LOST RIVER, W.Va. February 1, 2021 – The Community Education Group (CEG) will be convening a statewide roundtable on the topic of harm reduction in West Virginia on Monday, February 8th, 2021 from 2:00 - 4:00 PM.
 This open panel discussion will be moderated by CEG’s Founder & Executive Director, A. Toni Young, and will feature local and state elected officials, private business representatives, public health experts, and harm reduction providers from across the state. 
“There are a lot of misconceptions about what ‘harm reduction’ actual is, whom it serves, and the impacts it has on our communities,” said Ms. Young. “After two decades of dealing with the opioid crisis in West Virginia, emotions are fraught and tempers are high. This roundtable is meant to bring all of the stakeholders to the table to come up with some answers and recommendations.”
 This roundtable discussion will occur during the regular monthly meeting of the West Virginia Statewide Stakeholders Coalition (WVSSC), a coalition of over 100 individuals, Community-Based Organizations, government agencies and departments, healthcare providers, insurers, and pharmaceutical partners that meets on the second Monday of each month (excluding federal holidays). Each meeting averages between 40-60 attendees, making this one of the best-attended coalitions in West Virginia.
 Registration is open to the public, and the WVSSC invites community members, community organizations and businesses, and healthcare providers, alike, to participate in this important roundtable. Those interested in attending my register using the following link: 
https://cutt.ly/JoinWVSSC
 All questions for the panelist should be submitted in advance to:
 info@communityeducationgroup.org 
The Community Education Group (CEG) is a 501(c)(3) not-for-profit organization with offices in Lost River, West Virginia, and Washington, D.C., working to eliminate disparities in health outcomes and improve public health in disadvantaged populations and under-served communities

Harm Reduction: A Community Conversation

LOST RIVER, W.Va. February 1, 2021 – The Community Education Group (CEG) will be convening a statewide roundtable on the topic of harm reduction in West Virginia on Monday, February 8th, 2021 from 2:00 - 4:00 PM.
  This open panel discussion will be moderated by CEG’s Founder & Executive Director, A. Toni Young, and will feature local and state elected officials, private business representatives, public health experts, and harm reduction providers from across the state.  
“There are a lot of misconceptions about what ‘harm reduction’ actual is, whom it serves, and the impacts it has on our communities,” said Ms. Young. “After two decades of dealing with the opioid crisis in West Virginia, emotions are fraught and tempers are high. This roundtable is meant to bring all of the stakeholders to the table to come up with some answers and recommendations.”
  This roundtable discussion will occur during the regular monthly meeting of the West Virginia Statewide Stakeholders Coalition (WVSSC), a coalition of over 100 individuals, Community-Based Organizations, government agencies and departments, healthcare providers, insurers, and pharmaceutical partners that meets on the second Monday of each month (excluding federal holidays). Each meeting averages between 40-60 attendees, making this one of the best-attended coalitions in West Virginia.
  Registration is open to the public, and the WVSSC invites community members, community organizations and businesses, and healthcare providers, alike, to participate in this important roundtable. Those interested in attending my register using the following link:  
https://cutt.ly/JoinWVSSC
  All questions for the panelist should be submitted in advance to:
  info@communityeducationgroup.org  
The Community Education Group (CEG) is a 501(c)(3) not-for-profit organization with offices in Lost River, West Virginia, and Washington, D.C., working to eliminate disparities in health outcomes and improve public health in disadvantaged populations and under-served communities

LOST RIVER, W.Va. February 1, 2021 – The Community Education Group (CEG) will be convening a statewide roundtable on the topic of harm reduction in West Virginia on Monday, February 8th, 2021 from 2:00 – 4:00 PM.

This open panel discussion will be moderated by CEG’s Founder & Executive Director, A. Toni Young, and will feature local and state elected officials, private business representatives, public health experts, and harm reduction providers from across the state.


“There are a lot of misconceptions about what ‘harm reduction’ actual is, whom it serves, and the impacts it has on our communities,” said Ms. Young. “After two decades of dealing with the opioid crisis in West Virginia, emotions are fraught and tempers are high. This roundtable is meant to bring all of the stakeholders to the table to come up with some answers and recommendations.”


This roundtable discussion will occur during the regular monthly meeting of the West Virginia Statewide Stakeholders Coalition (WVSSC), a coalition of over 100 individuals, Community-Based Organizations, government agencies and departments, healthcare providers, insurers, and pharmaceutical partners that meets on the second Monday of each month (excluding federal holidays). Each meeting averages between 40-60 attendees, making this one of the best-attended coalitions in West Virginia.


