Charleston – Health officials say there has been one death associated with the ongoing surge in HIV cases in Cabell County.
"There has been one death associated with the Cabell County HIV cluster," Allison Adler, spokeswoman for the state Department of Health and Human Resources, said in an email.
It's unknown what the cause of death was. Christine Teague, program director for the Charleston Area Medical Center Ryan White program, said HIV can make people more vulnerable to other illness and that HIV can be terminal when it progresses to AIDS within 10 years, if not treated. She also noted that it's possible people are being diagnosed now who have had the virus for some time.
She also said drug overdoses have become more common among patients with HIV in recent years in West Virginia.
Adler declined to release further details, including whether the person resided in Cabell County or when the death occurred, citing privacy reasons.
Cabell County is currently experiencing a dramatic HIV increase due to the sharing of needles for injection drug use. HD Media reported last week that the number of related cases was up to 53. The county typically experiences eight new cases per year.
Elizabeth Adkins, a spokeswoman for the Cabell-Huntington Health Department, also confirmed there had been a death. She declined a request to speak more generally about HIV risk and prevention with Cabell County health officials, deferring to state officials. But Adler, WV DHHR spokeswoman, did not respond to an emailed request for an interview about HIV risk and prevention Monday.
Teague, Ryan White program director, noted that HIV is both preventable and treatable.
She added, though, that people who use drugs and people who are homeless can be a difficult population for health care providers to reach and educate.
She noted that workers in Cabell County have had a difficult time getting those diagnosed to come to doctor's appointments. Many are homeless and difficult to track down and encourage to enter treatment.
"I really think what we'll end up having to do is more street medicine where we're actually going out into the community, whether it's at places like Covenant House," she said, referencing a nonprofit in Charleston, "or literally under the bridge, to actually do their care there."
Teague noted that treatment can mean long hours spent in doctor's offices and that many are dealing with poverty, addiction and hopelessness.
She said one person said, "Well, I'm going to die anyway of my drug use, so why even bother with taking an HIV medicine?" A couple others said they couldn't take the time to sit for hours in a doctor's office.
She noted hours waiting in doctor's offices and on lab work can be difficult for someone "who has it all together and feels well."
"Then, how do you work with that mindset of 'I'm going to die anyway. I'm probably going to overdose next week or I'm going to die of liver failure, probably in a year; why should I even bother with my HIV?' " she said.
"It's just sad. It's pitiful. When you have so many barriers and stigma on top of it, it can be very, very difficult."
Teague also said that people shouldn't panic. HIV isn't spread through casual contact.
But she said they should be tested and be aware of their risk. Local health departments as well as other health care providers offer testing. People who inject drugs and sex workers are more at risk.
Some people may believe they aren't at risk because the surge is primarily among people who use drugs, Teague noted.
But she said people who have sex with people who inject drugs may also contract the virus. Condoms reduce risk of HIV spreading. People should be sure to know the status of their sexual partners, she said.
Teague noted that HIV began primarily among men who have sex with men in the United States but quickly spread to other groups.
To reduce risk, public health officials say people who use drugs and plan to continue using drugs should use clean needles and use clean needle exchange programs where available. DHHR-certified clean needle exchange programs are available in 16 counties in West Virginia, DHHR has previously said. That includes locations at health departments in Raleigh, Fayette, Greenbrier and Wyoming counties.
State public health officials have also said people who inject drugs can reduce chances by no longer injecting drugs or by using only sterile needles, cleaning their skin with a new alcohol swab before injecting, making sure not to get someone’s blood on their hand or their needle, disposing properly after one use and not giving needles away.
Public health officials have known much of West Virginia was particularly susceptible to an HIV outbreak for years, because of the high rate of injection drug use, access to health care and the prevalence of poverty. In 2016, the Centers for Disease Control and Prevention reported that of 220 counties most vulnerable to an HIV outbreak, 28 were in West Virginia, most in the southern part of the state. They've known for more than three decades that clean needle exchange programs, which have begun in the state over the last several years, were effective in preventing the spread of HIV.
The Register-Herald reported in April that many of West Virginia's programs are under-utilized, as it takes time to build trust with the target population.
Teague said that treatment for HIV is covered by Medicaid, Medicare and private insurers in West Virginia. The Ryan White program can help people who don't have insurance and is open to people from 19 counties in southern West Virginia. They help people pay for transportation to Charleston, she said. She said for more information, people can call 304-388-8106.
"Cost should not be a factor in people coming to engage in care because that's what we're here for," she said.
Pre-exposure prophylaxis (or PrEP), a preventative medication for those at high risk, such as sex workers, people who share needles, or people with a sexual partner with HIV, is covered by Medicaid and Medicare, but private insurers may charge high co-pays, she said.
Gilead Sciences, the company that makes PrEP – the brand name is Truvada – offers a patient-assistance program for low-income people who need the medication, she said. The medication will become available more cheaply in generic form next year, she said, and is also expected to become more widely covered by private insurers, without co-pays.
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