West Virginia Is Trying To Block Needle Exchanges Amid The Worst HIV Outbreak In The US

 A dangerous HIV outbreak gripping Charleston, West Virginia, comes even as the state is trying to dismantle one among the foremost effective ways to prevent it: needle exchanges.

Undercover cops have run stings on a volunteer group that distributes clean needles from parking lots within the city’s neglected side. And lawmakers are moving not just to outlaw the program, but to criminalize it.

“I’ve been here 25 years, and this is often the most important problem like this I’ve seen here,” said clinical pharmacist Christine Teague. She helped spot the city’s HIV outbreak while volunteering with Solutions Oriented Addiction Response (or SOAR), the needle exchange group now in the middle of the state’s legal fight.

The outbreak has spread to 50 people, most of whom are intravenous drug users. The stunningly high HIV rate is now alarming public health experts nationwide.

“The outbreak is that the most concerning HIV outbreak within us at this point,” Demetre Daskalakis, the HIV prevention chief at the CDC, said in an email to BuzzFeed News. “It is feasible the present case count represents the tip of the iceberg.”

Last month, Daskalakis spoke to the Charleston council about the outbreak, explaining that the textbook public health response would be to extend needle exchanges.

Instead, the West Virginia state legislature has moved to dam such programs. Last week, the state senate passed a bill, now into account within the state’s House of Delegates, that might give local sheriffs final say over needle exchanges, require the tracking and returning of each needle, and impose criminal penalties for operating without a license — a restriction aimed directly at shutting down SOAR. Public health experts say the bill is extremely dangerous and comes at a time when needle exchanges are needed most.

“Two of the four largest HIV outbreaks within the country are here in West Virginia, which is that the background during which they're trying to shut these programs down — ongoing rapid transmission of HIV,” said epidemiologist Robin Pollini of West Virginia University, pointing to a different recent outbreak in nearby Cabell County. The state has had a decades-long problem with illicit drug use that started with the overprescription of pain pills, leading people hooked into opioids to start out injecting heroin, fentanyl, and methamphetamine.

Long controversial as an intervention that “enabled” drug use, needle exchanges gained acceptance amid an overdose epidemic that killed quite half 1,000,000 people nationwide within the last decade. The Trump administration endorsed the programs as a public health measure in 2019.

The Charleston health department pack up its own needle exchange in 2018, spurring SOAR to require its place. The West Virginia health commissioner who involved its closure, Rahul Gupta, is reportedly into account to become the Biden administration’s “drug czar,” drawing fire from public health experts critical of his approach to the opioid epidemic.

Home to 178,000 people, Charleston, and its surrounding county now have a better rate of latest HIV cases among people that inject drugs than ny City, consistent with the CDC. The outbreak is another sign of the US’s ongoing problem with opioid-related diseases, made worse by an epidemic that’s led to record overdose deaths and hobbled public health departments.

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“It’s a public health disaster,” said epidemiologist Gregg Gonsalves of the Yale School of Public Health. Closing needle exchanges, like Charleston, did in 2018, likely contributed to the new HIV outbreak, he suggested. “Epidemics like this don’t begin of nowhere.”

As the pandemic started, SOAR volunteers quietly distributed needles and therefore the overdose-reversing drug, naloxone, said the group’s co-leader, Joe Solomon. On the city’s side, where nearly 30% of properties are abandoned, they gave out clean needles from their cars, then moved to grocery parking lots until they were chased off by police. Finally, the program turned to its current location, a Unitarian Church parking zone. “This is all driven by the pandemic. We had to seek out how to assist people,” Solomon said.

The group also tested people for HIV, spotting a number of the primary signs of the present outbreak. From August to October, eight of the 120 HIV tests they administered came back positive. “For a city this size, that’s huge,” said Christine Teague, who administered the tests for SOAR and is the medical director of the Charleston Area Medical Center’s HIV center. Teague quickly notified the town and state about the cases.

But in October, the group became the topic of local TV news reports that portrayed its efforts as suspicious, Solomon said. At an equivalent time, the town local department began an investigation, dispatching informants and undercover officers to request needles.

A Jan. 12 police report investigating SOAR’s efforts called its motives “unknown” and concluded that it gave each participant 30 clean needles, along with side naloxone and disposal containers, “condones the utilization of illegal substances” and “increased the probability of used needles being discarded instead of disposed of properly.” The report also noted that the group had given an HIV test to an undercover cop at one among its weekend needle exchanges. In an almost comic ending, the police report concluded that the group couldn't be prosecuted because it had been not selling needles, and since a city law requiring that needle exchanges be state-licensed was unenforceable since the state didn't offer licenses.

