Abstract

Impact of policy changes and defunding on harm reduction: Syringe exchange utilization in Cabell County, West Virginia

Candace Smith, MPH¹ and Sumaira Khalid Ariturk, Ph.D, MSPH, PharmD²
(1)Community Education Group, Huntington, WV, (2)Marshall University, Huntington, WV

APHA 2025 Annual Meeting and Expo

Background:Cabell County, West Virginia, reported 174 overdose deaths per 100,000 people in 2023, among the highest in the U.S. Since 2018, harm reduction services in the county have faced constraints due to policy changes and funding cuts. The Cabell-Huntington Health Department’s Harm Reduction Program (CHHD-HRP) experienced disruptions in syringe access and outreach. More recently, proposed reductions in federal funding for harm reduction efforts and local NGOs are expected to further impact rural Appalachian communities. This raises concerns about the emerging burden of infectious diseases such as HIV and hepatitis C among people who inject drugs (PWID) in high-risk counties.

Objectives:Impact of policy changes and defunding on syringe exchange utilization in Cabell County and implications for emerging disease burden in PWID populations across rural West Virginia.

Methods:We used a mixed-methods approach, including a retrospective review of CHHD-HRP client visit data from 2015 to 2021 and syringe distribution and return data from 2015 to 2023. Qualitative data were collected through key informant interviews with the department’s HRP director and lead nurse. Interview notes were thematically analyzed to explore implementation barriers and policy impact on service delivery.

Findings and Discussion:Following policy changes in 2018 and 2021, program utilization and syringe return rates declined significantly. These changes coincided with a rise in hepatitis C and HIV cases among PWID. Thematic analysis revealed increased ID, residency requirements, staff reductions, limited outreach, and community stigma as key barriers. From a systems thinking perspective, these findings highlight how harm reduction programs operate within an interconnected system where changes in policy, funding, staffing, and community engagement influence HRP delivery and harm reduction outcomes. The effects of the newly proposed funding cuts are not yet measurable, previous trends suggest that further defunding could destabilize this system and exacerbate the incidence of hepatitis C and HIV in rural West Virginia.

Assessment of individual and community needs for health education Protection of the public in relation to communicable diseases including prevention or control Public health or related public policy Systems thinking models (conceptual and theoretical models), applications related to public health