person wearing gloves holding HIV test

Southern Indiana’s HIV Outbreak: A Lesson on the Importance of Incentivizing HIV Testing

By 2015, major news outlets were reporting on what the CDC was calling “one of the worst documented outbreaks of HIV among IV users in the past two decades.” Between 2011 and 2015 over 200 people in southern Indiana’s Scott County acquired HIV. The primary source of the spread was the sharing of needles to inject opioid drugs. While the outbreak has now been contained, there linger many lessons to be learned from the tragedy that struck this small rural county in southeast Indiana.

Some of those lessons are about the havoc being wreaked on much of rural America by opioid abuse. But the lessons I’m focusing on here are the dangers of disincentivizing HIV testing, especially among high-risk populations like injection drug users.

Scott County’s HIV outbreak was in many ways the perfect storm.

Opioid drugs abuse was on the rise at the same time that the last remaining clinic for free HIV testing was shutting its doors. Conservative-led funding cuts to Planned Parenthood in Indiana led to the closure of five Planned Parenthood clinics in rural Indiana. As a result, in 2013, Scott County lost its only provider of free HIV testing: a Planned Parenthood clinic that did not provide abortion services.

But a lack of local free testing options may not have been the only source of a testing disincentive encountered by Indiana residents at risk to HIV transmission. Another source may be its HIV criminalization laws. In Indiana, failing to disclose your HIV-positive status to sexual partners or needle-sharing partners when you know that you’re HIV positive is a Level 6 felony. However, this same offense for someone who is isn’t aware of their status is only a Class B Misdemeanor. Thus, someone who is sexually active or sharing needles and who wants to shield himself from felony charges, simply not getting tested for HIV is one way to avoid such prosecution.

By creating financial barriers and legal disincentives for people to get tested for HIV, Indiana set itself up for an outbreak of HIV to be difficult to detect until, as in Scott County, the outbreak has naturally run much of its course.

Indiana is not alone in criminalizing HIV. The majority of the states have HIV criminalization laws. Nor is Indiana alone in taking measures to defund planned parenthood. Here’s to hoping states begin to change course before rather than after future outbreaks.

Mark Satta

Mark Satta is an Assistant Professor of Philosophy at Wayne State University. He holds a JD from Harvard Law School and a PhD in Philosophy from Purdue University. His research interests include First Amendment law, health law, bioethics, and epistemology. He was a 2018-2019 Student Fellow at the Petrie Flom Center, where he completed a project entitled, "Spitting at Science: HIV Criminalization Laws and the Duty to Legislate in Accordance with Current Scientific Knowledge."

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