Loud dance music pours out of a historic church in downtown Bluefield, West Virginia, around 7 on a Friday evening. About 30 people are eating barbeque, beans and chicken at a newly formed support group for lesbian, gay bisexual, transgender and queer people.
As the guests grab their food and have a seat, Darryl Cannady stands inside the echoey church talk. He isn’t a preacher; he’s the executive director of a non-profit called South Central Educational Development, which has its headquarters inside this old church building. Tonight’s event is aimed at adults, though there is one high school student in attendance.
The guests have all received bags with information about how to prevent sexually transmitted diseases.
“Read the information. We provided you with lots of condoms and lubrications. And remember, safe sex is the best sex,” Cannady says, in a thick gravelly voice as he begins to talk about the need for more people to get tested for HIV.
The atmosphere in this room is quite different from a doctor’s office. People are laughing and singing along. One person, a drag queen, gets up to dance, and the room erupts in applause.
Cannady is hosting this meeting as a way to talk with the LGBTQ community about the increasing risk of hepatitis and HIV in southern West Virginia, and other parts of Appalachia. The risks are increasing because of high rates of drug use, combined with poor access to health care. On this night, Cannady’s organization is also hosting free HIV testing, here in the church building.
“Prevention is number one. I think you got to catch it before it starts," Cannady says. "So if you're not doing anything preventative when you have an outbreak you can say how did that happen. You know how it happened you didn't do anything to stop it.”
Someone who agrees with Cannady is Dr. Gordon Smith, a professor at the West Virginia University School of Public Health, who is studying the risk of an outbreak of HIV in southern W.Va. “Unfortunately, because the testing is so poor, we could be right in the middle of it and we wouldn’t even know it.”
Smith’s team received a $1 million grant last year from the National Institute of Drug Abuse, a part of the National Institutes of Health, the Centers for Disease Control and the Appalachian Regional Commission to help increase surveillance and prevention of HIV and hepatitis C in southern West Virginia.
The other lead researcher with the project is Dr. Judith Feinberg.
“You know ideally it should have been done five years ago, because you could have prevented HIV and you could have curtailed the spread of diseases like Hepatitis C,” she says.
Hepatitis C, like HIV is spread by sharing bodily fluids, either through needles or sexually.
Feinberg says her group plans on partnering with community-based organizations, like Cannady’s organization in Bluefield, to do more testing and outreach.
Cannady says he’s on board with the partnership, but he’s concerned that the WVU researchers are not going to fund his organization’s efforts. “We're not staffed large enough to actively go out and address this head on with the community as we used to do.”
Cannady used to do more HIV testing and prevention in southern West Virginia. But then, in 2009, his organization lost funding it had been getting from the Department of Health and Human Resources to do HIV prevention.
It wasn’t just his organization. About 10 years ago, the CDC began reducing funding for prevention and surveillance of HIV in states with a low prevalence of people who’ve tested positive for the disease.
West Virginia took some of the biggest cuts. One result has been the reduction of resources available for local, community-based organizations, says Dr. Rahul Gupta, Commissioner of DHHR's Bureau for Public Health.
“Since 2009, HIV prevention in West Virginia has seen a reduction of about a million dollars from the CDC,” Gupta says.
“Most funding is directed to the prevention activities that are most likely to have significant and lasting results on the HIV epidemic,” A CDC representative said in a statement.
But that strategy doesn’t always work to prevent unexpected outbreaks.
Back in 2015, Scott County, Indiana, an area that hadn’t previously been a high prevalence area, experienced a massive HIV outbreak. CDC officials were quite surprised by this epidemic, recalls Dr. John Brooks, a researcher with the CDC’s Division of HIV/AIDS Prevention. "And we marshaled a lot of resources not only to stop the outbreak from growing, and then to better understand what happened there and how we can prevent it from happening elsewhere,” Brooks says.
Brooks was one of the lead authors of a 2016 CDC study that concluded many of the nation’s most vulnerable counties are in Appalachia. Now, in order to prevent more unexpected outbreaks of HIV, Brooks says the CDC is looking at shifting more of their funding back to rural communities, because the opioid epidemic is creating a higher risk here.
West Virginia will receive an 18 percent increase for HIV prevention and surveillance next year, as part of a new effort by the CDC. It will be the first increase in funding for HIV prevention the state has seen in 10 years.
Exactly how much this funding will trickle down to community-based organizations, though, is unknown.