The Presidential Advisory Council on HIV/AIDS (PACHA) focused on the response to the HIV epidemic in Appalachia when it convened for its 78^th full council meeting on September 20, 2023, in Charleston, West Virginia. The Council participated in site visits, heard from panelists, and engaged with community members during a “PACHA-to-the-People” community engagement session, all of which focused on addressing the syndemic of HIV and substance use disorder (SUD). The Council also passed a resolution, approved a letter to the HHS Secretary, welcomed new members, and said farewell to members whose terms had expired.

In her opening remarks, Assistant Secretary for Health ADM Rachel Levine, MD, reflected on her prior experience as Secretary of Health in Pennsylvania, 57 counties of which are in the Appalachia region. “I am familiar with many of the region’s health concerns and health disparities,” she noted. “I know from personal experience that dedicating attention and effort in this region is absolutely critical for ending the HIV epidemic. The region faces specific challenges and vulnerabilities that require tailored interventions. At the same time, it also boasts many strengths and assets that can be engaged in those tailored interventions.”

Panelists Share Insights on HIV & Substance Use in West Virginia

The meeting began with a discussion of HIV epidemiology both statewide and in the Charleston area by Matthew Christiansen, MD, Commissioner of the West Virginia Department of Public Health, and Michael Kilkenny, MD, CEO and Health Officer of the Cabell-Huntington Health Department. They noted that while West Virginia has historically been a low HIV incidence state, it has recently experienced clustered outbreaks of HIV transmissions related to injection drug use and the opioid crisis. As a result, the state and local health departments are working to address both issues together by expanding provider capacity; implementing syringe services programs (SSPs) to the extent that state and local laws allow; engaging community partners, health centers, and universities; calling in CDC expertise; and moving peer recovery support specialists into emergency departments. They also highlighted that the state recently published the 2022–2026 West Virginia HIV and Hepatitis C Elimination Plan

Another panel, “Addressing HIV and Substance Misuse in Appalachia” featured six diverse West Virginia perspectives on the challenges experienced in the largely rural state where infectious disease and behavioral health services are concentrated in a few larger cities, making access difficult for residents who need them. Panelists suggested that punitive attitudes toward people with SUD result in policies that limit availability of effective interventions for both SUD and HIV, such as SSPs. Further, PACHA members heard perspectives from a community-based organization, a university’s minority health initiative, a free clinic, and the state’s Ryan White HIV/AIDS Program on community-based efforts to address the HIV epidemic. Those panelists highlighted examples of how listening to community members has enabled them to better tailor behavioral health, wellness, and HIV care services. Gayle Conelly Manchin, Federal Co-Chair of the Appalachian Regional Commission, provided a regional perspective. She noted that Appalachia spans 423 counties across 13 states from Mississippi to New York and that the communities in the region have experienced success when they work together to address shared challenges.

PACHA-to-the-People Continues with Site Visits & Community Engagement Session

PACHA continued its ongoing efforts to hear firsthand from people in communities who are responding to HIV every day through both site visits and a community engagement session. Members visited four community-based organizations in Charleston that contribute to the response to HIV:

• The Healing HouseExit Disclaimer, a holistic behavioral health program dedicated to serving women impacted by trauma, including women with and experiencing risk for HIV.
• West Virginia Health RightExit Disclaimer, a free and charitable clinic whose four locations and two mobile clinics provide free comprehensive care, including HIV testing, PrEP, behavioral health, and harm reduction to more than 43,000 medically-underserved, uninsured, and underinsured adults across 35 counties.
• Community Education GroupExit Disclaimer, which works to improve access to healthcare services by scaling resources and funding to address the syndemic of HIV/AIDS, viral hepatitis, opioid addiction, and SUD among underserved rural communities in West Virginia and Appalachia.
• Charleston Area Medical Center’s Ryan White HIV/AIDS Program Mobile UnitExit Disclaimer, which operates weekly in a neighborhood that is the heart of an HIV outbreak in Kanawha County and provides comprehensive integrated testing/outreach and HIV care to approximately 50 unstably housed people with SUD.

Complementing the site visits, the meeting included a “PACHA-to-the-People” community engagement session during which members of the HIV community in the region shared ideas, concerns, and recommendations directly with PACHA members. These voices inform the Council’s perspectives on issues and their work. Community members offered thoughts on a wide variety of topics, including frustration with the Congressionally imposed ban on use of federal funds to purchase syringes as part of harm reduction programs; a desire for federal incentives for states to permit SSPs and harm reduction programs where they are currently outlawed; concern about changes to the 340B drug discount program that supports a variety of other services in many organizations; the need for more providers of Medication Assisted Treatment for SUD and for those providers to be trained in HIV and hepatitis C services; requests to ensure adequate consumer involvement in planning councils and other bodies making program and funding decisions; and concerns about limited availability of housing even when there are HOPWA or other resources that could pay for it.

Council Actions

During the meeting, the Council also welcomed 13 new members and bid farewell to seven members whose terms were ending. Read more about the new and departing members.

The PACHA members also discussed and approved a resolution recommending that CDC remove the upper age limit (currently age 64) in its HIV testing recommendation.

PACHA also voted to send a letter to HHS Secretary Xavier Becerra expressing concern about both the need for Congressional action to reauthorize PEPFAR and significant cuts to the federal domestic HIV prevention and care budget proposed in the House of Representatives. The letter urged the Secretary to do all he can to facilitate PEPFAR reauthorization and prevent cuts to domestic HIV programs and services.

View videoExit Disclaimer from the meeting.