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Politics
Justice, the road governor, works in the shadows

LEWISBURG — Since he declared a state of emergency almost 15 months ago, Gov. Jim Justice has continued old practices by operating largely out of public view.

Despite Justice holding more than 200 press briefings during the COVID-19 pandemic, where, when or how the governor spends his time off camera is left to one’s educated guess.

Justice agreed to reside in Charleston and pay $65,000 in legal fees in a deal reached more than two months ago to settle a lawsuit filed by former Democratic legislator Isaac Sponaugle, who claimed Justice violated the state Constitution by refusing to live in the Governor’s Mansion on the Capitol grounds or elsewhere in Charleston.

“The Governor resides at the Governor’s Mansion in Charleston. Any insinuation otherwise is preposterous …“ Justice’s communication’s office wrote in a request for comment for this report.

Justice’s movements indicate otherwise.

The governor’s presence frequently is marked by his black SUV. On briefing days, Capitol security lowers the protective barriers near the west entrance so Justice can park a short distance from the door. When he holds meetings in the Governor’s Mansion before or after briefings, he drives the 150 yards in between. Sightings of Justice’s SUV on Capitol grounds are rare during the early morning or at the end of the workday.

Justice’s Office of General Counsel declined to fulfill multiple records requests for this report. The Gazette-Mail sought schedules and calendars for three months of Justice’s recent travel, five months of phone records related to government business, all expenses related to operation of the Governor’s Mansion and his travel and meal costs.

His office provided none of those documents.

“To the extent any calendar is maintained, it is in draft format, contains appointments that may or may not occur, is revised by staff daily, is never corrected, and is not an accurate log of Governor Justice’s appointments,” wrote Berkeley Bentley, Justice’s deputy general counsel. “That said, if there is a specific appointment you wish to confirm, please revise your request accordingly and we will endeavor to provide you with records responsive to such a request.”

His office said it could not find any records showing his phone conversations. It claimed records related to Executive Mansion expenses cannot be released to the public because the governor uses it as his residence. His office declined to provide travel logs for his West Virginia State Police escort — a trooper is regularly seen tailing Justice during his four-hour round trips from Lewisburg to Charleston and back. Those trips translate to hundreds of hours on the road for the governor.

Cathy Justice, the governor’s wife, is the owner of two homes next-door to each other in downtown Lewisburg, according to property records. Jim and Cathy Justice live in a one-story home bought for $205,000 in 2000. In 2010, Cathy Justice purchased the home next-door for $250,000, according to records. The trooper who escorts Justice appears to stay in this home, according to their movements in recent months.

The Governor’s Mansion cost taxpayers $203,000 when it was constructed nearly 100 years ago. Mansion staff are compensated by taxpayers. Tens of millions of dollars in building improvements have been publicly funded. A voicemail left at the Governor’s Mansion seeking staff size, basic costs and other general upkeep information was not returned.

Justice is known to frequent fast-food restaurants along the route to the Capitol and in Charleston’s East End. Following a May 3 briefing, a reporter watched Justice and the trooper enter the East End Wendy’s parking lot, decide against braving the long lunchtime line, then circle back across the street to the McDonald’s drive-thru. On Thursday, the Justices were spotted in their black SUV in the Wendy’s drive-thru.

By providing his travel records, Justice’s office could prove he now spends his nights in Charleston. Utility bills at the Executive Mansion would indicate when the Justices began living there full-time. Payroll documents would show if Justice kept a full-time staff working at the mansion for four years on the taxpayers’ dime, despite splitting his time between Charleston and Lewisburg. They would also show if there is a full-time staff working there now.

By declining to provide these records, Justice’s movements can be known only by his brief public sightings outside of media briefings, or by reporters going out to find him. What West Virginia’s governor does during work hours, with whom he meets and when and where he is when he’s not at the Capitol is a public unknown.

Not for public knowledge

The week of March 22-26 was a busy one for the governor.

Or was it?

Members of the West Virginia House and Senate were in high gear for week seven of nine of the 2021 Legislative session. New COVID-19 cases reached 499 in one day — more than double the daily average for most of the month. West Virginians marked a year in a pandemic.

