CHARLESTON, W.Va. — It’s been more than three years since federal health officials arrived in central Appalachia to assess a troubling HIV outbreak that’s spreading mostly among people who inject opioids or methamphetamine.
Infectious disease experts from the Centers for Disease Control and Prevention provided a list of recommendations after their visit, including one to launch syringe service programs to stop the spread at its source. But those who have spent years striving to protect people who use drugs from overdoses and disease say the situation likely has not improved, in part because politicians contend that such programs encourage illegal drug use.
Joe Solomon is a Charleston City Council member and co-director of SOAR WV, a group that works to address the health needs of people who use drugs. He is proud of how his close-knit community has risen to this challenge but is frustrated by the limitations placed on his efforts.
“You see a city and a county willing to operate on a larger scale than ever before, but our hands are still tied behind our backs,” Solomon said.
The hand he is referring to is easy access to clean syringes.
In April 2021, the CDC came to Charleston — the seat of Kanawha County and the state capital, located at the confluence of the Kanawha and Elk Rivers — to investigate dozens of newly discovered HIV cases. Chief of HIV Intervention at CDC Shoot it “The most alarming HIV outbreak in the United States” and warned that the number of reported diagnoses could be just “the tip of the iceberg.”
Now, despite the attention and resources directed toward the outbreak, researchers and health workers say HIV continues to spread. They say the outbreak persists largely because of restrictions imposed by state and local policymakers on syringe exchange efforts.
Research suggests that syringe service programs are linked to what is estimated 50% discount In HIV and Hepatitis C, the CDC Recommendations issued To guide the outbreak response with an emphasis on the need to improve access to those services.
Local officials have not heeded this advice yet.
In late 2015, the Kanawha-Charleston Health Department launched a syringe service program I closed it In 2018 it was under pressure, with then-mayor Danny Jones describing it as a “mini-mall for addicts and drug dealers”.
SOAR stepped in, hosting health fairs that distributed naloxone, an opioid overdose reversal medication; Treatment provided and referrals; Providing HIV testing; Replace clean syringes with used ones.
But in April 2021, The state legislature passed a bill Limit the number of syringes people can exchange and make it mandatory to present a West Virginia ID. The Charleston City Council then added its own guidelines, including requiring individual labeling of syringes.
As a result of these restrictions, SOAR has stopped exchanging syringes. Right to Health in West Virginia An exchange program is now operating in the city under restrictions.
Robin Pollini is an epidemiologist at West Virginia University who conducts community-based research on injection drug use. “Everyone I talked to who used this program only used it once,” she said. “And the numbers they report to the state prove that.”
Syringe exchange Managed by the Ministry of Health In nearby Cabell County — home to Huntington, the state’s largest city after Charleston — it’s not so restrictive. As Solomon notes, this program More than 200 syringes exchanged For each one spent in Kanawha.
A common complaint about syringe programs is that they lead to syringes being dumped in public places. Jan Rader, director of the Huntington Mayor’s Office of Public Health and Drug Control Policy, regularly walks the streets and said she rarely comes across discarded syringes, noting that it is necessary to replace a used syringe with a new one.
In August 2023, the Charleston City Council voted against a proposal from the Charleston City Council Women’s Health Center of West Virginia to operate a syringe exchange in the city’s West Side community, where opponents have expressed concerns about increased drug use and crime.
Pollini said it is difficult to estimate the number of people infected with HIV in West Virginia because there is no coordinated testing strategy. All efforts are translated.
“You would think that in a state with the worst HIV outbreak in the country, by this time we would have a statewide testing strategy,” she said.
In addition to the SOAR testing conducted in 2021 at health fairs, there was extensive testing during the CDC investigation. Since then, a number of HIV cases have been reported in Kanawha County decreasedBut it’s difficult to know whether that’s a result of getting the problem under control or a result of limited testing in at-risk groups, Pollini said.
“I lean towards the latter option, because never before in history have there been an HIV injection-related outbreak among people who use drugs and this disease has been solved without expanding injection service programs,” she said.
“If you go out and look for infection, you will find it,” Pollini said.
Solomon and Pollini praised his ongoing outreach efforts — through riverside encampments, in abandoned homes, and on county roads — Ryan White HIV/AIDS Program To test people most at risk: people known to inject drugs.
“It’s a miracle-level work,” Solomon said.
But Kristen Teague, director of the Ryan White Program at Charleston Area Medical Center, acknowledged that wasn’t enough. In addition to HIV, her concerns include high rates of hepatitis C and endocarditis, a life-threatening infection of the lining of the heart’s chambers and valves, and the cost of hospital resources needed to treat them.
“We’ve presented that data to the Legislature, and it’s not just for HIV, but for all the long hospitalizations that Medicaid basically pays for,” she said. “And nothing seems to break through.”
Frank Aney is a CAMC researcher specializing in cardiovascular disease, a Charleston City Council member, and an advocate for syringe service programs. Research he co-authored 462 cases of endocarditis were found in Southwest Virginia associated with injection drug use, costing federal, state and private insurers more than $17 million, of which less than $4 million has been recovered.
Teague is also concerned about rural counties in West Virginia, most of which do not have a syringe service program.
Tasha Withrow, a harm reduction advocate in adjacent rural Putnam County, said her feeling is that HIV numbers are not alarmingly high there, but she said it’s hard to know, with limited testing and growing stigma in the rural community.
In a follow-up report issued in January 2022, the CDC recommended increasing access to harm reduction services such as syringe service programs by expanding mobile services, street outreach, and telehealth, using individuals the patient “trusts,” to improve service delivery. Basic. For people who use drugs.
Teague would like every rural county to have a mobile unit, like the one her organization runs, to provide harm reduction supplies, medications, behavioral health care, counseling, referrals, and more. This is an expensive task. Proposed opioid settlement funds through First West Virginia Foundation You can pay for it.
Polini said she hopes state and local officials will allow the experts to do their work.
“I would like to see them allow us to pursue the science and run these programs the way they are supposed to be run, and in a broader geographic area,” she said. “Which means it shouldn’t be a political decision; “It has to be a public health decision.”
KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs of KFF – an independent source for health policy research, polling and journalism. Learn more about KFF.
Use our content
This story can be republished for free (details).