The battle against the coronavirus is sapping the resources of those on the front lines of the fight against HIV.
As of Aug. 13, state health officials said, there have been 72 confirmed cases of HIV in West Virginia this year, almost half the record-breaking total of 146 last year, led by HIV clusters in Cabell and Kanawha counties.
“COVID-19 has really set us back. We’re going to need to spend a long time regaining a lot of the ground we’ve lost in the past few months,” said Dr. Michael Kilkenny, medical director at the Cabell-Huntington Health Department. “Compared to , while we had remarkably controlled our HIV outbreak last year, we never actually stopped it. There was always going to be a certain level going forward we were working on stopping, and we’re going to have to get back to that level in years to come.”
Cabell reported 69 cases last year and has reported 17 this year as of July 31, per DHHR. Kanawha has reported 20 cases so far compared to 28 last year.
Almost all of this year’s cases — 16 out of 17 in Cabell and 18 out of 20 in Kanawha — are linked to intravenous drug use, a trend that did not begin until 2018.
Up to then, nearly all cases of HIV in the state were linked to male-to-male sexual contact. The average number of cases reported annually in West Virginia was 77, slightly more than half last year’s record total.
Health experts say drug use is up across the state and nationwide. State Office of Drug Control Policy officials say that in recent months emergency calls and emergency room visits related to overdoses have increased.
“We are taking every opportunity we can to reach people in need, but we know COVID-19 has caused less opportunity for people to reach treatment for drug use and addiction,” said Angie Settle, CEO of West Virginia HealthRight, a free clinic in Charleston. “Looking at overdose rates and if there’s less access to treatment and people are still using, well of course, if we have more people with substance use disorder, of course there are going to be more [HIV cases] tied to that.”
Some rehabilitation centers limited intakes amid the pandemic. While telehealth efforts lead to an increase in call-in therapy and support groups, the services haven’t been accessible to all, and, Settle said, can be less effective than in-person support for people in recovery.
“Seeing your support system, having a routine, all that’s been broken,” Settle said. “Services are adapting, but there are gaps, certainly.”
The Centers for Disease Control and Prevention classifies half of West Virginia’s counties in the top 220 most vulnerable counties in the nation for significant increases in HIV tied to intravenous drug use.
“These are all parts of the same problem. We can’t only treat HIV, we need to look at the entirety of the situation, and that means treating substance use disorder and the factors that cause it, as well,” said Dr. Sherri Young, health officer at the Kanawha-Charleston Health Department.
HIV testing has decreased at both agencies amid the pandemic, Kilkenny and Young said.
Shutdowns because of the pandemic cut off outreach that health departments and organizations like HealthRight use to identify HIV cases and connect patients to care. The added stress of COVID-19 response also meant that resources in some cases are spread too thin to adequately confront other health issues still facing communities.
“It’s clear that we have finite resources and COVID-19 is a resource-consuming disease,” Kilkenny said. “One illness is not better than another, or more valued in treatment than another. These are two deadly diseases and we’re in a very bad position of trying to allocate resources at two threats at once, and we’re having limited success.”
Last year, the Kanawha-Charleston Health Department formed an HIV Task Force composed of care providers and nonprofits who work directly with people experiencing homelessness and those suffering from substance use disorder.
The task force hasn’t met since February. Task force members are regularly communicating, but such initiatives as mobile HIV testing have stalled, Young said.
“It’s something we want to do, but we need to figure out how to do safely,” Young said. “We don’t want to expose someone getting tested to COVID-19, and we’re working on figuring out a way to maybe join those two initiatives.”
HIV testing is still available in both Kanawha and Cabell, but many people haven’t sought it amid the pandemic. Settle said people were nervous about going to health offices, where they might be exposed to COVID-19. Clinic visits and traffic has increased recently but still lags normal levels, Settle said.
Nothing replaces personal interaction in treatment, Young said.
“Previously when we would go out and hold testing events, you have people really fearful of HIV and really fearful of their results,” Young said. “To hold their hand, share a story while they wait for the results, just talking to them — a personal connection is made. If you lose them outside of that 10 minutes they’re waiting, or don’t have that connection with them in the first place, it’s harder to reconnect and certainly harder to get them to care.”
Keeping people in care after a diagnosis is difficult, said Christine Teague, program director at Charleston Area Medical Center’s Ryan White Program.
“It’s our biggest challenge in HIV care right now, that engagement and retention piece. We exist to take care of the most vulnerable and most challenged populations, and we have the wraparound support services to do that,” Teague said. “Ninety percent of what we do is dealing with the social services aspect of it — the housing, the homelessness, the poverty issues. The other 10%, the medical side, that’s the easy piece.”
While the unintended consequences of the pandemic are impossible to ignore, Kilkenny said, he’s also noticed “an unintended benefit.”
As evictions slowed in Cabell during the pandemic and fewer people worried about being displaced from homes, treatment and health care became a priority.
“We really saw the public health improve for a lot of our poorest people during that time, and it was not necessarily in ways that we could measure with disease, but just in that stability and that ability to take care of other things,” Kilkenny said. “What we’ve learned from homelessness is that it’s very destabilizing. You cannot launch without a launch pad. You cannot achieve anything but your next meal and next place of shelter if you don’t have those. The true importance of us really tackling homelessness as a social and public health problem, it was an unintended benefit to see how important that is in many ways.”