One-Lane Country Road

Community Education Group’s Community Perspectives Blog Going Live

Community Education Group will be launching its new blog, Community Perspectives, on May 18th, 2020.

Community Perspectives will focus on the issues that impact the work CEG does in West Virginia, nationally, and globally, and will feature weekly articles by CEG’s staff, including Founder & Executive Director, A. Toni Young, West Virginia Policy Coordinator, Marcus J. Hopkins, and Project Coordinator, Ty Williams. We will also feature one guest column each month, from people whose work creates a huge impact on the lives of the people we serve.

Check back on Monday, May 18th, 2020, for our inaugural post from our fearless leader, A. Toni Young, with new posts coming out each Monday.

Logo of National Hepatitis Testing Day, held on May 19th, 2020

Community Education Group Recognizes Hepatitis Awareness Month

May is Hepatitis Awareness Month and CEG is participating by raising awareness of how the opioid and meth addiction crises in West Virginia intersect with the state’s grim record for having the highest rates of new Hepatitis B (HBV) and Hepatitis C (HCV) diagnoses in the United States.

In 2017, West Virginia reported the highest rates of new Hepatitis B and Hepatitis C infections in the U.S., with rates of 11.7 (per 100,000) and 5.6 (per 100,000), respectively. The national rate of new infections for both diseases is 1.0.

That same year, West Virginia had both the highest rate of overall drug overdose deaths (57.8 per 100,000), and the highest rate of opioid-related drug overdose deaths (49.6 per 100,000) in the U.S. The national overall and opioid-related drug overdose deaths are 21.7 and 14.5, respectively.

These statistics are not unrelated.

According to the West Virginia Office of Epidemiology and Prevention Services, a majority of cases of both HBV and HCV reported injection drug use and/or street-drug use as the primary risk factor for transmission (OEPS, 2018).

CEG is working tirelessly to bring attention to West Virginia’s syndemic of Substance Use Disorder, HBV, HCV, and HIV, as well as the work of our state’s various Harm Reduction Programs – those run by both county health departments, non-profits, and Rural Health Service Providers.

Stay tuned to #CEGInWV’s website and social media pages as we reveal the exciting projects we have in store for both West Virginia and across the nation. While you’re waiting, be sure to get tested for Hepatitis on National Hepatitis Testing Day – May 19th, 2020.

References

West Virginia Office of Epidemiology & Prevention Services. (2018, April). HEPATITIS B AND HEPATITIS C INFECTION IN WEST VIRGINA 2016 – Surveillance Summary – April 2018. Charleston, WV: West Virginia Department of Health & Human Resources: Bureau for Public Health: Office of Epidemiology & Prevention Services: Hepatitis: Data and Surveillance: Summary Reports. Retrieved from: https://oeps.wv.gov/hepatitis/documents/data/Summary_2016_Acute_HBV-HCV.pdf

Wooden Grist Mill in the Fall

Communicating Public Health Messages Through Community Engagement

Any time there’s a public health crisis, healthcare officials are faced with the challenge of how best to communicate messages to the public. With that in mind, CEG has sourced two articles focusing on how to communicate public health messages both on social media and in rural settings—areas where CEG is working tirelessly to communicate with folks in West Virginia.  Check out the links, below:

Social Media in Public Health: A Vital Component of Community Engagement
By: Mark R. Miller, William D. Snook, and Elizabeth Walsh

Community Engagement Toolkit for Rural Hospitals
From: Washington State Hospital Association

AIDS 2020 Virtual Conference Logo

COVID-19 and HIV

COVID-19 has raised myriad questions
across the healthcare landscape, but
especially in the HIV community. For
people living with HIV, each new virus
represents an unknown set of variables,
each of which must be considered by
both patients and providers.

The International AIDS Society has put
together this helpful primer on HIV and
COVID-19 which answers many of these
questions. Check it out at the link below,
and learn more about Virtual AIDS
2020 – the 23rd Annual International
AIDS Conference here. The conference
will be held July 6-10, 2020.

