The Kanawha-Charleston Health Department reported 16 diagnosed cases of HIV in Kanawha County so far this year, a relatively unalarming number, given the annual average is 14 cases per a year, and 2018 saw 17 cases. What is a bit alarming, said Dr. Sherri Young, KCHD health officer and executive director, is the increase in cases involving intravenous drug use.
On Wednesday, community leaders and Kanawha County health officials met at the health department for the inaugural meeting of an HIV Task Force. While Young said they weren’t necessarily concerned with the number of reported cases, they felt it important to get in front of a potential problem and make the community as prepared as it can be.
“We’ve long had HIV in our community for decades. There have been low numbers, but they’ve been here,” said Dr. Cathy Slemp, state health officer. “This isn’t new, but we need to be prepared on how we’re going to handle it moving forward. We need education, we need to fight stigma and we need to connect people to care.”
Annually, an average of two HIV cases are linked to injecting drugs. This year, there have been six, Young said. This isn’t unexpected — the HIV cluster in Cabell County has also, for the first time ever, been tied to IV drug use instead of sexual contact.
Despite the similarities between the two areas in terms of at-risk population, Slemp said, the cluster in Cabell County and the micro-cluster in Kanawha County are unrelated.
According to Young, epidemiologists have been able to track contact through people who have been diagnosed, and there do not seem to be high levels of transmission from Cabell to Kanawha or vice versa.
“This is not simply an extention of the Cabell cases,” Slemp said. “We have transmission that is occurring in our community here, currently, and that’s what we need to handle. Those are the people we need to find and get connected to services.”
The new HIV Task Force — a working name — is operating in part due to a $68,000 grant from the Greater Kanawha Valley Foundation. The money will be used to extend testing services and support into other parts of the county, namely rural areas where there may be more people at risk with less avenues to access care.
KCHD officials were joined Wednesday by representatives from Charleston Area Medical Center, West Virginia HealthRight, Covenant House, the Kanawha Sheriff’s Office, the city of Charleston and others.
Absent from the meeting were members of the substance use disorder community or individuals who work in mental health — something Young said is going to change at the next meeting, in November.
“That was part of our goal today: recognize who isn’t at the table, and who needs to be. We need those people here, and we’re going to invite them,” Young said.
The community partners are exploring ways to bring services farther out in the county. It’s not easy, as testimonies from Angie Settle, CEO of West Virginia HealthRight, and Christine Teague, program director of CAMC’s Ryan White Program, showed.
Even if you can test someone for HIV, Teague said, the real challenge is getting them connected to proper treatment if found positive. Tests don’t come back immediately, and the prospect of undergoing hours of appointments and lab work can be terrifying for people, she said.
“We need to be immediately addressing these folks, and we need to find a way to bring what they need to them, not wait for them to come to us,” Teague said. “They may be extremely vulnerable — some might be experiencing homelessness — but we’ve got to find a way to reach them.”
Janet Briscoe, director of epidemiology at KCHD, said she envisions working with preexisting community groups and faith-based organizations to contact people and link them to care. That way, they aren’t being approached by total strangers, but by someone they know and trust.
Another struggle that became obvious at Wednesday’s meeting was the need to overcome the stigma surrounding HIV.
There’s the idea, Briscoe said, that it’s still the “HIV from the ’80s — a death sentence,” but that’s not true anymore. With care and medication, those diagnosed can live just about full lives, relatively healthy.
“We need to educate on that, to those at risk and even those who aren’t. We need to work on lowering the stigma to get others involved and caring about the issue,” Briscoe said.
Part of that education is interacting with those who use drugs and ensuring they’re aware of the risks associated with sharing needles.
“The risk here is not that people are using drugs,” Briscoe said, “it’s that they are sharing around potentially unsanitary equipment to use these drugs.”
Until last year, KCHD ran a syringe exchange program that allowed IV drug users to replace dirty, used needles with clean ones. The program closed under political pressure and one is still offered at West Virginia Health Right.
Young said there was no “linear evidence” to link the increase of IV drug users diagnosed with HIV to the closure of the syringe exchange program.
For the past several years, nearly half of West Virginia’s counties have been classified as vulnerable for an HIV outbreak by the U.S. Centers for Disease Control and Prevention. Since 2016, the southern coalfields of West Virginia have been exceptionally susceptible due to higher rates of drug use (especially injected drugs) and poverty and less access to health care, specifically preventative care.
Young said she hopes the early efforts to connect with less urban communities in Kanawha County will be successful, and that other places also earmarked as vulnerable will be able to replicate the task force’s model in their area, if needed.
Already, she said, there are meetings being set up with officials in Boone County and Putnam County to identify community risks there, and aid them in implementing more testing and treatment efforts.
“Every life matters here, whether you’re a part of that vulnerable population or not, it should matter to you as a human,” Young said. “We want to help people tackle this because we all benefit from progress here.”