As Kanawha County faces an impending HIV outbreak that could cost billions in taxpayer dollars, the West Virginia Senate’s Health and Human Resources Committee entertained a bill Thursday that would make it more difficult to operate programs proven to slow such diseases and save lives.
Senate Bill 334 would create a licensure program mandatory for any harm reduction program looking to operate in the state. To be licensed, a program would need letters of support from the county commission, sheriff and health officer of any county they intend to operate in.
The bill also would keep any program running a syringe service program — a tool proven through years of worldwide research to decrease disease spread and lessen drug use habits — from receiving any state-funded support.
Syringe service programs in operation would be required to implement a 1:1 exchange ratio, meaning the number of syringes a person returns dictates how many they receive. They would require an ID from every client. Syringes would be tagged with serial numbers tied back to the program they originated in.
All of these measures go against the advice of the federal Centers for Disease Control and Prevention, and programs run in this fashion are not proven to decrease disease spread nearly as much as needs-based programs, where there are low access barriers and syringes are given on a needs basis.
Sen. Eric Tarr, R-Putnam, is the lead sponsor of the bill, which is a re-imagining of legislation he introduced in previous years that would have outright banned the operation of syringe programs in the state.
As he presented his bill to the committee Thursday, Tarr spoke at length about needle litter and needle-stick injuries, which he said he believes pose a large risk to the public at large.
Many in West Virginia share this belief and fear, but Dr. Judith Feinberg, professor of behavioral medicine and infectious diseases at the West Virginia University School of Medicine, said it is often unfounded.
“There is a wealth of evidence that shows that the popular concerns about syringe programs are not supported,” Feinberg said.
No entity in West Virginia tracks needle-stick injuries among the public.
Sen. Mike Maroney, R-Marshall, who is a radiologist and chairs the Senate health committee, said Thursday the point of this bill is accountability.
“[We want] to keep these programs in place, to help so many people and prevent infectious disease, but to hold them accountable and have rules associated with the programs,” Maroney said.
But other doctors and medical experts invited to testify on the bill Thursday disagreed.
“I think this bill will effectively close down needle exchange programs in the state, and I believe it will significantly increase the cost burden to our taxpayers,” said Dr. Kevin Yingling, who practices internal medicine in Huntington. “I understood the massive threats [of needle litter] stated by [Tarr], but I believe this bill does not address those threats, and don’t see this as a solution to his concern.”
Yingling said, if there is a concern about needle litter, there needs to be something done about disposal. In Morgantown, where Milan Puskar Health Right runs a needs-based syringe program, the city installed disposal bins to address litter, and officials say they’ve seen increases in proper needle disposals.
Studies also show that places running needs-based programs actually see less needle litter in communities, as there is an incentive for people who use them to pick them up for returns.
It’s unclear how much training first responders across the state, such as police officers and refuse workers who tend to encounter more needles in public places than those in other professions, are given on the proper handling and disposal of syringes and other “sharps.”
In Charleston, the City Council is working to survey all firefighters, police, refuse workers and public grounds police on their perception of harm reduction programs and their fears of needle litter.
In the capital city, 20 employees have been stuck by needles while on duty in the past three years: eight in 2018, two in 2019 and 10 in 2020, according to incident reports filed with the Occupational Safety and Health Administration. While Charleston police last month began tracking needle litter pickups and calls for them, there is no previous data to compare that could show an increase or decrease.
What is clear, though, is the increase in HIV in the Kanawha Valley tied to injected drug use, which best-practice syringe programs could drive down.
In 2018, there were two cases of HIV tied to injected drug use in Kanawha County, according to the state. In 2019 there were 15 and, last year, there were 35 — one less than the entirety of New York City reported in 2019, despite having millions of more residents.
Many diagnosed with HIV in Kanawha County also suffer from hepatitis C, according to data from the state health department.
West Virginia continuously ranks second in the nation for the rate of hepatitis C cases, and first for the rate of hepatitis B cases, according to health officials.
In recent presentations to the Kanawha-Charleston Health Department’s HIV task force and Charleston City Council, Dr. Demetre Daskalakis, head of the CDC’s division on HIV/AIDS prevention, warned officials that, while an HIV outbreak might start in one area, there’s no guarantee it will end there.
This is especially true for a state like West Virginia, where 28 of the 55 counties — and every county bordering Kanawha, save for Putnam and Jackson — are considered to be among the most vulnerable in the nation for an HIV outbreak tied to injected drug use, according to the CDC. McDowell County is the second most at-risk in the entire country.
While all of the experts invited to testify on this bill Thursday spoke on the severity of the growing HIV cases, the language within the proposed legislation does little to address how programs run under such stringent restrictions would succeed in lessening disease if they are difficult to run, limited on funding and inaccessible for many who need them.
Also not yet included in the bill is an appropriate fiscal note from the state health department on how much implementing this law would cost the state.
“The lifetime cost of treating HIV is $510,000 [per case],” Yingling, who also served as the dean of Marshall University’s School of Pharmacy, said. “That cost will be burdened onto the taxpayers of West Virginia.”
According to the West Virginia Center on Budget & Policy, it will cost more than $47 million in taxpayer money to treat every Kanawha County resident who was diagnosed with HIV or hepatitis in 2019 alone.
Health officials across the state — and those at the CDC — agree that cases for HIV and hepatitis C, as well as hepatitis B and endocarditis, will continue to rise if there is not swift action, and the costs associated with them also will increase.
Daskalakis, with the CDC, specifically recommended a three-pronged approach to stopping such outbreaks: Test people often, ensure they can access the appropriate care and provide as many clean syringes as needed to vulnerable populations.
As rates of HIV and other diseases tied to injection drug use are on the uptick nationwide, according to the CDC, this is a critical time to consider interventions instead of stigma, WVU’s Feinberg said.
“We have the evidence in front of us as to whether well-run syringe service programs affect public health in terms of cases of [hepatitis and HIV]. When the [Kanawha-Charleston Health Department’s syringe program] was closed, that was followed by a more than doubling the number of cases of hepatitis C,” Feinberg said. “It’s quite clear now that we have a significant HIV outbreak in Charleston and Kanawha County.”
SB 334 will be back with the Senate Health and Human Resources Committee on Tuesday, where legislators can add amendments and vote on it.