Syringe Exchange Fears Hobble Fight Against West Virginia HIV Outbreak

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CHARLESTON, http://w.va/. — More than three years have passed since federal health officials arrived in central Appalachia to assess an alarming outbreak of HIV spread mostly between people who inject opioids or methamphetamine.

Infectious disease experts from the Centers for Disease Control and Prevention made a list of recommendations following their visit, including one to launch syringe service programs to stop the spread at its source. But those who’ve spent years striving to protect people who use drugs from overdose and illness say the situation likely hasn’t improved, in part because of politicians who contend that such programs encourage illegal drug use.

Joe Solomon is a Charleston City Council member and co-director of SOAR WV, a group that works to address the health needs of people who use drugs. He’s proud of how his close-knit community has risen to this challenge but frustrated with the restraints on its efforts.

“You see a city and a county willing to get to work at a scale that’s bigger than ever before,” Solomon said, “but we still have one hand tied behind our back.”

The hand he references is easier access to clean syringes.

In April 2021, the CDC came to Charleston — the seat of Kanawha County and the state capital, tucked into the confluence of the Kanawha and Elk rivers — to investigate dozens of newly detected HIV infections. The CDC’s HIV intervention chief called it “the most concerning HIV outbreak in the United States” and warned that the number of reported diagnoses could be just “the tip of the iceberg.”

Now, despite attention and resources directed toward the outbreak, researchers and health workers say HIV continues to spread. In large part, they say, the outbreak lingers because of restrictions state and local policymakers have placed on syringe exchange efforts.

Research indicates that syringe service programs are associated with an estimated 50% reduction in HIV and hepatitis C, and the CDC issued recommendations to steer a response to the outbreak that emphasized the need for improved access to those services.

That advice has thus far gone unheeded by local officials.

In late 2015, the Kanawha-Charleston Health Department launched a syringe service program but shuttered it in 2018 under pressure, with then-Mayor Danny Jones calling it a “mini-mall for junkies and drug dealers.”

SOAR stepped in, hosting health fairs at which it distributed naloxone, an opioid overdose reversal drug; offered treatment and referrals; provided HIV testing; and exchanged clean syringes for used ones.

But in April 2021, the state legislature passed a bill limiting the number of syringes people could exchange and made it mandatory to present a West Virginia ID. The Charleston City Council subsequently added guidelines of its own, including requiring individual labeling of syringes.

As a result of these restrictions, SOAR ceased exchanging syringes. West Virginia Health Right now operates an exchange program in the city under the restrictions.

Robin Pollini is a West Virginia University epidemiologist who conducts community-based research on injection drug use. “Anyone I’ve talked to who’s used that program only used it once,” she said. “And the numbers they report to the state bear that out.”

A syringe exchange run by the health department in nearby Cabell County — home to Huntington, the state’s largest city after Charleston — isn’t so constrained. As Solomon notes, that program exchanges more than 200 syringes for every one exchanged in Kanawha.

A common complaint about syringe programs is that they result in discarded syringes in public spaces. Jan Rader, director of Huntington’s Mayor’s Office of Public Health and Drug Control Policy, is regularly out on the streets and said she seldom encounters discarded syringes, pointing out that it’s necessary to exchange a used syringe for a new one.

In August 2023, the Charleston City Council voted down a proposal from the Women’s Health Center of West Virginia to operate a syringe exchange in the city’s West Side community, with opponents expressing fears of an increase in drug use and crime.

Pollini said it’s difficult to estimate the number of people in West Virginia with HIV because there’s no coordinated strategy for testing; all efforts are localized.

“You would think that in a state that had the worst HIV outbreak in the country,” she said, “by this time we would have a statewide testing strategy.”

In addition to the testing SOAR conducted in 2021 at its health fairs, there was extensive testing during the CDC’s investigation. Since then, the reported number of HIV cases in Kanawha County has dropped, Pollini said, but it’s difficult to know if that’s the result of getting the problem under control or the result of limited testing in high-risk groups.

“My inclination is the latter,” she said, “because never in history has there been an outbreak of injection-related HIV among people who use drugs that was solved without expanding syringe services programs.”

“If you go out and look for infections,” Pollini said, “you will find them.”

Solomon and Pollini praised the ongoing outreach efforts — through riverside encampments, in abandoned houses, down county roads — of the Ryan White HIV/AIDS Program to test those at highest risk: people known to be injecting drugs.

“It’s miracle-level work,” Solomon said.

