CHARLESTON — When the Kanawha-Charleston Health Department closed its needle exchange program last year, some of the most vulnerable people in the region became more likely to contract HIV and hepatitis C and more likely to overdose.
They also lost their connection to many of the only people they knew who cared about those things.
Several months ago, researchers at Johns Hopkins University interviewed people who had used the needle exchange.
According to a study, released Monday, needle-sharing, which increases risk for contracting certain diseases, increased in the area after the closure.
Needle exchanges, also called harm reduction programs, curb the spread of diseases like HIV and hepatitis C by reducing needle-sharing among people who use drugs.
But after the exchange in Charleston closed, one woman told the researchers she knew a person with HIV who shared needles.
The 24-year-old woman said they'd all had to share, at some point.
"Every time I do a shot I go ‘I feel it,'" she said. "'I feel the HIV coursing through my veins.’ And it's a joke, but at the same time, it's not. I laugh about it because if I don’t, I'd probably scream..."
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Harm reduction is a tenet of public health practice that came about because health care providers have a duty to try to save lives, whether or not people use drugs.
It's also an approach that recognizes attempts to require people to be free from drugs, before attempting to save their lives, stems from a misguided understanding of the insidious, brain-altering ensnare of addiction.
Sean Allen, the lead researcher of the study, noted that harm reduction programs are "not new." He said that public health researchers have decades of research that has helped them come to understand that needle exchange programs work, and how to design the best possible program.
"Harm reduction programs are one of the best strategies communities can implement to prevent HIV and viral hepatitis outbreaks, as well as overdose," he said. "People should always come before politics.”
Kanawha-Charleston Health Department's needle exchange closed over a year ago, in March 2018, after then-Charleston Mayor Danny Jones and then-Police Chief Steve Cooper began publicly attacking it, blaming it for what they said was an excess of used needles in the city and for bringing people into the city who would then commit crime.
The Charleston Police Department sent press releases about low-income people arrested for minor crimes, like shoplifting and trespassing. They would note that the person was carrying a needle.
Following the closure, mayoral candidate JB Akers, who went on to lose the election, made his opposition to the exchange a central campaign issue.
The West Virginia Department of Health and Human Resources (DHHR), after interviewing some health department employees, recommended suspending the needle exchange program in Charleston.
But DHHR didn't interview needle exchange participants. Researchers at Johns Hopkins wrote that an "objective and balanced" assessment of the exchange should have "at a minimum" included the voices of those people who used the program.
According to the study, those people said they believed that community members in the area didn't feel empathy for people with substance use disorders.
"I mean, I’ve known lawyers and doctors that, you know, do the same thing that I do [inject drugs]," said one 41-year-old woman. "You know, I have a college degree... I’ve always had a good job, my entire life, until last year. The last year I’ve had some problems, but I’m far from uneducated, and I’m far from, you know, dirty or someone to be thrown away and just, you know, forgotten about. But a lot of people look at it that way."
Meanwhile, they said they trusted the staff at the needle exchange.
"They would always ask questions," the 41-year-old woman said. "... when they were asking questions, they weren’t asking like in a nosy sort of way or anything. They were asking because they wanted to know. They wanted to learn.
"They wanted to understand."
“They taught me not to be ashamed to ask for help,” said one female participant.
A 40-year-old man added, "They made me feel like I was a person."
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About six months after the closure, in September 2018, researchers at Johns Hopkins interviewed 27 people who inject drugs – 16 men and 11 women – and who lived in Kanawha County.
Six had not used the program, but were familiar with it. Researchers recruited the participants from the streets. About 60 percent mainly injected meth. About 40 percent mainly injected heroin.
After the needle exchange closed, most of the people began buying syringes on the street, according to the study, perhaps from someone who was diabetic, or perhaps "gently-used" by another drug user. But they didn't have a steady supply.
One 49-year-old man said that after the exchange closed, needle-sharing turned into an "epidemic" of its own.
"That's how bad it's getting," he said. "I mean, you've got four or five people sharing a needle, and then they'll throw it down on the ground and maybe somebody else come along and they pick it up and they think burning it with a lighter will sterilize it. Well, that's not so. And then the next thing you know, four or five people use that needle. One needle will probably do 15 people."
