CHARLESTON, W.Va. – Brooke Parker has spent the past two years helping to combat the HIV epidemic that has disproportionately affected those living on the fringes of the community, combining homeless neighborhoods, abandoned homes and roads less traveled along the river.

She goes out of her way to build trust in the people she meets and offers water, condoms, referrals to services, and opportunities to get tested for HIV — anything that might be helpful to someone in need.

Since 2018, she has seen how active work is fighting the ongoing HIV epidemic in the city and nearby areas. She also saw the political toll of the effort.

Parker, 38, is a care coordinator. Ryan White HIV/AIDS ProgramA federal initiative that provides nationwide HIV-related services. Her work helped build roads in a particularly hard-to-reach community. It is becoming increasingly difficult to find a place to spend the night without being touched by the police. And many in this close-knit group of homeless individuals and families are reeling from the recent death from complications of AIDS of a woman Parker knew well.

The woman was not yet in her 30s. Parker encouraged her to seek medical care, but she lived on the streets; Each day brought new challenges. If Parker had been able to meet basic needs and get a few good nights’ sleep to clear her head, she would have been more likely to receive care.

As political winds blow against efforts to control the state’s growing HIV epidemic, Parker and a cadre of experts believe such losses will continue and likely worsen.

In the year In August 2021, the Centers for Disease Control and Prevention completed its investigation of an HIV outbreak in Kanawha County, home to Charleston, where people who inject opioids and methamphetamine are at high risk. They called the CDC’s chief of HIV prevention.”The most serious HIV epidemic in the United States“And he warned that the number of reported cases may only be the “tip of the iceberg”.

HIV is easily transmitted through contaminated needles; The CDC reports that the virus may occur They survive up to 42 days in the used syringe. Studies show that providing clean needles to people who use IV drugs is effective in combating the spread of HIV.

Following the investigation, the CDC He gave recommendations To promote and improve sterile injections, diagnosis and treatment. He urged the authorities to look for easy access to services.

But in the midst of this crisis, state and local government officials have enacted laws and regulations that make it difficult to obtain clean needles. In April 2021 State Legislature enacted legislation. It limits the number of syringes people exchange and requires them to present identification. The Charleston City Council added an ordinance that would provide for criminal charges for violations.

As a result, advocates say, a large number of those at high risk for HIV are vulnerable and undiagnosed.

Public health experts also worry that HIV infection is spreading in nearby rural areas; It is difficult to find a sterile needle and test.

Joe Solomon is executive director. Solutions oriented addiction responseAn organization that provided clean syringes in exchange for infected people in Kanawha County. Solomon said the CDC’s recommendations are what SOAR once offered, like co-locating essential services. But SOAR has stopped short of exchanging needles in efforts to criminalize such activity.

Solomon was recently elected to the Charleston City Council Measures to deal with the drug crisis in the regionThe response to so-called harm reduction is “an attack on public health,” he said.

Epidemiologists agree: Side-by-side syringe exchange and HIV testing, which are helping to stimulate HIV testing, may exacerbate the HIV epidemic.

Fifty six new cases In 2021, 46 of the 2021 HIV cases reported in Kanawha County — a population of less than 180,000 — were linked to injection drug use. At the end of November, 27 new cases It has been reported This year, 20 related to drug injection.

But the CDC’s “tip of the iceberg” assessment resonates with researchers and advocates. West Virginia epidemiologist Robin Pollini interviewed people with needlestick-related HIV in the county. “They’re all saying syringe sharing is rampant,” she says. She believes it is reasonable to estimate that there are more than 20 people in the county who have contracted HIV from contaminated needles this year.

Pollini is among those who worry that testing initiatives are not reaching the most vulnerable people: people who use illegal drugs, many of whom are transient, and who may have reason to be wary of authorities.

“I don’t think you can really know how many cases there are unless you have a very smart trial strategy and a very strong relationship,” she said.

Studies show ongoing, well-targeted testing Access to clean needles It can effectively slow or stop the HIV epidemic.

In the year In late 2015, the Kanawha-Charleston Health Department started a syringe exchange, but in 2018 He closed it After the city imposed restrictions on the exchange of needles and who can receive them. Then-Mayor Danny Jones called it “a mini-mall for junkies and drug dealers.”

When authorities abandoned the effort, SOAR began hosting health fairs and exchanging used clean needles. He also distributed the opioid overdose drug naloxone; Provides treatment, referrals and fellowships; and offered an HIV test.

But when the new state restrictions and local criminal law were implemented, SOAR stopped exchanging needles, and attendance at the fairs declined.

“it is Undisputed and well founded. It is comprehensive; It’s inclusive,” Pollini said of the research that supports syringe exchange. “You can’t even get funding to study the effectiveness of syringe service programs because the science behind what they do is based on that.”

In the year Syringe exchange has been credited with preventing an HIV outbreak in Scott County, Indiana, involving more than 200 intravenous drug users in 2015. At that time, then-Gov. Mike Pence – After being defensive at first – Approved the first of the state Syringe service.

A team of epidemiologists in a study with the Scott County Health Department determined that stopping the program would result in a nearly 60% increase in HIV infections. But in June 2021, local officials voted to close it.

In Kanawha County, SOAR was getting in. Interviews with many customers highlighted that people felt safe at the health fairs. You may request services anonymously. But many find that the promise of clean needles brings them back.

Based in Charleston West Virginia Health Rights Dr. Steven Ischnauer, executive director of the Kanawha-Charleston Health Department, operates a syringe exchange that he says has helped reduce the number of new HIV diagnoses. But advocates say the restrictions imposed — particularly the ID requirement, which many potential customers lack — will hinder its success.

HIV tests are available this year in nearby Cabell County, and Pollini fears the HIV epidemic could take root in the state if more aggressive action is not taken. As of Dec. 1, 24 of West Virginia’s 55 counties had reported at least one positive test this year.

HIV It can be prevented. it is. Also treatableBut the treatment is expensive. The average cost of anti-HIV medication is from 36,000 to 48,000 dollars per year. “If you’re 20, you could be 70 or 80,” says Christine Teague, director of the Ryan White Program in Charleston. This is a cost of over $2 million.

Saving lives and money requires both being proactive — ongoing, comprehensive testing — and responding when issues arise, he said.

It also requires “meeting people where they are” as it is often said – building trust that opens the door to education about what HIV is, how it is spread and how to fight it.

Tege also said he wanted one more thing: addressing the basic needs of the fringes; Above all, housing.

Parker agrees: “They become worshipers of low-barrier and transitional housing.”

But Teague questions the political will to fully address HIV among West Virginia’s most vulnerable.

“I hate to say it, but people seem to think this is a group of people who are beyond help,” she says.


KN (Kaiser Health News) is a national news division that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of the three major work programs on the KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides information to the nation on health issues.

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