Justice held a media briefing Monday morning, then gathered dozens of local business leaders in the afternoon for a “town hall” to drum up support for his plan to repeal West Virginia’s personal income tax — a move set to blow a billion-dollar hole in the state’s budget.

On Tuesday that week he attended a ribbon-cutting ceremony in Morgantown, then held a sparsely attended “town hall” on his tax plan that was never made publicly viewable. He appeared to end his day just after 3 p.m. stocking trout at Coopers Rock Lake. The following day, he held a late morning briefing before traveling to Beckley to hold an afternoon income tax “town hall” at the Tamarack.

Justice held dueling “town halls” in Martinsburg and Berkeley Springs on Thursday, and Friday he held an early morning media briefing— his only three public events for those two days. This schedule also doesn’t account for his time coaching the Greenbrier East High School girls basketball team.

Justice arrived late for every briefing during this week — on par for his daily tardiness throughout the pandemic — despite his stranglehold on any and all COVID-19 response and restrictions. Justice’s only unannounced sighting during this week came when a reporter spotted Justice and the trooper turning off the Lewisburg Interstate 64 exit just after 6:20 p.m. following the Tamarack event, then eyed his SUV outside at his downtown Lewisburg home just before 6:30 p.m.

With his office’s refusal to provide his schedule, it’s unknown how long the governor spent working with lawmakers during the peak of the legislative session. State House Speaker Roger Hanshaw, a fellow Republican, said while he spent more time with the governor this past session than in previous years, it was due to Justice’s signature piece of legislation.

“Our interaction this session was almost exclusively limited to the personal income tax,” Hanshaw said. “He certainly was more hands-on this year with the personal income tax proposal than with almost anything else.”

Hanshaw said Justice has always made himself available whenever the speaker has asked. But the legwork is done with the governor’s staff, Hanshaw said. Justice is a “big ideas guy” who “likes to chart very broad courses and then leave the details of executing a plan to his staff.”

“I’ll say this about the governor,” Hanshaw said, “when he comes forward with an idea that is his, he takes it seriously and does spend the time on it — and [he] did bulldog it this session.”

Asked how he learned of Justice’s tax repeal plan, Hanshaw, the state’s highest-ranking delegate, answered: from media, not from Justice nor his staff.

Meeting with Justice directly is a hot ticket. Joe Gouzd, president of the United Steelworkers Local 8-957, said there’s been nothing but crickets from the governor’s office regarding the old Mylan Pharmaceuticals plant closure set for this summer in Morgantown. Nearly 1,500 well-paid workers will lose their jobs, and Gouzd said he hasn’t heard from Justice’s office whether the governor has formed a task force to save these jobs, which lawmakers called on Justice to do in concurrent resolutions this past session. The governor’s press team did not answer questions from the Gazette-Mail, including whether the task force had been formed, for a recent story on the closure.

Gouzd said Justice raced to save a closed-down hospital in Fairmont while he ran for reelection during the pandemic, “but yet 20 miles north, where we actually manufacture drugs to save lives,” Gouzd said, it’s just not politically convenient for Justice to intervene. Union Vice President Bill Hawkins said Justice “doesn’t give a s---.”

With whom Justice has met lately is not for public knowledge, according to his office’s responses to records requests. That is, unless you know of a specific appointment Justice recently had, and you formally request his office to confirm it.

The logic behind requiring the head of the executive branch to live at the seat of government is partially to ensure the state’s top official is on hand when crises arise, said Patrick Hickey, a West Virginia University political science professor from 2012 to 2020. West Virginia, site of floods, snowstorms and plant and mine disasters, is a state where its people live in a quasi-permanent state of preparedness.

“The idea is when stuff like that happens, the governor is right there,” Hickey said. “You know where the governor is. You don’t have to go looking for the governor. The governor is right there with his or her staff on hand, ready to go and ready to respond to that crisis.”

Hickey said the requirement also provides more transparency to taxpayers who want to know how the head of the executive branch spends his or her time. While West Virginia’s Legislature is part-time, the governor’s office is not.