In the weeks leading to the Kanawha-Charleston needle exchange closure, Charleston city officials had pointed to Health Right's program as a model program. Angie Settle, CEO of Health Right, had suggested her free clinic could see the patients previously seen at the health department's program, which was seeing about 400 people a week.
Five of the 27 people included in the study used Health Right's program. None had gone there recently, and most had only gone once.
"They're not accepting and they're just very rude," one woman said. "They're very rude with me and I don't like going there at all.
"They make you feel like you're a bad person, like, you know what I mean?"
The researchers noted that the Health Right policy requiring participants to bring back one syringe for every syringe distributed is against public health best practices and would dissuade people from coming. Public health experts say that successful harm reduction programs make it as easy as possible for people who use drugs to access syringes.
Some of the participants, particularly men, thought their HIV risk was low. HIV hasn't historically been prevalent in West Virginia.
But in 2017, health officials detected an HIV outbreak in Raleigh, Wyoming and Summers counties that eventually spread to 57 people in 15 counties. Health officials believe that outbreak was primarily spread by men having sex with men, but some also reported injection drug use.
And an hour from Charleston, the number of people tied to an ongoing HIV outbreak spread by needle-sharing in Cabell County has continued to climb. Allison Adler, spokeswoman for DHHR, reported that the number was up to 46 cases earlier this month.
Most of the study participants, though, said they didn't want to reuse syringes. They didn't want to catch hepatitis C, which can lead to liver cancer. They didn't want to catch HIV, which is treatable, but can be fatal if the person is not diagnosed and linked to care.
So they would use their syringes as long as possible.
But researchers still found an increase in needle-sharing.
One woman thought it was OK to only share among four friends. Others trusted people who told them their HIV or hepatitis status — even though the closure of the needle exchange led to a reduction in HIV and hepatitis testing.
Someone would say, "I got this one, man. I only used three times," one 35-year-old man said.
"By that time you want it so bad, you're like, man, I don't care. I'll give you 10 bucks for that needle, just give it to me, man."
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Along with HIV and hepatitis testing, the needle exchange was part of a comprehensive harm reduction program that also provided contraception and drug treatment referrals.
It also offered naloxone.
People interviewed said they noticed less of the life-saving drug available on the streets after the closure.
While the health department continued to give out naloxone, many of the homeless people didn't know that.
“Since the exchange closed?" said a 24-year-old woman. "I thought it [naloxone] disappeared into thin air or something because I have not seen not a one... Oh, it’s been months. Months.”
The study also said that since the exchange, people who use drugs became more likely to overdose.
“We heard heartbreaking stories from people in Charleston who were fighting to stay alive," said Allen, the lead researcher. "They described being stigmatized for addiction in ways that turned my stomach. People who use drugs deserve respect."
Researchers at Johns Hopkins suggested that future research should focus on how to stop the kind of "fear-based, inaccurate" messaging that led up to the closure of the Kanawha-Charleston needle exchange.
“There has never been a more critical time for policymakers, health care providers, and the broader community to support evidence-based strategies to prevent the consequences of the opioid crisis, including HIV outbreaks and overdose," Allen said. "Harm reduction programs save lives.”
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For months before the exchange closed, officials in the addiction-ravaged city of Charleston had taken to blaming "criminal vagrants" from other states for many of the city's problems — homelessness, poverty, addiction and the crime that comes with it.
City residents joined a Facebook group, Charleston Has Had Enough, to take and share photos of some of those "vagrants."
“I mean, around here in Charleston, they hate us," said one 38-year-old man. "And they know us. They take pictures of us...”
“It could make somebody so emotional that they go out and try to overdose...,” one 28-year-old man said.
But another added, "A lot of them don’t care if you die."
The Charleston Gazette-Mail later found that most of the "vagrants" in the area were actually from West Virginia.
"I want to change," one 37-year-old man told the researchers. "But it's hard to change when they make you feel different than or less than."
Another said that people in Charleston think "we're the most disgusting, evil, cold-hearted people they've ever seen."
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