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Expert: W.Va.’s Drug Epidemic Is Holding Back Its Economy And Hurting Its Children

A senior policy advisor to the Legislature presented a sobering picture of West Virginia’s drug epidemic on Monday.

Despite the state’s billion dollar response, West Virginia has led the nation in overdose death rates since 2010, according to a senior policy advisor to the legislature.

Jeremiah Samples, former deputy secretary at the now reorganized Department of Health and Human Resources (DHHR) and current senior policy advisor to the Legislature, presented an analysis of the state’s substance use disorder (SUD) crisis to the Joint Committee on Health on Monday.

“The bottom line is that we have not made enough progress on this crisis,” Samples said. “We’re nowhere near where we need to be, and our data relative to other states, and even our own expectations, has fallen far short. We need to reassess all of our SUD strategies and expenditures through the prism of what is impacting real people in our society.”

A survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that 208,000 people in West Virginia used illicit drugs in the last month.

“That’s an average,” Samples said of the number. “It’s a gut-wrenching number to hear, but that’s where we stand.”

Samples also cited a West Virginia University Match Survey that found 359,880 West Virginians used drugs in the past year.

“We can’t sustain that as a society,” Samples said. “That is, it’s crippling to the state.”

In 2010, West Virginia’s fatal overdose death rate per 100,000 people was 28.2. Even after the state spent millions combating the problem, in 2022, West Virginia’s fatal overdose death rate had grown to 80.9 per 100,000 people.

“Our overdose death rate since 2010 has increased by 135 percent,” Samples told the committee. “West Virginia’s overdose death rate is 151 percent higher than the best state in the country, 85.6 percent higher than the national average and 36.4 percent higher than the next worst state (Tennessee).”

Samples cautioned against taking overdose death reports out of context.

“Any downturn is positive,” Samples said. “Those are real lives that people, that are not dying. However, the trend, we’ve had a couple blips where we’ve gone down in the past, but the trends are really what matter, and from a trend perspective, we have increased exponentially since we started leading the nation in overdose deaths.”

According to CDC data, the nation saw a 6.7 percent decrease in overdoses from January 2023 to January 2024. During that same period, West Virginia saw a 1.92 percent increase in overdoses.

“West Virginia is not keeping pace with the decrease in other states,” Samples said. “Before the pandemic, we were at a plateau of sorts. The pandemic hits and fentanyl issues become exponentially worse. Overdose death rates across the country explode. They increased in West Virginia, more so than most states. I think we were perhaps third, we saw the third biggest increase during the pandemic. But the bottom line is, we’re not decreasing at the same rate as some of these other states. So we’re not coming back down to that plateau. We need to get to that plateau and then continue to go down.”

The Current System

Samples explained that West Virginia’s state government response involves “over a dozen agencies,” led by the Governor’s Council on Substance Abuse, founded in 2018, and the Office of Drug Control Policy (ODCP), founded in 2017.

One of those agencies is the Bureau for Behavioral Health (BBH), the designated state mental health authority recognized by the federal government as the single state agency for substance abuse services.

The bureau receives federal block grant funding for substance abuse and prevention. It is responsible for SUD provider infrastructure and manages the state’s Crisis and Referral Line, 1-844-HELP4WV, contract.

“They (BBH) apply for these big federal grants,” Samples said. “They’re responsible for the infrastructure of the state for SUD and their annual budget is roughly $225 million.”

Samples said from 2017 to 2020, BBH was forced to send $34.2 million back to the federal government for funds that were not used from those grants.

“This came up in LOCHHRA (Legislative Oversight Commission on Health and Human Resources Accountability) last year,” Samples said. “We’re unclear from 2021 forward, how much money has been sent back, but it is something that the legislature and the state should explore and investigate.”

In 2023, legislation was passed directing the ODCP to report to the governor’s office. In the DHHR reorganization, the ODCP was placed administratively within the Department of Human Services.

Samples said it is hard to track SUD spending in West Virginia, but the state fiscal year 2025 budget for the ODCP is $2.3 million.

“You can directly attribute hundreds of millions again, in direct expenditures on SUD, just in West Virginia, annually,” Samples said. “And then there’s hundreds of millions more we know that we’re spending that are indirect, for example, child protective services, the child welfare crisis, there are hundreds of millions in indirect costs in just child welfare alone.”

A 2021 study that includes the economic impacts of the crisis by the West Virginia Center on Budget and Policy estimated that the drug crisis costs West Virginia $11.3 billion a year.

