THE BURNED OVER DISTRICT

And mainlining drug addicts are the primary vector in spreading the disease. Indiana is also a Republican state so the state in its wisdom has banned funding for the most effective means of stopping the spread of the disease, needle exchanges. It was only the emergency aspect of the problem that forced Gov. Pence to allow counties to set up needle exchanges if they picked up the tab themselves.

The trailer has no electricity — a generator runs the lights, a phone charger and a tiny space heater — but Maupin had bins of whatever a heroin addict might need — syringes in various gauges, aluminum cookers the size of a tea light, ampoules of sterile water, cotton pellets to absorb impurities, gauze, Band-Aids and tourniquets. “You offer them something that they will use and that they need, you get contact with them. And each encounter you mention the different other services that you have,” including HIV testing and referrals to rehab, Maupin explains. “A lot of times they're just really afraid to take that step.”

However modest, Fayette County’s syringe exchange program is a big step forward for Indiana, which banned syringe exchanges until last year. The Republican governor, Mike Pence, is a vocal opponent of the practice as condoning drug use, although it has been proven effective by years of research in preventing the spread of HIV and hepatitis. Even as 31 other U.S. states — including all four of its neighbors — opened the door to syringe exchange, Indiana kept it firmly shut. That changed abruptly in early 2015 when Scott County, another tiny rural community in central Indiana, reported dozens of new cases of HIV, all of them linked to a group of intravenous drug users who had been sharing needles. Under pressure from state and national public health experts, Pence signed an emergency measure in March 2015 establishing a needle exchange in Scott County and later allowed other counties to start their own. “The outbreak pulled it out of the realm of politics and morality and pushed people who had otherwise been more hard-line about this to a place of pragmatism,” says Daniel Raymond, policy director of the Harm Reduction Coalition, a national group advocating for more humane policies toward drug users.

But Indiana’s grudging acceptance of syringe exchanges has done little more than shift the state’s responsibility for a public health crisis to the communities that are least able to handle it. While allowing needle exchanges, Indiana has left in place a ban on state funding, requiring counties such as Fayette that need the programs to come up with the money on their own. “We’ve basically tied both hands behind our back after we said, go for it!” says Beth Meyerson, a professor of public health at Indiana University and co-director of the Rural Center for AIDS/STD Prevention.

A spokesperson for Pence said the governor’s “calendar is full” and declined to provide a comment for this article.

And with the parallel rise in cases of Hep C, you might think any governor would want to slow or stop the spread of long term expensive diseases. In a Republican state, you would be wrong.