Syringe program restrictions led to severe HIV outbreak in rural W.Va.; state often leaves local health depts. in the dark

Most residents of West Virginia now live more than 75 miles from a
sterile-syringe program. (Graphic by The Guardian; click on it to enlarge)

West Virginia is seeing a severe outbreak of the human immunodeficiency virus (HIV) that causes AIDS, spurred by state restrictions on clean-syringe programs for intravenous drug users, The Guardian reports. The problem may be particularly severe in rural areas, which now have even less access to the programs.

"Kanawha County, where Charleston is the seat, diagnosed 40 people who inject drugs with HIV in 2020, about as many as New York City, a place 47 times more populous," Jessica Glenza reports. "Last year, the head of HIV prevention at the Centers for Disease Control and Prevention warned Kanawha had the nation’s 'most concerning' outbreak of HIV among injection drug users." Cases began rising there in 2018 after the city restricted syringe programs. Soon afterward, nearby Huntington, then the state, followed suit. Since 2018, nearly half of such programs in the state shut down.

"The new law requires programs to offer a range of health services in addition to the exchange, only serve people with a West Virginia ID card, and aim to get one used syringe back for each new one they give out," Quenton King reports for Mountain State Spotlight.

Glenza reports, "The restrictions mean that almost 1 million people in West Virginia, the state with the highest drug overdose rate in the U.S. for nine years running, now live between 20 and 75 miles of the nearest needle exchange. Meanwhile, experts worry HIV is spreading undetected in rural West Virginia, where testing and treatment is limited."

However, it's difficult to assess the impact of HIV in rural areas: To preserve patients' privacy, the state's health department only releases ballpark numbers, King reports. That means even county health departments are in the dark about the local extent of the problem, and they are generally left out of the loop on HIV cases.

Robin Pollini, a substance-abuse and infectious-disease epidemiologist at West Virginia University, "says that it should be considered a significant concern when HIV appears in any county that previously had no cases, but especially in rural counties where access to care is limited," King reports. "There are actions that counties can take — from ramping up testing to creating harm reduction programs — by just knowing the number of HIV cases popping up in the county."

But local agencies might have a difficult time responding even if they knew about new cases. "With the current landscape — stressed by Covid, underfunded, and with new laws restricting the types of harm reduction programs they can offer — county health departments have few opportunities to address potential outbreaks, even if they see them coming," King.