Diving deep into Harm Reduction Part 3: Community Acceptance, Perception and Stigma

Nov 28, 2018

Less than two years after it began, the Kanawha-Charleston Health Department shut down it’s harm reduction program. Among other things, the program provided thousands of clean needles to drug users with the goal of reducing needle borne diseases, but faced significant pushback from some in the community.  


As the state continues to grapple with the drug epidemic and its impact to public health, those running harm reduction programs in other West Virginia communities say the closure of the Charleston program, and the narrative that the needle exchange program was destroying the city, is having a negative impact on public perception of harm reduction efforts.

 

“Everyone understands that this drug epidemic is the biggest public health issue that we have dealt with,” said Terry Harlin, administrator of the Fayetteville harm reduction program. “I feel like what happened in Charleston hurt us a little bit.”

 

Harlin said when the Charleston program closed in [insert when here], members of the community began questioning the necessity of the Fayette County program.

 

“We definitely started hearing people locally, ‘well it didn’t work in Charleston so why would you continue doing that here?’” she said. “Even though there’s lots of evidence and research out there that show that harm reduction does help to prevent the spread of disease and does help to get people the help that they need.”

A Shifting Narrative

 

The trickle effect to other programs like Fayetteville’s likely happened in the last six months the Kanwaha-Charleston program was open, when the narrative around the program shifted. Outgoing Charleston Mayor Danny Jones was especially outspoken critic of the program.

“Needles were everywhere and our property crimes went through the roof,” he said.

 

No study has been done quantifying whether the harm reduction program caused an increase in needle litter, making it hard to confirm the veracity of the claim. But we do know, according to data from the health department, that during the two years the program was open, more than 650,000 needles were distributed and only about 66 percent of them were returned.

 

West Virginia University public health researcher Robin Pollini said that doesn’t mean the unreturned needles ended up on the street. In West Virginia it is legal to dispose of sharps in the trash if you package them and label them in a certain way, she said.

“And so the Charleston program, just like many programs across the state, gives out puncture proof containers and information on how to dispose of those safely,” said Pollini. “And so we don’t have any idea how many of those ended up properly disposed of in household trash and how many didn’t.”

Dr. Susan Gardner, assistant dean of the University of Charleston School of Pharmacy, said she has seen little evidence of widespread needle litter.  The school of pharmacy was one of the volunteer groups very involved in the Kanawha-Charleston Harm Reduction Program.

“There are times where I just took a walk on the East End looking -- looking!,” she said. “[I say to myself] ‘ok, if it’s this bad surely I’ll see it.’ And the only time I’ve ever come across a needle in Charleston is doing a syringe cleanup.”

Us Versus Them

 

But without a study of Charleston’s needle litter, there’s also no way to prove that the 200,000 unreturned needles didn’t end up on the streets.

 

Members of the Charleston police department said they’ve observed much less needle litter since the program closed, but the department also has reams of photographs from first responders and community members of needles found in public spaces.

 

Comments on news articles and Facebook posts seem to paint a community drowning in needles.

 

On some level, needle litter itself, isn’t the issue.

 

“So part of the narrative that was built around the Kanawha program was this us and them of like ‘we’re the community and those people are drug users,’” said Pollini, from WVU. “Those people are part of our community they’re West Virginians right?”

In Wyoming County a Different Narrative

Wyoming County launched its needle exchange program in May. Executive Director Fred Cox said their program has been relatively well-received -- he guesses because they had a small HIV outbreak prior to the program opening.

 

“A picture’s worth a thousand words I’d guess you’d say,” Cox said. “So, that picture was really clear to us here and I really do think that help changed some minds.”

 

He said if they hadn’t had the outbreak he doesn’t think they would have had to support to open the program as a prevention measure.

 

Some speculate that may be another reason Charleston’s program struggled in the end.

Outgoing Charleston mayor Jones said there were no reports of outbreaks of hepatitis C or the AIDS virus prior to the launch of the city’s harm reduction program.

 

“It’s not up to us to ruin a town over the fact that people have communicable diseases,” he said.    

 

Rahul Gupta, formerly the head of the state’s public health department, said harm reduction is a multifaceted idea that encompasses not just needle exchange, but testing and family planning and treatment of diseases.

 

“And other issues that come across that are consequential in some ways like needle litter and other things there have to be plans in place to address those -- what we can’t afford to do is ignore them,” he said.

 

There often are demands, Gupta said, to do things differently. But he believes there’s always a middle ground you can get to with negotiation. And you do that, he said, because “people’s lives are at stake.”

 

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Marshall Health, Charleston Area Medical Center and WVU Medicine.