UPDATE: On Monday, April 5, U.S. Senator Joe Manchin (D–W.Va) requested that the Centers for Disease Control and Prevention review the HIV outbreak in his home state, reports the Associated Press. Specifically, Manchin asked the CDC to review the comments made by federal health official Demetre Daskalakis, MD, who said the outbreak could be the tip of the iceberg. Local health officials in Kanawha County, West Virginia, had expressed concern that Daskalakis’s remarks were “made without factual and empirical evidence,” according to the AP.

West Virginia will receive $2.4 million in federal funding to help the state prevent and treat HIV, The Associated Press reports. The money arrives as an HIV outbreak among injection drug users shone a national spotlight on the state’s opioid epidemic and sparked debates about syringe exchanges and the economic burdens that result from injection drug use, such as the cost of preventing and treating HIV, hepatitis B and hepatitis C. 

The latest jump in HIV rates stems from cases in Kanawha County, which includes the state capital, Charleston. HIV cases linked to injection drug use increased from two in 2018 to at least 35 in 2020. This compares with 36 in New York City, which has over 8 million more residents than Kanawha County (population: 178,000).

As reported in February, Demetre Daskalakis, MD, MPH, a federal health official, characterized the HIV outbreak as the “most concerning in the United States among people who inject drugs.” He recently told BuzzFeed News, “It is possible the current case count represents the tip of the iceberg.”

Syringe exchanges are an effective way to lower the spread of HIV and hepatitis B and C, which can be transmitted by sharing needles. The exchanges also offer health officials a way to reach injection drug users and link them to treatment, including for substance use disorders.

Yet state officials have been trying to stop needle exchanges in Kanawha County. Not only have police officers run sting operations on the exchanges, reports BuzzFeed News, but legislators are trying to criminalize the exchanges.

To illustrate the true economic consequences of the opioid epidemic, the West Virginia Center on Budget Policy issued a report titled Saving Lives and Saving Money: The Case for Harm Reduction in Kanawha County, WV.

“Overall,” the report states, “the total economic damage caused by the drug crisis in West Virginia amounted to about $11.3 billion; in Kanawha County, the total reached $1.7 billion. These amounts represent approximately 15% of the state and county gross domestic products, respectively.”

You can read more about the report in The Charleston Gazette-Mail. One section of the report breaks down the costs associated with medical conditions often contracted by people with substance use disorders. The report notes that in Kanawha County alone:

  • To treat the 35 new HIV cases reportedly related to intravenous drug use (IDU) in 2020 will cost nearly $17 million.

  • To provide curative treatment for the 635 cases of chronic hepatitis C (HCV) associated with IDU in 2019 will likely cost as much as $44.5 million.

  • The estimated cost of treating the chronic hepatitis B (HBV) cases likely caused by IDU in 2018 is $196,000. While this is a relatively small cost, it would be virtually avoidable with regular HBV screening and vaccinations for drug users at a cost of about $62 per adult.

  • Another disease increasingly tied to IDU is infective endocarditis (IE), an infection of the lining of the heart. The 77 IDU-related cases treated at the Charleston Area Medical Center in 2019 cost nearly $4.2 million.

In related news, read “HIV Task Force Launches in West Virginia Amid Drug Use Concerns” and the recent profile on Daskalakis, “Meet the ‘Queer Health Warrior’ Who’ll Lead Federal HIV Prevention Efforts.”

Hepatitis B and C, which are infections of the liver, and HIV can be spread through shared needles. To learn more about transmission, prevention and treatments, see the HIV Basics in POZ and the Hepatitis B Basics and Hepatitis C Basics in HepMag.com.