“Acting as a part-time governor” was what Sponaugle said triggered the residency lawsuit in the first place. The governor’s mishandling of $150 million in federal funding for a state-run flood recovery program, along with “scandals, [other] mismanagement of public monies, no communication with Cabinet secretaries and a decrease in productivity of state government,” as Sponaugle’s 2018 lawsuit described Justice’s performance, proved to be the inflection point.

“When he got elected, he just decided he wasn’t going to show up,” Sponaugle said. “He was delegating all of that responsibility and duties to various other people in his Cabinet that weren’t elected. You couldn’t get ahold of them, and [Justice] didn’t have an idea of what was or was not going on during that time period.”

As the pandemic winds down, Sponaugle said, the terms of the settlement should ensure Justice can’t return to the shadows. But with Justice’s decreasing public appearances comes increasingly more time he can spend away from the public eye.

Justice has batted down residency criticism in the past by saying the governor’s job is not confined to the Capitol grounds or Charleston.

“The Governor is on the job all the time,” his office said.

With no records to support the assertion, those who question it are left to take the itinerant governor’s word for it.


Energy_and_environment
Raleigh County community says coal dust from nearby mine is taking its breath away

Eunice should have been Becky Rectenwald’s place to settle.

The dust settled there instead.

Rectenwald, 58, moved to the former Raleigh County mining town from Marmet nearly four years ago for cleaner air and a larger yard for her dogs as she kept taking care of her mother.

Eight months ago, at 15% lung capacity with chronic obstructive pulmonary disease, asthma and bronchitis, Rectenwald left her 79-year-old mother in Eunice in the care of her 18-year-old granddaughter.

The filters on Rectenwald’s oxygen machine and ventilator had turned black. She had to go.

“The way we’ve gotta live, it’s sad,” Rectenwald says. “I can’t be with my family because of it.”

The portable ventilator that Rectenwald uses did nothing to obscure her words of desperation as she sat wedged between the ventilator and a picnic table at Marsh Fork High School Memorial Park on an unseasonably hot spring evening. Rectenwald made the trek down Coal River Road with her sister, with whom she’s been staying in Elkview more than an hour away.

She was surrounded under the pavilion by a dozen former neighbors.

They were there to clear the air, too.

“We’d just like to have the dust cut down,” Sandra Stewart, 71, said.

Stewart’s house of 32 years on the northern edge of Eunice sits nearest the coal pile for the Marfork’s Coal Company’s Black Eagle underground mine about 1,000 feet away.

Eunice residents said the mine has wreaked havoc on their health and homes since soon after operations began in 2018, its coal dust pervading their lungs and living rooms, its ventilation fans whirring so loudly that talking outside became impossible, its blasting knocking pictures off walls and damaging house foundations.

Many of the community’s residents living closest to the Black Eagle mine have been gathering for weekly meetings since April to talk about the mine and what to do about it.

The organizer of the meetings, Shelia Walk, has lived 42 of her 49 years in Eunice.

It’s home for her and her husband, who was a mine worker for 13 years before he was diagnosed with Parkinson’s disease and laid off.

It’s home for her parents, including her father, a disabled veteran who has been having fewer asthma attacks since moving to a section of the community farther from the Black Eagle mine.

It’s home for her 5-month-old grandson, who was born prematurely and has already had breathing problems.

Walk’s home was her brother’s before he died, so she’s not eager to walk away from it.

“I would love to stay here, because I’m never going to be this close to my family,” Walk said. “If something’s wrong, I can walk to my daughter’s [house]. If I had to, I could walk to my parents’ [house]. I don’t see us ever being able to find homes that close together.”

But standing at the edge of the picnic shelter facing her neighbors, Walk reached what has become an increasingly common conclusion in recent months in Eunice.

“If they can, I would appreciate it if the dust and the noise would quit. If not, then they should relocate us,” Walk said to a smattering of applause from her neighbors.

Walk talked about Alpha Metallurgical Resources, Marfork Coal Company’s Bristol, Tennessee-based parent company.

If Alpha won’t pay them to move, the residents want the company to at least do more to reduce coal dust pollution, a change that would create a positive trend following what they said was an end to the mine’s ventilation fan noise pollution in April.

But Eunice residents said they haven’t been able to reach Alpha representatives, and Walk said no one from the mine has spoken to residents about operations there.

