In 2018, the syringe service program (SSP) in Cabell County, West Virginia, was shuttered by the local health department. By January 2019, the West Virginia Bureau for Public Health was investigating a spike in HIV transmission.
The bureau stated in its April 2019 health advisory that while historically the main behavioral risk factor for HIV transmission was “male-to-male sexual contact,” in this case the virus was spreading among communities of people who inject drugs (PWID).
West Virginia’s HIV crisis among PWID spans multiple counties. The Centers for Disease Control and Prevention recommended urgently increasing access to SSP after investigating the Kanahwa County outbreak in 2021. By then, the state had already imposed the notoriously harmful restriction known as “one-to one,” which only allows SSP to distribute a fraction of the sterile syringes needed.
All this took place while Dr. Anthony Fauci was still the director of the National Institute of Allergy and Infectious Diseases (NIAID), but he doesn’t appear interested in the well-established link between the outbreaks and the lack of sterile syringe access.
“The fact that you have an increase probably reflects two things,” Fauci said on a November 2023 Zoom call with West Virginia University medical students. “It’s the lack of PrEP (pre-exposure prophylaxis) accessibility, for those who are susceptible and a lack of accessibility to treatment for those who are already infected.”
The public associates HIV with sexual transmission, often at the expense of PWID. Fauci does too.
The public tends to associate HIV with sexual transmission, often at the expense of PWID. Fauci stuck to that too, even after he was given a recap of the data showing PWID as the primary community at risk in this case.
“Drug addiction, as we all know, is a disease and not a crime. And when you’re trying to prevent someone from getting infected from injection drug use, that’s a very difficult problem unless you get sterile needles [at] a needle exchange,” Fauci responded, before immediately pivoting back to PrEP and antiretroviral therapy (ART). “But for sexual transmission, we should be looking in the community about why is there a lack of the access to what we know is a highly effective prevention.”
Fauci didn’t respond to Filter‘s request for comment about whether SSP also qualified as highly effective HIV preventions marked by lack of access, nor what made transmissions among PWID communities a more difficult problem than others.
He similarly ignored PWID in 2021, telling West Virginia Senator Joe Manchin that the focus was on PrEP and ART, along with restoring HIV testing services that were hampered by COVID-19 at that time. This is frustrating because SSP are critical for access to testing, in addition to access to syringes. They’re also where many people get bridged to PrEP. They’re just not popular enough for Fauci.
A slide from the Centers for Disease Control and Prevention’s 2021 investigation into HIV transmission in Kanawha County
Fauci wasn’t always so invested in access to HIV medications. At the beginning of his 38-year tenure as NIAID director, he was known for fighting against it.
Before modern ART, the options for those of us with HIV were miserable. AZT and ddT made you so nauseous it was almost impossible not to vomit, but doctors would tell you that you weren’t allowed to for at least half an hour. The ddT tablets were the size of quarters.
People were clamoring for the new medications delayed in development, and Fauci was saying we couldn’t have them because they weren’t approved yet—even though as the public face of HIV research he had significant influence that it took him a long time to use. Safer for us to die than to try experimental treatments.
He made the public afraid of LGBTQ people and of drug users, and only modernized his narrative after enormous efforts by activists like those in ACT UP. He legitimized rumors that the virus could spread via casual contact, which even at that time was a claim scientists didn’t support. But it was something the public believed.
This is his gig and always has been. HIV, ebola, COVID—he comes out heavy as the Epidemic Guy, sows fear around some popular early theory by claiming the science supports it, and then whenever it’s no longer fashionable to be afraid of it, he moves on.
Over the past four decades, public perception of LGBTQ people has evolved more than it has for PWID. PrEP and ART have the level of public support required for Fauci’s stamp of approval. SSP, for some reason, aren’t quite popular enough.
Top photograph of Anthony Fauci in 1981 via National Institutes of Health. Inset graphic via West Virginia Office of Epidemiology and Prevention Services.