title: Against the Odds: Syringe Exchange Policy Implementation in Indiana.
abstract: Indiana recently passed legislation allowing local governments to establish syringe exchanges. While the effectiveness of syringe exchange programming is established, there is a dearth of studies about associated policy adoption and implementation. This study documents the experiences of 24 Indiana counties engaged in the process of establishing syringe exchange programming under new state law. A mixed method, qualitative, exploratory case study was conducted from May 2015 to April 2016. We observed rapid and widespread policy adoption interest, and yet counties reported significant policy ambiguity, epidemiologic and resource capacity issues. The emergence of health commons involving information and tangible resource sharing networks allowed institutional rearrangement in the midst of resource scarcity; however, such rearrangement appeared to be a central threat to policy adoption and implementation given state structural barriers. The emerging commons could be a critical policy success factor, as it would achieve efficiencies not possible in the current resource environment, and can help achieve institutional rearrangement for the improvement of population health. Several recommendations for improvement are offered.
authors.affiliation: Rural Center for AIDS/STD Prevention, Indiana University School of Public Health-Bloomington, 1025 E. 7th Street, Bloomington, IN, USA. bmeyerso@indiana.edu.
authors.forename: Beth E
authors.identifier: http://orcid.org/0000-0003-1762-7179
authors.initials: BE
authors.lastname: Meyerson
authors.affiliation: Rural Center for AIDS/STD Prevention, Indiana University School of Public Health-Bloomington, 1025 E. 7th Street, Bloomington, IN, USA.
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Lawrence
authors.affiliation: Rural Center for AIDS/STD Prevention, Indiana University School of Public Health-Bloomington, 1025 E. 7th Street, Bloomington, IN, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Miller
authors.affiliation: Indiana Minority Health Coalition, 3737 North Meridian Street, Indianapolis, IN, 46208, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Gillespie
authors.affiliation: Harm Reduction Coalition, 22 West 27th Street, 5th Floor, New York, NY, 10001, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Raymond
authors.affiliation: Prescription Drug Abuse Prevention Task Force, Office of the Indiana Attorney General, 302 West Washington Street, 5th Floor, Indianapolis, IN, 46204, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Kelley
authors.affiliation: Rural Center for AIDS/STD Prevention, Indiana University School of Public Health-Bloomington, 1025 E. 7th Street, Bloomington, IN, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Shannon
mesh_terms: D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D006284:Health Plan Implementation / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D006291:Health Policy / Q000331:legislation & jurisprudence; D006801:Humans; D007196:Indiana; D018671:Needle-Exchange Programs / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D015819:Substance Abuse, Intravenous / Q000150:complications*; D013594:Syringes
keywords: HIV; Health commons; Local government; Syringe exchange; hepatitis C