Registration is open to the public, and the WVSSC invites community members, community organizations and businesses, and healthcare providers, alike, to participate in this important roundtable.

Those interested in attending my register using the following link:

https://cutt.ly/JoinWVSSC


All questions for the panelist should be submitted in advance to:


info@communityeducationgroup.org


The Community Education Group (CEG) is a 501(c)(3) not-for-profit organization with offices in Lost River, West Virginia, and Washington, D.C., working to eliminate disparities in health outcomes and improve public health in disadvantaged populations and under-served communities

West Virginia Statewide Stakeholder Coalition November 2020 Meeting Flyer

WVSSC Meeting – November 9th, 2020

An image of the New River Gorge Bridge with the words "WV Statewide Stakeholder Coalition" above it

The November 2020 meeting of the WVSSC will take place on Monday, November 9th, 2020 from 2:00 – 4:00 PM


This month’s meeting features the following guests:


Substance Abuse and Mental Health Services Administration

Photo of Dr. Neeraj "Jim" Gandotra

Dr. Neeraj “Jim” Gandotra
Chief Medical Officer
(SAMHSA)

Photo of Dr. Jean Bennett

Dr. Jean Bennett
SAMHSA Regional Administrator
Region III


Substance Use Disorder

Photo of Stephanie Lancaster

Stephanie Lancaster
Director of Community Health Solutions
Indiana, Ohio, & West Virginia
Emergent BioSolutions


HIV

Photo of Shawn Balleydier

Shawn Balleydier
Assistant Director
Director of HIV Prevention and Care
Division of STD, HIV and TB
Office of Epidemiology and Prevention Services
Bureau for Public Health/WVDHHR


Viral Hepatitis

Tiffany West
Gilead Sciences


Members of the WVSSC

New River Bridge Bridge Day Celebration

Community Education Group Forms West Virginia Statewide Stakeholder Coalition

FOR IMMEDIATE RELEASE

Public Health and Community Organizations Join Forces to Combat Triple Threat of Substance Use, HIV, Hepatitis Outbreaks in West Virginia

New Coalition Will Take on Rising Infection Rates and Drug Overdose Deaths in the State

SHEPHERDSTOWN, W.Va. SEPTEMBER 17, 2020 – The West Virginia Statewide Stakeholder Coalition (WVSSC) convened for the first time on September 1, 2020, to address West Virginia’s growing “syndemic” of HIV/Hepatitis C (HCV) outbreaks and drug overdose deaths. The group’s primary mission is to break down technical, regulatory, and administrative barriers that limit testing, treatment, and support across HIV, viral hepatitis, and substance use disorder [SUD] programs. Such barriers create “treatment silos” that fail to reflect the medical and social realities behind the interrelated health crises—and thereby impede effective intervention.

The meeting was convened by the health advocacy organization Shepherdstown-based Community Education Group (CEG). CEG formed the new statewide coalition aimed at stemming the rising tide of fatalities and HIV and viral hepatitis infections driven by West Virginia’s ongoing opioid crisis. 

“We are facing an unprecedented Substance Use Disorder epidemic in West Virginia,” said A. Toni Young, Founder and Executive Director of CEG. “An epidemic that is directly linked to our state’s highest-in-the-nation rates of Viral Hepatitis, to three HIV outbreaks in the past four years, and to the highest rate of drug overdose deaths in the nation. It constitutes an immediate and ongoing threat to public health, requiring a proportional response. The West Virginia Statewide Stakeholder Coalition assembles the expertise and collaborative strategy to spearhead that response.”

The WVSSC will focus on expanding awareness, education, rapid testing for HIV and Viral Hepatitis, treatment for SUD, and linkage-to-care networks which refer those recently diagnosed with HIV or Viral Hepatitis to treatment resources. 

The first WVSSC meeting brought together 65 individuals and organizations including state government and public health officials, healthcare providers, national organizations, school board officials, community-based organizations, and others from across West Virginia. 

