Harm Reduction Restrictions and Budget Cuts Cause HIV to Spread in West Virginia

About five years after an HIV outbreak linked to opioid use in rural West Virginia made national headlines, health departments in the state say they are working with scarce funding and resources to test for HIV and connect those living with the virus to lifesaving treatment, the Mountain State Spotlight reports.

Anita Stewart, DO, the top doctor at the Nicholas County Health Department, said four people in the county have tested positive for HIV in the past 18 months. Unlike other West Virginia areas, such as Kanawha County, which experienced an outbreak of 63 cases between 2019 and 2021, Nicholas County hadn’t reported new HIV diagnoses for several years before the current cases.

Many people in West Virginia towns struggle with opioid addiction. As access to the prescription painkillers that inundated the state in the late 2010s has dwindled, many people have turned to injecting heroin and fentanyl. However, in recent years, West Virginia lawmakers passed a bill restricting how harm reduction programs could operate, causing many syringe services to close and leaving injection drug users at risk for HIV. What’s more, budget cuts to West Virginia’s local health departments have impacted access to care.

Howard Gamble, the Wheeling-Ohio County Health Department administrator, told the Telegraph that his department operates one of the few syringe service programs in West Virginia. He added that the agency struggles to afford rapid HIV tests due to lack of funding, which “makes a huge impact on how we can respond to everyday efforts.”

Although only four individuals have officially been diagnosed with HIV in Nicholas County over the last 18 months, the actual number of cases is likely higher since testing rates for the virus are so low.

County agencies across the state already lacked proper funding needed to prevent and treat HIV, according to Greg Puckett, a member of the West Virginia Public Health Advisory Committee and a Mercer County commissioner.

“We have massive amounts of HIV that is undocumented,” Puckett told the Telegraph. “I’m 100% confident of it because we are not testing enough.”

Testing is vital to ending the HIV epidemic. People who are positive can get connected to care and treatment. Those who achieve and maintain viral suppression experience slower disease progression, enjoy better overall health and are less likely to develop opportunistic illnesses. What’s more, people with an undetectable viral load don’t transmit HIV to others through sex, dubbed treatment as prevention, or Undetectable Equals Untransmittable, or U=U).

In 2021, West Virginia, Puerto Rico, Mississippi and South Carolina had the greatest unmet need for pre-exposure prophylaxis (PrEP), according to AIDSVu data, highlighting the need for increased awareness of and access to the HIV prevention medication in the South.

While writing the 2025 state budget, West Virginia lawmakers slashed funding for local health departments because they worried that the state would have to return $465 million to the federal government. After learning that this wouldn’t be the case, an additional $5 million was allocated to the Department of Health—but only for emergencies, according to Gamble.

“I do not foresee that county health departments will be the recipients of that in any fashion,” he said.

Even restoring funding, experts say, wouldn’t be enough to support local agencies. What’s more, the 2021 syringe service restrictions are still in effect.

“That’s hard, knowing that there’s something that could be done to make someone healthier, to make communities healthier, and then not being able to respond,” said Stewart, who hopes the county’s commissioners will approve her department’s recent syringe service program application.