Leadership and Ending the HIV Epidemic

I had a snow day Friday. I was scheduled to speak at a meeting on “Opioids: Lessons Learned from the AIDS Epidemic," but it was cancelled due to weather. I was planning on discussing several themes: working together, getting people with addictions into health care, new ways of thinking, remaking the rules, and, very important - leadership. 


Of course, I quoted liberally from my book. At any rate, here is a snippet from the part called "A Tale of Two Cities or How Not to Manage an Epidemic." I start with the history of HIV and my recollections of the earliest days, 1981-1985.  

Lets fast forward to 2015 . As the global initiative to End the HIV Epidemic by 2020 was underway, let’s go to Scott County in southern Indiana, near the Kentucky border. In a year’s time, health authorities identified 161 new cases of HIV in injection drug users. Unlike New York State, Indiana does not make clean needles available to injection drug users (i.e.,new ways of thinking). In 2016, the authorities reluctantly issued an “emergency order” to make clean needles available. The epidemic wound down. 

Then, in 2017, local authorities stopped the needle exchange. The response from the local commissioner was that “Morally, they are breaking the law, and I can’t allow that.” 

By way of history, the current vice-president of the United States was the governor of Indiana during this needle sharing epidemic. His initial response to the problem was to pray and think about the problem (while people were becoming HIV-positive). But I don’t want to get political here.

In contrast, the New York City police chief was asked recently about "Supervised Injection Facilities" for injection drug users (evidence in Europe and Canada shows these facilities prevent overdoses and deaths). The chief said, “We need to do this. It’s about saving lives.” The NYC response redefines the rules and is built on 35 years of sound public health policy in New York State. 

Indiana's moral ground argument does nothing to help people who do not have a voice and are struggling with addiction, and does nothing to prevent HIV. Note: New York State has made clean needles available to injection drug users 25 years ago.

Leadership is why we can talk about EtE 2020 in New York while Indiana was grappling with HIV related to shared needles; something we rarely see in New York State today.