CHARLESTON, W.Va. — More than three years have passed since federal health officials arrived in central Appalachia to assess an alarming outbreak of HIV spread mostly between people who inject opioids or methamphetamine.

Infectious disease experts from the Centers for Disease Control and Prevention made a list of recommendations following their visit, including one to launch syringe service programs to stop the spread at its source. But those who’ve spent years striving to protect people who use drugs from overdose and illness say the situation likely hasn’t improved, in part because of politicians who contend that such programs encourage illegal drug use.

Joe Solomon is a Charleston City Council member and co-director of SOAR WV, a group that works to address the health needs of people who use drugs. He’s proud of how his close-knit community has risen to this challenge but frustrated with the restraints on its efforts.

“You see a city and a county willing to get to work at a scale that’s bigger than ever before,” Solomon said, “but we still have one hand tied behind our back.”

The hand he references is easier access to clean syringes.

In April 2021, the CDC came to Charleston — the seat of Kanawha County and the state capital, tucked into the confluence of the Kanawha and Elk rivers — to investigate dozens of newly detected HIV infections. The CDC’s HIV intervention chief called it “the most concerning HIV outbreak in the United States” and warned that the number of reported diagnoses could be just “the tip of the iceberg.”

Now, despite attention and resources directed toward the outbreak, researchers and health workers say HIV continues to spread. In large part, they say, the outbreak lingers because of restrictions state and local policymakers have placed on syringe exchange efforts.

Research indicates that syringe service programs are associated with an estimated 50% reduction in HIV and hepatitis C, and the CDC issued recommendations to steer a response to the outbreak that emphasized the need for improved access to those services.

That advice has thus far gone unheeded by local officials.

In late 2015, the Kanawha-Charleston Health Department launched a syringe service program but shuttered it in 2018 under pressure, with then-Mayor Danny Jones calling it a “mini-mall for junkies and drug dealers.”

SOAR stepped in, hosting health fairs at which it distributed naloxone, an opioid overdose reversal drug; offered treatment and referrals; provided HIV testing; and exchanged clean syringes for used ones.

But in April 2021, the state legislature passed a bill limiting the number of syringes people could exchange and made it mandatory to present a West Virginia ID. The Charleston City Council subsequently added guidelines of its own, including requiring individual labeling of syringes.

As a result of these restrictions, SOAR ceased exchanging syringes. West Virginia Health Right now operates an exchange program in the city under the restrictions.

Robin Pollini is a West Virginia University epidemiologist who conducts community-based research on injection drug use. “Anyone I’ve talked to who’s used that program only used it once,” she said. “And the numbers they report to the state bear that out.”

A syringe exchange run by the health department in nearby Cabell County — home to Huntington, the state’s largest city after Charleston — isn’t so constrained. As Solomon notes, that program exchanges more than 200 syringes for every one exchanged in Kanawha.

A common complaint about syringe programs is that they result in discarded syringes in public spaces. Jan Rader, director of Huntington’s Mayor’s Office of Public Health and Drug Control Policy, is regularly out on the streets and said she seldom encounters discarded syringes, pointing out that it’s necessary to exchange a used syringe for a new one.

In August of last year, the Charleston City Council voted down a proposal from the Women’s Health Center of West Virginia to operate a syringe exchange in the city’s West Side community, with opponents expressing fears of an increase in drug use and crime.

Pollini said it’s difficult to estimate the number of people in West Virginia with HIV because there’s no coordinated strategy for testing; all efforts are localized.

“You would think that in a state that had the worst HIV outbreak in the country,” she said, “by this time we would have a statewide testing strategy.”

In addition to the testing SOAR conducted in 2021 at its health fairs, there was extensive testing during the CDC’s investigation. Since then, the reported number of HIV cases in Kanawha County has dropped, Pollini said, but it’s difficult to know if that’s the result of getting the problem under control or the result of limited testing in high-risk groups.

“My inclination is the latter,” she said, “because never in history has there been an outbreak of injection-related HIV among people who use drugs that was solved without expanding syringe services programs.”

“If you go out and look for infections,” Pollini said, “you will find them.”

Solomon and Pollini praised the ongoing outreach efforts — through riverside encampments, in abandoned houses, down county roads — of the Ryan White HIV/AIDS Program to test those at highest risk: people known to be injecting drugs.

“It’s miracle-level work,” Solomon said.

