What’s happening in West Virginia shouldn’t be a surprise. 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. released a list of 220 counties similarly vulnerable to such outbreaks among people who use intravenous drugs. The densest concentration of those counties is along the Appalachian Trail, with 28 of them in West Virginia — more 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 unlike in places like New York — with its comprehensive sex education; efforts at queer- and trans-specific public health; embrace of public syringe exchanges; and what its health 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 best and antagonistic at worst .

For instance, despite research showing that syringe programs are effective at limiting transmission of H.I.V. and encouraging people to enter drug treatment, two cities in West Virginia — Clarksburg and Charleston — have recently moved to close or limit their needle-exchange programs. Negative press, business worries and conservative approaches are among the reasons the programs have been reduced when they urgently need to be expanded (along with statewide testing and education about preventive H.I.V. medication).

I have seen such tragic, avoidable public health policies unfold in a suburban setting in my own research in America’s heartland. Since 2014, I have been reporting and researching in St. Charles County, Mo. , a “white flight” suburb to the west of St. Louis, where the local prosecuting attorney charged Michael L. Johnson with multiple felonies for transmitting H.I.V . (Mr. Johnson’s conviction was overturned on appeal in 2016.). Even though criminalizing H.I.V. is not effective in decreasing rates of H.I.V., one of the reasons the county wanted to prosecute and imprison Mr. Johnson was likely to prevent him from transmitting the virus to others in order to protect the public health. Yet in 2017, St. Charles County closed its only clinic for sexually transmitted infections, which provided nearly 1,000 exams a year. With fewer people getting tested — and with fewer people living with the virus taking medication that can prevent transmission to others — more people in this area could become H.I.V. positive.

While it’s true that people who are black, queer, transgender, homeless, incarcerated or poor, or who use injection drugs, are disproportionately affected by H.I.V. and AIDS, the misguided impression that members of these groups are the only ones affected has unfortunately contributed to the media’s choice to deprioritize coverage of H.I.V. and AIDS in recent years .

Meanwhile, the rural, heterosexual white Americans who have been the subject of countless national profiles because they’re imagined — incorrectly — to represent all of President Trump’s supporters, are more at risk all the time. But while we’re bombarded by analyses of many aspects of their plight, we don’t hear about this crisis facing them.

It’s time for that to change, and for policymakers to address the root conditions that allow H.I.V. and AIDS to flourish in rural communities. In West Virginia this includes increasing access to health care, supporting all workers hurt by deindustrialization and undoing the stigma tied to sex and drug use.

These changes will, of course, provide much-needed help for the people in urban cities where H.I.V. rates are dropping as well. But the new major terrain of the crisis right now is in rural America, and it can’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 faculty of the Institute of Sexual and Gender Minority Health and Wellbeing at Northwestern University.

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