The HIV Status of the Union

Perfectly placed among the Appalachian Mountains’ scenic valleys and rivers, it is not hard to understand why Charleston, West Virginia became the state’s capital in 1877. The historic region first made headlines for its abundance of resourceful salt deposits that fell in Union hands during the Civil War, and Trump’s campaign promise to revive the coal industry brought the area’s struggles to national attention in 2017. But as of late, the city has stepped into the spotlight for a different reason.

Sporadic HIV cases have been on the West Virginia Department of Health’s radar since 2017.

The high rate can be attributed to West Virginians’ easy access to prescriptions, as “West Virginia providers wrote 69.3 opioid prescriptions for every 100 persons, compared to the average U.S. rate of 51.4 prescriptions” in 2018 according to the National Institute on Drug Abuse. This abundance of access provides a gateway to addiction and other opioids like heroin that require injection.

Low economic conditions and drugs always go hand in hand. The state has been financially deteriorating for the past few years due to the dying coal industry. Bill Raney, President of the West Virginia Coal Association said “Job losses and poverty are the fertile ground in which drug abuse grows . . . many of our people have simply given up looking for jobs. They have lost their homes, their cars, their dreams, and their hope” in an interview with Forbes.

In Kanawha County, which houses the city of Charleston, 44 active cases of HIV were recorded in 2020, according to state data. The count may seem small but is extremely alarming for the state’s capital. For reference, New York City reported 36 HIV cases in 2019, according to the CDC. As the most populated city in West Virginia, it is a likely reflection of what is soon to come statewide.

Christin Teague, a clinical pharmacist in Charleston, spotted the HIV outbreak through volunteering with the SOAR SEP (Syringe Exchange Program). When someone comes in to receive new needles, the group also offers the opioid overdose reversal drug Naloxone (Narcan), condoms, and HIV tests. Groups like SOAR, Solutions Oriented Addiction Response, are working hard to provide aid through this growing crisis. The group is one of the many programs that has given out clean needles to prevent the spread of disease from sharing needles.

Unfortunately, legislative boundaries have been blocking needle exchange initiatives from reaching maximum efficacy for years. Eliminating exchange programs is undoubtedly to blame for the recent HIV outbreak. Even though SEPs have been proven to reduce cases, according to the CDC, some still argue that such programs create crime and enable users to abuse opioids. Lawmakers against SEPs often create policies that sneakily legally disqualify programs, leaving very few standing if any at all. The county has chosen to not provide proper assistance and on top of that, fights against those that are working to do so, contributing to worsening the HIV outbreak.

The outbreak can be traced back to the 2018 shutdown of the Kanawha Charleston Health Department’s Syringe Exchange Program in 2018. A community attitude, shaped by a lack of education and distorted fears around crime, favored getting rid of the programs. Reports of first responders being accidentally stuck with needles only added fuel to the fire, spooking the whole town. The community wanted to ignore the issue to make it appear as if there were no drug users living in the city, only people commuting to come to programs.

This was devastating for participants. One 40-year-old man said the workers at the KCHD, “made me feel like I was a person” in a 2019 study. That study also found that “PWID (persons who inject drugs) described more frequently injecting with used syringes and engaging in a range of high-risk injection practices after the SSP was suspended,” leading to the current pending epidemic. Without access to clean needles, users likely reverted back to sharing with whoever they met, reigniting the spread of HIV.

Grassroots Charleston programs such as SOAR stepped up to fill the space left by the KCHD. Due to a lack of communication with the government, most intel about what was going on with the program came from an undercover investigation by the KCPD. Police investigation created an image that organizations were shady and once again caused speculation within the community. SOAR became the next target and met the same fate as the health department.

The most recent development was passed on April 10, 27-7. Senate Bill 334 implemented a new licensing policy with the Office for Health Facility Licensure and Certification, ensuring tight governmental oversight over all distribution. All distributors without a license must suspend activity until their application has been approved by the office, once again leaving participants in the dust. These examples supply a vivid picture of what is currently taking place all over the South. Crushing programs that could save citizens from HIV, other diseases, and even an overdose, is a heartless act.

On top of facilities closing down, the emergence of COVID-19 accelerated the speed of HIV spread. As the coronavirus began to dominate the nation’s health resources and news coverage in early 2020, it left those suffering from opioid addiction falling down the ladder of national priority.

Opioid use, specifically in the forms of heroin and fentanyl, nationally disproportionately affects the same groups that are suffering the most from COVID-19, groups of color. But how is this happening if White people make up the majority of opioid users?

Charleston’s 74 percent White population deems it a city that perfectly illustrates how the narrative opioid crisis is skewed by the media. News coverage largely centers around testimonials of White patients falling into a hole of abusing their prescribed pain medicine. The city population does line up with the national rate, as White Americans make up 80 percent of opioid overdoses according to PBS. The danger of this association of opioids with Whiteness is that it excludes populations of people of color from access to resources and care for opioids.