COVID-19 and HIV: What you need to know
From: International AIDS Society

Community Education Group's COVID-19 Infographic

Community Education Group Launches COVID-19 Best Practices Infographic For Harm Reduction Programs

As the Coronavirus (COVID-19) forces society to engage in preventative measures such as social distancing, #CEGInWV has created a Best Practices poster for use by Harm Reduction Programs offering services to People Who Use Drugs during this pandemic. In this time of uncertainty, it is imperative that those operating HRPs do everything in their power to ensure the safety of both their staff and their clients, as well as engage clients in best practices to stay safe while using.

Bridge with mist and the CEG logo and website

So, I’ve Been Thinking: What COVID-19 Reveals About Our Public Health System

CEG Founder & Executive Director, A. Toni Young, with Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases

So, I’ve been thinking about how none of us can truly avoid the impact of COVID-19. Either we know someone who’s been impacted by it, or we have been impacted by it ourselves, or maybe we are now working from home, even reconfiguring our whole organizations and the way we do our work. Everybody is impacted—but I’ve been thinking especially about how COVID-19 impacts the most vulnerable, and what this shows about the gaps in our health system.

It is no surprise that already-vulnerable groups need protection during this pandemic. CEG’s mission is built around addressing social, economic and environmental factors that generate health disparities in low-income communities, among people of color, and in marginalized groups such as the LGBTQIA+ community. That mission is also what ultimately led CEG to expand its operations beyond urban communities of color.

It turns out that poor rural communities in states like Louisiana, West Virginia, Missouri, and Mississippi actually have a lot in common with poor urban communities, in terms of vulnerability due to underlying social determinants of health. Yet some poor and rural states have been slower to respond to the pandemic, perhaps in part because lower population density in rural areas may seem to mitigate risk. Unfortunately this can lull people into a false sense of security, causing them to neglect taking precautions like physical distancing, wearing a mask, and washing hands.

Rural areas also tend to have fewer doctors and nurses. Here in West Virginia, almost 20% of adults do not have a personal doctor or primary care provider. This shortfall could result in underreporting, as well as making it harder for people to get referrals for testing. Even when people do have doctors, transportation issues can limit their access to healthcare services. Add to that factors like poverty, food insecurity, low rates of literacy and education, and frequent distrust of government, and you begin to understand how vulnerable these communities can be. The COVID Community Vulnerability Map created by the healthcare analytics company Jvion illustrates this clearly.

These parallels between vulnerable urban and rural communities make it clear that even while many of us advocate for different demographics and constituencies, we can and must come together in our response to COVID-19, just as we must unite in responding to ongoing threats such as HIV, hepatitis, and opioid use. We can no longer afford to operate in isolation, or respond in isolation when a crisis hits. We all need to work together to ensure that our citizens are protected and cared for.

At CEG, we hope to start up a “getting to know you” webinar series about these common struggles shared by disparate communities whether they urban or rural, black or white. But that’s just the beginning. If we are going to become more resilient, we have to absorb the lessons COVID-19 is teaching us about our health system. As recently noted by Hanna Love and Jennifer S. Vey of the Brookings Institution, in moving forward we should “adopt service-based systems or outreach-team approaches that connect people with permanent supportive housing, employment training, child care subsidies, doctors and therapists, and financial and budgeting assistance.”

To accomplish this, we will need to fashion a network of responders for our communities that is diverse. We will need to look at what we have and what we can bring to the collective. If we come together and we work together on goals like improving mobility and portability of services, we can reach the people who are in the greatest need. Some of these people are poor, black or brown, living with HIV. Others are white, rural, drug users. All of them need us to work collectively, reimagine how we address health crises, and build a stronger and fairer system that can help prevent such crises in the future. That’s how we get better and stay better: together.

New River Gorge in Summer

Community Education Group & TruEvolution Partner For COVID-19 Congressional Sign-On Effort

On behalf of TruEvolution (Riverside, CA) and the Community Education Group (Shepherdstown, West Virginia), I am writing to invite your organization to join a coalition of rural-serving Community-Based Organizations (CBOs), rural health organizations, and Federally-Qualified Health Centers (FQHCs) in asking the House and Senate to include in the forthcoming COVID-19-related stimulus bill specifically appropriated funding dedicated to supporting, expanding, and mobilizing Rural Health Service Providers (#RHSPs) and the long neglected and underfunded public health infrastructures in rural America.