But Christine Teague, Ryan White Program director at the Charleston Area Medical Center, acknowledged it hasn’t been enough. In addition to HIV, her concerns include the high incidence of hepatitis C and endocarditis, a life-threatening inflammation of the lining of the heart’s chambers and valves, and the cost of hospital resources needed to address them.

“We’ve presented that data to the legislature,” she said, “that it’s not just HIV, it’s all these other lengthy hospital admissions that, essentially, Medicaid is paying for. And nothing seems to penetrate.”

Frank Annie is a researcher at CAMC specializing in cardiovascular diseases, a member of the Charleston City Council, and a proponent of syringe service programs. Research he co-authored found 462 cases of endocarditis in southern West Virginia associated with injection drug use, at a cost to federal, state, and private insurers of more than $17 million, of which less than $4 million was recovered.

Teague is further concerned for West Virginia’s rural counties, most of which don’t have a syringe service program.

Tasha Withrow, a harm reduction advocate in bordering rural Putnam County, said her sense is that HIV numbers aren’t alarmingly high there but said that, with little testing and heightened stigma in a rural community, it’s difficult to know.

In a January 2022 follow-up report, the CDC recommended increasing access to harm reduction services such as syringe service programs through expansion of mobile services, street outreach, and telehealth, using “patient-trusted” individuals, to improve the delivery of essential services to people who use drugs.

Teague would like every rural county to have a mobile unit, like the one operated by her organization, offering harm reduction supplies, medication, behavioral health care, counseling, referrals, and more. That’s an expensive undertaking. She suggested opioid settlement money through the West Virginia First Foundation could pay for it.

Pollini said she hopes state and local officials allow the experts to do their jobs.

“I would like to see them allow us to follow the science and operate these programs the way they’re supposed to be run, and in a broader geography,” she said. “Which means that it shouldn’t be a political decision; it should be a public health decision.”

Frisco, TX – West Virginia trailed by 18 early in the second half and got within five in the fourth quarter but the Mountaineers (6-7) could not contain the Memphis offense and dropped the Frisco Bowl to the 25th-ranked Tigers (11-2) Tuesday night 42-37.

West Virginia senior quarterback Garrett Greene finished his final game as a Mountaineer with 423 total yards and three touchdowns, while redshirt sophomore receiver Hudson Clement finished with a career-high 11 receptions for 166 yards and two touchdowns.

West Virginia went three and out on its first two possessions of the game, losing the field position battle and Memphis started its second drive inside WVU territory at the 45.

Senior running back Mario Anderson started the drive with a 12-yard run, setting up a keeper from quarterback Seth Henigan on a third and four to keep the drive alive before delivering a shovel pass to Anderson for the touchdown and the 7-0 lead.

Junior running back CJ Donaldson fumbled the ball and was recovered by defensive lineman Mond Cole at the WVU 41.

Memphis kept the drive alive with a dump pass to redshirt junior running back Greg Desrosiers Jr for 20 yards, but the Mountaineer defense held the Tigers to a field goal to begin the second quarter and WVU trailed 10-0.

The Tigers momentum continued to build after the Mountaineers failed on a fourth and one near midfield, giving Memphis the ball inside WVU territory for the third consecutive possession. On the first play of the drive, Desrosiers busted through the right side for a 465-yard touchdown run and Memphis went up 17-0 at the 10:46 mark of the second quarter.

West Virgina answered with its first touchdown drive of the game, driving 75 yards on six plays Clement picking up the yards in chunks, hauling in his first pass for 13 yards, then corralled a 33-yard touchdown pass to cut the deficit to ten, 17-7 with 7:28 remaining in the half.

Memphis appeared poised to build its lead back to 17 after Henigan dropped a 25-yard pass to Roc Taylor on third and nine to the WVU 37, but the defense held the Tigers for their second field goal of the night.

Greene got the Mountaineers within six after scrambling 56 yards for the touchdown with 1:44 left in the first half.

The Tigers quickly responded. On third and six, Henigan connected with Taylor for 35 yards. Two plays later, Henigan threw his second touchdown pass from 18 yards out to redshirt senior receiver Demeer Blankumsee. The Tigers opted to go for two and converted for the 28-14 lead with less than a minute remaining in the half.  

West Virginia was able to get within field goal range before the half and senior kicker Michael Hayes nailed the 46-yarder to cut the deficit to eleven, 28-17.

The Henigan, Taylor connection continued the first play of the second half for a 48-yard pass and catch to begin the 75-yard touchdown drive, and Anderson finished it with a three-yard touchdown run and a two-point conversion extended the Tigers lead 35-17.

