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Syringe Distribution Meets City Roadblock Amid Ordinance Concerns

A volunteer-run harm-reduction group in the city of Charleston called SOAR has come under fire from city officials for distributing syringes as part of its “mobile outreach” efforts.

A representative from SOAR (Solutions Oriented Addiction Response) says group members started distributing syringes some time after the 2018 shutdown of the Kanawha Charleston Health Department syringe program.

SOAR shut down its program three weeks ago after the city’s police chief claimed they were violating a municipal ordinance. However, the city’s ordinance may not actually prohibit anyone from distributing syringes.

Volunteers with SOAR set up a tent in Charleston, WV.

Every two weeks, SOAR sets up tables in a church parking lot to provide free services to anyone that wants them. People come to get anything from rapid-HIV testing and wound treatment, to a cup of hot chocolate and a conversation. Volunteers pass out supplies like Naloxone, snacks, and condoms. Until three weeks ago, these supplies included sterile syringes for anyone who needed them. People, like Tommy, who lives in the streets.

Tommy spoke out about the problem on Thanksgiving, sitting under a bridge in Charleston. Tommy said now that SOAR has stopped giving out sterile syringes, he’s had to Macgyver his old needles in order to reuse them.

“I had to take a matchbook because you use the striker as your sandpaper to try to sharpen the end of that needle back.”

As he talked, Tommy took out two syringes — a clean one and an old one that he’s tried to sharpen back into shape. Despite his efforts, the old syringe looked a little crooked. To demonstrate how dull his old needle was, he jabbed it against a plastic bag he was holding in his other hand.

“Well, you see how it’s bent? I mean, it was a ‘Z’ the other day.” Holding up the old syringe, he said, “I had no choice, but to use this. It barely goes through the plastic.”

Tommy said when access to clean syringes dries up, people often resort to buying used ones. “You’ve got this black market out here where you’re buying a used needle. Now, yeah, you’re trying to bleach it. You’re trying to — but where’d it come from?”

Experts say limiting access to needles doesn’t impact addictions.

“In 20 years of doing this work, I’ve never met a person who said: If I didn’t have access to sterile syringes, I would stop injecting,” said Robin Pollini, a researcher at WVU, who holds a Ph.D. in public health from Johns Hopkins. “It just doesn’t work that way.”

Pollini says this isn’t the first time the City of Charleston has shut down a harm reduction program. In 2018, the Kanawha- Charleston Health Department’s sterile syringe program closed its doors after the city put restrictions on it — restrictions, she says, that prevented the program from operating according to best practices as outlined by the CDC.

“They were serving a very large number of people, which is what you want these programs to do, because you need to have enough people having access to sterile syringes, to reduce the transmission of disease.”

The WV Center on Budget & Policy recently released a report that confirms Pollini’s point. The study looked at HIV transmission from people reusing needles in Kanawha County. It found the rate of HIV transmission started going up 2018, the same year the KCHD’s syringe program shut down. As of October 2020, the transmission rate had increased by more than five times since the shutdown of the city’s program.

The report also showed that statewide the number of fatal overdoses from all drugs was down 15 percent over the past three years, in contrast to Kanawha County where the number has been rising steadily.

“Here’s a perfect case study of when you restrict these programs, and reduce the number of people who can use them, you are not effective in preventing disease in the community,” Pollini said.

According to Pollini, SOAR was picking up the city’s slack. But in recent interviews Mayor Amy Goodwin and Police Chief James Hunt have said SOAR’s syringe program was violating a municipal ordinance. The ordinance says that any person distributing syringes in Charleston has to first get “any and all licenses required under state law.” Hoyt Glazer, an attorney in Huntington, says there’s just one problem with the ordinance.

“At this point, I don’t see there’s any statute that requires licensure,” Glazer said of the W.Va. State Code.

Glazer says there is no license required by the state for people to distribute syringes. In fact, the state guidelines for syringe programs don’t even use the word “license.”

“It uses the word certification. A certification is different than licensing. And, I’m not aware of any statute that requires an entity to have actual licensing in order to go forward with the distribution of the syringes.”

He adds that anyone being told they can’t distribute syringes by city officials could have grounds to sue.

“If they’re going to challenge the person or program that’s providing the syringes, a person could possibly challenge that and make arguments that it was a violation of their rights to distribute materials that are not otherwise prohibited by the criminal code.”

The city’s attorney responded to West Virginia Public Broadcasting by saying that the city council may move to amend the ordinance in the future. The WV-ACLU, which represents SOAR, says it doesn’t currently plan to sue the city. In fact, a representative from SOAR says his organization is “eager to work hand in hand with the city to address public health and safety for our whole community.”

Under a bridge in downtown Charleston, Tommy said that “whole community” includes people like him—people who are suffering from addiction. In the weeks since SOAR stopped giving out syringes, Tommy says he’s seen someone pay $6 for another person’s used syringe. In recent weeks, he’s even had to use a set of pliers he carries with him, to remove a broken needle from a friend’s arm — a common occurrence when using old syringes, he said.