Representatives attendees for WVSSC include: West Virginia Department of Health and Human Resources; the Bureau for Public Health; the Office of Epidemiology and Prevention Services; the Office of Laboratory Services; the Office of Drug Control Policy; the Doddridge, Marion, Marshall, Mid-Ohio Valley, and Monongalia County Health Departments; Berkeley County Schools; the Hancock County Commission; the Jefferson Berkeley Alliance on Substance Abuse Prevention; the United Ways of Central WV, Marion, and Taylor Counties; Community Connections; David Medical Center; the Eastern Panhandle Regional Planning and Development Council; Eastridge Health Systems; EnAct, Inc.; the Family Resource Networks in Fayette, Gilmer, and Jackson Counties; the Morgan County Homeless Coalition; the Regional Intergovernmental Council; the West Virginia Institute of Community and Rural Health; West Virginia University; and many other private and public community members from across the state.

WVSSC’s primary goals include: 

1.)   Working to deconstruct disease state silos between Substance Use Disorder, HIV, and Viral Hepatitis by increasing awareness, education, and building linkages to care and treatment networks;

2.)   Working to expand HIV screening, rapid testing, surveillance, treatment, and linkage to care throughout West Virginia, reaching into hard-to-reach and hard-to-treat parts of the states;

3.)   Helping to develop statewide elimination plans for HIV and Viral Hepatitis;

4.)   Developing statewide working groups focused on SUD, HIV, and Viral Hepatitis;

5.)   Offering educational opportunities to Providers, Organizations, and Consumers centered around HIV, Substance Use Disorders, and Viral Hepatitis

NEXT MEETING: The next open meeting of WVSSC will be held on October 13, 2020, at 2:00 PM ET.  All are invited. Sign up by filling out the form at this address

Community Education Group & WVU to Host Statewide HIV Meeting

Presenters to include NIH and community health leaders
Monday, September 14, 2020

MORGANTOWN, W.VA.: Great strides have been made in recent years in the field of HIV and AIDS prevention and research. On September 29, from 11 a.m. to 1 p.m. national and community health leaders will be leading a virtual discussion on these advances and challenges that remain in West Virginia communities.

This virtual event will be divided into two segments. The first segment will begin at 11 a.m. and will feature a keynote address by Maureen Goodenow, PhD, who serves as the associate director of AIDS research and the director of the National Institute of AIDS Research. Goodenow will be followed by Ming Lei, PhD, who serves as director of the Division of Research for Capacity Building at the National Institute of General Medical Sciences. Following their remarks, a panel of West Virginia health leaders will weigh in on current research efforts and how they directly affect the Mountain State. In addition to Goodenow and Lei, Judith Feinberg, professor and vice chair of research with the West Virginia University School of Medicine will serve on the panel, with additional panelists to be announced. Attendees will be able to ask questions of the panelists.

At noon, the discussion will turn towards community efforts, led by a panel of health department and community experts who work daily to educate and treat West Virginians with HIV. Confirmed panelists include: Terrence Reidy, MD, MPH, health officer, Berkeley/Morgan and Jefferson Counties Health Departments, Michael Kilkenny, MD, physician director, Cabell Huntington Health Department and Laura Jones, MSW, executive director of Milan Puskar HealthRight. More panelists will be added as they are confirmed.

This event is the first installment of the West Virginia Clinical and Translational Science Institute’s “In Focus” series, which will center around specific health topics in fall 2020. The first session will be hosted in partnership with the Community Education Group, an organization working to foster community engagement in community-based research programs while giving a voice to people whose lives are directly affected by HIV/AIDS and other health crises.

This event is free and open to the public, particularly those involved in clinical care and HIV and AIDS research.

Attendees must RSVP at the event webpage. A link to the ZOOM webinar will be shared one week prior to the event.

Inaugural West Virginia Statewide Stakeholder Meeting a Resounding Success

#CEGInWV hosted a very successful inaugural West Virginia Statewide Stakeholder Meeting, on Tuesday, September 1st, 2020.

The meeting brought together 65 individuals and organizations, including state government and public health officials, healthcare providers, national organizations, school board officials, Community-Based Organizations, and others from across West Virginia.

