A cluster of HIV cases in Cabell County reflects a shift in how the disease is being transmitted, West Virginia health officials say.
The Charleston Gazette-Mail reports Cabell County’s cluster — the only one currently known in West Virginia — is up to 49 confirmed cases, according to the West Virginia Department of Health and Human Resources.
All the cases were contracted by intravenous drug use through sharing of contaminated syringes.
The cluster, tracked since January 2018, represents a sharp uptick from the baseline average of eight cases annually over the past five years.
In 2017, West Virginia had one of the nation’s lowest rates of HIV diagnoses (4.3 cases per 100,000 residents), according to the Centers for Disease Control and Prevention. Neighboring Kentucky (7.9 per 100,000) fared similarly.
The HIV cases could potentially be devastating for Appalachian communities already ravaged by opioid addiction
The rise in HIV cases is particularly troubling considering Cabell County has an estimated 1,800 active IV drug users, creating an ample at-risk population for the virus to spread.
HIV is difficult to track and impossible to predict, but introducing the virus in the region’s drug-using population is an obvious cause for concern for state health officials.
“We expect the case count to increase just because we know there’s people out there that have not yet been tested,” said Shannon McBee, senior epidemiologist at DHHR, in a joint interview alongside Dr. Cathy Slemp, State Health Officer, at the state office in Charleston.
“Until we can get a handle on how many people have been tested in Cabell County, it’s likely we’ll continue to see cases,” McBee said.
HIV cases are still comparatively sparse in West Virginia. The dynamics for addressing it have changed, however, as the chief at-risk population shifts, and it’s created new challenges for those in public health.
Unlike typically close-knit and stable LGBTQ communities, reaching intravenous drug users can feel like chasing shadows. More than half of those in the current Cabell County outbreak are homeless; they’re typically transient and often from out of town, and aren’t likely to seek assistance on their own.
That means meeting them where they’re being housed, where they get their meals and where they encounter the medical system, McBee said — and that’s been the new challenge from a public health perspective.
While the diseases themselves aren’t comparable, much of the lessons and community partnerships built during last year’s hepatitis A outbreak can be applied to HIV outreach. As in HIV, hepatitis A spread primarily among the homeless and transient.
“This is not something that public health can just step in and fix,” Slemp said. “This is about how we work together as a community to come together. We can guide, support and lead in public health, but it really is about how a community and providers come together to help diagnose and link people to care for HIV.”
Cabell County is well equipped to handle its own HIV cluster, Slemp and McBee agreed, both through the services it provides and the partnerships built in response to the opioid epidemic, which can easily adapt to HIV prevention.