Samples also cited a Center for Disease Control and Prevention (CDC) report that found West Virginia experienced 1,335 known overdose deaths in 2022.

“Despite all the investment and expenditure, since 1999 we’ve seen a 1,680 percent increase in our overdose death rate,” Samples said. “Since 2010 which, again, 2010 is when we started leading the nation, [we’ve seen] a 135 percent increase. Since 2017, [we’ve seen] a 56 percent increase. So we have not been getting results. We’ve not been reversing the trend.”

According to Samples, Medicaid is the largest source of treatment funding for SUD in the state, serving approximately 50,000 members with an SUD diagnosis annually.

Medicaid is expected to spend about $140 million on SUD medical and behavioral health claims in West Virginia in 2025. In addition, Medicaid spends approximately $70 million on medication-assisted treatment (MAT) drugs.

“Medicaid’s annual expenditure, when you include MAT and the services, the claims are about $210 million,” Samples said. “Fatal overdoses have increased amongst the Medicaid population from 2018 to 2020, and so we’ve not seen appropriate progress there either.”

West Virginia Medicaid’s Substance Use Disorder Waiver

Since the launch of West Virginia’s Medicaid SUD Waiver, or 1115 Waiver, fatal overdose rates have continued to rise.

West Virginia Medicaid’s biggest SUD expenditure is the 1115 Waiver, which was developed to help increase the availability of SUD prevention and treatment services for Medicaid members.

The waiver was requested by the state and approved in 2017 by the federal government. It allows the state to provide additional services beyond what the federal government requires.

In 2018, the Bureau for Medical Services announced the expansion of services under the SUD Waiver, adding coverage of methadone as a withdrawal management strategy, a Naloxone distribution initiative, coverage of adult residential treatment, peer recovery support systems, withdrawal management services and the use of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) tool to identify SUD treatment needs in the Medicaid community.

The SUD Waiver cost $12.2 million in 2019 and increased to $129.3 million by 2023. The Federal Reserve was responsible for $114 million of the 2023 total. West Virginia paid $15.3 million the same year.

Projected expenditures in 2027 are expected to grow to $161 million, according to Samples.

West Virginia Medicaid has proposed further expansion of the SUD waiver to the federal government. The application is under review with the expiration of the current waiver on September 30, 2024.

Proposed expansions include:

Expanding peer support to more settings
Sending quick response teams to clients who have overdosed or are experiencing a crisis
Providing Medicaid coverage to eligible individuals incarcerated in state prisons starting 30 days before their release
Offering involuntary secure withdrawal management and stabilization for individuals deemed to be a danger to themselves or others
Supporting a holistic and integrated approach to treatment
Education and outreach for Human Immunodeficiency Virus (HIV) and Hepatitis C (HCV) concerning substance use
Addressing social determinants of health to encourage self-reliance and support continued recovery housing offering clinical-level treatment services.
Supported house and supported employment
Offering the TRUST protocol for people with stimulant use disorders
Reimbursing short-term residential and inpatient treatment services in settings that qualify as an institution that treats mental diseases for Medicaid-eligible adults with serious mental illnesses.

West Virginia’s SUD Outcomes

Samples then shared some encouraging outcomes with the committee from this spending.

According to CDC provisional data, there was a decrease of 9.4 percent in overdose deaths nationally from March 2023 to March 2024. In West Virginia, that same data showed a decrease of 4.91 percent during the same time period.

Samples also cited a decrease in new HIV cases from 153 in 2021 to 100 in 2023.

“This was a really big deal a couple of years ago, Kanawha County alone, which was one of the worst hit counties, saw a 66 percent decrease from 2021 to 2023,” he said. “The 2024 data, which is available online, it’s looking really good. It’s actually even more positive than that. So kudos to everyone that’s worked on that.”

According to a 2022 report from the CDC, 2,400 people were living with HIV in West Virginia.

“Other positives, Medicaid, managed care organizations, providers, recovery homes, they’re starting to make a lot of progress in better measuring our outcomes, better measuring what’s actually happening in the state, so we can pivot and actually make progress on this crisis,” Samples said.

Samples also said he is hopeful about the West Virginia First Foundation, the organization formed by an act of the legislature that is responsible for dispersing West Virginia’s opioid settlement funds.

