{"id":31241,"date":"2019-02-28T05:00:42","date_gmt":"2019-02-28T11:00:42","guid":{"rendered":"http:\/\/stateimpact.npr.org\/oklahoma\/?p=31241"},"modified":"2019-02-28T07:40:29","modified_gmt":"2019-02-28T13:40:29","slug":"trump-plan-to-halt-hiv-hits-rough-road-in-rural-oklahoma","status":"publish","type":"post","link":"https:\/\/stateimpact.npr.org\/oklahoma\/2019\/02\/28\/trump-plan-to-halt-hiv-hits-rough-road-in-rural-oklahoma\/","title":{"rendered":"Trump plan to halt HIV hits rough road in rural Oklahoma"},"content":{"rendered":"<div id=\"attachment_31242\"  class=\"wp-caption module image aligncenter\" style=\"max-width: 1920px;\"><img decoding=\"async\" loading=\"lazy\" class=\"size-large wp-image-31242\" src=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-4-1920x1280.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-4-1920x1280.jpg 1920w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-4-672x448.jpg 672w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-4-768x512.jpg 768w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-4-150x100.jpg 150w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-4-300x200.jpg 300w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-4-620x413.jpg 620w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-4-1620x1080.jpg 1620w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-4.jpg 2000w\" sizes=\"(max-width: 1920px) 100vw, 1920px\" \/><\/p>\n<p class=\"wp-media-credit\">Jackie Fortier \/ StateImpact Oklahoma<\/p>\n<p class=\"wp-caption-text\">Dr. Michelle Salvaggio, medical director of the Infectious Diseases Institute at the University of Oklahoma Health Sciences Center in Oklahoma City, points to drugs used to treat HIV\/AIDS. Medical advancements since the epidemic surfaced in the 1980s have helped many of her HIV-positive patients lead healthy lives.<\/p>\n<\/div><p>One of the goals President Donald Trump announced in his State of the Union address was to stop the spread of HIV in the U.S. within 10 years.<\/p><p>In addition to sending extra money to 48 mainly urban counties, Washington, D.C., and San Juan, Puerto Rico,\u00a0<a href=\"https:\/\/www.hiv.gov\/federal-response\/ending-the-hiv-epidemic\/overview\" target=\"_blank\" rel=\"noopener noreferrer\">Trump\u2019s plan<\/a>\u00a0targets seven states where rural transmission of HIV is especially high.<br \/>\n<iframe loading=\"lazy\" src=\"https:\/\/w.soundcloud.com\/player\/?url=https%3A\/\/api.soundcloud.com\/tracks\/581714244&color=%23ff5500&auto_play=false&hide_related=true&show_comments=false&show_user=true&show_reposts=false&show_teaser=false&visual=false\" width=\"100%\" height=\"150\" frameborder=\"no\" scrolling=\"no\"><\/iframe><!--more--><\/p><p>Health officials and doctors treating patients with HIV in those states say any extra funding would be welcome. But they say strategies that work in progressive cities like Seattle won\u2019t necessarily work in rural areas of Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma and South Carolina.<\/p><p>Stigma around HIV and AIDS and around being gay runs deep in parts of Oklahoma, said <a href=\"https:\/\/doctors.oumedicine.com\/michelle-r-salvaggio-oklahoma-city-infectious-diseases\" target=\"_blank\" rel=\"noopener noreferrer\">Dr. Michelle Salvaggio<\/a>, medical director of the\u00a0<a href=\"https:\/\/www.oumedicine.com\/department-of-internal-medicine\/department-sections\/infectious-diseases\" target=\"_blank\" rel=\"noopener noreferrer\">Infectious Diseases Institute<\/a> 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 state\u2019s second-largest city.<\/p><p><strong>A Long Drive For Anonymity<\/strong><\/p><p>Salvaggio\u2019s clinic has six exam 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\u2019 drive northwest of Oklahoma City.<\/p><p>But Salvaggio said that ended up being a waste of money. \u201cWe had to let that position go because nobody would go see her,\u201d Salvaggio said. \u201cBecause they didn\u2019t want to be seen walking into the HIV case manager\u2019s office in that tiny town \u2014 that can only mean one thing.\u201d<\/p><p>In Oklahoma, as in much of the U.S.,\u00a0<a href=\"https:\/\/www.cdc.gov\/hiv\/group\/msm\/bmsm.html\" target=\"_blank\" rel=\"noopener noreferrer\">black gay and bisexual men have the highest risk<\/a> of HIV infection. Other groups with elevated risk in Oklahoma include Latinos, heterosexual women and Native Americans.<\/p><p>Salvaggio applauds the goal of ending HIV transmissions within 10 years but said she doesn\u2019t think it\u2019s feasible in Oklahoma. The plan fails to recognize the particular ways different populations experience the epidemic, she said.