At least nine people in Kanawha County who previously tested positive for HIV have been returned to care, as agencies in the region have worked in recent months to increase testing and outreach amid the continuing HIV crisis, Dr. Sherri Young, health officer at the Kanawha-Charleston Health Department, reported at Tuesday’s HIV task force meeting.
So far in 2021, 16 new HIV cases have been detected in Kanawha County, with 14 of those tied to intravenous drug use, according to surveillance data from the state. Last week, representatives from the U.S. Centers for Disease Control and Prevention came to Kanawha to help bolster the region’s efforts, which Dr. Shannon McBee, state epidemiologist, said is going well.
“It has helped us in the past, and we think it’s going to be a great help with this cluster, as well,” McBee said. “There is already progress being made and by July, we’re hoping to have the full report of analysis and recommendations from [the Epi-Aid team.]”
In 2019, the state was granted Epi-Aid, which is short-term targeted assistance for a specific public health challenge, to help control HIV spread in Cabell County. There, McBee said, recommendations included more, widespread testing efforts and ensuring there are low barriers to care.
The Cabell-Huntington Health Department’s syringe service program was key to helping engage with at-risk populations — mostly, as is the case in Kanawha County today, people who inject drugs. People would come to the health department for syringes, and then be given some kind of incentive — free food, gift cards, etc. — to refer other people to come in to get tested for HIV.
That worked well, McBee said, especially in connecting contacts of people who are positive or at-risk with care, or at least testing.
But Kanawha doesn’t run or host a syringe service program outside of the one at West Virginia Health Right, which is limited in scope and serves a fraction of the people that Cabell-Huntington does.
In the meantime, agencies that work directly with people who inject drugs and people who are homeless are focusing on filling the small gaps where they can, until the CDC’s Epi-Aid team provides its final analysis.
A month before Epi-Aid arrived, two disease-intervention specialists from the CDC were relocated to the Kanawha- Charleston Health Department to help with case investigations and contact tracing for people previously diagnosed and those who have been lost to care.
Through the Charleston Area Medical Center’s Ryan White Program, a representative now works in the hospital’s emergency department to refer at-risk people to testing and care before they leave the hospital. It’s a critical position, as most of the county’s HIV cases over the past five years have been detected in hospitals.
“Those are people already having a health care crisis,” said Dr. Christine Teague, who leads the Ryan White Program
The Kanawha-Charleston Health Department is investing in day passes for city buses, to help transport people to caregivers where necessary.
Health Right, through its recently opened West Side clinic, is utilizing “strike teams,” said Angie Settle, CEO for the agency. There, employees go out in teams to find at-risk people and bring them in for testing.
The West Side clinic also brings services closer to the people who need them, Teague said. Many of the cases they’ve identified through the Ryan White Program over the past several months are people living or located on Charleston’s West Side.
Still, a major issue is the challenge of keeping people — especially those who are homeless, who are deep in addiction and those who might travel around — connected with care. Even if they’re interested in receiving and keeping the care, medications often get stolen, said Ellen Allen, who runs Covenant House, a day center in Charleston for people who are homeless.
For years, talks have been ongoing regarding providing free lockers for the homeless, to prevent theft. Although some local churches or groups might have limited offerings, the need is greater than what’s available.
Stable housing, Allen said, would solve many parts of this.
“Housing is health care,” she said. “In this case, it’s the greatest piece we have.”
When people are in housing, it’s easier to keep them in contact with the system, she said. If peer-recovery and other behavioral medicine pieces are provided with that housing, it allows providers to cut deeper, to the root cause of a person’s struggles.
Young said it’s clear the ongoing HIV crisis in Kanawha is serious, but it’s also a side effect of the drug and addiction crises that have had a stronghold in Appalachia, and specifically West Virginia, for decades.
“I know people want this to be wrapped up quickly, and the response parts are quick. But the long term solutions are going to take time,” Young said. “We’ve got to treat addiction. If we’re not treating that, there’s no way to make any progress on the other fronts.”