“The first foundation, this is a new development and something that I think we should have hope for. The foundation stems from efforts by the Attorney General Patrick Morrissey, securing an opioid settlement of approximately $1 billion,” Samples said. “This is the number one per capita opioid settlement in the United States.”

Drugs And Economics

While there are some positive indicators for the future of West Virginia’s drug epidemic, Samples said the state has not had any significant successes but has seen plenty of failure.

“The failures have consequences, the economic impact of the drug crisis,” Samples said. “One study said $8.8 billion a year in impact. Another study said $11.3 billion a year in impact, just on the economy, a 12 percent economic drag on our GDP (Gross Domestic Product), annually.”

Samples said the drug crisis costs West Virginia at least one-eighth of the state’s total economy based on spending on health care, substance use treatment, criminal justice costs, the societal burden of fatal overdoses and lost worker productivity.

The “drag” on West Virginia’s GDP is more than double that of the next highest state, Maryland where substance use disorder-related costs consumed 5.4 percent of its GDP.

Then, Samples addressed West Virginia’s labor workforce participation rate (LFPR), or, the number of people in the labor force (working or looking for work) as a percentage of the total population 16 years and older. West Virginia’s LFPR is at 55.1 percent in July 2024, according to the St. Louis Federal Reserve.

“We’re no longer last, and I don’t say that in jest,” Samples said. “I mean, we were last place in labor force participation rate from 1976 to 2022, so progress is progress, and we are making some progress in that realm, but the drug crisis is holding us back.”

According to Samples, the economic impact of productivity loss for non-fatal substance use disorders has a reported cost of $316 million dollars and 1,206 jobs to the state, while the economic impact of productivity loss due to overdose fatalities carries an additional cost of $322 million and 5,905 jobs.

“When you look at the unemployment rate, which is at 4.2 percent right now, relative to our labor force participation rate, our labor force participation rate has pretty much been level, but our unemployment rate has gone down,” Samples said. “There’s just people not in the job market looking for work, and this is attributable to the drug crisis.”

West Virginia has the highest death rate for working-aged populations and the second lowest life expectancy in the U.S. at 72.8.

“Even going back to 1990 West Virginia has had a lower life expectancy than the national average, but there’s been a gap that’s built, and even as the national life expectancy has gone down, we’ve gone down more,” Samples said.

West Virginia’s Children Pay A Price

According to Samples’ report, 83 percent of child welfare removals were from homes with known drug use.

“West Virginia’s foster care rate grew 61 percent from 2010, to 2021,” Samples said. “It’s 23 percent higher than the next worst state, and 118 percent higher than the national average.”

Data from the Annie E. Casey Foundation shows that West Virginia leads the nation in its foster care entry rate.

“The difference between the entry rate and the foster care rate, entry foster care rate, is just kids in foster care,” Samples said. “The entry rate is kids coming in.”

Samples said West Virginia has led the nation in foster care entry rates since 2010.

“We are 131 percent worse than the national average, and 54.9 percent worse than the next worst state in foster care entry rates, and that’s Alaska,” Samples said.

In 2000, six out of every 1,000 West Virginia children entered foster care. In 2021, 13 out of every 1,000 West Virginia children entered foster care. West Virginia’s entry rate increased 117 percent from 2000 to 2021.

According to the U.S. Department of Health and Human Services Administration for Children and Families Administration on Children, Youth and Families Children’s Bureau, in 2020, West Virginia had the highest percentage of children nationally suffering from substantiated maltreatment with drug abuse by the caregiver.

2020 CDC data also showed West Virginia had the highest rate nationally of infants screened in by Child Protective Services (CPS) with prenatal substance exposure.

Also in 2020, there were 712 babies screened in by CPS in West Virginia with drug exposure, compared to 526 babies screened in California, which has a population of 39.5 million people. West Virginia has a population of 1.7 million people.

“We only have about 17,000 babies born in the state a year,” Samples said. “It’s not a lot. If you extrapolate from our birth score numbers, then you’re looking at and not just the difference between neonatal abstinence syndrome (NAS) and in uterine substance exposure. NAS is worse. The babies basically full-blown addicted, is kind of the simple way to say it. we’re looking at around 2,500 babies every year that are exposed to drugs in the womb.”

The Future

In his final address to the legislature, Samples told lawmakers West Virginia’s drug epidemic response needs to be reevaluated.

“The most important thing we need to do, in my opinion, is we need to measure what matters so that we can then pivot and organically improve our response to this crisis,” Samples said. “We need to measure every aspect of our substance use disorder policies and expenditures, and we need to tie it back to a core societal measure.”