<\/p><p>Native Americans in Oklahoma, for example, can\u2019t count on the anonymity of a large health clinic.<\/p><p>\u201cWhen they go into an Indian Health Service clinic, it is possible that they will see their cousin behind the desk, and their cousin\u2019s brother-in-law working in medical records, and their niece\u2019s boyfriend working in the pharmacy,\u201d Salvaggio said.<\/p><p>Even if Native Americans have access to HIV care at the clinic, she said, \u201cthey are literally in fear of being outed.\u201d<\/p>\n<div id=\"attachment_31243\"  class=\"wp-caption module image aligncenter\" style=\"max-width: 2000px;\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-31243 size-full\" src=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-2.jpg\" alt=\"\" width=\"2000\" height=\"1368\" srcset=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-2.jpg 2000w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-2-1920x1313.jpg 1920w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-2-672x460.jpg 672w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-2-768x525.jpg 768w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-2-150x103.jpg 150w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-2-300x205.jpg 300w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-2-620x424.jpg 620w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-2-1579x1080.jpg 1579w\" sizes=\"(max-width: 2000px) 100vw, 2000px\" \/><\/p>\n<p class=\"wp-media-credit\">Jackie Fortier \/ StateImpact Oklahoma<\/p>\n<p class=\"wp-caption-text\">Ky Humble, who now lives in Oklahoma City, says there needs to be more support for people who are HIV-positive.<\/p>\n<\/div><p><strong>Social Support Services Needed<\/strong><\/p><p>Ky Humble\u2019s hometown is Afton, Okla., which had a population of about 800 when he was growing up. He belongs to the Cherokee Nation and was raised a Southern Baptist. He doesn\u2019t remember learning about HIV at all when he was in school.<\/p><p>\u201cEven if I did, it clearly wasn\u2019t enough,\u201d Humble said. \u201cI knew I was gay in middle school; I think I would have paid attention.\u201d<\/p><p>When he was diagnosed with HIV six years ago, at age 21, Humble felt as if his life was ending.<\/p><p>\u201cI knew that that was a thing, [but] I was very ignorant,\u201d he recalled. \u201cI was two weeks away from graduating from college \u2014 you\u2019re supposed to be on top of the world. I thought it was a death sentence.\u201d<\/p><p>He called his mom right away. She immediately drove across the state to be with him.<\/p><p>\u201cWe just sat there and cried for six hours straight,\u201d Humble said. \u201cAnd then we actually went [out] and bought several books on HIV, and just started reading them \u2014 to try to figure out what was going on.\u201d<\/p><p>Today, Humble is healthy. His\u00a0<a href=\"http:\/\/sfaf.org\/hiv-info\/basics\/what-is-undetectable.html\" target=\"_blank\" rel=\"noopener noreferrer\">HIV levels are undetectable<\/a> and he gets regular medical treatment to keep it that way. He now lives in Oklahoma City, but his family still lives in his hometown. He said some people back in Afton know he has HIV, and some don\u2019t.<\/p><p>\u201cIt\u2019s like coming out as diabetic,\u201d Humble said. \u201cI don\u2019t necessarily tell people that I\u2019m HIV-positive. It\u2019s just part of who I am; it doesn\u2019t define me.\u201d<\/p><p>He said he is cautiously optimistic that the Trump administration\u2019s plan could mean more funding for HIV prevention in Oklahoma. But rural Oklahomans, Humble said, also need access to \u201cwraparound services\u201d \u2014 such as food pantries, mental health therapy and transportation assistance \u2014 to help them deal with the disease.<\/p><p>\u201cI have friends who have HIV and live in rural areas, and just getting to appointments is challenging,\u201d he said.<\/p>\n<div id=\"attachment_31244\"  class=\"wp-caption module image aligncenter\" style=\"max-width: 1920px;\"><img decoding=\"async\" loading=\"lazy\" class=\"size-large wp-image-31244\" src=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-1-1920x1246.jpg\" alt=\"\" width=\"1920\" height=\"1246\" srcset=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-1-1920x1246.jpg 1920w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-1-672x436.jpg 672w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-1-768x498.jpg 768w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-1-150x97.jpg 150w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-1-300x195.jpg 300w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-1-620x402.jpg 620w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-1-1664x1080.jpg 1664w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2019\/02\/HIV-PHOTO-1.jpg 2000w\" sizes=\"(max-width: 1920px) 100vw, 1920px\" \/><\/p>\n<p class=\"wp-media-credit\">Jackie Fortier \/ StateImpact Oklahoma<\/p>\n<p class=\"wp-caption-text\">Andy Moore, Clinic Administrator of the Infectious Diseases Institute at the University of Oklahoma Health Sciences Center at a conference on HIV and AIDS in rural Oklahoma, just days after President Trump&#8217;s announcement.