Kanawha County HIV rates decline for the first time since 2018

For the first time since 2021 — when the Centers for Disease Control and Prevention dubbed Kanawha County as home to “the most concerning” HIV outbreak in the nation tied to injected drug use — Dr. Christine Teague is feeling encouraged.

Teague, who runs the Ryan White HIV/AIDS Program at Charleston Area Medical Center, said the decrease in newly reported cases combined with the increase in viral suppression for many who are HIV-positive is good news for the region. It’s a silver lining as state policies, like heavy restrictions on syringe service programs, complicate response efforts known to quell the spread of such diseases.

In 2022, Kanawha County reported a total of 31 new HIV cases, with 24 of those tied to IV drug use. That’s a 44% decrease from 2021, when the rates peaked at 55 total cases with 46 tied to injected drug use. And it’s the first time case rates have dropped at all since 2018. 

Before that year, the average number of annual HIV cases in the county was 14, with just two of those tied to IV drug use, according to the state Department of Health and Human Resources. For the years between 2018 and 2022, the average number of cases involving intravenous drugs comparatively skyrocketed to 22 annually.

In the first half of 2023, there have been 10 total new HIV diagnoses in the county, and half of those involve drugs. If the rate continues at that pace, this year could be the second consecutive decrease for Kanawha.

Trusting the data

Teague and Angie Settle lead of West Virginia Health Right, which offers the only certified syringe service program in the area. They said people often question whether testing rates have decreased, and if that’s why there’s been a decline in cases. Neither of them, however, believe that’s the case, and they said there are multiple reasons to trust the data — even if it’s not perfect. 

For one, Teague said, there are fewer cases being diagnosed in hospital settings, where previously people who were very ill would test positive for the virus while receiving treatment for other ailments often tied to drug use.

“We’ve seen about one or two new positives in hospital settings over the last six to eight months, and that is incredible compared to before,” Teague said. 

Settle said this is an important metric to track: People previously were being diagnosed when they became very ill, sometimes due to HIV but often because of other, often related conditions like endocarditis, infected wounds and hepatitis.

Ongoing care

There’s also been more success recently in keeping people who test positive for HIV engaged in care, which historically has been a struggle for service providers in Kanawha County. Of about 35 people who frequent the Ryan White Program’s mobile unit, nearly 80% of them are now undetectable for HIV after ongoing treatments. 

“So while people still do have the virus, we’re clearly doing a better job at keeping them engaged with care and medication, which means they aren’t transmitting the virus anymore,” Teague said.

Service providers in recent years have developed more targeted outreach and testing efforts in the county. Previously, testing would be widely available to the public but not necessarily to high-risk populations, which include many people who are unhoused and drug users who are often cautious about interacting with medical providers due to negative experiences in their past.

Today, providers are putting more thought into where they go and how they build trust with at-risk people, Settle said. Health Right, for instance, uses what the organization calls “strike teams,” where people go out on the street regularly to talk with and test at-risk people. Teague said this means the positivity rate may increase for tests being administered, but that isn’t necessarily a bad thing.

“When we see that, we know we’re in the right place and testing the right people,” Teague said. “That is a positive when it comes to response efforts.”

Challenges persist, though, in finding long-term solutions for a problem that has been growing in the state for years.

Red tape for harm reduction

Until 2022, a task force existed in Kanawha County to help coordinate response efforts among service providers in the region. After the CDC’s visit two years ago, however, the task force was handed over to the state, and its meetings stopped being held publicly. Dr. Steven Eshenaur, head of the Kanawha-Charleston Health Department, which previously ran the meetings, said in April they are no longer open to the public so those attending can discuss private patient information. 

There are also questions about the state’s response. Last year, Teague said the Department of Health and Human Resources was compiling a five-year plan for its response to the HIV crisis. Teague has never seen that plan, however, and it’s unclear where the effort stands.

“The five-year plan has been approved and will be posted on the Bureau for Public Health’s website,” DHHR Interim Director of Communications Emily Hopta said in an email.

Representatives for the Department of Health and Human Resources did not respond to requests for comment by publication.

Underlying all of this is the fact that needs-based syringe service programs — the most effective at slowing the spread of infectious diseases among drug-using populations, according to a body of medical research dating back decades — are heavily restricted through both state statutes and, in Charleston, local ordinances.

Health Right’s syringe program is the only one operating in the region, and while it certainly fills a hole, Settle said there is “always more work to be done” when it comes to combating HIV and hepatitis rates.

Former abortion clinic looks to add syringe services to Charleston’s West Side 

The Women’s Health Center of West Virginia is applying for a state license to offer syringe services as part of its harm reduction program. It’s an arduous process, however, and requires the approval of the Charleston city council, the county commission and state regulatory agencies.

Katie Quiñonez, executive director of the center, said the red tape is worth cutting through, though, if it means more resources for people living with substance use disorder.

“Even one case [of HIV] a year is too many,” Quiñonez said.

‘We need to stay focused’

Iris Sidikman, coordinator for the harm reduction program at the Women’s Health Center, said it’s good to take note of decreases in disease rates but to not forget the context in which they occur.

“If cases are ‘coming down’ now, they’re coming down from what was an incredibly high number,” Sidikman said.

Teague said there still remains a lot of work before Kanawha and the rest of the state are in a position to truly celebrate HIV being under control. 

“There are still lots of missing pieces out there. What’s going on in our correctional facilities where there isn’t testing? Where is the state plan at? As a community or region, why are we not all doing more?” Teague asked.

There are still high barriers to care, and a lack of testing in more rural areas like eastern Kanawha County means case counts aren’t as accurate as they could be county-wide — even if they reflect improvements for Charleston. 

Because of the drop in case numbers, however, Teague said some have lost interest in doing the work, or at least paying attention to it.

“People have moved on now that the numbers are down,” Teague said. “But we need to stay focused for the good of everyone here.”