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In a presentation to Kanawha County’s HIV task force Thursday, representatives from the federal Centers for Disease Control and Prevention referred to the continuing spread of HIV in the county as “the most concerning [HIV outbreak] in the United States.”

Thursday’s presentation came as the Charleston City Council debates the merits of a needs-based syringe service program operating in the city, which the CDC recommends to be a necessary tool in battling increased spread of diseases tied to intravenous drug use.

Since 2018, the number of HIV cases tied to intravenous drug use in Kanawha County has continued to rise: There were two in 2018, 15 in 2019; and at least 35 recorded in 2020, according to Shannon McBee, the top epidemiologist with the West Virginia Department of Health and Human Resources.

Kanawha County’s case count from 2020 nearly outpaced that of New York City in 2019, which is home to millions of more residents but recorded just 36 HIV cases tied to intravenous drug use that year, according to the CDC.

Dr. Demetre Daskalakis, head of the CDC’s HIV/AIDS prevention program, told those on Thursday’s call that urgent action is needed to quell the growing presence of HIV and hepatitis in the community. Considering the drug use rates in the region, Daskalakis said, a low-barrier syringe service program could prove effective in this fight, but there is much room in the region for community education on the issue.

Daskalakis referred to Scott County, Indiana, which was the epicenter of an HIV outbreak in 2015 after local leadership abstained from using proven tools, such as syringe services and general harm reduction programs, to lessen the spread of the virus.

There, once a syringe service program was implemented and combined with available treatment facilities for substance use disorder, the region experienced a more than 75% suppression rate of HIV spread. By 2017, nearly 200 people using the area’s syringe service program had transitioned into substance use disorder treatment.

This was possible, Daskalakis said, only by making the program as big as it needed to be, and with it operating on a needs-based model to ensure anyone who needed the services, no matter their situation, could access them.

Daskalakis also said syringe service programs can serve as a key connection point for those seeking medical care, which is crucial in keeping people diagnosed with HIV as healthy as possible.

McBee, presenting for the state, said that, of all the HIV diagnoses in Kanawha County, more than half were detected during a hospital visit.

This means that many living with the virus are getting care only during “a health crisis,” and not through preventative or routine visits or screenings, which makes it more difficult to catch cases early and decrease preventable spread among the community.

Before 2014, HIV cases tied to intravenous drug use nationwide were on the decrease, per the CDC. Then, that downward trend stopped. Since 2014, outbreaks tied to drug use have become more common, but, per capita, Kanawha County is continuing to see larger increases while other regions are slowing.

Of 3,000 U.S. counties, only four had more HIV diagnoses among intravenous drug users in 2019 than Kanawha County recorded in 2020 (2020 data for many places is still preliminary). Three of those, Daskalakis said, held an average population of more than 4 million people. The fourth was Cabell County, with 69 recorded new HIV cases in 2019, of which 63 were tied to intravenous drug use.

In 2020, Cabell County recorded 37 HIV cases tied to IV drug use — more than Kanawha, but a decrease from the prior year compared to Kanawha County’s increase.

Cabell County runs a needs-based syringe service program through its health department, which local officials say sees great success.

Statewide in West Virginia, however, it’s likely that HIV cases — those tied to drug use and those not — were undercounted in 2020, as testing declined amid the COVID-19 pandemic. The data, current and historic, linking infections to intravenous drug use also is collected through surveying patients, where it’s expected that people might underreport or not be transparent about drug use habits out of fear or stigma.

Throughout 2020, community health group Solutions Oriented Addiction Response worked with health care workers from across the county to run HIV testing sites and connect patients to care. It was shocking at these events, according to Dr. Robin Pollini, a harm reduction expert and associate professor at the West Virginia University School of Medicine, to see positives pop up in the first hour or two of service.

“You almost never see that, and hearing it happen multiple times among a handful of people tested, that tells you something is different. Something is missing, something is wrong,” Pollini said in a past interview regarding these services.

For the past 18 months, the community health group also has operated a needs-based syringe service program on Charleston’s West Side, to fill a service gap volunteers felt was left when the Kanawha-Charleston Health Department’s program was shut down in 2018.

While West Virginia Health Right, a free clinic on Charleston’s East End, runs a syringe service program, there are barriers, said Dr. Christine Teague, who heads Charleston Area Medical Center’s Ryan White program.

Teague, who has worked extensively with Health Right and SOAR, said there are some concerns with Health Right’s model. She said she knows of people being banned or turned away from the program for not returning the correct number of syringes, not having identification available and, at times, other more arbitrary reasons.

In December, the CDC issued guidelines for the most effective syringe service programs, which are proven to reduce disease spread and increase public safety, as well as rehabilitation participation among clients.

The best-practice standards are set through five key points: involving people with addiction experience; using a needs-based model where there is not a requirement to return as many syringes as one takes; providing expanded services (like HIV testing) along with syringes; collecting data on needs and trends; and ensuring program sustainability.

SOAR’s program is the only one in the region known to meet these standards, even while the group is not certified by the state for needle distribution. This lack of certification — which, per state code, is not necessary to operate a syringe program at any level — has served as grounds for some City Council members’ current attempt to recriminalize such distribution in the city.

Those with the city who are against such a program have shared concerns about needle litter, public safety and needle-stick injuries among the public. Despite these concerns, which have dominated many recent council meetings, only one City Council member — Keeley Steele, who chairs the city’s Public Safety Committee — appeared to be on Thursday’s meeting call.

Daskalakis was quick to soothe those concerns, however, with data going back years showing that such programs actually reduce needle litter while providing area first responders with more training and resources to avoid potential dangers.

McBee, speaking for the state, said it’s obvious this is a growing concern that will not be treated overnight, but that there needs to be widespread community buy-in for progress to be made.

“During these unprecedented times we are all facing, it’s going to take all stakeholders at the table for a whole community approach [to address HIV],” McBee said.

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