CEG’s Founder and Executive Director, A. Toni Young, presented about CEG’s work in the state of West Virginia, including the following:

  1. Working to deconstruct disease state silos between Substance Use Disorder, HIV, and Viral Hepatitis by increasing awareness, education, and building linkage to care networks;
  2. Working to overturn West Virginia’s 2007 legislative moratorium (§16-5Y-12) on new Opioid Treatment Programs that offer Methadone for use as Medication-Assisted Treatment (MAT);
  3. Working to expand HIV screening, rapid testing, surveillance, treatment, and linkage to care throughout West Virginia, reaching into hard-to-reach and hard-to-treat parts of the states;
  4. Working with the West Virginia Bureau for Public Health, Department of Health and Human Resources, and Office of Laboratory Services to clarify, adapt, and revise West Virginia’s HIV testing statute (§64-64);
  5. Working to increase Viral Hepatitis vaccination, testing, surveillance, and treatment services throughout the state;
  6. Helping to develop statewide elimination plans for HIV and Viral Hepatitis;
  7. Developing statewide working groups focused on SUD, HIV, and Viral Hepatitis;
  8. Establishing regular statewide stakeholder meetings to discuss strategies for addressing West Virginia’s most pressing public health needs.

Toni was joined by Ana Paula Duarte (Southern AIDS Coalition), Adrienne Simmons (National Viral Hepatitis Roundtable), Nicole Elinoff (National Alliance of State and Territorial AIDS Directors – NASTAD), and Mike Weir (NASTAD), all of whom presented on their respective areas of expertise.

The video of this first meeting has been made available on CEG’s YouTube channel (here), and the full meeting was streamed live on CEG’s Facebook page (here). You can also download the slides used during the meeting by clicking on their respective buttons.

Thank you, to everyone who attended this first meeting, and we look forward to working with our partners across West Virginia to build a stronger community, one project at a time.

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 Launches West Virginia Opioid Treatment Survey

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

CEG has launched a statewide survey for providers and People Who Use/Inject Drugs (PWUD/PWID, respectively) focusing on West Virginia’s 2007 legislative moratorium on opening any new Opioid Treatment Programs in the state.

In 2007, the West Virginia state legislature enacted a legislative moratorium (§16-5Y-12) on the opening of new Opioid Treatment Programs (OTP), halting in place the number of programs that prescribe and dispense Methadone for use in Medication-Assisted Treatment (MAT) to treat Opioid Use Disorder (OUD).

This moratorium limited the number of OTPs in the state to only 9 sites, statewide, who can legally provide MAT services using Methadone. It also prevents these facilities from opening secondary satellite locations, essentially locking in place where people can seek inpatient or outpatient MAT services using Methadone.

Since the passage of (§16-5Y-12), West Virginia’s opioid addiction crisis has raged out of control, leaving with the highest rate of Drug Overdose Deaths, the highest rate of new Hepatitis A infections, the highest rate of new Hepatitis B infections, and the second-highest rate of new Hepatitis C infections in the United States in 2018. In addition, Injection Drug Use (IDU) of both opioids, and stimulants accounted for 91 (62.3%) of the 146 new HIV infections in West Virginia in 2019.

The survey will gauge awareness of West Virginia’s 2007 Moratorium on the expansion of existing or opening of new Opioid Treatment Programs, as well as attitudes related to West Virginia’s Opioid Addiction Crisis. There are also sections related to Substance Use Disorder (SUD), SUD/OUD Treatment Provision, and the provision of other services that are inextricably linked to West Virginia’s opioid addiction crisis.

This survey takes between 5-30 minutes to complete, depending on how many questions pertain to the person taking this survey. Not every person surveyed will be required to answer every question.

To participate in our survey, either fill out the form, embedded below, or click on the button. Please note: the form scrolls within the page.

Photo of a gloved hand holding two purple vacutainer tubes filled with a blood sample

Infectious Disease Testing in Rural America

Marcus J. Hopkins
Policy Coordinator
Community Education Group

By: Marcus J. Hopkins

When I first tested HIV-positive, I was living in Atlanta, GA.  It was April 12th, 2005, and I was 23 and unready to face my diagnosis.  I ignored it, for two years, in part of that unpreparedness, and in part because, at the time, the treatment recommendation was to not initiate treatment until patients were diagnosed as having AIDS, the qualification for which is having one’s CD4 cell count drop below 200 cells per mm3

On October 17th, 2007, after being admitted to Broward General in Ft. Lauderdale, FL, I had them run my numbers, after ignoring them for over two years, and that CD4 count came back at 67.

It was official – I had AIDS.

Once I got a doctor and got prescribed my medications, I went to a Rite Aid with my supposedly full-coverage employer-provided insurance, only to be told that, after filling the scrip for one of my three medications, my insurance was maxed out, and I wouldn’t be able to get the drugs I desperately needed.  I’m not really a big “crier,” but at that time, I wept in a pharmacy.

