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Ryan Fischer/The Herald-Dispatch Cabell-Huntington Health Department workers demonstrate how the INSTI finger-prick HIV test and the Ora-Quick Advance oral HIV test are conducted on Monday, May 13, 2019, at the Cabell-Huntington Health Department in Huntington.

HUNTINGTON - Cabell County's ongoing HIV cluster, still the only one active in West Virginia, has risen to 71 cases, according to the West Virginia Department of Health and Human Resources.

The total crept up by an average two additional new cases each week over the past nine weeks. This indicates a marginal rise in the frequency cases are now being diagnosed. In the prior nine weeks (April 28 through June 21), Cabell County averaged one new case each week.

One death, in June, has been associated with the Cabell County cluster, DHHR confirmed.

The cluster, tracked from January 2018 to the present, represents a sharp uptick from the baseline average of eight cases annually over the past five years. West Virginia, like most Appalachian states, has historically had some of the nation's lowest rates of HIV diagnoses (4.3 cases per 100,000 residents), according to the Centers for Disease Control and Prevention. Neighboring Kentucky (7.9 per 100,000) and Ohio (8.8 per 100,000) have fared similarly.

But so far, Cabell County alone already has more confirmed HIV cases this year than the entire state of West Virginia has had in a single year since 2008 (84 cases that year), according to DHHR statistics.

The stark increase reflects a shift in how HIV is being transmitted - what has historically been spread by sexual contact between men is now being passed between intravenous drug users through unclean syringes.

Likewise, Cabell County's cluster has spread primarily among the county's population of intravenous drug users, of which there are an estimated 1,800 active in Cabell County.

Though it is currently the only active HIV cluster in West Virginia, a new handful of cases have cropped up along the Ohio River Valley in the wake of the nationwide opioid epidemic.

The situation is still defined as a cluster rather than a full outbreak. The West Virginia Bureau for Public Health characterizes a cluster as being confined to a certain population - in this case, IV drug users -where it may be able to be controlled with minimal risk to the general public.

The cluster has noticeably contributed to more individuals using the county's Harm Reduction Program, the Cabell-Huntington Health Department reported at its June Board of Health meeting. The influx indicates the population at risk - chiefly intravenous drug users - is aware they are vulnerable and actively seeking help to protect themselves.

The Harm Reduction Program, which includes the syringe exchange, saw 937 visits in May, including 52 new individuals enrolled, according to statistics reported at the department's monthly board of health meeting Wednesday. In April, the program had 853 visits.

Clients actively mention their HIV fears when visiting the Harm Reduction Program, said Dr. Michael Kilkenny, CHHD physician director, in a prior interview.

The goal of a syringe exchange is to provide one clean syringe for every intravenous injection of drugs. Syringe exchanges have been used for more than 30 years in hundreds of locations nationwide - including nearly 20 in West Virginia - to discourage the use of sharing dirty needles leading to the spread of blood-borne illnesses like HIV and hepatitis.

These programs have nearly universal support from public health officials, state and federal, as an effective, inexpensive means to controlling disease. Syringe exchanges also encourage an otherwise hard-to-reach population of intravenous drug users to visit a clinical setting, which then can become a talking point to referring them to treatment.

Between 2018 and May 2019, more than 900 harm reduction clients in West Virginia were referred to treatment - about 300 of those from Cabell-Huntington's program alone, according to DHHR.

Cabell-Huntington's syringe exchange serves an estimated 600 individuals with varying regularity - some weekly, others with months between visits.

DHHR posts weekly updates on Cabell County's HIV totals each Monday at oeps.wv.gov/hiv-aids.

Follow reporter Bishop Nash on Twitter at @BishopNash.

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