The police didn't reach bent the group for his or her investigation. Charleston’s chief of police didn't answer an invitation for comment from BuzzFeed News.

Nationwide, there are quite 300 needle exchange programs, which usually provide clean needles and naloxone to people that use intravenous drugs. Decades of public health research show that needle exchanges limit outbreaks of HIV, hepatitis, and other illnesses among IV drug users, cutting the danger of those diseases by an estimated 50%.

Nevertheless, their status in many nations remains contentious. West Virginia is one among many nations where politicians have tried to limit them, often citing complaints about needle litter where they operate.

Sherri Young, executive of the Charleston health department, told BuzzFeed News that the city’s now-shuttered needle exchange program was “very damaging to the community, damaging to the health department.” She added, “I don’t desire the community seems like they need us to be a part of the needle service.” Young cited a city survey of fireside, police, and structure personnel released on Monday, which showed that 17% of respondents reported being stuck by needles at some point on the work. quite 80% said they felt that exchanges should require a one-for-one needle return and disagreed that there was a requirement to expand syringe services.

Instead, in response to the HIV outbreak, Young last week announced that the health department would expand testing, including a mobile van intended to succeed in people “living in abandoned houses and under bridges.” people that test positive for HIV will have housing assistance offered to them, she said, but the health department won't offer needle exchange services, despite what the CDC’s HIV prevention chief, Daskalakis, recommended. “I’m concerned that, but I do need to follow the direction of my board and that I do need to remain within the law,” Young said.

The new bill’s sponsor, Republican state Sen. Eric Tarr, a physiotherapist, read aloud from the police work into SOAR in his testimony about the bill, using it to argue for more enforcement oversight of needle exchanges.

Tarr claimed drug use within the state was due to shoddy recovery homes that “import IV drug users into West Virginia .” He argued that instead of reducing disease, needle exchanges promote crime, though studies have shown this is often false. Last year, Tarr pushed a bill attempting to outlaw needle exchanges altogether. Now, he said, he supports creating licenses for exchanges overseen by the police, offering an amendment to his bill to offer sheriffs veto power over programs and requiring patients to enroll in recovery programs to receive bar-coded needles.

Public health experts who spoke with BuzzFeed News fiercely opposed the bill, arguing it might effectively block needle exchanges from operating and will cause a much bigger HIV outbreak, as initially happened in Indiana in 2014. therein state, then-governor Mike Pence resisted allowing needle exchanges for months as a dangerous HIV outbreak spread during a southern county.

The basic biology of the white plague means people that are physically hooked on opioids will inject them to avoid withdrawal symptoms whether there are needle exchanges or not. Providing people with clean needles may be a cheap intervention in comparison with the $510,000 per person it takes to treat patients with HIV. And it stops outbreaks: When Indiana started offering people clean needles and access to recovery programs in 2015, HIV cases within the affected counties dropped by 75%.

“We aren't pleased with the direction this bill is taking,” said Laura Jones, executive of the Milan Puskar Health Right clinic in Morgantown, West Virginia, which runs a needle exchange therein city, one among quite a dozen within the state.

“The whole idea is meeting people where they're at so that they learn they will trust you, and seeing a substance use disorder as ill-health — not something for the county sheriff to oversee,” Jones added. “It’s like making every diabetic account for each needle they use.”

Multiple components of the West Virginia Senate bill go against the CDC’s best practices for needle exchanges, said West Virginia University’s Pollini, like the one-for-one needle return (impractical for people experiencing homelessness, whose possessions are regularly lost, stolen, or impounded), the need that participants sign contracts to receive needles (a high hurdle for people that are frightened of being arrested), and law enforcement’s authority over the programs.

“The foundation for the opposition is simply a really poor understanding of the science, or resistance to the science altogether,” Pollini said.

As SOAR continues to distribute needles and conduct HIV tests, the group’s volunteers are now taking direct action training in anticipation of the state outlawing their efforts.

In a letter to the Charleston council in February, the top of the opposite needle exchange on the city’s side supported requirements for a one-for-one needle return policy. It adopted the policy after the city’s own program closed, but more people use SOAR’s needle exchange program on the side. The side program was “a model that was started necessarily, and that I think it's time to revisit,” said Teague, who is affiliated with both sites. “It’s clear we aren't meeting the requirements of the community, or we wouldn’t have the outbreak.”

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