Every two weeks, the Charleston woman gets tested for HIV at the Unitarian Universalist church off Kanawha Boulevard.
It’s an easy process: Get a number, wait until it’s called, then step behind a small tent in the church parking lot for the test. It has become routine for her. It’s among the small steps she takes to keep herself safe from HIV and hepatitis while battling substance use disorder.
“All the time ... people are out here, finding dirty needles, using them because it’s that or nothing,” said the woman, who asked to be referred to only by the initials A.K. “People don’t understand what addiction does to you, what choices you make, how you see dangers to yourself. Sometimes, I guess, you care less what might happen to you because other people, they see you as less. They tell you it.”
She has known people who have contracted HIV from intravenous drug use. They’re not careless people, she said, but sometimes they’re desperate.
“It’s hard to find people to trust sometimes, especially that don’t judge, that want to be the help,” A.K. said. “These are my people, about the only people I do trust.”
Volunteers from Solutions Oriented Addiction Response have been operating a needle exchange program every other week. The community health group also has set up tables in the Unitarian Universalist church parking lot, where volunteers offer feminine hygiene products, blankets, hand sanitizer, face masks and snack bags with water, chips and granola bars.
“This wasn’t a secret. People may not have known what we were doing, but that doesn’t make it a secret we were keeping,” said Joe Solomon, co-founder of the Solutions group. “If people didn’t know, it’s because these services — what we’re offering — it’s, you know, it’s not really for them.”
One table is stacked with educational pamphlets on naloxone, addiction, HIV, recovery, mental health struggles and other topics. Everyone who comes through is offered a container to safely dispose of needles.
This is what harm reduction looks like.
“Recovery is not the primary goal of harm reduction programs, and it shouldn’t be,” said Dr. Robin Pollini, a substance abuse and infectious disease epidemiologist at West Virginia University. “What you’re doing, literally, you are reducing the harm that people could face. You’re providing harm reduction services and building trusting relationships. The idea that a harm reduction program is failing if people aren’t in recovery is false.”
Officials shut down the Kanawha-Charleston Health Department’s needle exchange program in 2018. A state Department of Health and Human Resources investigation criticized the program for, among other things, ineffective patient tracking, the lack of a detailed plan to prevent needle litter and the failure to offer and provide substance use treatment before dispensing needles.
Since then, HIV and hepatitis cases in Charleston have risen. Testing has decreased this year with resources being directed to the coronavirus pandemic, but HIV and hepatitis rates have continued increasing. Overdoses also have increased, according to state Office of Drug Control Policy data.
Jenny of Charleston uses intravenous drugs but hasn’t stepped foot in the health department since 2018.
“Why would I? I don’t think they really want to help me,” she said.
Others like Jenny cited stigma and fallout from the needle exchange program shutdown.
“I feel it’s easy for people to, like, look at us and not care, to not think we’re human or care what happens,” Kristy of Charleston said. “I hear people when they say we should die, that we deserve it. It’s not kind, not at all. I’m still a person.”
People affected by the needle exchange program include parents, children and neighbors. Many are homeless. Some live with mental illness.
“Time and time again, the people who need these services feel their leaders don’t care. They don’t know who they can trust if they need help, or who will actually listen,” Solomon said. “That’s where we wanted to step up. We wanted to make sure, absolutely sure, we were bringing whatever resources we could to people, not waiting for them to come to us.”
Following a television news report this fall on Solutions’ needle exchange program, Charleston police Chief Tyke Hunt said authorities would investigate, citing concerns over safety, specifically needle litter and needle-stick injuries, referring to wounds caused by accidental needle punctures.
Neither the city nor state tracks needle-stick injuries. From January to November 2020, there were less than 120 calls to Metro 911 for needle pick-ups in Kanawha County.
Twenty needle-stick injuries were recorded among Charleston City employees over the last three years, eight in 2018, two in 2019 and 10 last year, according to incident reports filed with the federal Occupational Safety and Health Administration. Five cases involved people being stuck while searching belongings. Most cases were punctures from uncapped needles in trash or people pricked while disposing of or bagging needles.
After the TV report, Solutions decided to temporarily suspend its needle program.
“I believe that harm reduction does work, but if my child was ill and I was deciding on treatment, I wouldn’t call the City Council to ask for opinions. I’d call his physician,” Charleston Mayor Amy Goodwin said. “You bet I believe the mayor, chief of police, city council and so on needs to be at the table when we have these conversations, but they need to be centered around a table led by medical professionals. This is not a political issue. It’s a medical issue.”
The local Board of Health would have to approve the return of any needle program run through the agency, said Dr. Sherri Young, health officer at the Kanawha-Charleston Health Department. She said no one has shared with her plans to revive the program.
Without such a program, said Dionne of Charleston, “People will die, I’ve got no doubt. These are the only people who are showing up for us.”
“There’s not a place like this,” A.K. said.
In December, the Centers for Disease Control and Prevention released new guidance for syringe service programs. The agency said the best-practice model is based on five key points: involving people with addiction experience, using a needs-based model where there is not a requirement to return as many needles as one takes, providing expanded services (such as HIV testing) along with needles, collecting data on needs and trends and ensuring program sustainability.
All these factors, Solomon said, are already a part of Solutions’ program.
“We’re here, we want to help and we’re doing exactly what the experts say we should do to help people,” Solomon said. “Why would anyone want to stand in the way of saving lives?”