Alpha did not respond to a list of questions for this story.

“It’s like nobody even cares,” Rectenwald said.

A raw dealWalk counted the number of homes in her section of Eunice nearest to the Black Eagle mine that house residents with disabilities.

She counted eight of 11.

Across the picnic shelter, her next-door neighbor Rick Jones, 65, said he has to change his furnace filter often.

“We don’t even get a month out of ours,” said Alleson Sneed, Rectenwald’s granddaughter.

Eunice residents said the quickly dirtying air filters have helped push their power bills to exorbitant amounts.

They fear their property values are trending in the opposite direction.

The prevalence of fixed incomes in Eunice makes the community’s mine problem worse.

Annabel Aliff, 57, wasn’t at the meeting but would like Alpha to buy her out, too.

Aliff says she was driven to apply for the state Department of Health and Human Resources Low-Income Energy Assistance Program for the first time in two decades because of the rising cost of heating and cooling her home as she avoids letting natural air in.

“I hate asking for help, but sometimes, what are you gonna do?” Aliff said.

When Aliff moved to her home in 2002, there were cookouts and bonfires.

“I could even go and lay out in the sun,” Aliff said. “But I wouldn’t even want to lay in the sun now because if I went out there with suntan lotion on me, the dust would stick all over me.”

Aliff doesn’t have a vehicle but gets rides from both her sister who has been staying with her and Walk, her next-door neighbor.

“God blessed me with good neighbors,” Aliff said. “I’m just getting a raw deal with the mine.”

Coal’s legacy on Coal River MountainThe Black Eagle deep mine has had two mining permit violations since beginning operations in 2018, according to state Department of Environmental Protection data – failure to establish blasting signs in September 2018 and tracking spoil and waste material onto a state road (Route 3 or Coal River Road) in March 2019.

But two Alpha subsidiaries — the Marfork Coal Company and Republic Energy— have more than two dozen active mine permits in Raleigh County and a long history of permit violations.

The two subsidiaries have accumulated nearly 350 permit violations over the last three-plus decades in the Coal River watershed for offenses such as lack of sediment control, improper blasting procedures and mining activity outside permit boundaries. Nearly 3,000 acres in the watershed have been disturbed under mine permits over that span.

Total active and approved surface mining permits plus sludge dams compose 15% of the roughly 51,000-acre Coal River Mountain, according to Vernon Haltom, executive director of Coal River Mountain Watch, a nonprofit group based in nearby Naoma that opposes mountaintop removal and other mining practices that have impacted public health and natural resources.

Walk’s son Junior, 31, is an outreach coordinator for Coal River Mountain Watch who has a house in Eunice and lives in Whitesville across the Boone County line. Walk said extensive mining activity has ravaged the Coal River watershed over the course of his lifetime.

Coal River Mountain Watch has opposed recent applications for new and renewed permits for surface mining on the mountain made by Republic Energy, saying dust from renewed blasting procedures would leave nearby residents at an elevated risk for cancer.

The DEP has approved Republic Energy’s recent permit applications, saying they met the state’s surface mining control and reclamation requirements, obligating the department to issue the permit.

“What’s going on here is a continuation over a century of exploitation of both the land and the people here,” Walk said in his parents’ backyard shortly before the meeting started. “Outside interests like the coal company that’s operating right over here have had their way with Southern West Virginia.”

Some residents would like onsite air quality monitoring but haven’t been able to procure any from the state DEP.

DEP acting spokesman Terry Fletcher said the agency has air monitoring equipment for assessments of federally mandated National Ambient Air Quality Standards at permanent sites.

The department’s Division of Air Quality will investigate dust and air quality complaints and take enforcement action when appropriate, Fletcher said.

An agency database of citizen complaints shows three about the Black Eagle mine, the two most recent coming from Eunice residents in early December about mine fan noise levels.

But Walk said she called the DEP more than 10 times to report mine noise and dust and never got an effectual response.

Raleigh County Commission President Dave Tolliver declined to comment through County Administrator Jay Quesenberry, who added officials had not heard complaints about dust or noise coming from the mine.

