One of the goals President Trump reinstated in his State of the Union address was to stop the spread of HIV in the U.S. within the next 10 years.
In addition to sending extra cash to 48 mainly urban counties, Washington, D.C., and San Juan, Puerto Rico, Trump’s plan targets seven states where rural transmission of HIV is especially dangerous.
Health officials and doctors treating patients with HIV in those states say any extra funding would be welcome. But they say that strategies that work in progressive cities like Seattle won’t necessarily work in rural areas of Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma and South Carolina.
Stigma around HIV and AIDS and around being gay runs deep and prolongs in parts of Oklahoma, says Dr. Michelle Salvaggio, medical director of the Infectious Diseases Institute at the University of Oklahoma Health Sciences Center in Oklahoma City. The institute is one of two federally funded HIV clinics in Oklahoma; the other is in Tulsa, the second-largest city in the state.
A long drive for anonymity
Salvaggio’s clinic has six examination rooms where she sees patients, many of whom drive hours for treatment. The clinic used to employ a case manager in rural Woodward County, a little more than two hours’ drive northwest of Oklahoma City.
In Oklahoma, as in much of the U.S., black gay and bisexual men have the highest risk of HIV infection. Other groups with elevated risk in Oklahoma include Latinos, heterosexual women and Native Americans.
Oklahoma’s uninsured rate is the second-highest in U.S.
Exactly how much money the president’s HIV plan will get is up to Congress. But even inexpensive, proven methods for fighting HIV — like distributing condoms — can be a tough sell in a state that doesn’t mandate comprehensive sex education.
Informational HIV talks with teenagers often turn into a basic health class for dispelling myths, says Andy Moore, clinic administrator of the Infectious Diseases Institute at the University of Oklahoma.
Salvaggio says thousands of people across Oklahoma would need to be tested for HIV to reach the administration’s goal. And Oklahoma has the second-highest uninsured rate in the nation after Texas — meaning many people don’t have a primary care doctor, let alone prescription drug coverage for drugs like Truvada, which can be used to prevent HIV infection.