Samples left lawmakers with a list of proposed policy solutions including:

Mandatory Treatment (Casey’s Law)
SUD Transparency Act: SUD Outcome and Expenditure Dashboard
Save Babies from Drugs Act
Improve CPS Management of Cases with Drug Addiction
Measure Outcomes of Recovery Homes
Analysis of syringe exchange outcomes and criminal penalties for illegal needle distribution
Enhanced drug testing and SUD services for those on government benefits
SUD Relocation Supports
Public Reporting on SUD expenditures and program outcomes
Expenditure and Opportunities Audit:
Ending Addiction Amongst Inmate Population
Expand Inmate SUD Services via RSAT and GOALS programs
Develop a ratio of law enforcement needs across communities and increase funding for more officers

“Our economy still struggling, I would propose that really we look at 10 core measures and that we use a smarter approach, which is really just an acronym for specific, measurable, attainable, relevant, time, evaluated and resourced,” Samples said.

Samples said he is “leaving the legislature next month,” but offered no further information after thanking legislative staff and lawmakers.

“It’s been an honor,” Samples said. “The President and the Speaker have been great to me. You all have been great to me. You know you’re wonderful people, and I’ll just always be available to you, should you need anything. I believe in this body, and I believe what you do, and I believe in your hearts.”

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Marshall Health.

Fears of Hidden HIV in Rural West Virginia

Among U.S. states, West Virginia ranks 18th in the rate of new HIV infections. But it may be an incomplete picture, especially in rural communities, where some health officials worry that cases are going undetected.

Among U.S. states, West Virginia ranks 18th in the rate of new HIV infections. But that may not be the full picture, especially in rural communities, where some health officials are concerned that cases are going undetected.

Mingo County, in the far southwest of the state, is illustrative. On a late July morning, Keith Blankenship, the administrator of the Mingo County Health Department, is showing off his state of the art, mobile medical van: a 27-foot Mercedes, with just a few hundred miles on the odometer.

“It has a refrigerator. All it does lack is a sink; you have to use a portable hand washing station.” Blankenship said as he pointed to a small cart neatly packed with medical items, “We still have some of our supplies in there. We’ve done a lot of testing.”

Last year, Blankenship sent this van around the county, seeking out people to test for HIV. Over the course of a few months, he estimates they tested around 300 people. Even in that relatively small group, several people tested positive for HIV.

But you wouldn’t know it from the official state tally. West Virginia publishes a regular report showing HIV diagnoses by county. The data is preliminary, but gives health officials an indication of trends and potential trouble spots. For Mingo County, 2022 onwards shows nothing but zeroes, i.e. zero new cases.

Blankenship knows that’s not accurate, but he also knows that reporting a case requires a second, confirmatory test. Last year, when the county nurse tried to follow up and do a second test on those patients, they were nowhere to be found. Of the people who had tested positive, most were homeless or lacked a permanent address.

“Most times we only get one shot, or one chance to work with the person,” Blankenship said.

A spokeswoman for the state Department of Health (WVDH) told us in an email that the agency doesn’t have all the details in Mingo County, but that the agency has staff around the state, who help track people down to conduct confirmatory testing and to connect those patients with care.

“Even so, there are instances where individuals are not found. This is common among certain at-risk populations where unstable housing or drug misuse may be a factor,” the email read.

But Mingo County isn’t alone. In Nicholas County, according to Health Officer Anita Stewart, the state only confirmed four HIV cases in the past two years. But Stewart said the official count is just the tip of the iceberg.

“My concern is that if we have one case, we know that we have at least two to three more that are undiagnosed in our community already,” said Stewart. “And if it’s related to injection drug use, it’s probably higher than that.”

She said that data showing zero cases in intravenous drug users in Nicholas County does not reflect reality. Asked how big an issue HIV is in Nicholas and other small counties, Stewart replied, “It’s hard to know.”

One big reason is that in most counties, there is no regular outreach and testing program. As Blankenship explained, “You can’t get numbers if you don’t test for numbers.”

In Mingo County, the testing program he started is now on hold because the health department no longer has access to the mobile medical unit. Blankenship said the van was on loan from West Virginia’s Center for Threat Preparedness, but last October, he was told he could no longer operate it because there was no money allocated to pay for fuel, licensing, inspections and other maintenance.

Today, the van is parked in a lot within view of Blankenship’s third-floor office in downtown Williamson.

