Fauci shares insight into West Virginia's HIV rate

According to AIDSVu, an interactive online mapping tool that visualizes the impact of the HIV epidemic on communities across the country, in 2021, there were 2,196 people living with HIV in West Virginia.

According to the Bureau for Public Health, preliminary reporting shows 83 cases of HIV diagnosed in West Virginia so far in 2023.

In a Zoom call with West Virginia University medical students, Dr. Anthony Fauci, former director of the National Institute of Allergy and Infectious Disease, voiced his concern about the number of HIV diagnoses in Morgantown and West Virginia as a whole.

In 2019, Cabell County was the epicenter of a large HIV cluster. However, since then, HIV cases have been increasing in other areas of the state. Currently, this increase is still most significant in Cabell County with a total of 21 positive cases so far in 2023, with Kanawha County at 18 infections so far this year.

Fauci, and Dr. Stef Shuster, associate professor of sociology at Michigan State University, visited West Virginia University virtually in a conversation on the history of LGBTQ+ health care in the United States. The conversation was facilitated by Ellen Rodrigues, director of WVU’s LGBTQ+ Center.

While Fauci is known nationally for his work during the COVID-19 pandemic, he has spent 40 years on the forefront of HIV and AIDS research and treatment.

“Many of us across the country think of HIV and AIDS as a disease that is manageable and perhaps in our rearview mirror, right? But we have unfortunately, reliable data showing that right here, in Morgantown, West Virginia, the home of our university, we’ve had, we have now a substantial uptick in cases of HIV AIDS,” Rodrigues said.

Fauci responded that an uptick in HIV cases “surprises and dismays” him.

“The fact that you have an increase probably reflects two things,” Fauci said. “It’s the lack of PrEP (pre-exposure prophylaxis) accessibility for those who are susceptible and a lack of accessibility to treatment for those who are already infected.”

Dr. Judith Feinberg is a professor of behavioral medicine and psychiatry and professor of medicine in infectious diseases, and the vice chair of medicine for research at WVU. She confirmed the recent outbreak or cluster of HIV and AIDS in Morgantown, defining a cluster as 10 infections or more.

“The one in Mon County, there are a couple of recent outbreaks, but the one in Mon county involves 10 men who have sex with men and they’ve been identified and offered care,” Feinberg said. “And I believe the majority are being cared for actually at what is called the positive health clinic here.”

Feinberg said that with modern preventative medication accessible and information available, cases of HIV and AIDS should be falling, not rising.

“Relative to the fact that before 2017, only an average of maybe 75 to 77 new cases were diagnosed a year, 10 new cases is a lot and in recent years since 2017, because we’ve had a number of HIV outbreaks across the state, that number has doubled,” Feinberg said. “I believe for 2021, which is the last year we have full reporting on, it’s something like 139. And it’s been running about double ever since 2017 and that’s really because that’s the point at which HIV entered the community of people who inject drugs.”

Feinberg said there are two major behavioral risks associated with HIV. And Fauci agreed with Feinberg’s conclusion about the reason for an uptick in cases in West Virginia.

“Injecting drugs has really recently overtaken men who have sex with men as the primary behavior risk for HIV,” Fauci said. “And how can we do better with this? Well, first of all, we need a public, we need the public to understand that this is happening.”

According to the West Virginia’s 2020-2022 Substance Use Response Plan, from 2014 to 2017, the drug overdose death rate in West Virginia increased from a rate of 35.5 per 100,000 to 57.8 per 100,000, far exceeding any other state in the nation.

“Drug addiction, as we all know, is a disease and not a crime,” Fauci said. “And when you’re trying to prevent someone from getting infected from injection drug use, that’s a very difficult problem unless you get sterile needles a little as a needle exchange, but for sexual transmission, we should be looking in the community about why is there lack of the access to what we know is a highly effective prevention. That’s my only comment about that. Very disturbing.”

That prevention is available as a pill to be taken frequently, or a shot, taken on a less frequent basis.

“That is entirely preventable,” Fauci said. “We now have pre-exposure prophylaxis that’s either in an oral form with a drug that you could take every day or in association with your sexual contact, or now most recently, highly, highly effective, injectable long acting every couple of months, pre-exposure prophylaxis that the efficacy of that in preventing infection, if utilized properly, is 90-plus%, 98%, sometimes close to 100%.”

With preventative medication available, experts think it is a lack of public perception of HIV and AIDs as a threat that leads to an uptick in infections.

“Changing public perception has been really hard. And I think, as I said, I think what happened is that this entered the public knowledge and the public imagination decades ago, in this more limited context of you know, men who have sex with men,” Feinberg said. “So I think, you know, education and having an awareness is really key, right?”