The pandemic has gone on so long that just about the full spectrum of possible feelings towards it have been experienced by now. Paralyzing anxiety has led to vocal unrest and calls for change, which have in turn led to sheer apathy. Rinse and repeat and/or feel it all at once. One could argue that these responses are perfectly understandable and expected considering the collective trauma members of society are experiencing, but the unfortunate reality is that there are now harsh truths that must be faced in this new world.
“In Jefferson County, we have seen the highest rate of transmission for new HIV cases that we’ve ever seen in recorded history of the AIDS epidemic,” says Michael Kopp, the community health manager for Louisville Metro’s harm reduction services program. That statement alone potentially elicits both a staggering sense of wrongness – it doesn’t feel right, empirically, statistically – as well as a profound numbness and defeat.
Institutions such as Louisville Metro’s harm reduction services program – the largest and most comprehensive of its kind in the state – are in place because the human beings in need of the program’s care don’t have time for numbness and defeat, and Kopp, who has been in a leadership position for the program since July 2021, doesn’t either.
At its core, harm reduction is about practicality. It is about facing the inevitability of drug use and resultant disease transmission and developing compassionate strategies to help communities cope. Those strategies often involve education and testing, of course, but the pillars of programs such as Kopp’s also go deeper: referral to social, mental health, and other medical services as well as prophylaxis – that is, specific action taken to prevent disease, in this case, HIV and Hepatitis C transmission– through abscess/wound care and syringe exchange.
“I think… two things are fueling this transmission that we’re seeing right now,” says Kopp. “One is the coronavirus pandemic. When this first came about, a lot of our services shut down for a while. We weren’t testing people because of the social distancing measures. Other resources and people were pulled from our team to assist in the COVID response.” All social programs offer under the pressure of finite resources and harm reduction services programs especially so. It stands to reason then that a sudden depletion and/or reallocation of those resources could result in exacerbated conditions.
Kopp believes that while his program’s services had reduced availability, the game has changed substantially, featuring new drugs on the scene many times more powerful than heroin. “I think that [the second contributing factor to the rising numbers are] the physiological effects of the drugs on the street now, namely fentanyl and carfentanyl. It’s a way more intense high. The half-life of the high is like thirty minutes and then there’s an intense urge or need to inject again because of withdrawal symptoms. So people are using more frequently and using at a higher [quantity].”
Kopp goes on to say that resources are not out there at the level they were before the pandemic and certainly not at the level they need to be with these new, unsettling trends in the community.
“People are left in isolation. A lot of people relapsed and had to come back into the program. A lot of these things are working together to create this perfect storm of what we’re seeing right now in the HIV rates in Jefferson County.”
It’s also worth mentioning that this phenomenon is not unique to Louisville.
“[It’s] statewide. I would say nationwide as well. We have community partners in Michigan that we converse with and discuss harm reduction trends and practices, and they’re seeing a severe increase in transmission as well,” he said.
While Kopp doesn’t believe that there is a one-size-fits-all solution that will work for every community facing these troubling times, he is of the belief that it is time to think outside the box. “More specifically we need to increase access to testing.”
One way that Kopp and the harm reduction services program are doing that is by increasing accessibility to HIV self-test kits for those individuals who are experiencing homelessness and/or other individuals who don’t feel comfortable with testing in a government healthcare system.
“We’re working on partnerships with Norton and University of Louisville and Louisville Metro. We’re working on targeted campaigns for PWID [People Who Inject Drugs] and other at-risk demographics.”
It may not seem like it, but these developments display a shift in tactics that are an appropriate response to the recent HIV transmission spike.
In the past, the testing had been largely stationary, on site in the health department.
“We’ve seen a large increase in HIV transmission with the PWID population, and so, historically that’s been a population that doesn’t have the accessibility to come to our building for testing,” says Kopp. “We’ve been increasing our mobile testing capacity,” he said.
Kopp has also worked hard to team up with organizations such as Feed Louisville who provide hot meals to the homeless community once a week, thus increasing his program’s presence for those who require its services.
Most importantly, Kopp and his team have received funding to begin development of a community advisory board. They are hoping to complete applications and begin work with the official board in March. “[We’re] working with a population that is not targeted to at all for pre-exposure prophylaxis… and working with them to create specific content that is relatable to their experience and then using that content to put together a media campaign using public art installations, media on billboards, and marketed swag material and hoping to see a response from this population because this content was created for this population by this population.”
Since the inception of the pandemic, it seems that the world changes every day, hour to hour even. With people like Michael Kopp and the rest of his team at Louisville Metro’s harm reduction services program, the future may not seem any less uncertain, but it is nonetheless comforting to know that there are institutions out there still working hard to adapt and do as much good as possible.
To learn more, please visit https://louisvilleky.gov/government/health-wellness/harm-reduction and/or listen to QueerKentucky’s Beards and Lavender podcast episode on the subject.