“They’ve got no choice but to use something that should have been retired last week.” According to Tommy, the problem of drug addiction isn’t going to be solved by taking resources away from people who inject drugs.

“Yes, there’s a problem. But, closing [syringe programs] down or turning your back to is not going to change the problem. Problem’s still here.”

Until sterile syringes are made accessible again, Tommy says a lot of his friends will still be here, too — on the streets of Charleston.

Rural Risk: Fighting Disease Amid The Opioid Crisis

Health officials in the Ohio Valley are investigating outbreaks of disease associated with needle drug use in what is emerging as a new public health threat from the region’s profound opioid addiction crisis.

In northern Kentucky the health department is tracking a cluster of 43 recent HIV cases, about half of which are related to needle drug use. In West Virginia, the Centers for Disease Control and Prevention just released a report on 40 new HIV cases diagnosed in 2017 in 15 mostly rural counties.

When CDC researchers looked for the country’s places most at risk for outbreaks of needle-borne diseases such as HIV and Hepatitis C, they found them in Kentucky, Ohio and West Virginia. The 2016 analysis found nearly a hundred counties in the Ohio Valley at high risk.

Health officials say the stigma associated with HIV can add to that risk. In rural communities, stigma can hinder monitoring, testing, and treatment and add to the risk of widespread outbreaks.

The stories of two rural West Virginia residents living with HIV show how powerful stigma can be and what it takes to overcome it.

Carl’s Story

Carl was in his senior year at Concord University in Mercer County, West Virginia, when he had some routine blood work done during a hospital admission.

“They found out that I was infected with HIV,” he said.

He thinks he contracted the disease from a same-sex partner. Even though he used protection, he said, his partner was careless one time.

In this story we use just Carl’s first name. He said it’s been a struggle telling people he has HIV because of the stigma against people with the disease.

“I have two people out of my entire family that know.”

Condoms and “shooting caps” available at a syringe service location

Even, among some doctors, Carl said, he encounters homophobia. He recalled an early visit to a doctor in nearby Beckley.

“She, in so many words said, ‘Well if I were you I wouldn’t have done the actions to get this,’” he remembered. “And that sent me spiraling, that a medical professional would be so crass to somebody that was so mentally fragile.”

At the time, Carl had just been diagnosed. He stopped taking his medication for a few days and almost gave up. Then he contacted the Ryan White program at Charleston Area Medical Center, where he now makes the two-hour round trip drive for check-up visits.

“Word Travels”

Tania Basta, who chairs the Department of Social and Public Health at Ohio University, has done research on the effects of stigma in rural Appalachia.

“There are providers who, in rural areas, unfortunately are still stigmatizing against their patients,” she said. “They may feel that, unfortunately, some people with HIV, they did this to themselves.”

Ohio University health researcher Tania Basta.

Like most places in central Appalachia, West Virginia does not have a high number of people with HIV or AIDS. At the end of 2016 the state health department recorded 1,746 people in West Virginia who were living with HIV.

But researchers like Basta worry about undiagnosed cases, especially in the rural areas of the state affected by the opioid crisis.

“Testing is an issue,” she said. “And I’m not saying that stigma is any higher in rural areas. It’s just that, because of the nature of living in small towns, where everybody kind of knows everybody, word travels quickly.”

The CDC report on the recent outbreak in West Virginia listed other factors contributing to the spread of disease: transportation from remote areas, poor health literacy, and stigma.

The new cases included both sexual transmission and needle drug use. Fourteen of the 15 counties where new cases were identified were on the CDC’s 2016 list of counties at high risk of disease. Yet only three of the counties had syringe service programs, which medical evidence shows is an effective way to reduce harm from drug use. Syringe services, also known as needle exchanges, can also serve as an opportunity to test for needle-borne disease.

Elena’s Story

Few people living with HIV or AIDS in southern West Virginia are willing to tell their stories in public. Elena Imes is one of them. She has lived with the disease for 18 years.

For many years before the disease progressed, Imes said, she did not know she had been infected by her husband. She worries that there are many undiagnosed cases in her community.

“Part of the problem is, the negativity of the disease itself, and the fear, and the stereotyping,” she said. People she meets often assume that “if you’ve got AIDS, you’ve probably did something bad, Christianly bad.”

And she sees that affecting people’s willingness to learn their HIV status

“They don’t want anyone to see them go take a test. Consequently, people don’t take the test.”

Imes has told her story to the media several times, but speaking out has brought some backlash. She recounted one incident from a few years ago, when she worked at a local Walmart.

Elena Imes at a World Aids Day event she organized

A woman recognized her from a TV news story.

“I know you, you’re from the TV, you’re killing us all!” Imes remembered the woman shouting in the parking lot, drawing a crowd. She accused Imes of infecting people by touching things when she stocked the shelves.

“That hurt so bad,” Imes said, tears welling up at the memory. “And that woman really thought she was warning everybody.”

Imes has had other experiences like this over the years. Another woman in her neighborhood was worried Imes could infect people by swimming at the local pool. So Imes stopped going there to swim.

