Whether it be willful ignorance 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 the 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. Unfortunately, in many cases, county departments of health made it easy due to the fact that they didn’t adhere to policies that called for a one-to-one exchange of a dirty needle for a clean one.

The U.S. Centers for Disease Control and Prevention called a 2021 outbreak centered in Kanawha County “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 lawmakers.

“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,” said Robin Pollini, a West Virginia University epidemiologist. “… 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, 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, as well, these programs must not simply be a spot where needles are handed out without following the rules. This is going to take everyone.