I find myself thinking about a train as we near World AIDS Day, honored yearly on Dec. 1. But this isn’t a scenic, tourist train ride. Instead, this is a steam locomotive chugging slowly and dangerously through the rolling hills of Appalachia.
The engine of this train is substance use. In West Virginia, we have seen an evolution of drug use from folks beginning to take opioid pills in the early 1990s to today, when we are experiencing an epidemic of opioid injection and other substances.
The next car on that train is viral hepatitis. West Virginia has one of the nation’s highest incidence rates of hepatitis C infection. Another car on the train is skin and soft-tissue infections from reusing needles, and another car is all the other sexually transmitted infections.
While we’re at it, this long, coal-powered train contains several more cars with labels such as lung cancer, diabetes and heart disease. All are preventable health conditions that West Virginians experience at higher rates than the rest of the country.
The caboose of this train is HIV. Historically, West Virginia’s annual rates of new HIV infections have been stable and relatively low, compared to some of our neighboring states. But, in 2019, we saw a sudden doubling of reported new cases, particularly in Kanawha County. Not surprisingly, HIV cases were on the rise at the same time that numerous syringe service programs across the state were forced to close. We know what works to stop the spread of new transmissions: access to sterile syringes and HIV and hepatitis C testing and treatment.
Another proven solution: opioid treatment programs. Sadly, there aren’t enough accessible programs in West Virginia because of an ill-advised moratorium. Health care advocates are now loudly calling for West Virginia legislators to end the methadone moratorium so that people throughout the state can have improved and increased access to substance use treatment. These programs are well-proven to help people quit injecting lethal drugs.
Achieving expanded access to prevention and treatment interventions requires policy change, but it also requires funding. During the upcoming legislative session, I’ll further educate legislators and community members about the evidence-based benefits of harm reduction and the need to overturn the methadone moratorium.
Thankfully, the funds are already available, sitting and waiting in the West Virginia government coffers.
Our state has received millions of dollars from opioid lawsuit settlements, with more money expected, recently estimated to be more than $1 billion. Leaders are working to finalize the process for distributing these funds to local governments and for statewide programs.
The questions remain: How will state and local governments decide to spend the money? Will most funding be given to law enforcement to perpetuate the ineffective and failed war on drugs?
I believe it should be directed to establish and expand evidence-based programs that offer access to HIV and hepatitis C testing and treatment, sterile syringes, naloxone, methadone and buprenorphine (considered the gold-standard treatments for opioid use disorder).
World AIDS Day is an important annual reminder that HIV has not gone away; it still affects thousands of West Virginians daily. And as we’ve seen in Kanawha County, we remain at risk of a new outbreak. To end the syndemic of HIV, viral hepatitis and substance use disorder, we must use all the tools available to engage those most at risk. That means swiftly revising our policies and thoughtfully allocating funds. We must find a path to allow for expanded drug treatment options in our state, including overturning the methadone moratorium.
If we work together, we can create a train full of people dedicated to eliminating HIV in West Virginia. Filled with people who work tirelessly to bring health care to the most vulnerable residents in rural West Virginia. Brimming with policymakers committed to ensuring anyone in need can utilize proven drug treatment programs. Packed with community health care practitioners on the ground, personally meeting and caring for at-risk neighbors with little to no transportation to obtain health care.
The new train will overflow with health care solutions, supportive communities and healthier West Virginians. On this 34th anniversary of World AIDS day, I am grateful for all the people building and boarding this new and improved train.