West Virginia HIV Outbreak Is A "Nightmare"

Approximately 74 new cases of HIV have been reported in Cabell County since January 2018.

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Despite having many public health policies in place to prevent the spread of disease—including a needle exchange program—one West Virginia county is seeing an alarming spike in new HIV transmissions largely brought about by drug users sharing needles.

Seventy-four new cases of HIV have been reported in Cabell County since January 2018, according to Politico.

“The ground is fertile,” Judith Feinberg, a professor of behavioral medicine and infectious diseases at West Virginia University, told Politico. “This is the nightmare everyone is worried about.”

Harm Reduction Efforts

In 2015, Cabell County started a needle exchange program. It also has drug treatment programs, STI testing and expanded access to PrEP, a treatment regimen that can reduce the risk of contracting HIV if taken daily. All of this is unusual, especially for a rural county. The fact that HIV has taken hold despite these efforts make the outbreak especially concerning.

Michael Kilkenny, physician director at Cabell’s health department, said he can’t explain why HIV cases are increasing, despite the county’s efforts. “I have no answer for that. At night, it’s what you ask when you are screaming at the sky,” he said.

Jay Adams, an HIV care coordinator at the federal Ryan White HIV/AIDS program, said that the outbreak would have been significantly worse in any other county.

“I don’t think this would have been contained with any degree of success in any other county in the state,” he said.

High-Risk Counties

A 2016 report from the Centers for Disease Control and Prevention (CDC) identified counties that were at high risk for new HIV infections because of the prevalence of intravenous drug use. Half of West Virginia’s counties—including Cabell—were on the list.

Other areas of the country, including Indiana and Massachusetts have seen spikes in HIV infections related to the opioid epidemic.

John Wiesman, Washington state health secretary and co-chair the Presidential Advisory Council on HIV/AIDS, said that officials are realizing how much the opioid epidemic is impacting HIV transmission. The Trump administration has aimed to stop new HIV transmissions by 2030, but that is a lofty goal, said Wiesman.

“We’re recognizing every day just how big a challenge this is,” he said. “There are a lot of things making this a really difficult task, and one of those is the opioid epidemic. We’ve got all of these overlapping issues coming together, a lot of which are social factors, which is why it is so important to have both a medical approach and a larger health and human services approach to this epidemic.”