“I can look at it every day out my window,” he said.

The email statement from the WVDH called it “speculation” that there might be more HIV cases than are being reported. But it also said, “HIV testing is essential for improving the health of people living with HIV and reducing new HIV infections,” and that increased screening “is essential for identifying new cases especially amongst high-risk populations, such as individuals who inject drugs.”

In most rural counties, outreach to people at high risk for HIV involves a patchwork of small organizations. For a large swath of southern West Virginia, the job of knitting them together falls to Brooke Parker, a social worker with the Ryan White Program based at Charleston Area Medical Center. She coordinates efforts across 22 counties, in many cases enlisting local organizations that can conduct testing under what’s known as a CLIA waiver – essentially, an extension of the license to conduct medical testing, held by Charleston Area Medical Center.

“It means that we can empower smaller groups or volunteers, even though they’re not healthcare providers,” she explained.

Parker relies heavily on the knowledge of local peer counselors and volunteers. “Our peer recovery coaches in the community are powerhouses,” added Parker. “They know the people better than any of us ever will.”

One July afternoon, Parker headed to Lincoln County, about halfway between Charleston and Huntington. As far as she knows, there’s been no HIV testing in Lincoln County since late last summer. But she’s been connected with a woman who works at a local clinic and wants to help.

“Lindsy was telling me that she has people regularly asking her, ‘where can I get tested for HIV?’” Parker said.

Parker’s goal was to conduct a few tests, and to assess whether Lindsy Bias, a peer counselor, is ready to handle a testing program, going forward.

If she can, Parker said, “This is the targeted testing that I’ve been missing in Lincoln County for a long time.”

In nine of the past ten years, Lincoln County reported zero HIV cases in intravenous drug users. But between them, Parker and Bias personally know at least two residents who currently receive HIV treatment in either Charleston or Huntington.

“Our assumption is that there’s more cases than we know about,” said Parker.

The two women meet for the first time in a parking lot near West Hamlin. Asked if she believes the tally of zero reported cases, Bias scoffs. “It’s because nobody’s getting tested.”

Parker sets up her gear on the open bed of her pickup truck. It’s a simple, efficient assembly line. The initial finger prick takes blood for an Oraquick rapid HIV test, which produces results in about 20 minutes. She also runs tests for Hepatitis-C, syphilis, and finally a second HIV test, called the INSTI, which delivers results in just 60 seconds.

With two different tests, there’s no issue of having to find the patient to confirm results. Parker makes good use of the waiting period.

“It’s a point in time where you’ve got someone’s undivided attention,” she said. “I have people sitting with me and talking to me for 15 minutes at a time, which is amazing.”

She asks about barriers to health care, and about personal risk factors like drug use.

“Is there an opportunity for harm reduction education to come in? Fifteen minutes is enough time to teach someone how to bleach their syringes,” Parker said.

After running a few tests in the parking lot, it’s time for a house call. With Bias’ car leading the way, the group turned on a narrow dirt lane and drove another mile until reaching a spot with two small houses and a man in front, wrestling with the engine of a riding mower. Parker backed her truck into the driveway, as men, women and two friendly dogs trickle out to meet us.

Bias knows them all. They’ve been asking her about testing. A tall woman, around 50 years old, helps everyone read and sign the consent paperwork. One by one, they step forward to let Parker prick their fingers.

The tall woman said it’s been years since she was tested for HIV, which was the last time she went to rehab. She wants to go back, but said she needs to find someone who will take care of her dog while she’s gone. In the meantime she’s nervous about getting an infection, but said she probably wouldn’t have gotten herself tested if not for the home visit.

Parker has a routine. As each person’s test strip gives results, she asks them to come with her on a short walk, away from the group. She shares the news and answers questions in private. Today, most of the news is good, but a few people test positive for Hepatitis-C. She and Bias explain how treatment works. For those who don’t have insurance, Bias promised to come by the next day with paperwork, to help them sign up.

It’s a start, but every place presents a fresh challenge. In Nicholas County, “We’re trying to use data to help drive where we test,” Stewart said .

By closely monitoring the sites of overdoses as well as infections like syphilis and gonorrhea, she aims to focus testing on the people at highest risk, which stretches the budget of her small department.

“Our resources are very, very limited, whether that’s testing, supplies or staff capacity,” she said.

In Mingo County, Blankenship is still lobbying state officials to get his mobile unit back on the road. He said he’s just had an encouraging conversation with a senior official at the Center for Threat Preparedness.