While the definition of “rural” varies, we hope to find a common ground in the disproportionate underinvestment of infrastructure, transportation, and geographic isolation experienced by many of our canyons, hills, plains, mountains, woods, and deserts. We invite you to participate on a call where we can discuss developing a coalition-led approach in our advocacy. The full text of the letter can be found here, and here are some of the highlights of we have requested:

  • Dedicate $5b in federal grant monies to be used for:
  • Sustaining and supporting existing operations rural health organizations, clinics, and CBOs;
  • Expanding operations in order to add or broaden their capacity to provide telehealth/telemedicine services;
  • Mobilizing operations by procuring and outfitting mobile units to take healthcare services where rural Americans live;
  • Investing in building and expanding the public health infrastructures in rural areas to increase access to services.

We have also provided a ten-point Fact Sheet, which you can find here. We hope that your organization will sign on to this letter and call your members of Congress. Individuals may also sign on to this letter – simply enter “Individual” or your field of work in the “Organization” field. We encourage you to join us and to share this sign on letter and fact sheet with your networks.

Thank you, for taking the time out of your very busy schedules to read this E-mail. If you have any questions, feel free to reach out to Gabriel Maldonado (TruEvolution) or A. Toni Young (Community Education Group).

Be well,

Community Education Group Launches New Website

The Community Education Group's new homepage

Things are a bit shinier around CEG
these days. As you may have noticed,
our website has been relaunched with
more than just a new coat of paint; we’ve
got a whole new design rolling out today.

Thanks to our partners at Fors Marsh Group, for their excellent work on giving our website a much-needed facelift!

Please take a few moments to dig through our site, and if you find any bugs, please drop us a line at info@communityeducationgroup.org, and we’ll address it as quickly as we can.

Photo of an outline of the state of West Virginia made out of white powder, presumably heroin or cocaine, and a rolled up straw for snorting it

Community Education Group RESPONDS: Misreading the Tea Leaves on West Virginia’s HIV Outbreak

At his recent abstract presentation delivered at the Conference on Retroviruses and Opportunistic Infections (CROI), Dr. R. Paul McClung presented a portrait of a successful HIV intervention in Cabell County, West Virginia. By his estimation, the response to what was then the third HIV outbreak in that state, beginning in January 2018, was a fine example of a successful infectious disease responseMedPage Today described it as “A Blueprint for Public Health Response,” and McClung cited a strong public health infrastructure in the county, including “…a large academic medical center, a large network of community health centers, and a ‘growing capacity to treat substance use disorder,’ such as a syringe service program in place since 2015” (Walker, 2020). Given the consistently negative press both the state and the county receive, this glowing review of Cabell County’s response is a welcome change—but it is also, unfortunately, a largely incomplete portrayal of events as they occurred, and of circumstances on the ground as they still stand.

While the staff of the Cabell-Huntington Health Department, their Harm Reduction Program, and the local community-based organizations and healthcare providers did an excellent job of working together to identify new cases of HIV among People Who Inject Drugs (PWIDs) and others in the county, what Dr. McClung fails to mention is that many—a significant percentage—of those cases identified in Cabell County between January 2018 and December 2019 were patients who were not/are not residents of Cabell County.

Huntington sits on the border of both Kentucky and Ohio and is also surrounded by several rural counties. It serves as one of the primary hubs of drug trafficking in the region, a place where people drive hours and hundreds of miles to get their drugs and, unfortunately, often contract infectious diseases in conjunction with the injection of those drugs. As Dr. McClung’s reporting correctly identified, a majority of the new HIV diagnoses were directly related to Injection Drug Use (IDU). According to the West Virginia Office of Epidemiology and Prevention Services (OEPS), of the 69 new cases identified in 2019, 63 (91.3%) reported IDU as a risk factor (OEPS, 2020). It was not, however, until January of this year (2020) that the state redefined how they count reported cases of HIV, allowing for counties to correctly attribute newly identified cases back to the patients’ counties or states of origin.

