On May 3, a federal trial began in Charleston, West Virginia, in which Cabell County and its largest city, Huntington, are suing prominent opioid distributors AmerisourceBergen Drug Co., Cardinal Health Inc. and McKesson Corp. for their roles in promulgating the opioid crisis that has ravaged the state. Across West Virginia, the effects of the opioid crisis can be felt in nearly every sector of life and almost everyone has been directly or indirectly affected – the opioid crisis has exacerbated long-existing West Virginia crises, such as the poverty rate and a shortage of foster care placements, but it has also spawned relatively new ones, such as the HIV crisis in Kanawha County.

The CDC has called the Kanawha County outbreak “the most concerning in the United States,” and for good reason – at least 35 HIV diagnoses were reported in Kanawha County in 2020, compared to New York City’s 36 in 2019. Many of these diagnoses can be traced to intravenous (IV) drug use, in which contaminated needles are shared between two or more users. However, the HIV Crisis will trickle down. HIV can be spread through drug use, sexual activity, and bodily fluids – meaning that we are all at risk, even if you aren’t a drug user. How did we get here? More importantly, how can we stop the spread?

In plain terms, the HIV crisis in Kanawha County can be largely attributed to “dirty” needles. People who use drugs often use together, and they often share needles. Even though this is risky, drugs lower inhibitions, making people more likely to engage in reckless behavior (like sharing needles) than they otherwise would.

In some areas, needle-exchange programs have been implemented to help combat this by allowing drug users to exchange their dirty needles for clean ones in a safe, non-judgmental environment. However, West Virginia recently passed Senate Bill 34, which imposes new restrictions on needle-exchange programs. For example, people who visit a needle exchange in West Virginia will be required to show ID, which seems counterproductive – drugs are illegal, so many people may be deterred from visiting once they no longer feel they are protected by anonymity. Notwithstanding the legal concern, people may be reluctant to share their ID because of the stigma surrounding drug use. 

HIV can be transmitted through sexual activity – putting a large segment of the population, particularly young people, at risk. It is well-documented that young people engage in unprotected sex at staggering rates. According to the CDC, the age group 15-24 accounts for half of all STD transmissions each year. Young people are sometimes impressionable and naïve, with the mindset “that won’t happen to me,” until it does. Thus, this puts young people who don’t engage in drug use at risk and exponentially heightens the risk for young people who do use drugs.

As referenced above, drug use lowers inhibitions. When young people (who already engage in riskier sex at higher rates) use drugs, they are significantly more likely to engage in unprotected sex which may result in the transmission of HIV. Schools should be doing more to educate students about HIV, including transmission through IV drug use. Even though West Virginia does mandate sex education and HIV is a required topic, teacher discretion means that some students are not getting the same quality of sex education as they should (PBS). Some parents resist sex education for religious reasons, while some teachers simply do not feel comfortable talking about the topics, which may be “awkward” or “uncomfortable.”

We, as a state, need to do better. When parents resist sex education and schools do not cover a topic, students will either learn about it from other students (which may be incorrect), or not learn at all. We owe it to students to be more transparent. 

The HIV outbreak in Kanawha County is a health hazard that impacts all of us – The first responder who gets blood on his hands is at risk. The teens having unprotected sex are at risk. The people who are battling addiction are at risk. Instead of legislating morality, we need to be more concerned with finding comprehensive solutions centered around education, data, and compassion. 

We need to look to health experts for guidance and trust their advice instead of trusting people with no medical background who use their positions to legislate their ideas of morality.