But Christine Teague, Ryan White Program director at the Charleston Area Medical Center, acknowledged it hasn’t been enough. In addition to HIV, her concerns include the high incidence of hepatitis C and endocarditis, a life-threatening inflammation of the lining of the heart’s chambers and valves, and the cost of hospital resources needed to address them.

“We’ve presented that data to the legislature,” she said, “that it’s not just HIV, it’s all these other lengthy hospital admissions that, essentially, Medicaid is paying for. And nothing seems to penetrate.”

Frank Annie is a researcher at CAMC specializing in cardiovascular diseases, a member of the Charleston City Council, and a proponent of syringe service programs. Research he co-authored found 462 cases of endocarditis in southern West Virginia associated with injection drug use, at a cost to federal, state, and private insurers of more than $17 million, of which less than $4 million was recovered.

Teague is further concerned for West Virginia’s rural counties, most of which don’t have a syringe service program.

Tasha Withrow, a harm reduction advocate in bordering rural Putnam County, said her sense is that HIV numbers aren’t alarmingly high there but said that, with little testing and heightened stigma in a rural community, it’s difficult to know.

In a January 2022 follow-up report, the CDC recommended increasing access to harm reduction services such as syringe service programs through expansion of mobile services, street outreach, and telehealth, using “patient-trusted” individuals, to improve the delivery of essential services to people who use drugs.

Teague would like every rural county to have a mobile unit, like the one operated by her organization, offering harm reduction supplies, medication, behavioral health care, counseling, referrals, and more. That’s an expensive undertaking. She suggested opioid settlement money through the West Virginia First Foundation could pay for it.

Pollini said she hopes state and local officials allow the experts to do their jobs.

“I would like to see them allow us to follow the science and operate these programs the way they’re supposed to be run, and in a broader geography,” she said. “Which means that it shouldn’t be a political decision; it should be a public health decision.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News’ free Morning Briefing.

This article first appeared on KFF Health News and is republished here under a Creative Commons license.

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  • Reduce Caffeine’s Impact on Kidneys

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    It’s Q&A Day at 10almonds!

    Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

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    So, no question/request too big or small

    ❝Avid coffee drinker so very interested in the results Also question Is there something that you could take or eat that would prevent the caffeine from stimulating the kidneys? I tried to drink decaf from morning to night not a good result! Thanks❞

    That is a good question! The simple answer is “no” (but keep reading, because all is not lost)

    There’s no way (that we yet know of) to proof the kidneys against the stimulating effect of caffeine. This is especially relevant because part of caffeine’s stimulating effect is noradrenergic, and that “ren” in the middle there? It’s about the kidneys. This is just because the adrenal gland is situated next to them (actually, it’s pretty much sitting on top of them), hence the name, but it does mean that the kidneys are about the hardest thing in the body to have not effected by caffeine.

    However! The effects of caffeine in general can be softened a little with l-theanine (found in tea, or it can be taken as a supplement). It doesn’t stop it from working, but it makes the curve of the effect a little gentler, and so it can reduce some unwanted side effects.

    You can read more about l-theanine here:

    L-Theanine: What’s The Tea?

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  • Tasty Versatile Rice

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    In the nearish future, we’re going to do some incredible rice dishes, but first we need to make sure we’re all on the same page about cooking rice, so here’s a simple recipe first, to get technique down and work in some essentials. We’ll be using wholegrain basmati rice, because it has a low glycemic index, lowest likelihood of heavy metal contamination (a problem for some kinds of rice), and it’s one of the easiest rices to cook well.

    You will need

    • 1 cup wholegrain basmati rice (it may also be called “brown basmati rice“; this is the same)
    • 1 1/2 cups vegetable stock (ideally you have made this yourself from vegetable offcuts that you saved in the freezer, then it will be healthiest and lowest in sodium; failing that, low-sodium vegetable stock cubes can be purchased at most large supermarkets. and then made up at home with hot water)
    • 1 tbsp extra virgin olive oil
    • 1 tbsp chia seeds
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    • 1 tsp turmeric powder (this small quantity will not change the flavor, but it has important health benefits, and also makes the rice a pleasant golden color)
    • 1 tsp garlic powder
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    This is the ingredients list for a super-basic rice that will go with anything rice will go with; another day we can talk more extensive mixes of herbs and spice blends for different kinds of dishes (and different health benefits!), but for now, let’s get going!

    Method

    (we suggest you read everything at least once before doing anything)

    1) Wash the rice thoroughly. We recommend using a made-for-purpose rice-washing bowl (like this one, for example), but failing that, simply rinse it thoroughly with cold water using a bowl and a sieve. You will probably need to rinse it 4–5 times, but with practice, it will only take a few seconds per rinse, and the water will be coming up clear.