Dr. McClung’s reporting leaves out the important fact that little to no investigation has been done on the ground in the rural counties that surround Cabell and Kanawha Counties, the site of the fourth HIV outbreak, identified in 2019. This is not because nobody wants to conduct these investigations, but because the resources simply do not exist for them to be done. Even in Cabell County, the Harm Reduction Program operates with only a handful of staff members for a job that requires ten. In these rural counties, entire county health departments operate with similarly small staffs, yet their responsibilities extend beyond just Harm Reduction and HIV testing. They are also tasked with protecting communities from environmental health risks, and with inspecting houses, institutions, recreational facilities, sewage and wastewater facilities, and drinking water facilities.

When we discuss West Virginia’s response to the inaccurately defined “cluster,” we cannot do so without acknowledging that we do not know whether or not the HIV outbreak was

contained to Cabell (nor if the outbreak in Kanawha Count was contained) simply because neither adequate testing, nor case investigation, has been conducted outside of Cabell and Kanawha Counties. To paint a portrait of a successful public health intervention without addressing the existing gaps in public health infrastructure and surveillance outside of urban areas of rural states is misleading.

When it comes to both drug use and infectious disease, two things are certain: (1) neither are contained solely within urban areas, and (2) both have been growing in rural America for more than a decade. We have yet to effectively grasp or contend with these rural health crises, despite the best efforts of county and state health departments.

Despite Dr. McClung’s accurate observation of Cabell County, there is a greater story to be told and greater needs to be met. We need more resources. We need enough funds dedicated to hiring appropriate staff. We need enough funds to adequately provide infectious disease testing and epidemiological reporting. We need enough funds to provide treatment. Right now, West Virginia’s rural counties lack those resources, putting a strain on Cabell to pick up where they cannot.

References

Driesbach, E. (2020, March 16). Treating patients ‘rapidly and effectively’ helped contain HIV outbreak in West Virginia. Thorofare, NJ: SLACK Incorporated: Healio: Infectious Disease: HIV/AIDS: Meeting News. Retrieved from: https://www.healio.com/infectious-disease/hiv-aids/news/online/%7Bd14dcd…

Office of Epidemiology and Prevention Services. (2020, March 01). HIV Diagnoses by County, West Virginia, 2018-2020. Charleston, WV: West Virginia Department of Health and Human Resources: Bureau for Public Health: Office of Epidemiology and Prevention Services. Retrieved from: https://oeps.wv.gov/hiv-aids/documents/data/WV_HIV_2018-2020.pdf

Walker, M. (2020, March 11). West Virginia HIV Outbreak: A Blueprint for Public Health Response – Used four pillars of federal initiative to manage local HIV epidemic. New York, NY: MedPage Today, LLC: Meeting Coverage: CROI. Retrieved from: https://www.medpagetoday.com/meetingcoverage/croi/85378

Community Education Group's Founder and Executive Director, A. Toni Young, with her dog, Hank

So, I’ve Been Thinking: Sharing

CEG’s A. Toni Young, Dr. Orisha Bowers, Amy Atkins, & Dr. Lynn Madden at the Project MO(H)RE announcement

So, I’ve been thinking about sharing. In particular I’ve been thinking that, as CEG starts this journey of working with health departments and Community-Based Organizations across the state of West Virginia, trying to integrate HIV into medically- assisted treatment programs, that our goal— and my goal, even my reason for being on the planet, frankly—must always be to share. I want to share what I know with other communities, and increase the capacity of other organizations to do the work that they do. But most importantly, I want to figure out how we can help individuals.

It seems like an obvious point: it’s important that we share our resources and information. But often we’re all forced into such competitive situations that we don’t instinctively share. We’re reluctant, suspicious about sharing. But if we truly have as our mission public health, or helping our community, then it’s critical that we share our knowledge, our resources, our capabilities, across all spectrums: financial, logistical, even emotional and spiritual.

As Angela Davis said, “We must always attempt to lift as we climb.” And not just because if we don’t lift up the people around us, one day it could be us in need. But because, as we grow and develop, as we get more funding and resources, or as we figure out something useful that can better our community, we need to remember: helping the people in our town, in our neighborhood, in our holler, in our families—that’s the whole point.

That’s what I’ve been thinking…

-A. Toni Young
Founder
Executive Director
CEG