On a hazy summer afternoon, a silver pickup truck rolled into a parking lot filled with pop-up tents in Charleston’s Kanawha City. As it came to a stop, four people from Marmet experiencing homelessness hopped out and began walking around a free wellness event.
Social service providers from around the county had gathered to help people like Pamela Hale, one of the Marmet residents. She was grateful for the resources available, ranging from hot lunches to basic first-aid care to HIV testing.
Hale, who referred to herself as the encampment’s “mama,” wished more people had joined her. But she said they’re often skeptical of social service workers who come by, like the ones who gave Hale a ride to the event.
“They think automatically, ‘cops,’” she said.
This community wellness event is one way health providers are trying to build bridges to eastern Kanawha County communities like Marmet, areas they’ve struggled to reach in the past. State and local infectious disease experts say this region has been among the most impacted by the effects of the county’s injection drug use crisis, including HIV, hepatitis C and endocarditis.
Health workers know an effective strategy for building relationships here, one that’s worked well in neighboring Fayette County: mobile syringe service units. These operations could be regularly set up near encampments, providing disease testing and also letting people exchange used needles for sterile ones.
“I think the high-risk group would come out for that,” said Christine Teague, the director of Charleston Area Medical Center’s HIV Care program.
But West Virginia lawmakers passed a law in 2021 granting local governments the power to approve and revoke the authorization of needle exchanges. And in Kanawha County, commissioners have only authorized one program — which operates in Charleston and is difficult for people in towns like Marmet, Rand, Belle and Montgomery to reach without reliable transportation. They’ve indicated they don’t see a need for more than one exchange in the county.
“I wish to God we could have a mobile syringe unit,” said Cassie Province, an outreach worker at the nonprofit Covenant House. “But they won’t let us do that.”
How we got here
The U.S. Centers for Disease Control and Prevention has repeatedly found that syringe service programs decrease infectious disease transmission and reduce needle litter. But the vital tool has faced pushback operating in Kanawha County for years. Since 2018, two programs have closed after both Charleston and West Virginia passed policies restricting syringe exchanges.
The 2021 state law stipulated how the programs could operate and gave county commissions and city councils the power to approve and close them. Health professionals at both the national and state levels worried about how these closures and others across the state would impact people who inject drugs. Charleston and Huntington were already in the midst of large injection drug-use HIV outbreaks, with a top CDC official calling Charleston’s the country’s “most concerning” outbreak of the year.
Outside of West Virginia’s two largest cities, rural spread was also expected. And data from Charleston Area Medical Center supports that, at least in Kanawha County, it’s been happening. Maps from the hospital system indicate that from 2017 to 2021, people in the county’s more rural, eastern parts have been at high risk of hepatitis C and HIV.
Teague said that region and Charleston’s West Side are the areas in Kanawha County most affected by diseases transmitted via used syringes. Unlike their efforts in the West Side of Charleston, her program and other health services have struggled to test and treat eastern Kanawha County residents — leading Teague to believe the HIV and hepatitis C case numbers in the area are significantly higher than official numbers indicate.
“This high-risk group may not be interested in coming out unless you have something useful for them,” Teague said. “Whether that’s syringe service programs or food or what have you.”
While the 2021 state law limits when and where mobile needle exchanges can operate, it does allow for them to exist. Robin Pollini, an infectious disease epidemiology professor at West Virginia University, said syringe service programs that are able to travel to small, rural eastern Kanawha communities would help mitigate HIV and hepatitis C spread.
“People who use drugs have traditionally not had good experiences with the health care system,” she said. “That’s why having a mobile unit, which is very different from having them come into a medical setting, is so important.”
But the law also requires approval from the county commission for any needle exchange program to operate. Kanawha’s commissioners have only authorized one program: West Virginia Health Right.
The free clinic runs its needle exchange program solely from Charleston and does not offer mobile services in the county. 2022 data from the state health department indicates Health Right distributed far fewer sterile needles than programs in Huntington and Morgantown.
In 2021, Angie Settle, the clinic’s executive director, told the Kanawha County Commission her organization’s needle exchange policies create “a multitude of safeguards” to make sure every syringe is returned. In that same meeting, she said Health Right does not plan on expanding its program. Settle did not respond to a phone call or an email asking whether those plans have changed.
In previous interviews, Kent Carper, president of the Kanawha County Commission, has said Health Right offers enough syringe exchange services for the county. When presented with multiple studies indicating that Kanawha would benefit from easier access to needle exchanges, he has questioned the researchers’ intentions and credibility. A spokesperson for the county said Carper and Ben Salango, a fellow commissioner, were both unavailable to comment for this story.
In a phone call, Lance Wheeler, the third commissioner, did not indicate whether he would support mobile syringe service programs in the county. He said he relies on administrators at Health Right and the Kanawha-Charleston Health Department to tell him and other local elected officials what the needs are to address the opioid epidemic.
Without any other authorized programs, no one else can legally offer that service. As a consequence, government decisions that helped diseases spread in eastern Kanawha County also hinder health professionals from using one of the most effective tools to mitigate it.
“Right now there is not sufficient capacity for the need in Kanawha,” Pollini said. “Or almost anywhere, really. But particularly in Kanawha.”
What a syringe exchange could do for Kanawha County
In Smithers, a town of just over 700 people on the border between Kanawha and Fayette counties, a mobile syringe service program shows the impact that one could have in eastern Kanawha County.
The county border runs through the town, and there’s little visible difference between the two sides. But, unlike Kanawha County, Fayette County Commissioners have authorized its health department to run a mobile needle exchange unit in the area. So, twice a month, Fayette County Health Department peer recovery specialist Paula McCutcheon travels to the Fayette side of Smithers and sets up a needle exchange for a few hours.
Her primary goal with the unit is to make testing and comprehensive harm reduction services as accessible as possible to any West Virginian who needs it.
“They can’t come to us, so we’re going to come to them,” McCutcheon said. “Our goal is to keep them alive and safe and meet them where they’re at.”
The Fayette Health Department program can only show up at specific times and places approved by the state. But to Brooke Parker, a clinical social worker with CAMC, McCutcheon is using the mobile exchange to create the type of trust the hospital’s HIV care program yearns to build with residents in eastern Kanawha County.
“She’s really out there in the community, and she knows exactly what needs to be done,” Parker said.
It’s the type of effort Pollini believes is crucial for the Upper Kanawha Valley, regardless of which side of the Fayette-Kanawha border someone happens to live in.
“That kind of service can be much more effective than just going in and doing testing,” she said. “Because you’re building those relationships.”