Report: Harm reduction restrictions helped fuel HIV outbreak

By TAYLOR STUCK The Herald-Dispatch tstuck@hdmediallc.com

HUNTINGTON — Access to HIV prevention and testing was limited in Cabell County prior to the HIV outbreak even with the county’s harm reduction program due to stricter requirements placed on the program in 2018, says a new report on the outbreak published Thursday by the U.S. Centers for Disease Control and Prevention.

The outbreak of HIV was identified by West Virginia’s Bureau for Public Health in January 2019. Though Cabell County had historically high rates of substance use disorder, it had low rates of HIV. From 2013-17, an annual average of two diagnoses of HIV infection had occurred among residents who inject drugs; however, in 2018, 14 diagnoses occurred, including seven in the final part of the year.

“Initial investigation found that at the time this increase in diagnoses of HIV infection was detected, access to HIV testing and pre-exposure prophylaxis (PrEP) in Cabell County was limited,” the report reads. “Although a harm reduction program, including access to sterile syringes, had been operating at (the Cabell-Huntington Health Department) since September 2015, stricter requirements, including proof of Cabell County residency, were initiated in May 2018, which limited access to these services.”

The report found knowledge about HIV, the outbreak and treatment for substance use disorder was low, and initiation of treatment for HIV or substance use disorder among individuals who inject drugs was also low.

Dr. Michael Kilkenny, medical director of the health department and co-author of the report, said the report is consistent with what the health department has said before: Harm reduction programs need to have as little restriction and provide as many syringes as possible to prevent HIV.

“It’s really clear restrictions are harmful to those efforts, and we are not an exception,” he said.

The restrictions were implemented after ongoing complaints from the community. The main complaint was syringe litter.

“It’s not any different than what we’ve gone through even recently with people attacking the program, somehow feeling that restricted is better when in fact it is worse,” Kilkenny said. “Generally, we are trying to work through our differences and make sure we do everything we can to prevent the disease and still make sure the public understands what we are doing, and that we have community support. We can’t do what we do without community support.”

The CDC and the state provided support to the health department in responding to the outbreak. The CDC provided staff members to interview people with a new diagnosis of HIV and offer HIV prevention services to approximately 600 identified partners and social contacts of those people. Working with the hospitals and other community services, outreach efforts began to educate and test.

As a result of the combined response activities, approximately 450 new clients enrolled in the harm reduction program, including approximately 50 people living with HIV infection, the report says.

As of Jan. 26, 82 cases were identified — now up to 85 as of April 8. Ninety-two percent were part of a single cluster of closely related infections, which points to rapid transmission of the virus.

Most of the identified cases occurred in those between the ages of 20 and 39. Twenty-nine percent had exchanged sex for drugs or money, and 88% had laboratory evidence of current or past hepatitis C.

“I think this demonstrates that restrictions are not helpful and have consequences that are very costly,” Kilkenny said. “We need to do the best we can do on all sides to make sure we have sterile syringes where they need to be, and don’t have unclean syringes where they don’t need to be.”

The harm reduction program at the health department continues to operate despite the COVID-19 pandemic. Kilkenny said the pandemic has made a complex situation even more complex, but they will get through both the HIV outbreak and the COVID-19 outbreak.

He said they will not be happy until they have zero cases of HIV.

Follow reporter Taylor Stuck on Twitter and Facebook @TaylorStuckHD.

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