State Sen. Rollan Roberts, R-Raleigh, declined to comment, saying he was out of the state last week and could not communicate with anyone about the situation. Roberts added that no one had contacted his office about Marfork.

State Delegate Christopher W. Toney, R-Raleigh, could not be reached for comment.

Wanting to go

There’s no sign of operations at the Black Eagle mine slowing down.

Alpha Chief Operating Officer Jason Whitehead noted steadily improving coal thickness at the mine during the company’s 2020 fourth-quarter earnings call in March and looked ahead to further mining there next year. An equity research analyst at the Benchmark Company investment banking firm observed that the Black Eagle mine was “ramping up.”

Residents say Alpha added a gravel road that runs along the mountain for more than a mile earlier this year along with at least one new ventilation fan.

Referring to Alpha, “[W]e’re getting our coal. We’re making our money. We don’t care,” said Rectenwald, whose father was a coal miner. “And it’s sad. It’s sad they don’t have any respect for humanity.”

Whether Alpha pays Eunice residents to move away, Rectenwald’s family is looking to pay their Eunice house off and start over someplace they can breathe a little easier — and together.

“Just go, just go, just go,” Rectenwald’s granddaughter Sneed said. “Don’t turn back. Just go.”


Health
As CDC comes to Kanawha, WV doctors look to what comes next

As a Centers for Disease Control and Prevention team landed in Kanawha County last week to bolster the region’s response to the HIV crisis, doctors across West Virginia and beyond watched and worried.

The options are limited, and so is time. While the Kanawha-Charleston Health Department and other local health agencies work to increase testing, some providers wonder what real tools are on the table for prevention.

“I don’t know how you respond to an HIV outbreak among people who inject drugs without expanding access to clean syringes” said Dr. Robin Pollini, an associate professor at the West Virginia University School of Medicine. “Cabell County did that. It controlled the outbreak. In Scott County, Indiana, that’s how they quelled it. Every response I’ve seen to outbreaks of this nature relies on expanding syringe services.”

A recently passed state law and a Charleston ordinance severely limit options for those programs.

The CDC has called Kanawha County’s HIV crisis “the most concerning” in the country. Twenty-eight of the state’s 55 counties are among the 220 most vulnerable in the nation for rapid spread of HIV and other bloodborne diseases among people who use drugs, according to the CDC.

Kanawha County, the epicenter of the current crisis, is ranked on that list. Forty-four new HIV cases were recorded last year, 39 tied to intravenous drug use, according to the state. Health officials say that was a year with record-low testing with resources sapped by pandemic response.

Before 2018, the county recorded an average of 14 new HIV cases a year, fewer than four tied to IV drug use. The number of cases swelled to 29 in 2019, with 15 involving IV drug use. So far in 2021, 16 new cases of HIV have been detected in Kanawha County, all but four involving injected drugs.

“That’s alarming. It’s a really significant increase over a relatively short amount of time,” said Dr. Brandon Marshall, an associate professor of epidemiology and a researcher at Brown University’s School of Public Health.

Marshall studies the effect of syringe service programs on disease spread in rural areas. He’s watched situations similar to the one in Charleston unfold.

“It’s most useful to be proactive, but if syringe service programs are off the table, there are other tools we can rely on that we’d call more biomedical interventions,” Marshall said. “I would hope to see a greatly expanded testing effort, contact tracing and treatment programs for people who are positive.”

The testing piece is already underway, but as a CDC team works to better understand the outbreak and suggest ways to tailor response, some observers worry the effort will come too late.

A study by Marshall and others in Clinical Infectious Diseases, a peer reviewed medical journal, shows that if proactive interventions — specifically syringe programs — are available before diseases start to spread, incident rates for infections can drop by as much as 90% among at-risk populations. Separate modeling in the same journal suggests that shutting down syringe programs in places that have seen high rates of bloodborne disease transmission — like HIV, hepatitis and endocarditis — could lead to more outbreaks.

Last week, local leaders in Scott County, Indiana, voted to close a syringe service program there despite its success in tamping down a 2015 outbreak. Marshall said this is evidence of how widespread the challenges are in operating sustainable harm reduction programs that include syringe services.

