Michael Kilkenny is emphatically looking for those people who have contracted HIV in his Cabell County in recent months. He and his team ask anyone who tests positive who he or she has had sex with and shared injections with. Then they examine those close to them.
Each time they have to wait days for the test results. Time is running out. If an HIV infection goes undetected, the disease spreads further. If left untreated, it can become acute and therefore fatal.
“We can only stop the outbreak if we really find and treat all those infected,” said Kilkenny, who heads the local health agency.
Cabell County, with its county seat of Huntington, is located in the far west of West Virginia, seven hours’ drive from Washington DC. Kilkenny has tested 80 people positively since the beginning of 2018. New cases are added weekly. According to experts, this is only “the tip of the iceberg”. Almost all infected people are addicted and inject their drugs. Before the outbreak, there were only a handful of HIV cases in Cabell County each year.
Michael Kilkenny is trying to get the biggest HIV outbreak in West Virginia under control
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Opium crisis after economic crisis
The Steel of West Virginia steel mill is located at the entrance to Huntington city center. The mighty outer walls are dark brown. It’s hard to tell which of it is rust and what is dirt. The parking lot in front of the factory is almost empty. Up until the 1970s, Huntington with its 50,000 inhabitants was a regional industrial and commercial center in an otherwise extremely rural region. Mineral resources such as coal and iron made people rich. Today the city is best known for its drug problem.
Painkillers containing opium were relatively common early on, where the better paid jobs were associated with heavy physical activity for a long time. The aggressive marketing of the pills by pharmaceutical companies from the 1990s made them pervasive. Since the economic decline, opium has not only relieved physical pain. According to official estimates, almost every tenth here is dependent today. A quarter of them inject themselves with drugs and are therefore particularly at risk for infectious diseases.
The steel mill reminds of economically better times. Today, the gross domestic product of West Virginia is comparable to that of Venezuela
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In 2015, Cabell County landed on a nationwide list by the U.S. health institute of those counties where the risk of an HIV outbreak is particularly high. Michael Kilkenny then did everything his tight budget allowed to prevent that. He started information campaigns and created more therapy places. In addition, addicts in Kilkenny’s agency have since been able to exchange used syringes for new ones. And yet: “We found that new injections can no more prevent an HIV outbreak than a seat belt prevents a car accident,” says the doctor, resignedly.
Controversial syringe exchange
The prevention program is repeatedly criticized for primarily promoting drug use instead of making it safer. A similar program was discontinued in a nearby county after protests. Michael Kilkenny still holds on to it. Even if it couldn’t prevent the outbreak, the clean syringes would help keep the number of infections as low as possible, he is convinced.
Addicts can exchange used syringes for packages with clean syringes and disinfectant wipes
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“West Virginia has always been a country with very few HIV cases. People overslept the risk,” said Judith Feinberg, a professor of medicine at West Virginia University. Also, many people, doctors and residents alike, are unaware that HIV has become a problem in West Virginia. Therefore, not enough people would be tested for the virus.
Blacklisted
Michael Kilkenny does not accept this criticism for his district. HIV was actually not a priority until 2015, he says. But that has changed since Cabell County was blacklisted by the US health institute. And since the onset of the HIV outbreak, his agency would have done everything to test, especially, addicts. To reach these people, the doctor relies on working with local social workers.
Kilkenny’s office is within walking distance of Amanda Coleman’s workplace. In between is the district court. With its golden dome it stands out. The rest of the city center is a mixture of poorly preserved brick buildings and unadorned post-war buildings. Many stores are empty. There is garbage in the house entrances. Urine smell stings in the nose.
“I have to have hope”
Coleman runs the “Harmony House”, a facility for the homeless. Homeless people can spend the day here, take a shower and get help finding accommodation. Dozens of people frolic on the narrow sidewalk in front of the entrance. It is unusually warm for late September. Over half of all those who have contracted HIV in Cabell County since the beginning of 2018 have no permanent residence.
Amanda Coleman: “We work hard to make our clients feel comfortable and trust us”
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So far, Coleman has had to send her clients to Kilkenny for an HIV test or have external personnel come in. Now she has three employees trained so that the examinations can be carried out on site. “I think we have a better chance of convincing more people to get tested if the HIV test can be part of a conversation.” The stigma surrounding the disease would have waned in recent years, but there is still too little knowledge about the disease and treatment options, she says.
University professors Judith Feinberg fears that despite all efforts, so far only a fraction of all infected people have been found and are being treated. She says the extent of the HIV outbreak in Cabell County and the surrounding counties cannot yet be estimated.
“I can’t tell how many HIV infections there will be in the end,” says the doctor. “I hope it won’t be more than eighty. But when we had 79 cases, I hoped it wouldn’t be more than 79,” he adds. And yet he was confident, almost out of duty: “I have to have hope in order to be able to continue my job.”
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