When was the last time you walked into your doctor’s office and asked to see a police officer? It sounds ridiculous, of course, until you really think about how Charleston attempted to solve its intravenous drug use problem.
This week, the Charleston Gazette-Mail’s Amelia Ferrell Knisely reported that, according to the West Virginia Department of Health and Human Resources, “a new case of hepatitis C was reported nearly every eight hours in Kanawha County [in 2018].” This rate of infection is a five-year high for the county. The rate accelerated after the Kanawha-Charleston Health Department shut down its public syringe exchange in March 2018 in response to new rules set by the then-mayor and Charleston Police Department.
And I’m sure former mayor Danny Jones and others at the center of the shutdown felt a great deal of pressure to police addict behavior — to uphold “good values” and “clean up the city.” But there’s a certain Indiana native who made a political career out of talking values, and he learned the hard way that people suffer when you send a cop to do a doctor’s job.
Vice President Mike Pence was the governor of Indiana from 2013-17. Within that same window, Scott County, Indiana, experienced an uptick in HIV cases so significant that it made national headlines. There were 215 diagnoses in a community of less than 24,000 people. A 2018 Yale School of Public Health study published in The Lancet HIV suggests that the number of cases could have been reduced by hundreds if state and local leaders had properly leveraged any number of earlier interventions, early detection processes, or appropriate public policy responses. And it all began with a spike in hepatitis C cases in 2010-11, in a county where more than 97 percent of those diagnosed reported injection drug use.
By 2014, when the community and Gov. Pence realized what was happening in Scott County, they were in crisis. And instead of responding with greater access to care, deployed efforts to further punish addicts and elevate “values” — including a backdoor erasure of needle exchange, something Pence publicly asserted “encouraged drug use.”
The results? The closure of the county’s only HIV-testing center in a statewide push to punish Planned Parenthood. Increased criminal penalties for the possession of a syringe with intent to commit a drug offense, while simultaneously launching a reluctant, hamstrung needle exchange program. A state law that requires the teaching of abstinence-only sex education if the school is to teach it all (it’s not required). A chain of regulatory bungles detached from reality for which hundreds of Hoosiers now have to answer.
Just as Pence made needle exchanges, testing, health care for addicts a political issue, then-mayor Jones faced a similar temptation or pressure. Facebook was full of local hand-wringing about discarded needles at the Charleston Town Center mall or “those people” clustered on church steps.
Jones, I’m sure, heard the distaste and discomfort some constituents aimed at those suffering from the rapidly spreading opioid crisis. He yielded to it by empowering local law enforcement leadership to draft exclusive, prohibitive rules for the exchange. Rules included ID requirements and testing for bloodborne illness. These proposed guardrails, meant to punish and not engage, eventually neutered the program and led to its indefinite suspension.
You can’t both criminalize and incentivize participation in a public health program. People won’t participate and more people will get sick.
Charleston did, at one time, have a leg-up on Scott County, in that the Kanawha-Charleston Health Department is committed to providing hepatitis C testing with a network of local partners. That edge is diminishing, though, as Knisley’s reporting suggests: Right now, the health department is only able to test a specific subset of the drug-using population. Funding for that effort does not expand HIV testing, something of a Venn diagram in the region right now, especially with a cluster of new HIV cases among IV drug-users in nearby Cabell County causing some concern about spread. And, of course, none of this speaks to the spread of disease to those not using drugs themselves.
I’m not breaking news here. The U.S. Centers for Disease Control and Prevention has already identified West Virginia, generally, and Charleston, specifically, as particularly vulnerable to a ballooning rate of HIV and hepatitis C infection. And effective, intensive efforts down the road in Huntington — including the maintenance of a needle exchange — shed harsh light on Charleston’s status as backsliders in the public health policy arena.
The needle exchange was serving 400 people at the time of its closure, and it was working. The Gazette-Mail reported that the exchange had helped reduce the number of hepatitis C cases to a recent low.
I am hopeful that county and city leadership can get back to what works, heeding the cautionary tales from nearby states and working with leaders across the United States facing the same challenges. Engage in learning communities with other cities, pool resources and trade effective models. Join communities fighting the opioid and hepatitis C epidemics in data-sharing, and asset mapping to more strategically understand where medical, treatment, testing and public safety resources are most needed.
But most of all, local leaders must advocate for a reality check in their ranks and among voters. Confront public health data related to the consequences of abstinence-only education. Absorb and structure responses to the fallout from national effort to stymie Planned Parenthood (clinics that often provide the only health care some men and women receive all year). Heed the data that shows Naloxone and overdose response training for residents proves to be an effective strategy for preventing deaths. Invest in sobriety and addiction treatment support, even for those without a fixed home address, so that those who have hepatitis C can be treated effectively.
And, please, eschew the idea that requiring a government issued-ID to access needles — from a police officer, no less — does anything more than ensure the further spread of disease.