“I’ve got high hopes,” Blankenship said. “I think that everybody involved wants to do the right thing, get it back on the road. As usual, there’s always legalities, but we’re trying to let our voice be heard, that the people of Mingo County deserve that van to be put in use.”

Editor’s Note: This story is part of a series we’re calling “Public Health, Public Trust,” running through August. It is a collaboration with the Global Health Reporting Center and is supported by the Pulitzer Center.

Needles And HIV Plus A Virginia Author’s New Book, This West Virginia Morning

Major HIV outbreaks in Huntington and Charleston over recent years have exposed conflicting views on the disease among state officials and national experts. Most disagreement surrounds a single topic: needles.

On this West Virginia Morning, major HIV outbreaks in Huntington and Charleston over recent years have exposed conflicting views on the disease among state officials and national experts. Most disagreement surrounds a single topic: needles.

West Virginia Public Broadcasting and the Global Health Reporting Center report together on this issue, with support from the Pulitzer Center. It was reported by Caleb Hellerman, with production help from Emily Rice, as part of an ongoing series called “Public Health, Public Trust.”

Also this episode, southwestern Virginia author Jim Minick is a staple at Appalachian book and literary festivals. The author or editor of eight books, his latest is called “The Intimacy of Spoons.”

Inside Appalachia‘s Bill Lynch talked with Minick about Appalachian book festivals and writing about silverware.

West Virginia Morning is a production of West Virginia Public Broadcasting, which is solely responsible for its content.

Support for our news bureaus comes from Shepherd University.

Maria Young produced this episode.

Listen to West Virginia Morning weekdays at 7:43 a.m. on WVPB Radio or subscribe to the podcast and never miss an episode. #WVMorning

What Happened to ‘The Nation’s Most Concerning HIV Outbreak?’

At the height of the COVID outbreak, Charleston, West Virginia was sideswiped by a second deadly epidemic: what the Centers for Disease Control (CDC) called the most concerning outbreak of HIV in the entire country.

At the height of the COVID-19 outbreak, Charleston, West Virginia was sideswiped by a second deadly epidemic: what the Centers for Disease Control (CDC) called the most concerning outbreak of HIV in the entire country. It came on the heels of a similar outbreak in Huntington, West Virginia, both driven by shared needle use among injection drug users. There was a bitter tug-of-war over how to respond, but it led to an intensive effort to reach the people most at risk.

Every Tuesday, a team from Charleston Area Medical Center drives two brightly painted minibuses to the west side of Charleston and set up shop in an empty parking lot on Washington Street. The operation is overseen by Christine Teague, director of the Ryan White program for HIV care.

“We provide comprehensive HIV early intervention services, which includes testing, linkage to care and medical and support services for people who are diagnosed with HIV,” said Teague.

By lunchtime, they have seen about two dozen patients, which makes this a typical Tuesday. With the smell of barbecue floating across the street, and storm clouds threatening, they linger and talk around a folding table and a few chairs, under a small white tent.

Cameron, a 38-year-old with a scraggly beard and a big grin, is there to pick up his HIV medication, and a little something for his dog Bailey. She’s whimpering for a treat. Cameron was diagnosed with HIV a few years ago, in the early days of the outbreak that swept through Charleston, back when he was still injecting drugs. He started treatment at the hospital clinic, but a lack of transportation made it challenging to make appointments.

“It’s more of a hassle,” Cameron said, who lives about two blocks from the parking lot where he’s just picked up his medication. “I don’t drive. I don’t have a license. I don’t have the transportation, and it’s just easier for me to walk here.”

Continuity of care is critical. Effective HIV treatment requires regular lab work to ensure that medication is keeping the virus in check. Sticking to a daily medication routine is a particular challenge for patients who are homeless or facing other tough circumstances. While a typical package of antiviral medication might include 30 days’ worth of pills, Teague’s team offers seven-day packets, which patients can renew each week when they stop by for a checkup.

Teague estimated that 80 percent of the patients at the minibuses are HIV-positive. They’re regulars. Along with medication, they are offered hygiene products, snacks and $10 gift cards, while greeting friends or just taking time to rest.

Like most people there, Megan assumed she caught the virus from a shared needle. Her initial diagnosis, in May 2021, came as a shock. “I’m a germaphobe,” she says with an embarrassed smile. “Now I’m a germaphobe with HIV.”

