Whether it be willful ignorance for the sake of scoring political points or a genuine misunderstanding of the broad range of strategies necessary to tackle a dual public health crisis in Appalachia, elected officials and policymakers are handicapping efforts against one of the major dangers spawned by our region’s substance abuse epidemic.

A KFF Health News report followed up on federal health officials’ effort a few years back to assess an outbreak of HIV in central Appalachia. The outbreak has been fueled by shared use of needles among those who inject opioids or methamphetamine.

But syringe exchange programs became an easy target for politicians who in some communities chose to put crippling restraints on them.

The U.S. Centers for Disease Control and Prevention called a 2021 outbreak centered in Kanawha County (but spreading into Cabell County, across the Ohio River and beyond) “the most concerning HIV outbreak in the United States.”

Despite scientific evidence that such programs can slow the spread of HIV and Hepatitis C as well as prevent cases of endocarditis, provide testing, AND keep syringe-users in touch with those who can connect them to resources for overcoming their addictions and getting their lives back on track, very few programs have been able to survive the restrictions put on them by cities, some counties and the West Virginia legislature.

“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,” Robin Pollini, a West Virginia University epidemiologist told KFF Health News. “Which means that it shouldn’t be a political decision; it should be a public health decision.”

Compounding the problem is that West Virginia has no coordinated strategy for statewide HIV testing. That means it is impossible to know whether the number of reported cases reflects the reality.

Joe Solomon, a Charleston City Council member and co-founder of SOAR WV (an organization that addresses the health needs of drug users), told KFF Health News there are many willing to give their all to the fight against the substance abuse epidemic and its accompanying public health crises. But “we still have one hand tied behind our back.”

What a shame so few who are able are willing to untie that hand. Policymakers at all levels must take another look at how better to support prevention efforts such as syringe exchange programs and work together to develop a testing program that will give us a more accurate picture of the monster we are battling.