Luckily, my then-partner lived with a man who would later form the ADAP Advocacy Association (aaa+) who told me about the Ryan White Act and how to get coverage for my medications.  After jumping through several hurdles, including gathering tax documents, paycheck stubs, a birth certificate, two forms of photo identification, and selling a kidney (that last one isn’t a thing), I was able to get an appointment and get approved for the AIDS Drug Assistance Program (ADAP).

I began taking meds on November 19th, 2007, and by Valentine’s Day, 2008, my viral load (the number of actively replicating HIV virus in my blood) was undetectable, where I have remained, with the exception of two months, for over 13 years.

During that time, I have moved from Florida to Tennessee, from Tennessee to California, and from California to West Virginia, and during those moves, I encountered a unique phenomenon: HIV testing has largely failed to reach rural America.

I know, right?  It’s 2020 – nearly forty years after the Centers for Disease Control and Prevention (CDC) published the first article directly related to what was then called GRID (Gay-Related Immune Deficiency) in the June 5th, 1981 Morbidity and Mortality Weekly Report (MMWR) – Pneumocystis Pneumonia – Los Angeles (CDC, 1981).  One would think that, after four decades, rural America would have its collective “stuff” together and be testing its population, right?

Unfortunately, no.

Both in Tennessee (specifically, Northeast Tennessee in the Appalachian Mountains), and in West Virginia, outside of the few metro areas, HIV testing has not been a priority.  For the very same reason that doctors in this part of the country told patients not to worry about getting vaccinated for Hepatitis B (HBV), people living in rural America – particularly in the geographically isolated Appalachian Mountain region – have been living under the shared illusion that their isolation has served as a good enough preventative measure against infectious diseases.  Worse, still, is that these Americans have been told that this is the case, not only by physicians who should know better, but by the people whom they elect into office.

This has been a common refrain about every epidemic in human history:

“This is a big city problem!  We don’t have to worry about heroin/meth/HBV/HCV/HIV/STDs/STIs/COVID-19, here!  Our folks are better than that!”

This prevailing theme has been proven false not just in the recent past, but over the course of millennia.  The people who believed that the rich, the politically empowered, and the men of the cloth (e.g. – priests) would never contract the plague in 14th Century Europe are the very same people who have claimed that those of us who live in rural America don’t have to worry about the ills of urban society, because our “goodness” protects us.

Perhaps, they should go and reread accounts from the 14th Century that depict entire monasteries filled with the bodies of the dead.  If that’s too far back for them to look, they might simply look at the recently discovered rural Plague Pit found in Lincolnshire, England on the site of a 14th Century monastery filled with 48 bodies, including more than two-dozen children (Sharman, 2020).

Dr. Hugh Willmott, one of the workers at the Thornton Abbey archaeology dig site in rural England said this:

“The finding of a previously unknown and completely unexpected mass burial dating to this period in a quiet corner of rural Lincolnshire is thus far unique, and sheds light into the real difficulties faced by a small community ill-prepared to face such a devastating threat.” (Sharman)

This assessment of past preparedness should serve as a dark portent of things to come, not only as they related to the burgeoning rates of new HIV diagnoses directly linked to Injection Drug Use (IDU), such as West Virginia has seen in the past three years), but as it relates to another, more pressing concern: COVID-19.

Having lived in West Virginia, again, for seven years, and carrying the banner that reads: “We must begin offering opt-out testing for Viral Hepatitis and HIV to every single person at every single medical appointment, regardless of specialty” (a long, unwieldy banner to carry, to be certain), I, along with others who work in the Infectious Disease space, have been sounding the alarm about COVID-19, as well.  Sadly – and yet, unsurprisingly – I have encountered much the same mindset about COVID-19 as I did when waving the HIV testing flag: “It can’t happen, here.”

Once COVID-19 really hits rural America – particularly the geographically isolated Appalachian Mountain region (I know…I keep hammering this description home) – rural America is not ready to respond.  We do not have in place the kind of rural public health infrastructure that is necessary to effectively respond to an outbreak in rural regions.

People who travel from rural areas to the suburbs or urban areas of their state for work will contract COVID-19.  They will carry that virus back to their loved ones, at home, as well as to every person they encounter, along the way.

Once they begin to shed virus, every single point of contact becomes a potential point of infection.

