For the last several months, one of the worst places I have ever been in the United States has been in the news. Not surprisingly the reason isn't positive. Scott County in southern Indiana (anchored by the metropolises of Austin and Scottsburg) was the site of a rapid spike in HIV infections from prescription opiate addicts sharing needles in that little slice of Real America. If you've never been to Scott County, you've been to Scott County. Just think of whatever nearby dilapidated, tumbleweed-strewn rural dump is nearby and you're there. Think of a big trailer park, but dirtier and poorer. Think of small towns that have no reason for existing anymore. That's Scott County. Everything necessary to create an HIV outbreak is there in spades: lack of healthcare, lack of public health services, lack of education, lack of employment, lack of money, and lack of anything to do but make and shoot the kind of drugs that destroy people from the inside out.

After some of his trademark waffling between right wing talking points and massive public and Federal pressure, Indiana Governor Mike Pence recently approved a temporary needle exchange program for Scott County. Then after he swore repeatedly he would veto it, he signed a law to the same effect. For a moment it seemed like a rare example of Republican lawmakers making a decision based on evidence rather than ideology. Not to oversimplify the issue, but everyone who isn't weapons-grade stupid or steeped too thoroughly in War on Drugs propaganda to see over the edge of their paranoia understands that things like needle exchanges are sensible policy. People addicted to things like heroin and meth are going to do things like heroin or meth every day regardless of whether they have proper sterile paraphernalia available. There is no opiate addict on the planet who ever said "Looks like I'm out of clean needles. Guess I have to quit using." Until some kind of treatment program intervenes (which in the United States usually takes the form of getting incarcerated, at least for poor people) to break people from addiction, addicts use drugs regardless of any externalities. Even anti-drug crusaders are capable of understanding that things like HIV and Hepatitis outbreaks are expensive public health problems that cost far more in the long term than a bulk-bought $0.49 syringe.

Don't worry, though. The yokels of Scott County have found a way to fuck it up. Even when events conspire to accidentally produce good public policy from the Governor and state legislature, leave it to the ingenuity of the kind of people in positions of power in America's rural sinkholes to ensure that no sensible ideas are enacted on the ground.

Why does it always have to turn out this way? Aside from the obvious lack of a stable economic base, why must places like Scott County suck so completely and consistently? Many Americans insist that not terribly long ago small town America was actually a fairly pleasant place to live. The same is said about any number of medium sized Rust Belt cities that have been on the decline since the 1950s. Obviously these places are poor and that's a big problem. But lacking great wealth doesn't mean everything has to be terrible. Your school district might not be rich, for example, but it doesn't cost anything to teach students that the Earth is not 6,000 years old. It costs nothing to teach real Sex Education rather than abstinence-only detritus.

I have been thinking about this a great deal lately, and I have an idea that doesn't invoke religion, the Culture Wars, or the Republican Party's messy divorce from reality. But that will have to wait 24 hours.