West Virginia University speaks about H.I.V. coming to rural America

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MORGANTOWN, W.V.a. – A West Virginia University professor of medicine was quoted in a letter sent to the New York Times by Steven W. Thrasher, professor at Northwestern University.

After two years of research in the southern coalfield counties, Dr. Judith Fienberg was asked to publicize her thoughts on HIV coming to rural America.

In the article, Thrasher mentioned that health care is relatively inaccessible, which Feinberg said, “It’s not so easy to get to the nearest town to see a doctor.”

Fienberg explained that the lack of transportation and stigma are the two biggest barriers to testing and care in West Virginia.

WBOY spoke with Dr. Fienberg to elaborate her stance on the discussion of H.I.V and other health care obstacles in West Virginia.

Q: In the article, you mentioned how health care is difficult to access and how lack of transportation and stigma are also barriers to getting tested. Would you be able to elaborate on that in relation to HIV coming to rural America?

A: “I have a research project that is located in several of the southern coalfield counties, and we just finished the second year.

The two biggest obstacles in terms of getting treatment for substance use disorder, getting tested for hepatitis B and C and HIV or getting care for those things were stigma and difficulties with transportation.

People with substance use disorder are often badly treated by the health care system. So, they don’t feel comfortable looking for care unless they’re really desperate, and because of transportation issues, people can’t get from A to B.

There’s almost no public transportation in these counties whatsoever. If you don’t have a car that’s insured, that works or have money for gas, you’re not going anywhere.

Some of these counties don’t have much in the way of population. Such as McDowell and Wyoming, which don’t have a stoplight between them. There’s almost no public transportation. It’s really hard for people to get around.

Those are just enormous obstacles for figuring out who has what infection and figuring out how you’re going to even get them to see somebody who can do something about it.

So when I was quoted saying that, that response came from that work. It’s a research grant funded by the National Institutes of Health.”

Q: In your opinion, what needs to be done in order to tackle this issue?

A: “We really need to get people to understand that substance use disorder is a chronic relapsing brain disease. It’s not a character flaw or a failure to have good morals or that these are bad people.

In fact, almost everybody who grew up here in West Virginia knows somebody who got caught up the drug epidemic, and you know they’re not bad or immoral people.

So partly what needs to be done is we need to overcome the stigma directed at the people who are addicted because if people feel like all they’re going to encounter is abuse if they ask for an HIV test and they are not going to do that. No one wants to be abused.

We need to overcome that so that we can actually get people out of the shadows and into care.

Transportation’s a much larger issue, of course, because it’s an issue of the infrastructure for that region. In general, West Virginia could use more economic development and in the southern coalfields where the primary industry was mining and most of these mines have all closed and there are not many employment opportunities.

We need to get people into care for their substance use disorder, but when they become sober and they’re in long term recovery, they’ll still need jobs.

And so, the issue is how are we going to provide appropriate economic development for that part of West Virginia? In fact, all over West Virginia, people need jobs and it’s not just isolated to the southern coalfields. They’re just a more dramatic example.”

Q: What does West Virginia need to do in order to make health care more accessible?

A: “Well, one big thing has already happened, right? We have Medicaid expansion, which really helps people who have no jobs or low incomes get medical care. We clearly need to help people get transportation to appointments.

But in terms of the interaction between the drug epidemic, HIV and hepatitis C, and all these other things, is that we need to have syringe services programs everywhere.

There are 55 counties in West Virginia and every county needs one because it’s a statewide problem. So we need more syringe services programs and we need a big campaign–– a big public service campaign to get people to understand that these are not bad people. These are people struggling with a disease. And yes, did they make a bad choice in the beginning by trying the drug? Yes, but how many people in their life can say they never made a bad choice in their lives? It’s kind of hard to put yourself in a perfect situation.

So I think the important thing is being able to acknowledge that these are people that we know in our community and that we care about. They are part of our families that we love, and what we want for them is to be as healthy as possible.

In the United States, West Virginia has the second-highest rate of acute hepatitis C in the nation and the highest rate of acute hepatitis B. And now with HIV here, we are really at such high risk of a more explosive outbreak.

The more people that get chronically sick and debilitated from untreated disease, the worse our workforce situation will be. And then the worse the economy of this state will be and it’s already not flourishing.

We want West Virginia to flourish. We don’t want West Virginia to be known nationwide with all these negative depictions of Central Appalachia, which are not accurate. They’re stereotypes and we want our fellow West Virginians to be healthy, get treatment and get back into the workforce.

So what West Virginia needs is more syringe services programs, less stigma, more encouragement of people and love for people who have substance use disorder.”

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