‘We still have darkness’: the town where an HIV outbreak occurred under Mike Pence

Dozens of residents filtered past a syringe disposal box in a parking lot as they headed to the free weekly meal at the Church of the New Covenant in the town of Austin, Indiana.

“We still have darkness around us, we still have addiction, it’s going to take Jesus’s return to stop all of it,” said Pastor Jacob Howell, who stopped using heroin a few years ago and devoted his life to God.

“I’d rather have them throw it in there than have some kid get stuck with it walking in the park.”

It’s still illegal to have a syringe without a prescription in the state of Indiana, but Austin is one of the exceptions to the rule: this town of just over 4,000 was the site of a 2015 HIV outbreak that ultimately infected more than 200 people, an infection rate on par with some of the world’s most HIV-affected countries.

Donald Trump’s vice-president, Mike Pence, has been tasked with heading up the US response to coronavirus, a dangerous disease that has now killed more than 3,400 people worldwide and quarantined millions. It has shuttered institutions from schools to the Louvre and put an end to pilgrimages to Islam’s two holiest cities in Saudi Arabia.

But before his time in the Trump administration, Pence was the governor of Indiana, and the 2015 HIV outbreak was the biggest public health crisis he had ever faced. He is widely seen to have botched the response.

When the outbreak was first detected at the start of 2015, there were immediate calls from public health experts for Pence to lift the ban on syringe exchanges to stop the spread of the disease, but he held off, remaining morally opposed to needle exchanges despite a wealth of evidence that such practices do not encourage more drug use, and successfully curb the spread of HIV.

Pence instead told people he was going to pray on what to do. By the time he finally signed an executive order in March allowing a needle exchange in Scott county, where Austin is located, weeks had passed and dozens of more cases had been confirmed.

In announcing Pence’s new coronavirus role last week, Trump said that the vice-president “has a certain talent for this” and pointed to his healthcare record as governor of Indiana.

But healthcare providers and public health experts have said that he mismanaged the HIV crisis in Austin, putting his own personal beliefs about syringe exchanges ahead of evidence presented to him.

Jacob Howell, pastor at the Church of the New Covenant in Austin, Indiana, battled his own addiction for years.

Jacob Howell, pastor at the Church of the New Covenant in Austin, Indiana, battled his own addiction for years. Photograph: Josh Wood

“I’m hoping he learned a lot from the experience of the HIV outbreak and how it was handled,” said William Cooke, who was the sole doctor in Austin when the outbreak began.

When a surge of HIV cases were detected in Austin in January 2015, Cooke and others intensified calls for Pence to lift the ban on syringe exchanges to halt the spread. When he was finally able to speak to the governor face-to-face, he said Pence “didn’t really want to talk about a syringe service program, so he moved on from that subject quickly. But I felt it was important that he needed to know that the only doctor in Austin supported a syringe service program.”

Cooke, who like Pence considers himself a conservative Christian, hopes the vice-president will listen to science this time around.

“History tends to be the best predictor of the future and there’s not a good track record coming from Indiana from a public health standpoint and listening to public health experts,” he said. “But I really hope that having gone through the HIV epidemic that he really learned that public health experts know what they’re talking about: they know the science they know what’s evidence based.”

In Scott county the impact of the syringe exchange programs has been dramatic: the number of HIV infections linked to the outbreak dropped from 187 in 2015 to just 10 in 2018 and seven last year, according to statistics provided by the county’s department of health.

Employees at the department of health were unwilling to comment on Pence, but they did say that the syringe program has been overwhelmingly successful in confronting the HIV outbreak. However, despite that success, opponents of the programs remain and without legislative action, exchanges in Austin and elsewhere in Indiana will be shut down next year.

Public health experts who offered recommendations on combatting the HIV outbreak in Indiana have questioned whether Pence can put evidence ahead of his own beliefs.

In combatting Covid-19 “we need a leader who is not only data-driven, but somebody who understands evidence – and somebody who can communicate it. Neither one of those things is in Mike Pence’s skillset,” said Beth Meyerson, the co-director of Indiana University’s Rural Center for Aids/STD Prevention.

Carrie Lawrence, the associate director of the center, said the Austin HIV outbreak showed that when Pence has to make a public health decision “his go to is his ideology or faith instead of going to the data or the evidence”.

Jacob Howell leads a small group in prayer following a weekly free dinner at the church.

Jacob Howell leads a small group in prayer following a weekly free dinner at the church. Photograph: Josh Wood

Pence likely already faces a conflict between ideology and expertise: while the Centers for Disease Control and Prevention (CDC) has warned that coronavirus has the potential to have serious disruption in the US, the president has largely downplayed the threat of the virus.

On Wednesday, Trump – without evidence – called the World Health Organization’s (WHO) coronavirus mortality rate “a false number” and said thousands of people infected with coronavirus “get better, just by, you know, sitting around and even going to work”.

In Austin, where the HIV outbreak occurred, there is hope that Pence’s experiences in Indiana will help him.

Howell, the pastor, said Pence made some missteps in 2015.

“I think he missed telltale signs prior – and then when the problem got big he acted on it,” he said. “It’s easier to put a fire out when it’s smoldering. Once it becomes a blaze, it’s harder to control.”

However, he said he trusts Pence and believes he is capable of handling the US’s coronavirus response.

“I think maybe [the HIV outbreak] was given to him as a test for this bigger obstacle now that he has to take care of,” he said. “Maybe he can take some of these hard lessons learned and apply them here. And I pray that he listens to doctors and goes against what even he himself might think to do what’s right.”

Howell said addiction remains a problem in Austin, but that “recovery is bigger”.

One of the people at the church’s free meal last week was Laura Nowling, 51, who has been sober for three years following addictions to methamphetamines, cocaine and alcohol.

Her life came crashing down in February 2016 when she was arrested for drug possession at Austin elementary school, where she was a teacher. Then, last year, her oldest son died at 26 from a fentanyl overdose in Ohio after getting hooked on opioids in Austin. Her two other children are recovering from addictions as well.

Nowling said the idea of a syringe exchange was wildly unpopular in Austin in 2015, particularly among those who had no personal connection to addiction.

“Even though it wasn’t popular at the time, [Pence] went ahead and made it,” she said. “So he went against public opinion, I guess. I think that’s good.”

She added: “I think if they’ve asked him to do that, he will take the initiative to do what’s right and not necessarily go with popular opinion.”


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