The Mountaineers responded on their opening drive of the second half. Junior running back CJ Donaldson had five tough carries for 27 yards while a 20-yard pass to sophomore Rodney Gallagher put the Memphis defense on its heels with a 20-yard reception and Clement snagged a pair of passes for 22 yards, including a 10-yard touchdown reception. The snap was mishandled on the extra point and WVU trailed 35-23 midway through the third quarter.

The West Virginia defense ended Memphis’ streak of six consecutive scoring drives and the Mountaineer offense took over at its own 10. The Mountaineers methodically moved the ball down the field until Clement snagged a 37-yard pass to get to the Memphis 15-yard line. Then, on fourth and goal from just inside the one, Donaldson punched it into the endzone to get WVU within five, 35-30 at the 12:02 mark of the fourth quarter.

Memphis struck right back after an 89-yard pass to Blankumsee, and redshirt senior running Brandon Rush followed with a one-yard touchdown run to go back up twelve, 42-30.

West Virginia responded with a 12-play 75-yard drive. Greene was 7-8 for 70 yards and three consecutive runs from Donaldson put the Mountaineers in the endzone to trim the Memphis lead to five, 42-37 with 4:17 left in the game.

Memphis picked up a pair of first downs and ran the clock to 56 seconds before senior kicker Tristian Vandenberg missed wide right and West Virginia took over at it own 31 yard line with 51 seconds remaining in the game.

On the first play the Mountaineers, Greene found Clement for 23 yards just over midfield into Memphis territory. Greene threw an interception, but redshirt senior receiver Preston Fox punched the ball away from junior linebacker Elijah Herring. However, after an replay review, the officials determined Herring gave himself up on the slide and awarded Memphis the ball as the Tigers held on 42-37.

The Power 4 is represented in its first game of the 2024-’25 college football bowl season, as the West Virginia Mountaineers battle the No. 25 Memphis Tigers in the 2024 Frisco Bowl. The game is scheduled to start at 9 p.m. ET (8 p.m. CT) with TV coverage on ESPN and streaming on-demand.

• How to watch: Live streams of the 2024 Frisco Bowl are available with offers from FuboTV (free trial), SlingTV (low intro rate) and DirecTV Stream (free trial).
• SlingTV is currently offering a 50% discount for the first month, with a starting price of $20 for a full month of live TV.
• For a limited time, FuboTV is offering $30 off the first month after the free trial period. With the $30 offer, plans start at $49.99 per month.

#25 Memphis Tigers (10-2) vs. West Virginia Mountaineers (6-6)

Scooter’s Coffee Frisco Bowl

When: Tuesday, Dec. 17 at 9 p.m. ET (8 p.m. CT)

Where: Toyota Stadium, Frisco, Texas

TV channel: ESPN

Live streams: FuboTV (free trial) | SlingTV (low intro rate) | DirecTV Stream (free trial)

Power 4 program or not coming out of the Big 12 Conference, West Virginia is still a 4.5-point underdog to the Tigers in the Frisco Bowl. The Tigers have thrived with the little things, building a stout rushing defense that ranks No. 10 nationally while posting the second-best turnover margin in the country (+1.33) and the third-highest average time of possession (33:48). Memphis scored arguably its best win of the season late over the Tulane Green Wave (34-24) to wrap its regular season on a four-game winning streak.

The ‘24 season was full of ups and downs for the Mountaineers, whose boldest headlines perhaps came earlier this month when they announced former WVU coach Rich Rodriguez will return to the sideline as head coach in 2025. At their best, the Mountaineers can unleash explosive running backs Jahiem White (817 yards, 7 TDs) and C.J. Donaldson (651 yards, 9 TDs) along with dual-threat quarterback Garrett Greene (656 yards, 5 TDs). Defense has been a glaring concern, though, ranking among the worst in the nation against the pass, allowing 268.9 yards per game.

2024 Frisco Bowl: Know your live streaming options

• FuboTV (free trial) – excellent viewer experience with huge library of live sports content; free trial lengths vary; monthly rate after free trial starts at $59.99 after current $20 discount offer.
• SlingTV (low intro rate) – discounted first month is best if you’ve run out of free trials or you’re in the market for 1+ month of TV
• DirecTV Stream (free trial) – not the same level of viewer experience as FuboTV, but the standard 7-day free trial is still the longest in streaming.

The Tigers and Mountaineers are set for a 9 p.m. ET start on ESPN. Live streams are available from FuboTV (free trial), DirecTV Stream (free trial) and SlingTV (low intro rate).