A grassroots program is responding to Charleston’s substance use epidemic, but stigma and an open police investigation are keeping people from getting help.

This story was originally published by Mountain State Spotlight. For more stories from Mountain State Spotlight visit their website.

On a Wednesday evening in mid-October, people gathered in a parking lot off of Kanawha Boulevard in Charleston, West Virginia. A man played guitar; a woman talked about the perils of virtual schooling during the pandemic. Blue and green canopy tents covered folding tables that were set up with snacks and bags of fluffy sandwich rolls.

A makeshift wound-treatment center stood under one of the tents. The ground to its right, coated in layers of pastel-colored chalk, read “HIV TESTING” and directed people to a van that served as a temporary medical lab. 

It was the atmosphere of a carnival and a refuge wrapped into one; free and welcoming to some of Charleston’s most stigmatized people — drug users and those who loved them. But HIV in Kanawha County was spreading at an unprecedented rate, and people were scared. 

“I’m sorry, I’m just so nervous,” said a woman named Stephanie, standing near the mobile testing clinic. Her eyes scrunched closed as a nurse squeezed a pin-sized drop of blood from her middle finger. She held a cigarette in her other hand, which she drew to her lips and finished off with a long inhale. 

“I don’t normally like to smoke around other people,” she apologized. “But right now, I can’t help it. I’m just so nervous. Oh God.”

Like most of the people in line, Stephanie — tall, with sandy hair piled high into a messy bun — uses intravenous drugs. She injects. And she asked that her last name not be published for fear of retribution, because in addition to getting tested for HIV, she had come out to the parking lot to pick up a supply of clean, sterile syringes. 

<figure class="wp-block-image size-large"><figcaption>SOAR street outreach during a Wednesday in October. Photo: Lauren Peace/Mountain State Spotlight</figcaption></figure>



<figure class="wp-block-audio"><figcaption>Stephanie waits for her test result.</figcaption></figure>

For decades, supplying people who inject drugs with clean needles has been proven a necessary practice in preventive medicine. Science has shown that syringe access programs, commonly called needle exchanges, prevent the spread of infectious diseases like Hepatitis C and HIV, can reduce the amount of syringe litter in a community and do not increase drug use. Needs-based programs, or those with low barriers to entry, such as not requiring people to bring a needle back to get another one, have been shown to be the most effective at preventing the spread of disease.

But as the overdose epidemic raged on in Kanawha County and experts warned an HIV outbreak was on the horizon, Stephanie and others like her faced a related crisis: one of logistics. Clean needles were increasingly difficult to come by. People were reusing and sharing out of desperation. 

In March 2018, Charleston suspended its health-department run needle exchange. The move left the state capital providing far fewer sterile needles — through a separate program — than much smaller communities across the state according to previously unreported data obtained by Mountain State Spotlight. 

Despite being the biggest city in the state, Charleston’s program is third from the bottom in terms of syringes distributed per 100,000 residents, according to the data, comparing certified harm reduction programs statewide.

“People can’t get needles,” Stephanie said as she waited for her test result. “I’ve watched them dig used ones out of the dirt and inject because they’re that desperate. I’ve seen needles break in people’s arms.”

By Spring 2020, nonprofit Solutions Oriented Addiction Response, WV — known as SOAR — began holding these biweekly gatherings in order to try and fill that void. Local residents came to these hushed parking lot meet-ups to get access to free, sterile sharps and life-saving medications — as well as food, water, first aid and HIV testing.

<figure class="wp-block-image size-large"><figcaption>A volunteer packs individual food bags for SOAR clients on a Wednesday night in August. Photo: Lauren Peace/Mountain State Spotlight</figcaption></figure>



<figure class="wp-block-audio"><figcaption>A man who goes by “Skipper” holds a bag of clean needles. He gets them for his friends, “because people’s always needing them.”</figcaption></figure>

Stephanie stood in the lot and finished her second cigarette. Around 25 minutes after she was tested, she was called back to the tent.

“Negative,” the nurse told her.

She brought her hand up to her heart and collapsed forward in a deep exhale. Another person wasn’t as lucky. They were taken behind a thick, tarp-like curtain. Positive.

Stephanie gathered her things.

“Thank you, guys. You guys save us. Every week you save us,” she shouted back towards the tents as she took her bag of needles and naloxone and exited the parking lot. “I’ll see you all next [time].”

But Stephanie, like 95 percent of the clients SOAR served, wouldn’t be back. 

In the following week, after a local TV segment aired on the underground exchange, Charleston Police opened an investigation into the nonprofit on the grounds that it may have violated a city ordinance requiring harm reduction programs be either approved by the police chief or licensed by the state.

In response to questions sent via email, Charleston Mayor Amy Goodwin wrote the decision about whether SOAR should operate in Charleston should be made by public health and medical professionals.

“If they determine the need is there, then [they] should determine the next step forward,” wrote Goodwin. “However, any harm reduction program that operates in Charleston must follow the best practices of federal and state health officials.”

SOAR maintains that its distribution of syringes did not violate Charleston city law, which does not explicitly forbid the distribution of syringes without consent. There’s also no state law that makes distributing syringes illegal. Even so, in response, the organization temporarily suspended its needle exchange.

Again, some of Charleston’s most vulnerable have been left without safe injection supplies, and HIV continues to spread.

<figure class="wp-block-image size-large"><img loading="lazy" width="780" height="520" src="https://www.100daysinappalachia.com/wp-content/uploads/2020/12/home-16.jpg" alt="" class="wp-image-23443" srcset="https://www.100daysinappalachia.com/wp-content/uploads/2020/12/home-16.jpg 780w, https://www.100daysinappalachia.com/wp-content/uploads/2020/12/home-16-300