A West Virginia organization called Community Education Group was recently awarded $500,000 to combat the spread of HIV in the state.
West Virginia is currently experiencing its fourth HIV outbreak in three years, driven by the state’s ongoing opioid crisis. The grant from Gilead Sciences will enable the organization to coordinate community response to the state’s growing HIV crisis by funding programs that use an integrated approach to preventing HIV, viral hepatitis and opioid usage.
Since the spike in HIV cases is connected with injection drug use, the Community Education Group plans to work with established regional coalitions that are already addressing the opioid epidemic. The organization’s goal is to integrate HIV education, training and policy development into ongoing community efforts. At the same time the organization hopes to build an overarching statewide coalition to mobilize advocates, researchers, policymakers and experts to meet with legislators and contribute to future planning for leveraging federal resources.
A health director in Cabell County says new data shows the spread of HIV is slowing following an outbreak of the disease over the past year.
Cabell-Huntington Health Department Medical Director Dr. Michael Kilkenny spoke with the county’s Board of Health last Wednesday.
The Herald-Dispatch reports Kilkenny said that from October to January only two new HIV cases were documented in Cabell. That is down compared to the average of six cases reported per month last year.
An uptick in HIV cases have been monitored in Cabell county since 2018, and an outbreak was confirmed by March of last year. As of January 16 there were 76 confirmed cases, according to the West Virginia Bureau for Public Health. Prior to the outbreak, Cabell saw an average of eight cases per year.
Kilkenny links the slow down to an aggressive harm reduction program; however, he said the county is maintaining an emergency response level for now.
Health officials in Huntington, West Virginia, say a cluster of HIV infections has grown to 71 confirmed cases. That’s in a city that usually sees about eight HIV infections in a year. As with an earlier such cluster in northern Kentucky, officials say the primary cause of infection is needle drug use.
Health officials say a harm reduction program is an effective tool against HIV infection. The programs usually offer a syringe exchange, access to addiction counseling, and health screening services such as HIV testing.
Credit Alexandra Kanik / Ohio Valley ReSource
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Ohio Valley ReSource
The programs have expanded rapidly in the Ohio Valley, a region hit hard by the opioid crisis and at highest risk in the nation of infectious disease outbreaks due to needle drug use.
But many people remain wary of syringe exchanges, and health officials are concerned that a backlash means some programs will close just when they’re most needed. The Huntington cluster of HIV cases appears to be correlated with the controversial closure of a nearby harm reduction program.
“The boomerang effect, the recoil, is going to be if these programs start closing, you’re going to see explosions of blood-borne pathogens, specifically HIV,” said Dr. Michael Brumage, director of the Preventive Medicine Residency Program in the West Virginia University School of Public Health.
High-Risk Region
In 2016 the Centers for Disease Control and Prevention spotlighted the counties in the U.S. at the highest risk of an HIV outbreak. Of the 220 high-risk counties, about a quarter were in Kentucky, West Virginia, and Ohio. The ten counties CDC found at highest risk were all in Kentucky and West Virginia.
Public health officials in the region have been working to implement syringe exchange harm reduction programs, which are widely supported as the most effective tool in combating HIV and other infectious diseases associated with needle drug use.
“It takes a while for them to build that level of trust up to come in,” he said. “That’s their one bridge, where they can be respected, and be given nothing but help to stay healthy.”
Corby-Lee said HIV prevention is the primary focus.
“That’s what they were designed for. But there are a lot of other benefits that come with it,” he said, such as peer counseling and screening for other diseases, such as Hepatitis C.
Credit Mary Meehan / Ohio Valley ReSource
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Ohio Valley ReSource
HIV/AIDS educator Greg Corby-Lee talking about harm reduction.
Corby-Lee said prevention and testing for HIV are becoming more widely available in the area, and stigma – which can thwart outreach, testing and treatment – is gradually diminishing.
But he and other health officials also worry about a backlash brewing in many communities, threatening the harm reduction programs. They fear that misconceptions about the programs may threaten the very communities at greatest risk of an outbreak.
Daniel Raymond is Deputy Director of Planning and Policy for the National Harm Reduction Coalition. He said that while harm reduction programs are generally expanding, some are closing in the communities where they are needed most. The programs can become the focal point for other problems associated with the addiction crisis, he said, such as litter from used needles, homelessness, and petty crime.
“A lot of these programs have been starting in communities that don’t have a long history with harm reduction,” Raymond said. “So the programs that end up being at risk of closure are often the ones that are getting scapegoated for a community’s drug problem.”