But it hasn’t all been bad. She has neighbors and church friends who’ve been supportive and who check on her. She has four adopted sons, all grown, who stop by sometimes. But for the most part, she has no family to lean on.

Imes lives in a small wooden house in Coal City in Raleigh County, where she runs a small animal rescue service. As we step through the front door, pink curtains and a thin layer of frayed plastic cover holes in her windows. When I visited she wore five layers of clothes indoors to keep warm.

She weighs less than 80 pounds. Her health is deteriorating and she’s struggling to get by.

“Financially, I’m in ruin.”

She doesn’t work at Walmart anymore. A few years ago, she lost her mode of transportation. One night, she tried to hitchhike to work, and was raped. Her perpetrators were never caught. Now, she worries that those who raped her are unintentionally spreading the disease.

Staying Put

As I listened to Imes tell her story, and Carl, I wondered why they stay where they are.

Imes said one reason is because she wants to stay and help other people who have the same disease.

“I would tell them the worst thing they could do is to keep it a secret,” she said. “If you can toughen up, you need to share it, be open about it. That’s the problem, if more people were open then the stigma wouldn’t be there.”

Because she’s been in the media telling her story Imes has become almost a one-woman support system for people here who have HIV. That’s something Carl said people need more of.

“The biggest fear that someone with this has this infection has is doing it alone,” he said. “And that often causes you to become depressed because you are lonely.”

I asked Carl if he’s ever considered moving to a bigger city, where he’d have access to medical treatment closer to home, and where he wouldn’t have to feel shame at his church, or at his local pharmacy.

“I would rather live here and put up a front then move somewhere and be myself,” he said. “I know that sounds kind of odd, but I do love this place. It is a beautiful place.”

Although he is worried that this article will lead his friends and family to find out he has HIV, Carl said he thinks it’s worth the risk. Telling his story might help someone decide to get tested.

Ohio Valley ReSource reporter Aaron Payne contributed to this report.

New Raleigh Group Hopes to Unite West Virginia Gay Population

There are several organizations in West Virginia that advocate on behalf of the lesbian, gay, bi-sexual and transgender community. Now, a new center in Beckley hopes to encourage communication between them and the gay population of the southern part of the state.

The West Virginia Gay and Lesbian Community Center is a non-profit organization that hopes to bring about communication among the different organizations in West Virginia that focus on gay rights.

Robert Dunlap is a lawyer in Beckley and an adjunct professor at Concord University. He helped cofound the organization and currently serves as its president.

“We really have a strong commitment to seeing Beckley be a more conducive place,
Dunlap said. “I mean frankly there’s not a focus on young gay West Virginians or older gay West Virginians. It’s something we’re reaching out widespread, across the strata.”

To help make Beckley a place of communication, the WVGLCC hopes to team up with other organizations across the state including Fairness West Virginia, West Virginia Equal, and PFLAG, which stands for Parents, Families Friends and Allies United with LGBT people. He claims only identify with what he calls ‘niche groups.’ Dunlap thinks Beckley also seemed like the ideal location because of the central location: it’s within a 45 to 50 minute drive from most of West Virginia’s largest cities.

Homelessness among LGBT youth is one issue the group plans on tackling. The National Coalition for the Homeless reports that 20 percent of the homeless population in this country are so because they’ve been rejected by their families.

Vice President Hannah Barker says she knows firsthand those who have been turned away.

“On a personal experience, many of my friends that I’ve had have come out to their families and they have been kicked out of their houses,” she said. “Stemming off that, many of their friends have had the same experience”

Not only that, but LGBT youth have been known to skip school because they’re bullied, affecting their academic future. The Center wants to better educate the schools and colleges around the state. But Barker realizes some of the roadblocks of acceptance from public schools.

“I feel that it is going to be a challenge.” Barker said, “But ultimately I hope that we can help the school, kind of give them information, help them understand, hey this is a really big issue that’s happening and it’s really important for young people to have the resources they need so they can continue going to school and have the normal resources any teenager would have.”

Another advocacy mission the new group hopes to take on is HIV prevention. The West Virginia Department of Health and Human Resources reports that there are just under 2,000 people living with HIV/AIDs in the state. The Center was recently given 5 thousand OraQuick testing units with the hopes of providing free, confidential testing. The center also hopes to provide post diagnostic testing.

Mike Adkins has two friends with HIV and says that most West Virginians are in the dark about the disease.

“People here really have no information of HIV,” Adkins said. “They’re not educated in it. They’re still fearful of what it means, thinking, ‘oh my god I can catch it by touching.’

So, why do these people choose to stay in West Virginia?

“Really we’re just happy to be here,” Dunlap said. “But we look after our own. We have a community that hasn’t always been present in Beckley. In Appalachia.”

Kathrine is a mother of an LGBT-identifying teen in the organization. She agreed with Dunlap’s sentiment.

“Why does the state want to throw out productive people,” she asked. “We have a hard enough time with the image in this state. You’ve got smart people, you’re going to make them leave when this state needs educated, competent people.”