None of the three counties where an HIV outbreak in West Virginia was detected last year had needle exchange programs, federal investigators wrote in a report published last week.
“In these counties, the spread of bloodborne pathogens via injection drug use is a major public health concern, and risk reduction programs offering syringe services were not available, although they were available in other counties,” the report’s authors wrote.
Investigators with the federal Centers for Disease Control and Prevention published a report online Thursday on the HIV outbreak last year in 15 counties in the southern part of West Virginia. Also Thursday, Charleston Mayor Danny Jones, who did not return multiple calls, told his radio audience he wants to end the needle exchange program at the Kanawha-Charleston Health Department.
Christine Teague, program director for the Ryan White HIV/AIDS Program at Charleston Area Medical Center, called it “ironic timing.” Sharing dirty needles spreads bloodborne diseases like hepatitis B and C and HIV; clean needle exchange programs can decrease risk for HIV.
Teague hopes to see city and health department officials come to an agreement, possibly by putting cans for disposal around town, or organizing groups to pick up needles.
“It’s just really scary to me to think that we’ve made such progress, but we could fall by the wayside again,” she said.
The report says that after the West Virginia Department of Health and Human Resources observed an HIV uptick in three counties from January 2017 to July 2017, health officials found 57 related cases of HIV in 15 counties, including 40 diagnosed in 2017. Emails between the CDC and the DHHR show those original counties were Wyoming, Raleigh and Summers.
The virus was spread through male-to-male sexual contact in 34 cases, intravenous drug use in five, both male-to-male sexual contact and intravenous drug use in three, and male-female sexual contact in two, according to the report. The method of transmission was unknown in 13 cases. HIV can also be spread from mother to child.
The DHHR notified health care providers and health departments that it observed the increase in August, and said in November that many cases had been linked to care.
Teague and Dr. Michael Brumage, who was instrumental in opening the needle exchange at the Kanawha-Charleston Health Department as health officer and executive director, have both said the DHHR was keeping information about the outbreak “close to the vest.”
Brumage noted that while Kanawha was not one of the affected counties, the CDC does consider it one of the 220 counties nationwide most vulnerable to an outbreak. He called the 2017 outbreak a “precautionary tale.”
“When I took this job, my fear was always that Kanawha County would become the next Scott County, Indiana,” he said. “I knew that if HIV showed up in the IV drug use population that the results would be devastating for all of Charleston, since we know from the AIDS epidemic in the 1980s that HIV never stays in one population group. It affects everybody in the community.”
While people from surrounding southern counties are coming to Charleston for the needle exchange program, several southern counties are set to begin their own programs, Brumage said.
Brumage has said the Charleston program has an 88 percent return rate. But, “I share the disgust,” he added.
“Every needle found is one too many,” he said. “We also have to remember that we’re not experts in harm reduction. We started this program two years ago. We grew to the size of Baltimore city’s in 20 months, so understandably we have some things to improve to try to make this program as safe and effective as possible.”
Brenda Isaac, president of the board for the Kanawha-Charleston Health Department, has said health officials plan to review the program.
The office charged with media relations at the DHHR, and Dr. Rahul Gupta, Commissioner of DHHR’s Bureau for Public Health, state health officer and one of the report authors, have not responded to inquiries. Neither has Charleston Police Chief Steve Cooper, although the police department sent photos of dirty needles to news outlets on Friday. He has said first responders are finding needles in abandoned houses and public spaces.
Mark Strickland, EMS supervisor for the Charleston Fire Department, said finding needles is a daily occurrence and first responders worry about catching diseases. He said they find needles in cushions during car wrecks, and on floors they must crawl on to extinguish fires.
“It’s become a tiger that’s a little tough to tame,” he said.
He added, though, that agencies involved are all facing different aspects of the opioid epidemic. Emergency responders save lives in immediate danger and respond to active emergencies; health officials are working to stop the spread of disease and get people into treatment.
“We don’t want the community to lose faith in emergency services or the health department,” he said. “We’re all trying.
“This is unfortunately kind of new territory for all of us and we’re just reporting facts to the community of what we’ve found.”