Now, she’s seven months pregnant. On the rare Tuesday when Megan doesn’t show up, someone else on the medical team walks to Megan’s apartment to deliver meds and check in.

“Cassie brought her breakfast the other day, because she didn’t have anything to eat,” nurse Shawna Walker said. “We’re just trying to support her in whatever little way an HIV program can, I mean, that’s not literally what we do, but we don’t want that baby to be positive, so we go to extraordinary lengths to help people.”

Megan’s diagnosis was part of an alarming wave of new cases in Charleston. Just a few months earlier, in October 2020, Dr. Teague had volunteered to test people at a get-together organized by SOAR, a local harm-reduction group. Of 40 people who underwent the tests, seven tested positive for HIV.

“With each one, my eyes just got bigger and bigger,” she said. “It’s a crisis [because] if there’s seven here, there’s going to be a hundred out there because the average contacts are three or four per person.”

National experts from the CDC came to help the investigation, and issued recommendations in August, 2021. Topping the list was a proposal to expand access to clean needles, the very type of program that the county health department had ended back in 2018.

Rather than follow this guidance, the state and then the city of Charleston passed new laws making it even harder for needle exchanges to operate.

But here the story takes a surprising turn. In 2021, Kanawha County saw 46 new cases in IV drug users. The following year, that number fell by half, and fell by half again, in 2023.

Dr. Steven Eshenaur, health officer and executive director of the Kanawha-Charleston Health Department, said this year is on track to be even lower.

“I think we’ve definitely turned the corner,” Eshenaur said. “For the past six or seven quarters, we’ve only had one new case per quarter in Kanawha County. That’s a remarkable turn.”

Some experts are cautious. They say the lower case count could just be a result of there being less HIV testing. But Eshenaur is confident that the decrease is real, and Teague agrees.

“People will often say, well, are your numbers down just because you’re not looking for it as much,” said Teague. “And I would say, in the community, there’s probably not as much [testing], but in the hospital, probably more, and we’re not seeing the same rate of positivity that we were three years ago.”

When it comes to addressing the outbreak, Eshenaur said, needle exchanges are just one piece of the pie.

“Identifying and treating the patients that have HIV was the single most important part of that. Those are the big pieces of the pie that really brought down our number of cases.”

Antiviral medication is central to the effort. For people at high risk, medication can actually prevent HIV infection in the first place. The regimen is called pre-exposure prophylaxis, or PrEP.

Medication also serves as prevention around a person who is infected. If the level of virus in their blood is low enough, controlled by medication, they will not pass the virus to others. When the virus is controlled, HIV patients can go on to live long, healthy lives.

Back at the minibuses, Cameron said that getting diagnosed and staying on medication, actually helped him to stop using drugs.

“I was able to get clean. I was able to find housing,” Cameron said. “It made me stop and realize that I could do those things, for some reason.”

Teague says she’s learned to be creative and flexible in how her team delivers care. This brand of care is labor intensive and intensely personal. For patients like Cameron and Megan, that’s what it takes.

If not for the minibuses, says Megan, “I don’t think a lot of people would get care. I really don’t.” She pauses to wipe away a tear. “I’m pregnant and emotional. Sorry!” She said she’s scared to miss a dose of her medicine, and is doing everything she can to make sure her baby is born healthy. So far, it’s working. Doctors tell her that the level of virus in her blood is now so low, her baby should be fine.

Editor’s Note: That story is part of a series we’re calling “Public Health, Public Trust,” running through August. It is a collaboration with the Global Health Reporting Center and is supported by the Pulitzer Center.

Revisiting An HIV Outbreak And Building Homes On Old Mine Sites, This West Virginia Morning

At the height of the COVID outbreak, Charleston was sideswiped by a second deadly epidemic: what the Centers for Disease Control called the most concerning outbreak of HIV in the entire country. There was a bitter tug-of-war over how to respond. But where did that leave the patients, and the people most at risk? And what’s happened to the outbreak since then?

On this West Virginia Morning, at the height of the COVID outbreak, Charleston was sideswiped by a second deadly epidemic: what the Centers for Disease Control called the most concerning outbreak of HIV in the entire country. There was a bitter tug-of-war over how to respond. But where did that leave the patients, and the people most at risk? And what’s happened to the outbreak since then?

West Virginia Public Broadcasting has joined with the Global Health Reporting Center, supported by the Pulitzer Center, for this story. This is the first of a series of joint stories we’re bringing you throughout August.