<\/p>\n<\/div><p><strong>Oklahoma\u2019s Uninsured Rate Is Second-Highest In U.S.<\/strong><\/p><p>Exactly how much money the president\u2019s HIV plan will get is up to Congress. But even inexpensive, proven methods for fighting HIV \u2014 like distributing condoms \u2014 can be a tough sell in a state that\u00a0<a href=\"https:\/\/stateimpact.npr.org\/oklahoma\/2019\/01\/24\/bills-aim-to-add-training-on-consent-to-patchwork-of-sex-education-in-oklahoma-schools\/\" target=\"_blank\" rel=\"noopener noreferrer\">doesn\u2019t mandate\u00a0<\/a>comprehensive sex education.<\/p><p>Informational HIV talks with teenagers often turn into a basic health class for dispelling myths, said Andy Moore, clinic administrator of the Infectious Diseases Institute at the University of Oklahoma.<\/p><p>\u201cWe\u2019ve had teenagers write questions like \u2018I\u2019ve heard that if you douche with Mountain Dew after sex that it kills sperm,&#8217;\u201d Moore said. They earnestly want to know if that\u2019s true. \u201cWe have to back way up and explain what sex is, how babies are made, different types of sex \u2014 before we can teach them about HIV prevention,\u201d he said.<\/p><p>Another issue in Oklahoma, Moore said, is that people aren\u2019t getting diagnosed with HIV until they\u2019re already sick because of AIDS, or close to that point.<\/p><p>\u201cWhich indicates that they didn\u2019t get tested until they had been living with the disease for six, eight, 10 years,\u201d Moore said. \u201cWe have one of the highest rates of late testing.\u201d<\/p><p>Salvaggio said thousands of people across Oklahoma would need to be tested for HIV to reach the administration\u2019s goal. And Oklahoma has the second-highest uninsured rate in the nation after Texas \u2014 meaning many people don\u2019t have a primary care doctor, let alone <a href=\"https:\/\/www.npr.org\/sections\/health-shots\/2018\/06\/30\/624045995\/rising-cost-of-prep-a-pill-that-prevents-hiv-pushes-it-out-of-reach-for-many\" target=\"_blank\" rel=\"noopener noreferrer\">prescription drug coverage for drugs like Truvada<\/a>, which can be used to prevent HIV infection.<\/p><p>It\u2019s also one of\u00a0<a href=\"https:\/\/www.kff.org\/medicaid\/issue-brief\/status-of-state-medicaid-expansion-decisions-interactive-map\/\" target=\"_blank\" rel=\"noopener noreferrer\">14 states that haven\u2019t expanded Medicaid<\/a> under the Affordable Care Act. So, even if more people were tested for HIV, getting those who need it into treatment wouldn\u2019t be easy, Salvaggio said.<\/p><p>Health care in Oklahoma is underfunded, she said, and couldn\u2019t cope with a sudden influx of new patients. \u201cI don\u2019t know what we\u2019d do with all those new patients,\u201d she said. \u201cWe don\u2019t have a facility to see them in, and we don\u2019t have [the] providers.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Experts say HIV prevention strategies that work in progressive cities like Seattle won\u2019t necessarily work in rural Oklahoma.<\/p>\n","protected":false},"author":199,"featured_media":31245,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[23],"tags":[443,1030,364,1031,322,174],"acf":[],"_links":{"self":[{"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/posts\/31241"}],"collection":[{"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/users\/199"}],"replies":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/comments?post=31241"}],"version-history":[{"count":6,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/posts\/31241\/revisions"}],"predecessor-version":[{"id":31261,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/posts\/31241\/revisions\/31261"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/media\/31245"}],"wp:attachment":[{"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/media?parent=31241"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/categories?post=31241"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/tags?post=31241"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}