Closure, then a Cluster
Dr. Brumage says that’s part of the problem he encountered when leading a harm reduction program in Charleston, West Virginia. The program ended most of its services last year amid local political pressure and complaints about discarded needles.
“I think it’s a simplistic view to look at and blame one program for all of the city’s woes, with homelessness, with use, with all these other things,” Brumage said. “And I think that’s a trick that many politicians use very well, is to find a culprit scapegoat and to blame it rather than really looking at deeper issues.”
Credit Courtesy of West Virginia University
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Dr. Michael Brumage.
The deeper issue, he says, is that the HIV threat is real and not going away. Less prevention equals more sick people. In Huntington, one person in the HIV cluster has died. However, Brumage is concerned that some Huntington residents are now viewing the cluster of infections as evidence to close its harm reduction program as well.
“Currently, some people in that community are saying, ‘Well, look, we have the syringe program, and we still got HIV, maybe we just need to close the program,’” he said. “The fact that you have a fire doesn’t mean you should close the fire department. You know, you bring more trucks on the scene.”
Brumage worries that the closure of the Charleston program may have contributed to the rise in HIV infections Huntington is now experiencing. The two cities are less than an hour’s drive apart along Interstate 64. And Brumage argues that Huntington’s cluster of infections could be much worse without a syringe exchange in place.
“My guess is had Huntington not had a syringe program, this problem would have exploded far worse.”
Other health officials say the growing HIV cluster in Huntington is a cautionary tale.
“It’s the looming disaster that we were all afraid of,” West Virginia University School of Medicine Professor Dr. Judith Feinberg told Mother Jones magazine.
Signs of Hope
Still, harm reduction proponents remain optimistic. The National Harm Reduction Coalition says that for every program closing, 20 more open. Kentucky has witnessed rapid growth in such programs.
Van Ingram, who leads Kentucky’s Office of Drug Control Policy, said that has only been possible with a fundamental shift in thinking about drug use as a health problem instead of a problem for law enforcement. He admits he was skeptical that the programs could take root in Kentucky. But it’s happening.
Credit Kentucky Drug Control Policy Office
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Kentucky Drug Control Policy Director Van Ingram.
“I never dreamed we’d have 56 programs,” he said. “I did not think as many communities would have said, ‘Yes, we have a problem, and yes, we’re addressing big issues.’ Those communities are much, much quicker in recognizing the problem than I thought they would. I’m glad to say, I was wrong.”
Bourbon County, Kentucky, is an example of the phenomenon Ingram is describing. After several failed votes the county approved a syringe exchange program last year. Judge Executive Mike Williams said he braced for the complaints and backlash.
“I got gas yesterday afternoon and had three conversations at the gas pump about three different things,” he said, but the syringe program was not one of the things people had concerns about.
Since the syringe program opened, helping about 100 people, he said he’s only heard concerns from three people.
West Virginia officials say the number of HIV cases in Cabell County has risen to 71.The state Department of Health and Human Resources posted the figure…
West Virginia officials say the number of HIV cases in Cabell County has risen to 71.
The state Department of Health and Human Resources posted the figure on Monday, saying the virus has spread primarily among intravenous drug users.
The cluster, tracked since January 2018, represents a drastic increase from the baseline average of eight cases annually over the past five years. Officials confirmed last month that one person associated with the cluster has died.
Dr. Cathy Slemp of the state Department of Health and Human Resources told The Register-Herald that there haven’t been any indications that the cases have spread outside Cabell County.
The health department says it is working to find gaps in health care and prevention coverage.
Health officials in a northern West Virginia community are expressing concern about an increase in HIV cases.
The Intelligencer reports Wheeling-Ohio County Health Department administrator Howard Gamble said six cases of the human immunodeficiency virus have been reported in Ohio County so far this year.
Gamble said the cases are classified as a cluster because they have a similar location and time frame. He said they don’t have a common source, but all are linked to intravenous drug use and prostitution.
Gamble said the cases are of concern because it could result in an outbreak if testing, prevention and education aren’t enhanced.
He said the area had two new cases of HIV reported in 2015 and three new cases reported in 2016. No new cases were reported last year.
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.
Credit courtesy Darryl Cannady
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Darryl Cannady is the executive director of South Central Educational Development
“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.
Credit Darryl Cannady, South Central Educational Development
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The south Central Educational Development building is located inside a former church in downtown Bluefield, W.Va.
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.”
Credit WVU
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Dr. Gordon Smith
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.
Credit WVU
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Dr. Judith Feinberg
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.