Plus, Kentucky has a bold plan to create seven new neighborhoods, most on top of old mining sites in the eastern part of the state. In the second installment of a three-part series on high ground housing Kentucky Public Radio’s Justin Hicks reports with the new communities, come some new challenges.

West Virginia Morning is a production of West Virginia Public Broadcasting, which is solely responsible for its content.

Support for our news bureaus comes from Shepherd University.

Maria Young produced this episode.

Listen to West Virginia Morning weekdays at 7:43 a.m. on WVPB Radio or subscribe to the podcast and never miss an episode. #WVMorning

Theater Production Brings Story Of AIDS Epidemic’s Impact On Black Americans To Eastern Panhandle

Donja R. Love’s “What Will Happen To All That Beauty” is showing in Shepherdstown throughout July as part of the annual Contemporary American Theater Festival.

In 2019, Black Americans accounted for more than 41 percent of AIDS cases in the United States, according to the Centers for Disease Control and Prevention.

But Donja R. Love, a playwright based in New York, says he rarely sees that reality reflected in the arts. More often, retellings of the AIDS epidemic forgo discussions of race entirely.

“I didn’t see myself reflected in the works. These works often hold space for white, cis queer affluent men. That’s not my story, and that’s not the story of so many folks who I know,” Love said. “So I wanted to do, as a dramatist, my part to say ‘I see you. I see me. I see us.’”

For Love, that meant writing his latest theater piece, “What Will Happen to All That Beauty?” — a multigenerational story about how the AIDS epidemic impacted a Black family in the 1980s.

Love’s production is showing throughout July at the Contemporary American Theater Festival at Shepherd University, an annual event that has brought together artists from across the country since 1991.

But Love doesn’t refer to the work as a play.

“I call it an offering. And I call it an offering because I think it’s so important to note that historically, throughout theater and just society, people of color, specifically Black folks, have been left out of the conversation around HIV and AIDS,” he said. “So this is a way for me to offer representation, to offer softness, grace, beauty and love to a community that for so long may not have felt that.”

House Management Intern Savana Petranoff scans an attendee’s entry ticket for a production at the Contemporary American Theater Festival.

*Photo Credit: Jack Walker/West Virginia Public Broadcasting*

This theme of compassion being denied to Black people living with HIV comes up throughout Love’s piece. But the story also shows how Black LGBTQ people still created spaces for community and compassion, often through one another.

Coming from New York, Love says putting a production on in West Virginia seemed daunting. He wasn’t sure what his reception would be like as a Black LGBTQ creative visiting the Mountain State.

But he’s found that people have been welcoming, and that audiences have been receptive to his work even when they might not personally relate to its content.

“The folks who may see themselves most reflected in the work may not be the ones most reflected in the audience,” Love said.

But Love says that means the piece, for many, can offer a moment of learning.

“Hey, now I know this thing. Now I know what’s happening. What can I do with the access that I have, with the resources that I have?” he said.

Folks involved with organizing the festival say the type of learning Love talks about is something they consciously want to bring to West Virginia.

The annual Contemporary American Theater Festival is held at the Marinoff Theater, located at Shepherd University in Shepherdstown.

*Photo Credit: Jack Walker/West Virginia Public Broadcasting*

“As one of the major cultural institutions in West Virginia, it is our duty and our responsibility to serve the community here,” said Peggy McKowen, the festival’s artistic director.

For her, serving the community partially means bringing high-quality productions to the state, and encouraging community members to show up with initiatives like recurring discounted rates for West Virginia residents. But it also means something a little deeper.

“Our responsibility to do that is what enables us to provide the opportunity for this kind of art, which is really asking the audience to participate, to be involved in, to really think about, to profoundly receive and feel something,” she said.

Like Love, McKowen said conversations that begin in theater can translate to real-life learning and change. Associate artistic director Theresa H. Davis says the festival’s influence extends even beyond the Eastern Panhandle.

“We have people that come from all over the country. Last year, I met a couple that said they heard about us [and] drove all the way from Florida to see the shows,” Davis said. “We are very proud to be able to produce work that brings together a community of festival friends from all over.”

Love, McKowen and Davis emphasize that getting the festival up and running is a team effort, requiring the support of production staff, actors and even audience members themselves.

In addition to Love’s piece, there’s a slate of four other plays running through the end of our month. To learn more or purchase a ticket to these performances, visit the Contemporary American Theater Festival’s website at catf.org.