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A surge of HIV cases in Kanawha County, West Virginia, is raising alarm. The Centers for Disease Control and Prevention considers the West Virginia outbreak to be the most worrisome in the country. In 2019 there were 50 new cases of HIV among people in Kanawha County who inject drugs, and in 2020 there were 35 new cases-dramatic increases over the average of five new cases per year prior to 2019. The new case totals in 2019 and 2020 were also higher than in other counties of similar size, which average one new case a year. In an interview for WBUR radio, Robin Pollini, associate professor of epidemiology at West Virginia University, noted that "during COVID the number of HIV tests that have been conducted has gone down, so the number of cases is actually probably much, much higher." Public health experts are particularly alarmed by current legislative efforts to discontinue or restrict needle exchange programs since they are considered to be the most effective strategy to curtail HIV outbreaks among injection drug users.