Alex Azar, the secretary of the Department of Health and Human Services, has expressed public support for needle exchange programs as a way to prevent the spread of HIV among people who inject drugs. Such programs also reduce the risk of hepatitis C virus (HCV).

“Syringe services programs aren’t necessarily the first thing that come to mind when you think about a Republican health secretary, but we’re in a battle between sickness and health, between life and death,” Azar said in Washington, DC, during a national HIV prevention conference.

“The public health evidence for targeted interventions here is strong, and supporting communities when they need to use these tools means fewer infections and healthier lives for our fellow Americans.”

Azar said that although he supports needle exchanges, the Trump administration opposes safe injection sites. These are spaces where people can use drugs, clean needles are provided and the staff is trained to respond to overdoses. Last year, California’s governor vetoed a bill that would have authorized the nation’s first safe injection site, in San Francisco.

Perhaps Republican health leaders support needle exchanges because they have learned from the HIV and hep C outbreaks that occurred among injection drug users in rural Indiana in 2015 under then-Governor Mike Pence, who initially opposed needle exchanges. His delayed response resulted in more than 200 people contracting HIV.

Injection drug use, fueled by the opioid crisis, is an increasingly common route of HIV transmission. Health officials have reported HIV clusters among injection drug users in Seattle and West Virginia.