President Trump's Plan To Stop HIV Faces A Tough Road In Oklahoma

Trump's proposal to tackle HIV promises extra help for seven states where HIV has become a rural problem. Experts in Oklahoma wonder if it will be enough, given the state's high uninsured rate.

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During the State of the Union, President Trump said he wants to stop the spread of HIV in the United States within 10 years. Part of the new plan targets cities, but it also focuses on seven mostly Southern states where the virus is a huge problem in rural areas. Jackie Fortier with StateImpact Oklahoma says HIV experts in that state still have a lot of questions.

JACKIE FORTIER, BYLINE: When he was diagnosed six years ago, Ky Humble (ph) wasn't sure what HIV was. He was just two weeks shy of graduating from the University of Oklahoma and headed for a career in politics. He was 21 years old and felt invincible.

KY HUMBLE: I knew that that was a thing. I didn't really know - I was very ignorant.

FORTIER: Humble grew up in Afton. That's a town of about 800 people in the state's northeast corner. He belongs to the Cherokee Nation and was raised Southern Baptist. Still, he had told his family he was gay the summer before he started college. So when the doctor broke the news that day that he had HIV, Humble's first call was to his mom.

HUMBLE: We both thought that it was a death sentence.

FORTIER: She immediately left work and drove three hours across Oklahoma to be with him.

HUMBLE: And we just sat there and cried for six hours straight, and then we actually bought several books on HIV and just started reading them to try to figure out what was going on.

FORTIER: They learned about treatment, and he started getting it. Six years later, Humble is healthy. Because he got tested, his HIV never progressed to AIDS. That's the ideal outcome, says Andy Moore, who manages the Infectious Diseases Institute at the University of Oklahoma. But in a state that hasn't expanded Medicaid and has the second-highest uninsured rate in the nation, Moore says just getting people in the door for an HIV test is a huge hurdle.

ANDY MOORE: We have one of the highest rates of late testing.

FORTIER: That means people in Oklahoma aren't getting diagnosed with HIV until they're already sick because of AIDS or close to that point.

MOORE: Which indicates that they didn't get tested until they had been living with the disease for, you know, six, eight, 10 years.

FORTIER: Advocates like Moore welcome any new funding but say strategies that work in cities like Seattle won't necessarily work in rural Oklahoma. Dr. Michelle Salvaggio, one of the few HIV experts here, says her Oklahoma City clinic tried putting a case manager in a rural area, but it failed.

MICHELLE SALVAGGIO: We had to let that position go because nobody would go see her because they didn't necessarily want to be seen walking into the HIV case manager's office in that tiny town because that can only mean one thing.

FORTIER: Salvaggio says it's more than just money. Tens of thousands of people would need to be convinced to get an HIV test.

SALVAGGIO: I don't think that our state has necessarily gotten out of the idea that potentially HIV is, you know, a gay punishment.

FORTIER: Even if more people get tested, getting them into treatment wouldn't be so simple. Salvaggio says Oklahoma health care is underfunded and couldn't cope with a sudden influx of new patients.

SALVAGGIO: We don't have a facility to see them in. We don't have providers to see them with.

FORTIER: It's up to Congress how much money the president's HIV plan will get. But even cheap, proven tactics for fighting HIV, like distributing condoms, can be a tough sell in a state that doesn't teach comprehensive sex education. For NPR News, I'm Jackie Fortier in Norman, Okla.

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GREENE: Jackie's story is part of a reporting partnership involving NPR, Kaiser Health News and StateImpact Oklahoma.

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