West Virginia's enduring, intertwined epidemics: Opioids and HIV

Dr. Sally Hodder, a leading infectious disease expert at West Virginia University, believes that despite the threat of COVID-19, the opioid and HIV epidemics should not be ignored. The two have become so intertwined in the Mountain State, that they must be treated together, she said.

"We cannot try to solve the opioid epidemic or our emerging HIV epidemic by combating them separately," said Hodder, who serves as director of the West Virginia Clinical and Translational Science Institute and associate vice president for clinical and translational research at WVU. "Since they are both so interconnected, we have to look at this as one larger issue, and treat it as such."

Hodder was recently published, along with WVU colleague and professor Judith Feinberg, in a Lancet series focused on the ongoing challenges to ending HIV. These challenges include racial, sexual and gender disparities; gaps in domestic HIV program funding; and a lack of access to treatment and prevention services. The Lancet is the world's oldest peer-reviewed general medical journal.

Hodder and Feinberg noted that while West Virginia has a variety of barriers (economic hardships, limited access to healthcare and treatment services) to combating these intertwined epidemics, one of the biggest obstacles that must be addressed is stigma.

"We won't be able to end the co-epidemics of HIV and opioids until we reduce the stigma associated with both substance abuse and HIV, especially in rural areas that may be suboptimally equipped to deal with these issues in the first place," Hodder said. "In places such as West Virginia, where the collapse of the coal mining industry and extreme poverty have exacerbated the opioid epidemic, decriminalizing substance abuse, providing clean, safe places for syringe service programs and other interventions, and offering comprehensive HIV prevention, care and treatment services are all essential to ending these intertwined epidemics."

West Virginia continues to lead the nation in drug overdose death rates at 51.5 per 100,000, according to the most recent Centers for Disease Control and Prevention data.

While West Virginia and Appalachia have historically seen very low HIV rates, the number of individuals who inject drugs has skyrocketed. This opioid epidemic-related transmission has led to multiple HIV clusters that have not been seen in the past.

"West Virginia has had HIV outbreaks across the southern coalfields, then in Cabell County, and most recently, in Kanawha County," said Dr. Feinberg, vice chair of research and professor, WVU School of Medicine. "In 2020, there were 37 new HIV diagnoses in Kanawha County compared to 38 in 2019 in all of New York City, leading the Centers for Disease Control and Prevention to say that this outbreak was currently their highest concern."

"What we saw in previous HIV outbreaks was that people lived in more urban areas," Hodder said. "This afforded them greater access to medical care and harm reduction services. These are things that are huge challenges in Appalachia. Geographical barriers may make finding and traveling to medical care and syringe services more difficult."

This is not the first time Hodder has fought HIV. After completing her medical training, she worked in Kenya and witnessed the emergence of AIDS in Africa. Hodder also spent 9 years running an HIV program in Newark, New Jersey, an area that at the time had an almost 3% HIV positive rate.

While there is still a lot of work to be done to combat these issues, Hodder remains hopeful.

"I have seen firsthand what communities can do together when people from multiple constituencies are part of the conversation," Hodder said. "Let's continue the great work that is ongoing in many West Virginia communities to provide necessary care, treatment and access to harm reduction that are all necessary to tackle HIV."