Why is medication to prevent HIV so hard to find in rural South? Stigma, poverty, racism, ignorant doctors . . .

Rate of people with HIV per 100,000 in 2017. (Map by AIDSVu)

A prescription medication called Truvada can protect users from HIV infection, but it's difficult to find in the rural South. That's a big part of the reason the South had about 20,000 new HIV diagnoses in 2017, more than the rest of the U.S. combined, Lenny Bernstein reports for The Washington Post. "Stigma, poverty, inadequate access to health care and lingering racial bias" are also reasons the South have a disproportionately large share of HIV infections.

The Trump administration says it wants to reduce HIV transmission by 75 percent within five years and at least 90 percent by 2030, but it's unclear how that will be implemented. President Trump's proposed 2020 budget would fund a program targeting HIV transmission in the rural South, but would also slash funding for Medicaid, which most people in poverty, some of them with HIV, depend on. Beyond that, it's unlikely the budget will pass in Congress as is, Bernstein reports.

Bernstein writes that the most effective way to fight HIV transmission is to increase access to Truvada (to prevent infection), and antiretrovirals to lower the viral load of already infected people so they can't transmit the disease. "Theoretically, you could end the epidemic tomorrow if you did that," Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases and one of the architects of Trump's plan, told Bernstein.

But in 2015, a third of primary-care doctors surveyed said they had not heard of Truvada, according to the federal Centers for Disease Control and Prevention. "Persuading many more people to take the drugs will require more federal money for health clinics as well as for education and outreach to certain groups, especially black men who have sex with other men. At current rates, half that group will be diagnosed with HIV infection," Bernstein reports.