""I prefer a simple introduction. I am a Christian, a conservative and a Republican, in that order," Indiana Governor Mike Pence said when he accepted the VP nomination at the Republican Convention on July 15. He is forever introducing himself with this little jingle, usually delivered with his index finger extended for "in that order."
His speech at the convention, like his subsequent campaign-trail appearances, was crisp, moderate and disingenuous. The focus was on "fiscal responsibility."
"In my home state of Indiana, we prove every day that you can build a growing economy on balanced budgets, low taxes, even while making record investments in education and roads and health care," Pence said, to cheers.
While economic growth in Indiana is above average, the improvements follow trends that preceded his tenure. Pence did succeed in tearing up the government safety net, including the public health spend. He increased mandatory minimums for drug offenses at a time when criminal justice reform is a bipartisan issue. And he signed two of the most sadistic anti-LGBT and anti-abortion bills in US history.
But his unique distinction lies in having enabled and exacerbated the first rural HIV outbreak since the earliest years of the AIDS epidemic.
As I spoke with some of those involved—including Ed Clere, a Republican state legislator who had the foresight to pursue a needle exchange bill before the crisis hit, and was punished by Pence for his pains—a malign picture emerged of the "reasonable" half of the Trump ticket.
The Real Extremist on the GOP Ticket
Make no mistake, the vice-presidential candidate is an extremist. Much of the media has failed to communicate this, and perhaps to understand it. They call him a "social conservative" when he is a militant theocrat.
Part of it is that Pence is a smart, disciplined and attractive man. His imitation of a down-home, plain-spoken Hoosier has become second nature. He is described as "polite," as "humble," as "look[ing] like a football coach." He likes to say that he is a conservative, "but I'm not in a bad mood about it." His sheer likeability is a powerful weapon. A Gallup poll (August 3 to 7) found that 64 percent of Republicans have a favorable impression of Pence, up from July's 40 percent. His favorability has grown to 33 percent among independents; he even scores 17 percent among Democrats, up from 5 percent in July. The more Americans see of him, the more they like him.
Donald Trump would make any running mate seem, by comparison, moderate. He makes Pence seem milquetoast. (Compare Pence's generic-masculine close-cropped white hair with the orange synthetic phenomenon orbiting Trump's skull.) The irony is that Trump appears to be the extremist when he is a hollow grifter with a personality disorder. Mike Pence is the real deal.
In March, Pence signed—"with a prayer"—a law that bans the abortion of fetuses with Down Syndrome and other genetic conditions, forces a woman to have an ultrasound 18 hours before an abortion, and forces her to bury or cremate the fetal remains, even she miscarries. Nationwide, women voiced their outrage, joining a "Periods for Pence" campaign. In June a federal judge blocked the bill, as Pence no doubt anticipated. The law demonstrated his allegiance to the "personhood" movement, which advocates giving full legal rights to zygotes and criminalizing abortion as murder.
Pence also wants to deny full legal rights to LGBT people. In March 2015 he signed the nation's most extreme "religious liberty" bill, to legalize anti-LGBT discrimination by people, churches and businesses. It sparked a firestorm—boycotts, protests. The bill was patently unconstitutional and indefensible. Yet Pence defended it and made a fool of himself on the national stage.
After he told the state legislature to add a clause prohibiting anti-LGBT discrimination, his theocratic backers turned on him. Up to that point, he had been a serious contender for the 2016 GOP presidential candidacy. Instead, he's now the toady of a godless barbarian. Karma is a bitch.
Culpable for the Spread of HIV
During all the drama around the anti-LGBT bill, HIV and hepatitis C were spreading like wildfire through a close-knit, isolated community of injecting opioid users in Austin, a small town in southeastern Indiana. Austin has a population of about 4,500; 10 percent of these people are estimated by the CDC to be addicted to opioids.
Eighteen months later, some 200 people there have HIV. About 50 percent of them are on HIV treatment; about 75 percent are co-infected with hepatitis C. Very few are in treatment for addiction; even fewer have quit opioids.
Last week, The New York Times ran a story headlined "Mike Pence on HIV: Prayer, Then Taking Action" (later changed to "Mike Pence on HIV: Prayer, Then a Change of Heart"). The piece portrays Pence sympathetically as a leader who, faced with an HIV outbreak apparently from out of the blue, had to decide between two equally legitimate but competing claims: his "moral opposition to needle exchanges on the grounds that they supported drug abuse" and "an epidemic that was growing more dire by the day."
"In recent interviews, local, state and federal health officials said Mr. Pence initially held firm [against allowing needle exchange in Austin]. So as they struggled to contain the spread of HIV, the officials embarked on a behind-the-scenes effort over several weeks to persuade him to change his mind, using political pressure, research and pleas for help from this remote, poor community."
On the one hand, one man's deeply held morals; on the other, 450 lives. What would Jesus do?
"On March 23, more than two months after the outbreak was detected, Mr. Pence said he was going to go home and pray on it."
This sentence merits a close reading. After ignoring an emergency for months, with health officials, legislators, the media turning against him, he finally "prays on it."
Then—not one, not two, but three days later—he surrenders to the political pressure.
The Times' "dark night of the soul" portrayal is false. The competing claims apparently weighing so heavily on Pence are not equally legitimate. His opposition to needle exchange cannot be weighed on the same scale as the life of even a single drug user at risk for HIV.
Why? Because there is no rational debate over the effectiveness of needle exchange as a public health measure. These programs dramatically reduce disease and death.
They can also help people in their struggle against addiction; some studies show that needle exchange users are five times likelier to enter treatment than other injecting drug users.
And Pence has not had "a change of heart." He still opposes needle exchange.
Since the Austin crisis, five more counties in Indiana have started syringe exchange programs to attempt to avert their own HIV outbreaks. Among some people on the front lines in Austin there is the conviction that Pence instructed the state legislature to provide so little support as to ensure the failure of these programs.
"I think it was just set up to fail from the get-go," Dr. Carrie Ann Lawrence, the head of Project Cultivate at the Rural Center for AIDS/STD Prevention at the Indiana University School of Public Health, told Politico. (Project Cultivate was central to the establishment of the needle exchange in Austin and has helped several counties negotiate the law's many technical complications in the application process to win state approval for a syringe swap.)
The evidence bears this suspicion out. When Pence became governor in 2013, he knew about Indiana's opioid problems. He had been warned by the CDC about fast-rising rates of hepatitis C. The agency advised him to open needle exchanges.
He remained silent about the threat of HIV until it was far too late.
"HIV is here to stay. In fact we've not quarantined it," said Dr. Shane Avery, a family physician in Scott County who beseeched and hectored the governor for years to do something, anything. "It's the governor's refusal to address this situation that I believe will result in Indiana's most historic failure in public health."
In May 2015, a pregnant 18-year-old girl died of the untreated complications of undiagnosed HIV infection, as if Austin, Indiana, were in sub-Saharan Africa."