A person is tested for HIV during SOAR street outreach in October. Photo by Lauren Peace.

A top U.S. government health official says the rise in HIV cases in Kanawha County linked to injection drug use is currently the “most concerning [outbreak] in the United States.”

Kanawha County had 35 new cases of HIV in 2020. Dr. Demetre Daskalakis, the head of HIV prevention for the U.S. Centers for Disease Control and Prevention, compared that to 2019,  when only four places in the U.S. had more cases.

He didn’t provide other numbers for 2020, and in a followup email a CDC spokesperson said data from 2019 was used because data from 2020 is still incoming.

“Among U.S. counties that have a similar population size to Kanawha, the average number of HIV diagnoses among people who inject drugs in 2019 was less than one,” Daskalakis said. “In New York City in 2019, there were 36 cases [compared to the 35 in Charleston last year].”

More than eight million people live in New York City. Kanawha County is nearly 50 times smaller.

“This is not an outbreak that you can address in two or three weeks, it may actually last for multiple years,” Daskalakis said. 

Slide from CDC presentation in Charleston on Feb. 11, 2021.

Daskalakis presented this information to Charleston officials on Thursday during an HIV Task Force meeting that was called to discuss the rise in cases among people who inject drugs. 

The presentation served as the most urgent call for intervention to date and reinforced the need to increase access to clean needles for people who inject drugs through syringe services programs, which — despite years of scientific evidence — have remained controversial in West Virginia’s capital city.

Cabell County had an HIV outbreak that required CDC intervention in 2019. That outbreak took place after the county-run needle exchange was scaled back. Experts say it should have served as a warning sign for Kanawha, where clean needles became difficult to access after the Kanawha-Charleston Health Department closed its own program in 2018.

“This is why this outbreak is of great concern,” Daskalakis said.

But his message was clear: “The faster we act to decrease the number of people with newly-acquired HIV,” the smaller the likelihood of further transmission and the sooner the outbreak can be contained.

Slide from CDC presentation in Charleston on Feb. 11, 2021.

While the CDC calls for action to contain the outbreak by increasing access to syringe services programs and access to viral treatment, Charleston City Council is debating a bill that would contradict with CDC recommendations and further limit the supply of syringes in Kanawha County.

The bill follows a police investigation into a local nonprofit, Solutions Oriented Addiction Response (SOAR), which began quietly distributing clean syringes alongside overdose-reversal medication as part of its grassroots harm reduction program. The nonprofit launched the program last year in response to the rise in HIV. The police investigation, which questioned whether or not SOAR’s distribution violated city law, concluded with no findings of wrongdoing. And although SOAR’s distribution follows CDC recommendations, the program was denied harm reduction certification by the state in January.

The newly-introduced bill now seeks to amend city law to criminalize the distribution of safe injection supplies unless coming from a program certified by the state. It’s on the agenda of the council’s public safety committee meeting set for Feb. 24.

In the interim, Dr. Sherri Young, who is the health officer for the Kanawha-Charleston Health Department, said that conversations would take place about steps to address the crisis.

But without quick action, “We could see hundreds of cases,” Daskalakis said. 

“Even though we are likely only seeing the tip of the iceberg, there is still a great opportunity to be able to interrupt and disrupt this transmission,” he said.

This story has been updated to include followup information from the CDC.

Correction: Cabell County drastically scaled back its syringe exchange; it did not eliminate it.

Lauren Peace is a Report for America Corps Member who covers public health.