Once they begin to show symptoms, they will have to travel back into the suburban and urban medical facilities for diagnosis, treatment, and, potentially, intensive care, and each person they encounter along the way has the potential to contract the virus.

This has been the course of every viral pandemic outbreak in human history.  It isn’t just a random prediction; it’s a pattern that repeats itself, every single time.  Sadly, Americans don’t seem to learn these lessons for ourselves, until someone we personally know and love dies.

Photo of the state of West Virginia outline with counties shaded red where confirmed cases of COVID-19 have been identified.  Counties without diagnoses are colored in grey.
Only four counties in West Virginia have no confirmed COVID-19 diagnoses

WBOY 12 in Clarksburg, WV has a running tally on new cases and deaths in the state of West Virginia (here) that reported an increase of 42 cases in the state since May 23rd, 2020 at 5:00 PM.  To most people, “42 new cases” doesn’t sound like a lot, compared to the overall population of the state.

When you think about the fact that those 42 patients will likely come into contact with at least three people (potentially creating 126 new diagnoses), and those three people will likely come into contact with at least another three people (378 more diagnoses, on top of the original 168)…like a 1980s Fabergé Organics shampoo commercial, only without the benefit of “…super fresh-smelling hair”.

Disclaimer: Blog posts on CEG’s Community Perspectives blog do not necessarily reflect the views of the Community Education Group, its grantors, its corporate sponsors, or its organizational partners, but rather they provide a neutral platform whereby each author serves to promote open, honest discussion about issues specific to their personal expertise, lived experience, and perspective. Please note that some of the content on Community Perspectives may be graphic due to the nature of the issues being addressed by the author.

It was these thoughts I was thinking, this morning, as I ventured to a Walmart in Grafton, West Virginia, to pick up something my mother had ordered, and saw only store employees and a handful of shoppers wearing facemasks (myself, included).

There was no social distancing; no facemasks to be found.  As I waiting to pick up my mother’s item, I listened to the haunting strains of Naked Eyes’ “Always Something There to Remind Me” and thought to myself, “I wonder if these people will remember this day as the day they contracted COVID-19.

References

Centers for Disease Control and Prevention. (1981, June 05). Pneumocystis Pneumonia — Los Angeles. Morbidity and Mortality Weekly Report, 30(21), 1-3. Retrieved from: https://www.cdc.gov/mmwr/preview/mmwrhtml/june_5.htm

Sharman, J. (2020, February 19). Medieval Black Death burial site in Lincolnshire uproots previous theories about plague. London, United Kingdom: Independent Digital News & Media Limited: The Independent: News: Science: Archaeology. Retrieved from: https://www.independent.co.uk/news/science/archaeology/black-death-mass-grave-uk-lincolnshire-thornton-abbey-plague-a9344091.html

CEG is a national organization that offers local programs and policy solutions.

We serving diverse populations, prioritizing indigenous populations and populations in need

CEG’s work includes Direct Service programs, Policy work, and Capacity Building

Disclaimer: Blog posts on CEG’s Community Perspectives blog do not necessarily reflect the views of the Community Education Group, its grantors, its corporate sponsors, or its organizational partners, but rather they provide a neutral platform whereby each author serves to promote open, honest discussion about issues specific to their personal expertise, lived experience, and perspective. Please note that some of the content on Community Perspectives may be graphic due to the nature of the issues being addressed by the author.

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

Screenshot of Steven W. Thrasher, PhD's opinion piece, HIV is Coming to Rural America, in the New York Times

Community Education Group Founder and Executive Director, A. Toni Young, in The New York Times

CEG’s founder and executive director, Toni Young, was featured in a piece published in The New York Times Opinion section: “H.I.V. Is Coming to Rural America And rural America is not ready” by Dr. Steven W. Thrasher (Northwestern University), speaking about West Virginia and rural America’s burgeoning HIV crisis lurking beneath the bucolic scenery: As A. Toni Young, an AIDS activist, puts it, the “epidemic of opioid addiction — fueled by drug companies’ promotion of pain medications beginning in the 1990s — is a crisis for rural regions in part because these regions are completely unprepared to deal with the magnitude of the problem.” Ms. Young founded what is now called the Community Education Group in Washington, D.C., in 1993, originally to address H.I.V. and AIDS in women. An African American lesbian, she has spent most of the past 30 years working to help members of the Black, gay and urban communities it affects.

Follow the link to read the full article: HIV Is Coming To Rural American And Rural America Is Not Ready