It’s been more than a year since public health officials in Clark County, Indiana, agreed to seek state approval for a legal syringe exchange to combat the region’s hepatitis C virus (HCV) and HIV threats. But local advocates say bureaucratic red tape continues to stall any progress that could be made toward instituting the much-needed harm reduction facility, the Courier-Journal reports.

In March 2015, Clark County legislators called for its first syringe exchange, after needle sharing among injection drug users was blamed for an HIV outbreak in nearby Scott County, Indiana. Since then, the Indiana State Department of Health has lifted its needle exchange ban in five counties, with many applications taking just weeks or days to gain state approval. However, it’s been more than six months since Clark County submitted a 200-page request for a needle exchange, and no progress has been made toward approving the application.

Local rumors have been circulating over the state’s perceived distrust of the nonprofit AIDS Healthcare Foundation (AHF), which is helping to fund and organize the project. Clark County’s application has already been sent back once since December 2015, with state health commissioner Jerome Adams demanding clarification on certain sections and that county health officials submit a formal contract with AHF to move forward.

Adams also recently said the state has to ensure that the nonprofit will abide by the state guidelines for needle exchanges. While Indiana can legally help pay for Clark County’s program, it has not set aside any funds this year to do so. As a result, AHF has asked the state for a special permit that would allow it to subsidize the cost of prescriptions through a mail-order pharmacy.

Indiana health officials argue that giving AHF that special designation may stand in the way of the state receiving federal Ryan White funding for HIV prevention. However, AHF has argued that if isn’t awarded the permit, it may drastically scale down its plans for Clark County.

As the state, AHF and the local health department try to resolve their issues, the opioid epidemic continues to spread across Clark County. The county of nearly 115,000 people was recently listed among the state’s highest for new hepatitis C cases and overdose deaths in 2016.