The Trump administration’s plan to halt the spread of HIV runs through places like rural Mississippi, where it is difficult to learn about PrEP, let alone find it.
Jackson, the capital of Mississippi, has the fourth-highest HIV rate among U.S. cities. The state’s rural communities also have been targeted in a Trump administration plan to stop HIV transmission by 2030. By Lenny Bernstein Lenny Bernstein Reporter covering health and medicine Email Bio Follow March 11 at 7:52 PM JACKSON, Miss. — Even in a tiny town in the Mississippi Delta, Robert Rowland, an openly gay, single, middle-aged man, has no problem finding sex partners.
In 2017, the last year for which figures are available, the South had about 20,000 new HIV diagnoses — more than the rest of the United States combined. A big reason: In most of the Deep South, it is difficult for people at risk of contracting HIV to find the medication critical to protecting themselves from the virus that causes AIDS and ending the 38-year-old epidemic.
The administration’s goal is to reduce HIV transmission by 75 percent within five years and by at least 90 percent by 2030, which would prevent 250,000 infections. The Food and Drug Administration approved Truvada in 2012, but a 2015 survey of primary-care doctors showed that a third of them had not heard of it, according to the CDC. The health agency estimates that 1.1 million people should be on PrEP but that only 90,000 were taking it in 2016.
Nathaniel, who is between jobs, grooms the hair of his friend Paul Floyd to help make ends meet. In Jackson, which has the fourth-highest rate of HIV infection among U.S. cities, Open Arms tries to recruit men for PrEP from places including clinics where sexually transmitted diseases are treated. More than three-quarters of those men express interest, but fewer than 20 percent actually show up for appointments, according to research by Leandro A. Mena, Open Arms’s medical director.
Poorer, rural communities also have significantly less access to health care. Mississippi regularly ranks among the poorest states in the nation, and the poor have the most difficulty sticking with health-care providers’ instructions and taking medications regularly. “I wasn’t having sex,” he said, “and in my life, there was so much I was going through.” He mostly keeps to himself, he said, because it is safer than being promiscuous. But “sometimes I let the devil come for me, and sometimes I let him win.”
Truvada sells for more than $1,600 a month. Until recently, it was not covered by all insurance companies and sometimes carried large co-payments. That changed in November, when the U.S. Preventive Services Task Force recommended that all people at high risk of contracting HIV should be on the medication. When the recommendation becomes final, insurance companies will have to cover the drug without co-payments.
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