What Happens When Homelessness, Politics, and HIV Collide?

By: Ranier Simons, ADAP Blog Guest Contributor

It is a futile waste of time and resources to try to improve the quality of life and standards of living for communities without examining social determinants of health. Social determinants of health (SDOH) are "individuals' personal circumstances that impact their health and well-being."[1] SDOH's five main domains are economic stability, education access and quality, healthcare access and quality, neighborhood and built environments, and social and community context.[2] The health and well-being of populations suffer greatly when SDOH are not adequately met. The devastating effects of the confluence of homelessness, drug addiction, and mental health issues currently is becoming increasingly visible all across the United States. Currently, West Virginia is confronting an avoidable community-level disaster.

Photo Source: Kaiser Family Foundation

Images of the plight of the impoverished living amidst urban sprawl are familiar. Unfortunately, there is also increasing amounts of suffering going under the radar in small cities and towns. One such town is Charleston, West Virginia. In Charleston, politics, homelessness, mental illness, and preventable infectious diseases, including HIV, swirl in a blender resulting in a smoothie of despair. People with grassroots first-hand knowledge of the plight of West Virginians are trying to shed light on their struggle. Marcus J. Hopkins, Founder & Executive Director of the Appalachian Learning Initiative (APPLI), is one such person. According to Mr. Hopkins, "The issues that plague West Virginia's population are not something that can be easily, efficiently, or quickly addressed."

"One of the unfortunate truths of life in West Virginia is that we are constantly trying not to correct, but to overcome—to survive—generations of economic decline, an education system that has been perennially underfunded and underperforming, a healthcare system that barely functions and only in a handful of cities in the state, a crumbling infrastructure, and communities that have been ravaged by nearly 30 years of prescription and illicit opioid use disorders in every part of the state. The state and federal governments have been virtually useless in addressing these issues, which results in grassroots organizations doing whatever they have to do in order to try to just keep people alive, only to have their actions criminalized by the very governments that are supposed to be helping."

Charleston has an unhoused population plagued by drug addiction, mental illness, and HIV. There is an abidance of evidence showing harm reduction is a proven solution to the poorly met SDOH of this population. However, politics have gotten in the way. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), "Harm reduction plays a significant role in preventing drug-related deaths and offering access to healthcare, social services, and treatment. This results in a reduction of overdose fatalities, acute life-threatening infections related to unsterile drug injection, and chronic diseases such as HIV/HCV."[3] 

The unhoused population in Charleston struggles with finding safe shelter, food, and even places to bathe or wash clothing. People have lived under bridges, uncovered on the streets ,and in unofficial tent camps in public spaces. Soup kitchens and places like the Manna Meal lunchroom are places where the unhoused and other poor citizens go to find sustenance. However, not having stable housing and food insecurity are exacerbated by drug addiction and HIV.[4]

Politics has shuttered places that used to be havens of clean needle exchanges for those addicted to intravenous drugs like heroin and other opioids. A nonprofit called SOAR ran a clean needle exchange on Charleston's west side until it was outlawed last summer.[4] Before that, the city of Charleston ended its own needle exchange in 2018. Without clean needle exchanges, people reuse and even share needles. This results in the spread of hepatitis, heart inflammation, and endocarditis (infection of the heart's inner lining). The U.S. Centers for Disease Control & Prevention (CDC) found that needle exchanges cut the rates of these diseases by half.[4] Treating hepatitis C in Charleston costs $25,0000 per person, while a new needle costs 50 cents.[4]

Sharing needles also contributes to the spread of HIV. The West Virginia public health bureau reports that since 2019 there have been 137 HIV cases diagnosed in Kanawha County, where Charleston is located,[4] and 76.6% of the cases in Kanawha County were directly related to injection drug use.[5] In 2020, 207 people died from overdoses in Kanawha County, which is one of the highest death rates in the state, while West Virginia, as a whole, has the highest overdose death rate in the United States.[4]

Photo Source: GETTY IMAGES

Politics also is a barrier to helping the homeless. There is political pressure to criminalize being homeless on the street. Police destroy the tents and shelters that many of the unhoused have built, in addition to disposing of their meager belongings. Recommendations for creating places like drop-in shelters for the homeless are usually met with opposition from business owners and other people who want the homeless to be swept out. They do not want to see them sleeping on park benches or the door stoops of their businesses. Other people do not want the visual reminder of the homeless’ existence and plight. 

People living with medical conditions, possibly mental illness, drug addiction, and no stable social network cannot be expected to thrive when trying to manage all of those things, in addition to being homeless. Proper harm reduction requires robust funding and programmatic infrastructure. It is necessary to help people get off of the streets and then help them maintain stability to stay off.

[1] Zia, S. (2021, April 28). What are social determinants of health? Retrieved from https://www.medicalnewstoday.com/articles/social-determinants-of-health
[2] U.S. Department of Health and Human Services.(2022). Social Determinants of Health. Retrieved from https://health.gov/healthypeople/priority-areas/social-determinants-health
[3] Substance Abuse and Mental Health Services Administration.(2022). Harm Reduction. Retrieved from https://www.samhsa.gov/find-help/harm-reduction#:~:text=Harm%20reduction%20plays%20a%20significant,diseases%20such%20as%20HIV%2FHCV
[4] Vergano, D. (2022, April 22). Here’s how homelessness and politics meet amid an HIV outbreak in one U.S .city. Retrieved from https://www.yahoo.com/entertainment/hiv-homelessness-politics-colliding-west-183301994.html?soc_src=social-sh&soc_trk=tw&tsrc=twtr
[5] Office of Epidemiology and Prevention Services. (2022, April 21). HIV Diagnoses by County, West Virginia, 2019-2022. Charleston, WV: West Virginia Department of Health and Human Resources: Office of Epidemiology and Prevention Services: HIV and AIDS. Retrieved from: https://oeps.wv.gov/hiv-aids/Documents/Data/WV_HIV_2019-2022.pdf

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.