Abstract: This case (Parts A&B) takes students behind the scenes at the Indiana State Department of Health (ISDH) as it struggles to recognize and manage an unusual outbreak of HIV in a poor, rural community. As ISDH learns, illegal injection of prescription drugs, mainly opioids, is spreading the disease. Users are sharing needles and thus exposing the second, third, or subsequent users to infection with HIV from potentially contaminated blood residue. ISDH recognizes that “needle exchange” is one method generally found effective in other states in reducing infections among injection drug users. Drug users can bring used needles to a clinic or other exchange location and receive fresh ones without fearing that they will be subject to arrest or other sanctions. However, Indiana, with a conservative legislature and governor, has by law long banned needle exchanges because it perceives these to encourage drug use. In reading and discussing this case study, students will learn about how Indiana Governor Mike Pence, Indiana Health Commissioner Jerome Adams, and the legislature all sought to balance public health concerns against long-held beliefs about how best to fight the war against drugs.
Learning Objective: Students will consider the conflicts that can arise between political imperatives and public health priorities. By considering the perspectives of the Department of Health, on one hand, and the governor and other political actors, on the other, they will have to consider the ways in which trade-offs and practical balancing of these imperatives can be achieved or how the situation might be locked into practices that would reduce the effectiveness of efforts to control the HIV outbreak. Students will also gain insight into the history of HIV-AIDS prevention and treatment, as well as into the politics of a disease that exposed deep divisions within US society.