In 2021, opioids hit the Native American community the hardest, with American Indians and Alaskan Natives 12 times more likely to die from meth overdose due to “dealers...lacing these non-opioid drugs with cheaper, yet potent, opioids to make a larger profit” according to the NY Times. Charleston’s population of color follows suit with national trends. For example, “American Indian/Alaska Native (15.9 per 1,000 births)” had the highest rates of Neonatal Opioid Withdrawal Syndrome (using opioids while pregnant, possibly leading to addiction after) in West Virginia, according to the National Institute on Drug Abuse.

Only 10 percent of people with an abuse problem in the general population seek treatment, according to the Substance Abuse and Mental Health Services Administration. For many people of color, getting hooked on opioids is essentially a death wish. Understandably, POC are less likely to seek treatment due to fear of being punished or jailed while trying to seek out help. Meanwhile, their White counterparts who do not have to deal with systemic oppression and all of the stigma that comes with it, have greater chances at recovery.

In a situation like this, it is hard to decipher who is really to blame for such a large crisis. Focus often turns back to the doctors and pharmaceutical companies, like Purdue Pharma, that let opioids loose on the market back in the 90s. Professionals knowingly misrepresented the risk of addiction, causing the deaths of around 50,000 people per year. These highly dangerous drugs infiltrated the country in a top-down fashion during each “wave” of substance, from prescription pills to the current era of fentanyl.

Former Charleston Mayor Danny Jones stated the solution to the drug problem is passing the ball to medical professionals to end the crisis. He stated "drug companies got us into this mess ....whatever needs to be done for these folks, should be incurred and paid for by the people that caused it. And if that meant that you would have prescribed drugs to wean people off, that was administered by a hospital, that's something worthy of having a conversation about” in a 2018 interview.

The idea that drugs “wean people off” is a perfect solution is a difficult point to make work in reality. Many who abuse opioids do not abuse them for a high as many assume. Most White people who are prescribed opioids are seeking pain relief from health conditions and injuries. People of color who do not have the means to afford healthcare turn to nonprescription opioids as their method of alleviating pain from health problems. This once again is caused by systemic racism. By excluding POC from access to healthcare, communities of color get bound to cycles of drugs, drug violence, and poverty.

Regardless of race, opioid addiction latches so easily because of strong withdrawal symptoms. Understanding this cycle of addiction is key to making decisions that benefit opioid users and help them on a path to recovery. SEP programs provide an invaluable opportunity to communicate with users and understand why they use and what they would need to begin a recovery process. This information could provide direction for a path to rid the country of this devastating disease.

One of the most powerful voices that destroyed the needle exchanges in Charleston is currently advising President Biden. Former West Virginia health commissioner Dr. Rahul Guptta publicly supported the suspension of the KCHD SEP program in 2018. As the leader of President Biden’s drug transition team in 2021, he does not have an official White House position yet. Unless he is able to influence federal legislation, his actions in Charleston won't be replicated on a national scale for now.

Interestingly, the Trump Administration’s policies tended to be more progressive on this topic. Secretary of Health from 2018 to 2021, Alex Azar, is an avid supporter of SEP programs. He also used his connections and expertise as a former pharmaceutical company president to gather support within the industry. Acknowledging the need to put politics aside, he said, “Syringe services programs aren’t necessarily the first thing that comes to mind when you think about a Republican Health secretary, but we’re in a battle between sickness and health, between life and death,” at the National HIV Prevention Conference in Washington in 2019.

The bright side is that the issue is not definitively partisan. Traditionally red states such as Georgia and Idaho made needle programs legal in 2019. With an epidemic on the horizon, there is no room for politics when there are millions of lives on the line. Fear of an HIV/AIDS epidemic like the one that loomed over the U.S. in the 80s is still very much a real threat, as many legislators were teenagers and young adults during the height. Recalling the mistakes and success in the 80s may prevent legislators from letting the country and their communities down in the next coming years.

Democrats and Republicans alike are brainstorming various possible solutions that make all parties involved feel heard and safe. On April 21, the Bipartisan Policy Center think tank with some of the brightest brains in the country met for the first time. The group is set to release an in depth-report with possible solutions for the crisis in early 2022.

While waiting on reports that are months away, grassroots volunteers are still working every day in towns like Charleston. Despite being raided and accused of illegal activity, SOAR is still not backing down. While they cannot distribute needles, they can still continue to provide resources for the same individuals that would come to exchanges. The group sends out texts offering snacks, naloxone, and HIV testing, efforts technically in no violation of any laws. In November 2020, the group sent a letter signed by more than 100 health care officials asking for permission to reopen exchanges from the West Virginia Department of Health. The group is also active almost daily on Facebook providing information on their latest efforts and updates on exchange program policy.

People have always been the priority of these organizations that realize one needle could determine the fate of someone struggling with abuse. This kind of unwavering resilience and compassion for others is what our most powerful systems should be modeled after. But until that day comes, local volunteers will continue to serve the people better than our current government model ever could.

By Taya Coates

VCU student, sunset enthusiast, and proud feminist passionate about making the world a better place.