Opinion | H.I.V. Is Coming to Rural America

What’s occurring in West Virginia shouldn’t be a shock. After a hepatitis C and H.I.V. outbreak in Scott County, Ind., in 2014 and 2015 that was fueled by deindustrialization and opioids, the C.D.C. launched a listing of 220 counties equally weak to such outbreaks amongst individuals who use intravenous medication. The densest focus of these counties is alongside the Appalachian Trail, with 28 of them in West Virginia — greater than half of the state’s 55 counties.

“There is no way that doesn’t wind up as an H.I.V. outbreak in the state,” Ms. Young says. Yet not like in locations like New York — with its complete intercourse schooling; efforts at queer- and trans-specific public well being; embrace of public syringe exchanges; and what its well being commissioner, Oxiris Barbot, describes as a “sex positive approach” — when it comes to confronting its H.I.V. epidemic, rural America is ill-prepared at greatest and antagonistic at worst.

For occasion, regardless of analysis displaying that syringe applications are efficient at limiting transmission of H.I.V. and inspiring folks to enter drug remedy, two cities in West Virginia — Clarksburg and Charleston — have not too long ago moved to shut or restrict their needle-exchange applications. Negative press, enterprise worries and conservative approaches are among the many causes the applications have been decreased once they urgently want to be expanded (together with statewide testing and schooling about preventive H.I.V. medicine).

I’ve seen such tragic, avoidable public well being insurance policies unfold in a suburban setting in my very own analysis in America’s heartland. Since 2014, I’ve been reporting and researching in St. Charles County, Mo., a “white flight” suburb to the west of St. Louis, the place the native prosecuting lawyer charged Michael L. Johnson with a number of felonies for transmitting H.I.V. (Mr. Johnson’s conviction was overturned on attraction in 2016.). Even although criminalizing H.I.V. is just not efficient in lowering charges of H.I.V., one of many causes the county wished to prosecute and imprison Mr. Johnson was seemingly to stop him from transmitting the virus to others so as to defend the general public well being. Yet in 2017, St. Charles County closed its solely clinic for sexually transmitted infections, which offered practically 1,000 exams a yr. With fewer folks getting examined — and with fewer folks residing with the virus taking medicine that may stop transmission to others — extra folks on this space may change into H.I.V. optimistic.

While it’s true that people who find themselves black, queer, transgender, homeless, incarcerated or poor, or who use injection medication, are disproportionately affected by H.I.V. and AIDS, the misguided impression that members of those teams are the one ones affected has sadly contributed to the media’s alternative to deprioritize protection of H.I.V. and AIDS in recent times.

Meanwhile, the agricultural, heterosexual white Americans who’ve been the topic of numerous nationwide profiles as a result of they’re imagined —  incorrectly — to characterize all of President Trump’s supporters, are extra in danger on a regular basis. But whereas we’re bombarded by analyses of many features of their plight, we don’t hear about this disaster going through them.

It’s time for that to change, and for policymakers to deal with the basis situations that permit H.I.V. and AIDS to flourish in rural communities. In West Virginia this contains rising entry to well being care, supporting all staff damage by deindustrialization and undoing the stigma tied to intercourse and drug use.

These adjustments will, in fact, present much-needed assist for the folks in city cities the place H.I.V. charges are dropping as effectively. But the brand new main terrain of the disaster proper now could be in rural America, and it may possibly’t be ignored any longer.

Steven W. Thrasher (@thrasherxy) is an assistant professor at Northwestern University’s Medill School of Journalism and is on the college of the Institute of Sexual and Gender Minority Health and Wellbeing at Northwestern University.

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