At the same moment HIV cases linked to injection drug use are spiking dangerously in West Virginia, state lawmakers have made it much harder to operate syringe service programs (SSP). This comes amid a years-long movement throughout the state to restrict or outright ban SSP, which have been proven to save lives and reduce infectious disease.
West Virginia’s current HIV outbreak is “the most concerning in the United States” and requires immediate action, according to the Centers for Disease Control and Prevention (CDC). It has hit hardest in Kanawha County, the state’s most populous county and seat of its capital city, Charleston.
So how are state lawmakers responding to this health crisis? On February 25, the state senate’s health committee considered a bill sponsored by Eric Tarr (R) of Putnam. The committee has not yet advanced the bill to a full vote. The legislation would severely restrict SSP by mandating that all programs obtain a special license in order to operate. To get the license, SSP would need approval from the county board, sheriff and health department.
Even though Kanawha County residents have been vocal about wanting SSP, any organization that offers such a program would be banned from receiving state funding under the bill. To make things even worse, programs would have to require an ID from all clients, and tag all syringes with serial numbers. Participants would be limited to receiving just one new syringe for every used one returned to the SSP.
This last requirement is possibly the most damning. The CDC has explicitly stated that this “one-to-one” requirement goes against the health needs of people who use drugs. Participants should instead be given as many syringes as they need, with minimal barriers. Essentially, if your goal is to prevent people from spreading HIV and hepatitis C, it’s none of your business whether they need one syringe or 30.
Tarr and his colleagues disingenuously claim that the point of this bill is to protect public health and have more “accountability.” Clearly, “public health” in this case does not refer to the health of drug users or those close to them. Just a year ago, Tarr led an effort in the senate to completely ban SSP, saying, “it’s a failed experiment and it needs to go away.”
A Familiar Pattern
“It’s been beyond difficult watching lawmakers in Charleston talk about this,” Brooke Parker of local harm reduction group SOAR West Virginia told Filter. “Many seem to maintain an air of willful ignorance about what is best practices.”
“Talk to anyone who uses drugs or has been affected by the drug crisis here, and most understand the simple logic of ensuring people have low-barrier access to safe, sterile equipment. The belief that we can criminalize or punish our way out of this mess is unconscionable.”
Kanawha County used to have a health department-run SSP. Over its two-and-a-half years in operation, it suffered fierce opposition from police as well as the mayor. In spring 2018, the county shut it down after the state revoked its certification.
Tragically—and predictably—the county’s HIV infection rate spiked. Kanawha County had seen only a handful of HIV infections related to drug use each year before the SSP closed. By 2020, the county with a population of 183,000 had 32 new cases of HIV—a 16-fold increase. For comparison, the entire city of New York—over 8 million people—had 36 new drug use-related HIV cases in 2019.
Kanawha County is not alone in West Virginia. We’ve now known for five years that an HIV outbreak was imminent in the state. In 2015, the CDC revealed that half of West Virginia’s 55 counties were at risk of a drug use-related HIV spike.
State and local officials need to expand access to syringes.
That same year, Cabell County, in the state’s western edge on the Ohio River, pioneered the first SSP in West Virginia; the county had a low HIV infection rate in the years that followed. But in July 2018, health officials restricted the program by only allowing it to give syringes to county residents. That was in response to false police claims that the program was fueling an increase in violent crime.
The HIV rate then surged, to 63 cases by 2019—more than 31 times higher than before the restrictions were implemented. The county responded by loosening the restrictions, even receiving federal assistance from the CDC. And then? The HIV rate dropped by nearly half in just one year.
Notice the pattern? In Morgantown, near the state’s northern border with Pennsylvania, health professionals launched an SSP in 2015. It has faced little pushback locally, continues to operate, and now leads the state in distributing the most syringes relative to its population size. Monongalia County, where it is situated, has averaged fewer than five new drug use-related HIV cases per year since it opened.
There’s no ambiguity here. If SSP are further restricted and banned in West Virginia, HIV will continue to spiral. State and local officials need to expand access to syringes. To restrict access is to guarantee the further spread of blood-borne diseases.
But even if the new restrictive bill passes, life-saving harm reduction work will continue in West Virginia.
“None of us are afraid of hard work,” Parker said. “Those of us that work in harm reduction—in all capacities, whether it’s in clinics or offices or research, or in the hollers and streets—are committed to making sure this generation of folks live to see what’s beyond this crisis.”