Volunteers set up HIV testing during SOAR street outreach in Charleston. Photo by Lauren Peace.

Kanawha County commissioners want more information about the severity of an HIV outbreak linked to injection drug use in West Virginia’s capital city.

But instead of turning to local health professionals who have been issuing warnings about the unprecedented increase in new cases for months — or asking the federal Centers for Disease Control and Prevention directly — they’re calling into question statements made by the CDC’s top HIV expert about the severity of the outbreak.

In a letter sent up the political chain to both of West Virginia’s U.S. senators, the commissioners requested a congressional inquiry into data presented by the CDC to Kanawha County politicians and leaders in health care in February. They’re also taking issue with the expert’s view that the outbreak is the most concerning in the United States.

Dr. Demetre Daskalakis says the HIV outbreak linked to injection drug use is the “most concerning” in the U.S. during an HIV task force meeting.

“We are concerned that statements referring to the ‘HIV Outbreak’ in Kanawha County as the ‘most concerning’ are being made without factual and empirical evidence,” the commissioners wrote. “Is there a peer-reviewed, evidence-based finding that would support this alarming allegation?”

The letter marks yet another political layer inserted in the midst of a public health crisis, rather than direct action to solve the problem.

Over the last three years, Kanawha County has seen at least a 700% increase in HIV cases linked to injection drug use. In a typical year, the county would have fewer than two new cases of HIV linked to injection drug use. But in 2019, there were 15 diagnoses. Last year, there were 35.

In interviews with Mountain State Spotlight, Commissioners Kent Carper and Ben Salango said they were surprised by the statements and wanted more information on the matter. Commissioner Lance Wheeler, who also signed the letter, was unavailable to comment.

“What’s the basis of [the statement that Kanawha is the ‘most concerning’]?” Carper asked. “If the basis is the number of new people that had HIV since 2018 or the year before then fine, that’s an answer. The next question is, what’s to be done about it?”

Dr. Demetre Daskalakis explains why the outbreak is so concerning during the task force meeting on 2/11/21.

Over the past four months, numerous public health experts, including current and former state health officers Dr. Ayne Amjad and Dr. Cathy Slemp, have testified on the severity of the current HIV outbreak in Kanawha County. 

“I like to think that I am the expert for [HIV in] southern West Virginia,” said Dr. Shelda Martin, who is Charleston Area Medical Center’s associate medical officer, during a Charleston City Council meeting earlier this month. She treats HIV patients at the center.

“I have never seen this and I think if we don’t take this seriously now, you’re going to have to think about being accountable in a couple of years.”

Dr. Shelda Martin, associate medical officer for CAMC, speaks before attendees of the HIV task force meeting on 2/11/2021.

But neither Martin nor her colleague, Christine Teague, were consulted by the Kanawha County Commission.

Teague, who has served as the program director for CAMC’s HIV treatment and prevention program for more than 20 years, said she was perplexed by the letter, but hopes that the commission is serious about working to address the outbreak.

“It seemed like the fixation is on the wording rather than the problem,” she said. “Whether we’re the ‘most concerning’ for HIV or not. This is a public health crisis that we need to do something about.”

Teague said she would be more than happy to speak with commissioners about the issue.

Lori Kersey, spokesperson for the Kanawha-Charleston Health Department, also said via email that the department was not consulted about the inquiry, but that KCHD is in “near constant communication with the county commission,” and believes the data on HIV in Kanawha to be accurate.

The scale of the problem

The statements in question were made by Dr. Demetre Daskalakis during a February CDC presentation before local health and political officials, including the county commissioners. 

Daskalakis’ presentation included information about how Kanawha County’s outbreak compares to others nationally and steps that could be taken to prevent further spread. It also detailed support the CDC could offer local health officials.

One slide of the presentation, comparing cases of HIV linked to injection drug use in New York City — where there were 36 positive cases identified in 2019 — to Kanawha County’s 35 in 2020 mistakenly listed Kanawha County’s population size as 48,000, the population of the City of Charleston, rather than 178,000. 

Although that number was corrected during the presentation, Carper said that created confusion about the scale of the problem.

Dr. Sherri Young makes a correction to one of the CDC slides during the presentation on 2/11/2021.

But even with the correction, the comparison is stark. Despite having a population roughly 45 times smaller than New York City’s, Kanawha County had just one fewer HIV case linked to injection drug use in 2020 than New York City had in 2019.      

“If Kanawha County is the most concerning, I just assumed something would happen,” Carper said. “I assumed something would come out of it. I guess I was waiting, but when that didn’t happen, I decided to ask some questions.”

The CDC’s policy is that it does not intervene in local health matters unless it is invited into a community. It can, however, come into a community and provide support through a program called Epi-Aid. But that has to be requested by local health officials. 

Dr. Demetre Daskalakis describes support the CDC can offer local officials during the task force meeting on 2/11/21.

The program has worked here before: state officials requested the aid to help address another HIV outbreak linked to injection drug use in Huntington. DHHR spokeswoman Allison Adler said the department does not currently have plans to request an Epi-Aid to address the outbreak in Kanawha. But she said the department was working with county health officials and referencing lessons learned from 2019.

Carper and Salango say they’re eager to get information returned from the inquiry and to learn more about the current health situation. Both said that one case of HIV in the county is too many.

“None of this really means anything other than people are sick and we need to try to help them. The rest of this is nonsense,” Carper said. “I have absolute and total respect for local health officials.”

Local health officials say there have been big efforts to ramp up HIV treatment and testing. But with pending legislation likely to restrict syringe service programs across the state and the city — a key tool to preventing further spread of disease — the question of how officials will act in a meaningful way to address the crisis, and when, remains.


Want to listen to the CDC’s presentation and view slides presented by federal and state health officials to the HIV task force and local leaders on Feb. 11?

Check out the clips below.

*** To view slides presented by state epidemiologist Shannon McBee, click here.

Press play to listen to the presentation given by state epidemiologist Shannon McBee before the HIV task force and local leaders on 2/11/2021.

*** To view slides presented by the CDC, click here.

Press play to listen to the presentation given by CDC head of HIV prevention and control Dr. Demetre Daskalakis before the HIV task force and local leaders on 2/11/2021.

To listen to the meeting in its entirety, press play on the audio clip below.

Press play to listen to the full HIV task force meeting with state local leaders, state health officials and the CDC on 2/11/2021

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