CHARLESTON, W.Va. (AP) – For years, West Virginia had the country’s highest rate of addictions and deaths from opioid overdose. Now the state is struggling with another health emergency not entirely independent: one of the country’s biggest peaks in HIV cases related to intravenous drug use.
The increase, concentrated mainly around the capital Charleston and the city of Huntington, is being attributed, at least in part, to the cancellation in 2018 of a needle exchange program that offered clean syringes to injecting drug users who were unable to give up addiction altogether.
Needle exchange programs are included in the Center for Disease Control and Prevention’s recommendations to control disease outbreaks among intravenous drug users. These programs exist in dozens of states, but they are not without their critics, including in West Virginia, who say they do not do enough to prevent or stop drug use.
The coronavirus further complicated the problem. Local health officials have struggled in part because the resources needed to fight the pandemic have made testing for hepatitis, HIV and other sexually transmitted diseases especially challenging, said Dr. Sherri Young, health officer for the Kanawha- Department of Health- Charleston.
“We couldn’t do big community events,” said Young. “We couldn’t do health fairs. It was not possible to connect the way we would have liked to do during the COVID response. ”
By 2014, only 12.5% of HIV cases in West Virginia resulted from the use of intravenous drugs. In 2019, 64.2% were, according to data from the state health department. The increase was mainly due to the clusters in Kanawha and Cabell counties.
Kanawha County, which includes Charleston and has 178,000 residents, had two cases of HIV related to intravenous drugs in 2018. The number grew to 15 in 2019 and at least 35 last year, said Shannon McBee, a state epidemiologist.
By comparison, New York City, with a population of more than 8 million, registered 36 HIV cases linked to intravenous drug use in 2019, according to the CDC. Counties in other states with populations similar to Kanawha had an average of less than one HIV diagnosis among people who inject drugs, said Dr. Demetre Daskalakis, head of HIV prevention at the CDC.
In a recent presentation, Daskalakis called the Kanawha County outbreak “the most worrying in the United States”. At a meeting of an HIV task force in Kanawha County last month, he warned that it could take years to deal with the increase.
“It is possible that the current case count represents the tip of the iceberg,” said Daskalakis. “There are probably many more undiagnosed cases in the community. We are concerned that transmission is underway and that the number of people with HIV will continue to increase unless urgent action is taken. “
Health officials said that needle exchange programs reduce the spread of communicable diseases. But city leaders and first responders complained that such a program in Kanawha County led to an increase in needles being left in public places and abandoned buildings, and it was closed.
The nonprofit Solutions Oriented Addiction Response, founded for the first time to combat the opioid epidemic, has entered the breach. In addition to providing clean needles to addicts in Charleston, the group shares information about HIV testing with residents, including homeless people, said SOAR co-founder Sarah Stone.
“We started doing our stuff about 18 months ago, because we knew it would happen,” said Stone.
Now that coronavirus numbers are dropping, county officials are also turning their attention to the HIV epidemic. They plan to step up testing, raise public awareness and set up mobile clinics to treat patients who may not have regular doctors or who are seeking medical treatment on their own.
For both HIV and coronavirus, “we will be ready to work,” said Young.
Similar efforts in Cabell County, where Huntington is located, have already led to a drop in HIV numbers there, health officials said. Cabell County officials partially credit a needle exchange program that they implemented in 2015. Kanawha County officials have no plans at this time to revive their program, however.
The state Senate passed a bill earlier this month, this would require needle exchange providers to obtain a license and also provide a range of other health services, including education on overdose prevention and referrals to substance abuse treatment programs. Stone said that such a bill could end his needle exchange operation.
Democratic Senator Ron Stollings, a Boone County doctor, criticized the bill.
“Public health has a mandate to prevent and control the spread of communicable diseases,” Stollings told lawmakers recently. “They will not be able to do this with the approval of this project. We’re throwing gasoline on the fire. “
For years, West Virginia has led the country in drug overdose deaths. In 2014, the rate was 35.5 deaths per 100 thousand residents. In 2018, it rose to 51.5, more than double the national average.
Dr. Sally Hodder, an infectious disease specialist at West Virginia University, said the opioid epidemic and HIV groups are “so interconnected that we have to look at this as a bigger problem and treat it as such”.
“In places like West Virginia, where the collapse of the coal mining industry and extreme poverty have exacerbated the opioid epidemic, decriminalizing substance abuse, providing clean and safe places for syringe service programs and other interventions, and offering prevention comprehensive HIV care and care, treatment services are essential to end these intertwined epidemics, ”said Hodder.