VALID MEASURE OF A WORSENING OPIOID CRISIS: DRUG INJECTION RELATED HIV CONTINUES TO SURGE IN WEST VIRGINIA
As a measure of high-risk use, persistently surging injection opioid use (IOU) is further confirmation of gold standard treatment failure, of a worsening crisis, and of attempts to hide it
by Clark Miller
Published December 31, 2024
This August 2024 headline describes well the pressing issues –
Dangerous effects of that underfunding, as we’ll see in additional reports, include the certain undercounting of numbers of new cases, most of which are tied to high-risk injection use of opioids.
“Not having the supplies is why they’re at risk of HIV,” said Stewart, the top doctor at the Nicholas County Health Department.
And her fear appears to be coming to pass. Over the past 18 months, she said health workers have detected at least four positive HIV cases in Nicholas County.
“We’ve never had a cluster here, and we haven’t had a new case of HIV in several years,” she said. “Until last year.
That limited budget means that Stewart and the Nicholas County Health Department can no longer afford rapid HIV tests, which are important for identifying people with HIV and connecting them with treatment. She’s now unsure of whether, like in other parts of the state, Nicholas County has more undiagnosed people with the disease.
Concerns are not limited to Dr. Stewart’s county.
Across the state, county health agencies already lacked the money needed to prevent and treat HIV, said Greg Puckett, a member of the West Virginia Public Health Advisory Committee and a Mercer County commissioner. …
“We have massive amounts of HIV that is undocumented,” Puckett said. “I’m 100% confident of it, because we are not testing enough.”
And in another county,
In Ohio County, health workers detected six new cases of HIV in the first half of 2024. It’s a significant increase in a county that averaged just three cases a year from 2016 to 2020.
“Are there additional cases out there? Probably,” said Howard Gamble, the Wheeling-Ohio County Health Department administrator.
By 2019, 64 percent of HIV cases in W. Virginia were attributed to injection drug use, dramatically up from 2014, and contentious opposition to existing clean needle exchange programs began to limit that resource, accurately predicted to become associated with increased cases.
Established links among the opioid crisis, injection opioid use, and HIV incidence are emphasized by W. Virginia public health officials, including infectious disease expert Dr. Sally Hodder, characterizing those elements as “so interconnected, we have to look at this as one larger issue, and treat it as such.”
Syringe programs survived and appear to provide protection in some areas, with intensive outreach efforts.
From an August 2024 report –
It’s a big operation. But when it comes to harm reduction, the footprint is small. Official filings show that Health Right handed out around two-thousand clean syringes last year. By comparison, the harm reduction program in Fayette County, with less than a quarter of Kanawha’s population, gave out 120,000.
Robin Pollini says it’s like fighting an epidemic with one hand tied behind your back.
“You have sort of a perfect storm of people with undiagnosed HIV in settings where they have no access to syringes,” she said “I go and talk to people in the community who know what’s happening, and what they have told me is that syringe sharing is rampant.”
And yet, even as needle exchanges were cut back, HIV cases in Charleston and Huntington have declined. To fight their epidemics, both Kanawha and Cabell counties rely on other strategies. They have expanded testing efforts to identify cases early. They’ve gotten more patients into treatment and they try to convince IV drug users to take antiviral medication, a regimen which can actually block HIV infection.
Settle said there’s been too much emphasis on syringe programs.
“Handing out syringes is easy,” said Settle. “The hard work is connecting with people, getting people into recovery. Because all this ties together: the HIV problem, recovery, trying to get people back on their feet. Because at the end of the day, if you get people to stop injecting, that ends the risk altogether.”
Clearly underlying those efforts are grave concerns of need for sustained, intensive, multiple approaches to address and moderate the high-risk and largely unreached behaviors generating HIV risk – injection opioid use.
Is that high-risk opioid use – a valid measure of worsening crisis and gold standard treatment failure – increasing?
Again from an August 2024 investigation –
Last year, Blankenship sent this van around the county, seeking out people to test for HIV. Over the course of a few months, he estimates they tested around 300 people. Even in that relatively small group, several people tested positive for HIV.
But you wouldn’t know it from the official state tally. West Virginia publishes a regular report showing HIV diagnoses by county. The data is preliminary, but gives health officials an indication of trends and potential trouble spots. For Mingo County, 2022 onwards shows nothing but zeroes, i.e. zero new cases.
Blankenship knows that’s not accurate, but he also knows that reporting a case requires a second, confirmatory test. Last year, when the county nurse tried to follow up and do a second test on those patients, they were nowhere to be found. Of the people who had tested positive, most were homeless or lacked a permanent address.
And in another county,
In nine of the past ten years, Lincoln County reported zero HIV cases in intravenous drug users. But between them, Parker and Bias personally know at least two residents who currently receive HIV treatment in either Charleston or Huntington.
“Our assumption is that there’s more cases than we know about,” said Parker.
The two women meet for the first time in a parking lot near West Hamlin. Asked if she believes the tally of zero reported cases, Bias scoffs. “It’s because nobody’s getting tested.”
And most recently, from a December 2024 news piece in the West Virginia Watch –
Now, despite attention and resources directed toward the outbreak, researchers and health workers say HIV continues to spread. In large part, they say, the outbreak lingers because of restrictions state and local policymakers have placed on syringe exchange efforts. …
Robin Pollini is a West Virginia University epidemiologist who conducts community-based research on injection drug use. …
Pollini said it’s difficult to estimate the number of people in West Virginia with HIV because there’s no coordinated strategy for testing; all efforts are localized.
“You would think that in a state that had the worst HIV outbreak in the country,” she said, “by this time we would have a statewide testing strategy.” …
“If you go out and look for infections,” Pollini said, “you will find them.”
Solomon and Pollini praised the ongoing outreach efforts — through riverside encampments, in abandoned houses, down county roads — of the Ryan White HIV/AIDS Program to test those at highest risk: people known to be injecting drugs.
But Christine Teague, Ryan White Program director at the Charleston Area Medical Center, acknowledged it hasn’t been enough. In addition to HIV, her concerns include the high incidence of hepatitis C and endocarditis, a life-threatening inflammation of the lining of the heart’s chambers and valves, and the cost of hospital resources needed to address them.
“We’ve presented that data to the legislature,” she said, “that it’s not just HIV, it’s all these other lengthy hospital admissions that, essentially, Medicaid is paying for. And nothing seems to penetrate.”
Those local-level, on-the-ground, and direct-service observations and reports paint a picture, the confirmed HIV cases one piece of that.
As in our clear understanding of recent, targeted, intense community level outreach and provision of naloxone resulting in thousands of prevented deaths in communities, the underlying, unreported and unidentified levels of surging high-risk opioid use are real, in fact are what required the desperate campaigns to begin to moderate deaths, including in West Virginia.
There are no compelling or moving clinical, ethical, public policy or other arguments against the provision, as harm reduction, of naloxone, of clean needles, of outreach for HIV testing.
And, it is vitally important to recognize those measures as what they are: emergency, responsive, stop-gap measures to save lives while the underlying drivers of risk persist and worsen over decades of failure of expert gold standard medical and “recovery” programming.
The only risk, a lethal one, from those emergency campaigns to save lives is risk of failure to indict the perverse, characterological impulses of America’s expert class and Medical/Media collusion to employ and distort the emergency reduction of deaths to fabricate claims of gains against a crisis of untreated, compulsive high-risk substance use that persistently worsens as provision of expert cures increases.
