CHARLESTON, W.Va. \u2014 More than three years have passed since federal health officials arrived in central Appalachia to assess an alarming outbreak of HIV spread mostly between people who inject opioids or methamphetamine.<\/p>\n
Infectious disease experts from the Centers for Disease Control and Prevention made a list of recommendations following their visit, including one to launch syringe service programs to stop the spread at its source. But those who\u2019ve spent years striving to protect people who use drugs from overdose and illness say the situation likely hasn\u2019t improved, in part because of politicians who contend that such programs encourage illegal drug use.<\/p>\n
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\u2019s proud of how his close-knit community has risen to this challenge but frustrated with the restraints on its efforts.<\/p>\n
\u201cYou see a city and a county willing to get to work at a scale that\u2019s bigger than ever before,\u201d Solomon said, \u201cbut we still have one hand tied behind our back.\u201d<\/p>\n
The hand he references is easier access to clean syringes.<\/p>\n
In April 2021, the CDC came to Charleston \u2014 the seat of Kanawha County and the state capital, tucked into the confluence of the Kanawha and Elk rivers \u2014 to investigate dozens of newly detected HIV infections. The CDC\u2019s HIV intervention chief called it<\/a> \u201cthe most concerning HIV outbreak in the United States\u201d and warned that the number of reported diagnoses could be just \u201cthe tip of the iceberg.\u201d<\/p>\n Now, despite attention and resources directed toward the outbreak, researchers and health workers say HIV continues to spread. In large part, they say, the outbreak lingers because of restrictions state and local policymakers have placed on syringe exchange efforts.<\/p>\n Research indicates that syringe service programs are associated with an estimated 50% reduction<\/a> in HIV and hepatitis C, and the CDC issued recommendations<\/a> to steer a response to the outbreak that emphasized the need for improved access to those services.<\/p>\n That advice has thus far gone unheeded by local officials.<\/p>\n In late 2015, the Kanawha-Charleston Health Department launched a syringe service program but shuttered it<\/a> in 2018 under pressure, with then-Mayor Danny Jones calling it a \u201cmini-mall for junkies and drug dealers.\u201d<\/p>\n SOAR stepped in, hosting health fairs at which it distributed naloxone, an opioid overdose reversal drug; offered treatment and referrals; provided HIV testing; and exchanged clean syringes for used ones.<\/p>\n But in April 2021, the state legislature passed a bill<\/a> limiting the number of syringes people could exchange and made it mandatory to present a West Virginia ID. The Charleston City Council subsequently added guidelines of its own, including requiring individual labeling of syringes.<\/p>\n As a result of these restrictions, SOAR ceased exchanging syringes. West Virginia Health Right<\/a> now operates an exchange program in the city under the restrictions.<\/p>\n Robin Pollini is a West Virginia University epidemiologist who conducts community-based research on injection drug use. \u201cAnyone I\u2019ve talked to who\u2019s used that program only used it once,\u201d she said. \u201cAnd the numbers they report to the state bear that out.\u201d<\/p>\n A syringe exchange run by the health department<\/a> in nearby Cabell County \u2014 home to Huntington, the state\u2019s largest city after Charleston \u2014 isn\u2019t so constrained. As Solomon notes, that program exchanges more than 200 syringes<\/a> for every one exchanged in Kanawha.<\/p>\n A common complaint about syringe programs is that they result in discarded syringes in public spaces. Jan Rader, director of Huntington\u2019s Mayor\u2019s Office of Public Health and Drug Control Policy, is regularly out on the streets and said she seldom encounters discarded syringes, pointing out that it\u2019s necessary to exchange a used syringe for a new one.<\/p>\n In August 2023, the Charleston City Council voted down a proposal from the Women\u2019s Health Center of West Virginia<\/a> to operate a syringe exchange in the city\u2019s West Side community, with opponents expressing fears of an increase in drug use and crime.<\/p>\n Pollini said it\u2019s difficult to estimate the number of people in West Virginia with HIV because there\u2019s no coordinated strategy for testing; all efforts are localized.<\/p>\n \u201cYou would think that in a state that had the worst HIV outbreak in the country,\u201d she said, \u201cby this time we would have a statewide testing strategy.\u201d<\/p>\n In addition to the testing SOAR conducted in 2021 at its health fairs, there was extensive testing during the CDC\u2019s investigation. Since then, the reported number of HIV cases in Kanawha County has dropped<\/a>, Pollini said, but it\u2019s difficult to know if that\u2019s the result of getting the problem under control or the result of limited testing in high-risk groups.<\/p>\n \u201cMy inclination is the latter,\u201d she said, \u201cbecause never in history has there been an outbreak of injection-related HIV among people who use drugs that was solved without expanding syringe services programs.\u201d<\/p>\n \u201cIf you go out and look for infections,\u201d Pollini said, \u201cyou will find them.\u201d<\/p>\n Solomon and Pollini praised the ongoing outreach efforts \u2014 through riverside encampments, in abandoned houses, down county roads \u2014 of the Ryan White HIV\/AIDS Program<\/a> to test those at highest risk: people known to be injecting drugs.<\/p>\n \u201cIt\u2019s miracle-level work,\u201d Solomon said.<\/p>\n But Christine Teague, Ryan White Program director at the Charleston Area Medical Center, acknowledged it hasn\u2019t been enough. In addition to HIV, her concerns include the high incidence of hepatitis C and endocarditis, a life-threatening inflammation of the lining of the heart\u2019s chambers and valves, and the cost of hospital resources needed to address them.<\/p>\n \u201cWe\u2019ve presented that data to the legislature,\u201d she said, \u201cthat it\u2019s not just HIV, it\u2019s all these other lengthy hospital admissions that, essentially, Medicaid is paying for. And nothing seems to penetrate.\u201d<\/p>\n Frank Annie is a researcher at CAMC specializing in cardiovascular diseases, a member of the Charleston City Council, and a proponent of syringe service programs. Research he co-authored found 462 cases of endocarditis<\/a> in southern West Virginia associated with injection drug use, at a cost to federal, state, and private insurers of more than $17 million, of which less than $4 million was recovered.<\/p>\n Teague is further concerned for West Virginia\u2019s rural counties, most of which don\u2019t have a syringe service program.<\/p>\n Tasha Withrow, a harm reduction advocate in bordering rural Putnam County, said her sense is that HIV numbers aren\u2019t alarmingly high there but said that, with little testing and heightened stigma in a rural community, it\u2019s difficult to know.<\/p>\n In a January 2022 follow-up report, the CDC recommended increasing access to harm reduction services such as syringe service programs through expansion of mobile services, street outreach, and telehealth, using \u201cpatient-trusted\u201d individuals, to improve the delivery of essential services to people who use drugs.<\/p>\n Teague would like every rural county to have a mobile unit, like the one operated by her organization, offering harm reduction supplies, medication, behavioral health care, counseling, referrals, and more. That\u2019s an expensive undertaking. She suggested opioid settlement money through the West Virginia First Foundation<\/a> could pay for it.<\/p>\n Pollini said she hopes state and local officials allow the experts to do their jobs.<\/p>\n \u201cI would like to see them allow us to follow the science and operate these programs the way they\u2019re supposed to be run, and in a broader geography,\u201d she said. \u201cWhich means that it shouldn\u2019t be a political decision; it should be a public health decision.\u201d<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n