CHARLESTON, W.Va. (AP) — Dozens of volunteers in West Virginia have formed the letters HIV SOS, as activists sought a public health emergency declaration for one of the nation’s highest spikes in such cases.

Volunteers in red T-shirts spelled out the letters on Saturday in Charleston.

Solutions Oriented Addiction Response co-founder, Joe Solomon, called on the Charleston City Council and the mayor to act on the HIV crisis and overdoses from prescription pain pills. He said it needs to be treated like the emergency that it is.

Federal health officials call the recent spike in HIV cases related to intravenous drug use in the surrounding county the most concerning in the United States.