In Rural Indiana, One Woman Connects Her Community to Lifesaving Services

Kelly Hans was in an Indiana jail when she learned about the outbreak.

It was mid-March 2015, and she had been arrested a few days earlier for drug possession. In the jail’s common room, a national news broadcast was reporting that HIV was spreading rapidly among people who, like her, shared syringes to inject drugs in rural Scott County.

“I remember them pulling us all out by groups, taking us to a trailer to be tested, and back to our cells,” Hans said in an interview with The Pew Charitable Trusts.

Hans tested negative for HIV but positive for hepatitis C, which, like HIV, often spreads when people share contaminated needles. Fortunately, she was treated successfully after being released from jail, no longer has the active virus, and has been in recovery from substance use disorder ever since. Today, Hans is executive director of Holding Space Recovery Project, an Austin, Indiana-based nonprofit that provides “harm reduction interventions and recovery support services.”

Courtesy of Jason Hans

In response to the outbreak, the state and Scott County health departments developed “one-stop shops” to offer an array of lifesaving services, including HIV and hepatitis C testing, health education, and counseling for substance use disorder. Then-Governor  Mike Pence (R), later the U.S. vice president, approved the distribution of sterile syringes via these programs, urged on by then-State Health Commissioner Jerome Adams, who would later serve as U.S. surgeon general in President Donald Trump’s first administration.

Within five years, new HIV infections in Scott County had dropped from 200 in the year of the outbreak to just one. Indeed, decades of research show that distributing sterile syringes prevents the transmission of deadly infections, reduces fatal overdoses, promotes the proper disposal of used needles, and connects more people to treatment and recovery. One study estimated that if Scott County had these programs in place before the outbreak, it could have prevented 90% of the infections.

Although state and local health leaders and Scott County’s past and current sheriffs supported the distribution of sterile syringes, the county commissioners rescinded their approval for this practice in May 2021. As news media reported at the time, the commissioners voting against the programs said they did not “want to enable dangerous behavior.”

But experts say these programs are proven to work.

Sarko Gergerian, a lieutenant with the Winthrop (Massachusetts) Police Department, serves a community where private organizations operate programs offering sterile syringes. Speaking as an individual and not on behalf of his employer, he told Pew that the programs are “fundamental, vital, absolutely necessary, and not utilized enough. We should all be actively working toward exceptional implementation of such programs nationwide. That means low barriers, no judgment, and creating an opportunity to make human-to-human connection with IV [intravenous] substance users.”

Thirty-seven states, the District of Columbia, and Puerto Rico authorize programs that distribute syringes, but experts warn that they are not as effective as they could be because of restrictions rooted in stigma rather than data.

Dr. Don Des Jarlais, a professor of epidemiology at New York University who has studied such programs since 1983, outlined some hallmarks of effective ones. “Don’t restrict the number of syringes. Encourage secondary distribution so that people can get syringes not just for themselves but their friends,” he said. “And understand that these programs are on the front line of improving the health of people who use drugs, and therefore the health of the community, and so you should try to make as many services available as possible, including testing for HIV and hepatitis C, access to substance use treatment, and distribution of naloxone to prevent overdoses.”

“All of the evidence from providing syringes shows no increase in drug use and drug injection,” Des Jarlais added.

Indeed, research shows that it can have the opposite effect. For example, a study of Seattle programs that offered sterile syringes found that, compared with people who never participated in such programs, former participants were 2½ as likely to reduce or stop injecting drugs, and new participants were five times as likely to enter drug treatment.

“Making it difficult to obtain syringes just forces people to share syringes and transmit viruses,” Des Jarlais said.

A nurse before she started using drugs, Hans experienced firsthand how addiction can overpower reason and force bad decisions. “Nurse Kelly knew better than to share syringes,” she said, “but when I was using, all of my nursing knowledge went out the window.”

In 2017, with two years of recovery under her belt, Hans earned her peer recovery coach credential and joined the Scott County Health Department to support HIV testing. It was there that she saw how increasing access to sterile syringes prevented infections and created opportunities to provide care to people with substance use disorder who would not have otherwise sought it.

“Who would have ever thought that the county government would have hired felons?” Hans said. “But they did, and that is how our program worked so well. Building trust was easier because [our clients] already knew us and trusted us, because we have that lived experience and we operate out of compassion and empathy.”

When Gergerian, the Massachusetts police lieutenant, approaches someone in a crisis related to substance use, such as an overdose, he tells them: “We don’t want you to die. We don’t want to lose you.”

“You can literally feel the energy change,” he said. “The look in people’s faces, in their eyes when they hear somebody representing the government—I don’t know who does that more than a uniformed police officer—saying these things without judgment. We don’t want to normalize dangerous, dysregulated drug use, but we are trying to destigmatize it so that we can bring it out from the shadows.”

In the years since Scott County stopped allowing the distribution of sterile syringes, Hans’ organization has continued to provide a range of other services, including distribution of fentanyl test strips and the overdose-reversal drug naloxone, testing for HIV and hepatitis C, and recovery coaching, but she has seen overall participation drop since 2021.

“We were so much more than just handing out clean syringes, but that was the main draw,” she said. “And once people were there, we could envelop them in all of those other services that we were providing. But without the syringes, people don’t come in like they used to.”

Josh Wenderoff works on The Pew Charitable Trusts’ health programs.