CHARLESTON, W.Va. (AP) — For years, West Virginia has had the nation’s highest rate of opioid drug addictions and drug overdose deaths. Now the state is wrestling with another, not entirely unrelated health emergency: one of the nation’s highest spikes in HIV cases related to intravenous drug use.

The surge, clustered primarily around the capital of Charleston and the city of Huntington, is being attributed at least in part to the cancellation in 2018 of a needle exchange program that offered clean syringes to injection drug users not able to quit the habit altogether.

Needle exchange programs are included in the Centers for Disease Control and Prevention’s recommendations for controlling disease outbreaks among intravenous drug users. Such programs exist in dozens of states, but they are not without their critics, including in West Virginia, who say they don’t do enough to prevent or stop drug abuse.

John Raby | WV AP News

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