    2) Warm the pan. It doesn’t matter for the moment whether you’re using an electronic rice cooker, a stovetop pressure cooker, electronic pressure cooker, or just a sturdy pan with a heavy lid available, aside from that if it’s something non-stovetop, you now want it to be on low to warm up already.

    3) Separately in a saucepan, bring your stock to a simmer

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    5) Put the rice into the pan. That’s right, with no extra liquid yet; we’re going to toast it for a moment. Stir it a little, for no more than a minute; keep it moving; don’t let it burn! If you try this several times and fail, it could be that you need a better pan. Treat yourself to one when you get the opportunity; until then, skip the toasting part if necessary.

    6) Add the chia seeds and spices, followed by the stock, followed by the yeast extract. Why did we do the stock before the yeast extract? It’s because hot liquid will get all the yeast extract off the teaspoon 🙂

    7) Put the lid on/down (per what kind of pan or rice cooker you are using), and turn up the heat (if it is a variable heat source) until a tiny bit of steam starts making its way out. When it does, turn it down to a simmer, and let the rice cook. Don’t stir it, don’t jiggle it; trust the process. If you stir or jiggle it, the rice will cook unevenly and, paradoxically, probably stick.

    8) Do keep an eye on it, because when steam stops coming out, it is done, and needs taking off the heat immediately. If using an automatic rice cooker, you can be less attentive if you like, because it will monitor this for you.

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    Want to learn more?

    For those interested in some of the science of what we have going on today:

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  • Are Fruit & Vegetable Extract Supplements Worth It?

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    At 10almonds we are always extolling the virtues of fruits and vegetables, but how much do those benefits still exist when we’re looking at a fruit and vegetable extract supplement?

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    Underrated Brain Boosters

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    Key to abbreviations:

    • RIST = Reynolds Intellectual Screening Test
    • ELISA = Enzyme-Linked ImmunoSorbent Assays
    • BDNF = Brain-Derived Neurotrophic Factor
    • CREB = cAMP-Response Element Binding Protein
    • cAMP = Cyclic Adenosine MonoPhosphate

    Source: Daily fruit and vegetable extracts may boost brain power ← we quoted a pop-sci article for the above summary, for easier readability while still having the critical conclusions in one place

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    If nothing else, be aware that the usual benchmark for statistical significance is p < 0.05, whereas the results in this study ranged from p < 0.01 to p < 0.001, in other words, ranging from 5x more significant than is required to be called “significant”, to 50x more significant than is required to be called “significant”.

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    Good news! It was…

    1. a commercially available supplement (JuicePlus), which is convenient, because it means we (and you, dear reader) can get it if we so choose
    2. not paid for by JuicePlus or anyone associated with them (indeed, the funding declaration on the study is “This research received no external funding”), so not subject to any conflict of interest that might introduce bias into the study

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    ❝A unique aspect of the polyphenol-rich nutraceutical evaluated in this study lies in its composition, which integrates a blend of fruit, vegetable, and berry juice powders.

    This product, Juice Plus+ Premium®, contains over 119 distinct polyphenolic compounds, including flavanols, anthocyanins, and flavones, as demonstrated in prior compositional analyses.

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    These characteristics ensure a more diverse interaction with neurobiological pathways, including those related to oxidative stress mitigation, synaptic plasticity, and cognitive function❞

    Source: Ibid. (it’s in the introduction)

    Want to try some?

    We don’t sell it, but for your convenience, here’s where to get JuicePlus supplements Amazon 😎

    Enjoy!

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  • The Mediterranean Diet: What Is It Good For?
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    The Mediterranean diet also won 1st place in various more specific categories, including:

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    Want to know more?

    You can click around, exploring by diet or by health category, here 😎

    Enjoy!

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  • Bamboo Shoots vs Asparagus – Which is Healthier?

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    Our Verdict

    When comparing bamboo shoots to asparagus, we picked the asparagus.

    Why?

    Both are great! But asparagus does distinguish itself on nutritional density.

    In terms of macros, bamboo starts strong with more protein and fiber, but it’s not a huge amount more; the margins of difference are quite small.

    In the category of vitamins, asparagus wins easily with more of vitamins A, B2, B3, B5, B9, C, E, K, and choline. In contrast, bamboo boasts only more vitamin B6. A clear win for asparagus.

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    Want to learn more?

    You might like to read:

    Asparagus vs Eggplant – Which is Healthier?

    Take care!

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  • How To Avoid Age-Related Macular Degeneration

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    Take care of yourself!

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    Learn to Age Gracefully

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