CHARLESTON, W.Va. — Brooke Parker has spent the past two years scouring riverside homeless camps, abandoned homes, and low-traffic streets to help contain the lingering HIV outbreak that has severely affected to those living on the margins of society.
She shows up to build trust with the people she meets and provides water, condoms, referrals to services and the chance to get tested for HIV – anything she can get her hands on. may be useful to those in need.
She has witnessed first-hand how being proactive can combat the HIV outbreak that has persisted in the city and surrounding areas since 2018. She has also witnessed the cost of HIV. attempt to withdraw politically from this effort.
Parker, 38 years old, is the care coordinator for Ryan White HIV/AIDS Program, a federal initiative that provides HIV-related services nationwide. Her work has helped build pathways to a hard-to-reach community who have a particularly difficult time. It is becoming increasingly difficult to find a place to sleep overnight without being run over by the police. And many in this close-knit group of homeless individuals and families are still shaken by the recent death, from complications of AIDS, of a woman Parker knew well.
The woman is only 30 years old. Parker encouraged her to see a doctor, but she was living in an alley; Every day brings new challenges. If she can get her basic needs met, a few nights of sleep to clear her mind, she’s more likely to be willing to receive care, says Parker.
Parker and a team of experts believe such losses will continue and may worsen as political headwinds in the state blow away efforts to control the spreading HIV outbreak.
In August 2021, the Centers for Disease Control and Prevention concluded an investigation into an HIV outbreak in Kanawha County, home of Charleston, where people who inject drugs and methamphetamine are most at risk. The CDC’s director of HIV prevention called it “The most worrying HIV outbreak in the US” and warns that the number of diagnoses reported may be just “the tip of the iceberg”.
HIV spreads easily through contaminated needles; CDC reports that the virus can Lasts up to 42 days in a used syringe. Research shows that giving clean syringes to people who use intravenous drugs is effective in fighting the spread of HIV.
After exploration, CDC issue recommendations to expand and improve access to sterile syringes, testing and treatment. It urges officials to jointly locate services for easier access.
But in the midst of this crisis, state and local government officials have enacted laws and ordinances that make it more difficult to purchase clean syringes. In April 2021, The state legislature passed a bill limit the number of syringes people can exchange and require them to show identification. Charleston City Council has added an ordinance criminally charging violations.
As a result, advocates say, a significant number of those most at risk of HIV remain vulnerable and untested.
Public health experts also worry that HIV infection is gaining a foothold in neighboring rural areas, where it is harder to obtain sterile syringes and testing.
Joe Solomon is the co-director of Solution-oriented addiction response, an organization that previously provided clean syringes in exchange for contaminated syringes in Kanawha County. Solomon said the CDC recommendations are exactly what SOAR was used to: co-location of essential services. But SOAR stopped exchanging syringes in the face of attempts to criminalize that work.
Solomon, who was recently elected to the Charleston City Council on a platform that includes Measures against drug crisis in the regionsaid the backlash against so-called harm reduction was “an attack by the public on public health.”
Epidemiologists agree: They argue that stopping the exchange of syringes and the HIV testing they help catalyze could exacerbate the HIV outbreak.
Fifty-six new cases HIV was reported in 2021 in Kanawha County – which has a population of just under 180,000 – with 46 of those cases being attributed to drug use. End of November, 27 new cases reported This year, 20 involved injecting drugs.
But the CDC’s “tip of the iceberg” assessment resonates with researchers and advocates. Robin Pollini, a West Virginia epidemiologist, interviewed people in the county who contracted HIV related to injection. “They all say that sharing syringes is rampant,” she said. She believes it is reasonable to deduce that more than 20 people in the county have contracted HIV this year as a result of contaminated needles.
Pollini is among those concerned that trial initiatives are not reaching those most at risk: illicit drug users, many of whom are transient, and those with There may be reason to be wary of authority figures.
“I think you can’t really know how many cases there are unless you have a very knowledgeable testing strategy and a very strong outreach,” she said.
Research shows that sustainable, well-targeted testing is associated with access to clean needles can effectively slow or stop HIV outbreaks.
At the end of 2015, the Kanawha-Charleston Department of Health launched a syringe exchange, but in 2018 close it after the city imposed restrictions on how many syringes could be exchanged and who could receive them. Then-Mayor Danny Jones called it a “small mall for addicts and drug dealers”.
When officials abandoned the effort, SOAR began holding medical fairs where they exchanged clean syringes for used syringes. It also delivers the opioid overdose pain reliever naloxone; treatment offers, referrals and scholarships; and provide HIV testing.
But when new state restrictions and local criminal ordinances went into effect, SOAR stopped exchanging syringes and attendance at its fairs plummeted.
“Its indisputable and well established. It is comprehensive; it’s inclusive,” Pollini said of the research supporting syringe exchange. “You can’t even get funding to study the effectiveness of syringe service programs anymore because they work like proven science.”
Syringe exchange is credited with stopping an HIV outbreak in Scott County, Indiana, in 2015, after the disease spread to more than 200 people who inject drugs. At that time, then-Gov. Mike Pence — after initially being resisted – approved the state’s first syringe service.
A team of epidemiologists worked with the Scott County Department of Health on a study that determined that stopping the program would lead to an increase in HIV prevalence by nearly 60 percent. But in June 2021, local officials voted to close it.
In Kanawha County, SOAR is making inroads. Interviews with many customers highlight that people feel safe at their health fairs. They can search for services anonymously. But most admit that the promise of clean needles is what got them there.
based in Charleston West Virginia Health Rights runs a syringe exchange that Dr. Steven Eshenaur, executive director of the Kanawha-Charleston Department of Health, says has helped reduce the number of new HIV diagnoses. But proponents say that the constraints imposed – particularly the requirement to show an ID, which many potential customers don’t – have hindered its success.
HIV diagnoses have increased this year in neighboring Cabell County, and Pollini fears that without more drastic action, an HIV pandemic could erupt across the state. As of December 1, 24 of West Virginia’s 55 counties have reported at least one positive diagnosis this year.
HIV preventable. Its It is also treatableBut treatment is expensive. The average cost of an antiretroviral regimen ranges from $36,000 to $48,000 a year. “If you’re 20, you could live to be 70 or 80,” says Christine Teague, program director for Ryan White in Charleston. That’s a cost of over 2 million dollars.
To save lives and money, says Pollini, requires being both proactive — continuous, comprehensive testing — and reactive — ramping up efforts as cases grow.
It also requires “meeting people where they are,” as the saying goes – building trust, opening up educational opportunities about what HIV is, how it spreads and how to fight it.
Teague says it requires something more than that: addressing the basic needs of the marginalized; The most important is housing.
Parker agrees: “Transitional and low barrier housing would be a godsend.”
But Teague questions whether political will exists to counter the full force of HIV among those most at risk in West Virginia.
“I hate to say it, but people seem to think this is a group of people that can’t be helped,” she said.
