a college degree but with the right training, we can provide work that gives every impoverished American the ability to contribute to all aspects of our economy. HIV is not just about a disease, it is very much about the factors that lead to acquiring the disease. Until we see that diseases such as HIV, TB and neglected tropical diseases are intimately linked with poverty, we will continue to struggle with controlling or eradicating their deadly effects from our world.