“We are seeing this everywhere, and a lot of the time it’s due to misperceptions of what syringe programs do and don’t do,” Marshall said. “We need to be clear about what they don’t do: they reduce crime, decrease injection litter and much more. We need to address these misconceptions. At the end of the day, this is an issue that carries a ton of stigma. That’s the real elephant in the room, often.”

The struggle is greater in West Virginia’s Southern Coalfields, where limited resources make consistent HIV testing difficult and expanded testing nearly impossible. That means HIV could be spreading undetected.

“I haven’t diagnosed anyone with HIV in the six, almost seven years, I’ve practiced here, but I know it’s coming and I expect it to happen soon. It’s happening now, we just aren’t seeing it,” said Dr. Joanna Bailey, who works at Tug River Health Association, a clinic with locations in Wyoming and McDowell counties, rated by the CDC among the country’s most vulnerable. “I test all of my patients for HIV at least once, and I do it usually with their initial visits. I wouldn’t be surprised to have one come up positive on a new patient who is actively using, or someone who moved to the area.”

HIV, or human immunodeficiency virus, attacks the body’s immune system and can lead to AIDS. There is no cure. AIDS-related illnesses killed roughly 690,000 people worldwide last year. Some 1.2 million people in the U.S. are living with HIV, according to the CDC. HIV can be controlled, but testing and early detection are critical.

Southern West Virginia largely relies on a loose system of health clinics to treat people in the region. The clinics are often under-resourced, and the needs outweigh the services — or expertise — available.

“We don’t have any doctors in Wyoming or McDowell counties treating HIV, and very few in Southern West Virginia, period, who treat HIV,” Bailey said.

Doctors and nurse practitioners are more than capable of treating HIV, Bailey said, but they need resources and training. On top of that, there has to be a system to help keep vulnerable people in care once they’re connected to it.

“Having a doctor who knows how to treat it is only part of the solution,” Bailey said. “We need case managers who know how to prescribe the medications, and keep people involved in their own treatment.”

That’s not as simple as it might sound.

“They might not have a car, and we don’t have a real public transportation system here. As a doctor knowing there is more that needs to be done, it’s frustrating sometimes to know that you’re out of your comfort zone as far as treating someone, but you don’t have any other choices,” Bailey said. “It’s difficult to know that if you tell them there’s not much you can do, and they don’t have transportation to Beckley or Princeton or Virginia, then a lot of people probably aren’t going to get care.”

That opens the possibility of greater disease spread. Once an outbreak starts, it’s difficult to stop.

“If you have outbreaks down here, where people can’t get to care, it could look like outbreaks in Africa, in the developing world, where people can’t get to care,” Bailey said. “That sounds scary, but it’s true.”

While a majority of documented spread so far is among people who inject drugs in more populated areas, that’s also where testing is targeted.

“No one operates in a vacuum,” Marshall said. “It’s not an option, from a public health point of view, to ignore the problem and hope it will go away. We know that doesn’t work.”


National
AP
Experts see strides on AIDS, but COVID-19 halted progress
Some researchers believe COVID-19 has derailed the fight against HIV and set back a U.S. campaign to decimate the AIDS epidemic by 2030

NEW YORK — Some researchers believe COVID-19 has derailed the fight against HIV, siphoning away health workers and other resources and setting back a U.S. campaign to decimate the AIDS epidemic by 2030.

Saturday marked the 40th anniversary of the first report that brought AIDS to the attention of the public. For a time, the battle against HIV — the virus that causes AIDS — was going well. But experts believe the U.S. could soon see its first increase in infections in years. Internationally, recent strides could also be undone because of COVID-19’s interruption of HIV testing and care.

“COVID was a huge setback,” said Jeffrey Crowley, a former director of the White House Office of National AIDS Policy who is now at Georgetown University.

COVID-19 has killed nearly 600,000 Americans in 16 months, approaching the 700,000 Americans that AIDS killed over 40 years.

Before COVID-19, health officials were celebrating how new medicines and other developments had gradually tamed HIV, prompting then-President Donald Trump to announce in 2019 a campaign to “eliminate” the U.S. epidemic by 2030.

