In February 2015, an unprecedented HIV outbreak fueled by intravenous drug use hit the small city of Austin, Indiana. Under pressure, then-Gov. Mike Pence reluctantly allowed a syringe exchange. Five years later, HIV is undetectable in most of the outbreak patients. Still, the lessons haven’t been learned nationwide. Fewer than a third of the 220 counties deemed by the federal government as vulnerable to similar outbreaks have active syringe-exchange programs.