But now, U.S. health officials are gathering data on exactly how much COVID-19 affected HIV infections and deaths, including how well testing, prevention and treatment kept up in the pandemic.

There are signs of a backslide.

Samuel Jenness, an Emory University researcher, used Atlanta-area data and statistical modeling to project major increases in some sexually transmitted diseases, including HIV.

At the least, COVID-19 halted recent declines in new HIV infections, Jenness said. “At the worst, it potentially brought us an increase of cases for at least the next couple of years,” he added.

Limited data collected by the Centers for Disease Control and Prevention suggests there were large drop-offs in HIV testing and other services.

The CDC looked at data from a lab that handles about a quarter of the nation’s HIV tests, comparing the numbers from March 13 through Sept. 30 last year with the same period the year before. The agency found there were 670,000 fewer HIV screening tests, and about 4,900 fewer HIV diagnoses than normal.

There also was a 21% national decline in prescriptions for pre-exposure prophylaxis, or PrEP, a kind of medicine people at risk for HIV take to prevent them from getting the virus through sex or injection drug use.

Why the declines?

Most U.S. health departments and community organizations had to scale back HIV testing, the first step in putting people with the virus on medicine that can keep them from spreading it. Also, health department workers who did the contact tracing to stop HIV outbreaks were shifted to COVID-19.

Even where HIV clinics were open, some people did not want to come in because of fear of catching the coronavirus.

There may be another reason: less sex.

Surveys suggest that at least during the initial months of the pandemic, many adults at higher risk for HIV infection had sex on fewer occasions and with fewer sexual partners.

But there also are signs that many people resumed their normal levels of sexual activity by summer, said Jenness, whose research focused on gay and bisexual men — a group that for years has had the highest HIV infection rates.

“People’s sexual behavior changed for only three months,” but prevention, testing and care disruptions are still going on, he said.

What does that mean for the national goals?

Data released this week showed the number of new infections declining for years, dropping to about 35,000 in 2019.

After Trump made his announcement in 2019, federal health officials clarified that the actual goal was a huge reduction in new infections over the next 10 years — down to fewer than 3,000 a year.

But Jenness and his fellow researchers predicted that the Atlanta area alone will see about 900 more HIV cases than normal over the next five years among gay and bisexual men.

Another bad omen: Drug overdoses are still rising, and shared needles are one way people spread HIV, noted Dr. Rochelle Walensky, the CDC’s director.

Recent surges in HIV infections in West Virginia have been tied to intravenous drug use, part of an ongoing shift in how the virus is spreading there. In 2014, 1 in 8 West Virginia HIV cases was attributed to injected drugs. By 2019, nearly 2 out of 3 were, according to state health department data.

All of this suggests that the 90% reduction goal will not be met, several experts said, though health officials have not yet abandoned that objective.

“We’re still working towards that goal,” said Kevin Delaney, a CDC HIV/AIDS researcher. “If we are missing millions of HIV screening tests from 2020, there will need to be an investment made to make those up. But the targets have not been changed.”

Walensky, a noted HIV researcher before she became CDC director, said it will be difficult.

“Do I think it’s doable? Absolutely,” she said. “Do I think we have the resources now to do it? I don’t think so yet.”

Worldwide, officials say there were about 38 million people with HIV/AIDS in 2019. An estimated 1.7 million people contracted HIV in 2019, a 23% decline in new HIV infections since 2010.

But COVID-19 interfered with testing and other health services globally, too. In Africa, one of the continents hardest hit by AIDS, experts noted interruptions in programs that check pregnant women for HIV and that provide male circumcision to reduce their risk of infection.

UNAIDS, the United Nations effort to stem HIV and AIDS, previously set goals to get certain proportions of infected people diagnosed and treated by 2020. This week, the organization said dozens of countries have hit the goals — “evidence that the targets were not just aspirational but achievable.” The agency has set even more ambitious goals for 2025.

But it will be difficult for the whole world to hit such targets, said Dr. Kevin De Cock, a Kenya-based global health expert.

“I’m not persuaded it’s judicious to talk about the end of AIDS,” De Cock said. “Internationally, I think we’ve made tremendous progress. [But] we are not on track to meet the goals that organizations like UNAIDS have declared.”


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