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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. (Jackie Fortier/StateImpact Oklahoma)

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.

In addition to sending extra money to 48 mainly urban counties, Washington, D.C., and San Juan, Puerto Rico,聽聽targets seven states where rural transmission of HIV is especially high.

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鈥檛 necessarily work in rural areas of Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma and South Carolina.

Stigma around HIV and AIDS and around being gay runs deep in parts of Oklahoma, said , medical director of the聽 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鈥檚 second-largest city.

A Long Drive For Anonymity

Salvaggio鈥檚 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鈥� drive northwest of Oklahoma City.

But Salvaggio said that ended up being a waste of money. 鈥淲e had to let that position go, because nobody would go see her,鈥� Salvaggio said. 鈥淏ecause they didn鈥檛 want to be seen walking into the HIV case manager鈥檚 office in that tiny town 鈥� that can only mean one thing.鈥�

In Oklahoma, as in much of the U.S.,聽 of HIV infection. Other groups with elevated risk in Oklahoma include Latinos, heterosexual women and Native Americans.

Salvaggio applauds the goal of ending HIV transmissions within 10 years but said she doesn鈥檛 think it鈥檚 feasible in Oklahoma. The plan fails to recognize the particular ways different populations experience the epidemic, she said.

Native Americans in Oklahoma, for example, can鈥檛 count on the anonymity of a large health clinic.

鈥淲hen they go into an Indian Health Service clinic, it is possible that they will see their cousin behind the desk, and their cousin鈥檚 brother-in-law working in medical records, and their niece鈥檚 boyfriend working in the pharmacy,鈥� Salvaggio said.

Even if Native Americans have access to HIV care at the clinic, she said, 鈥渢hey are literally in fear of being outed.鈥�

Social Support Services Needed

Ky Humble鈥檚 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鈥檛 remember learning about HIV at all when he was in school.

鈥淓ven if I did, it clearly wasn鈥檛 enough,鈥� Humble said. 鈥淚 knew I was gay in middle school; I think I would have paid attention.鈥�

When he was diagnosed with HIV six years ago, at age 21, Humble felt as if his life was ending.

鈥淚 knew that that was a thing, [but] I was very ignorant,鈥� he recalled. 鈥淚 was two weeks away from graduating from college 鈥� you鈥檙e supposed to be on top of the world. I thought it was a death sentence.鈥�

Ky Humble, who now lives in Oklahoma City, says there needs to be more support for people who are HIV-positive.(Jackie Fortier/StateImpact Oklahoma)

He called his mom right away. She immediately drove across the state to be with him.

鈥淲e just sat there and cried for six hours straight,鈥� Humble said. 鈥淎nd then we actually went [out] and bought several books on HIV, and just started reading them 鈥� to try to figure out what was going on.鈥�

Today, Humble is healthy. His聽 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鈥檛.

鈥淚t鈥檚 like coming out as diabetic,鈥� Humble said. 鈥淚 don鈥檛 necessarily tell people that I鈥檓 HIV-positive. It鈥檚 just part of who I am; it doesn鈥檛 define me.鈥�

He said he is cautiously optimistic that the Trump administration鈥檚 plan could mean more funding for HIV prevention in Oklahoma. But rural Oklahomans, Humble said, also need access to 鈥渨raparound services鈥� 鈥� such as food pantries, mental health therapy and transportation assistance 鈥� to help them deal with the disease.

鈥淚 have friends who have HIV and live in rural areas, and just getting to appointments is challenging,鈥� he said.

Oklahoma鈥檚 Uninsured Rate Is Second-Highest In U.S.

Exactly how much money the president鈥檚 HIV plan will get is up to Congress. But even inexpensive, proven methods for fighting HIV 鈥� like distributing condoms 鈥� can be a tough sell in a state that聽comprehensive sex education.

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.

Salvaggio holds one of the medicines she prescribes to her patients with HIV.(Jackie Fortier/StateImpact Oklahoma)

鈥淲e鈥檝e had teenagers write questions like 鈥業鈥檝e heard that if you douche with Mountain Dew after sex that it kills sperm,鈥欌�� Moore said. They earnestly want to know if that鈥檚 true. 鈥淲e have to back way up and explain what sex is, how babies are made, different types of sex 鈥� before we can teach them about HIV prevention,鈥� he said.

Another issue in Oklahoma, Moore said, is that people aren鈥檛 getting diagnosed with HIV until they鈥檙e already sick because of AIDS, or close to that point.

鈥淲hich indicates that they didn鈥檛 get tested until they had been living with the disease for six, eight, 10 years,鈥� Moore said. 鈥淲e have one of the highest rates of late testing.鈥�

Salvaggio said thousands of people across Oklahoma would need to be tested for HIV to reach the administration鈥檚 goal. And Oklahoma has the second-highest uninsured rate in the nation after Texas 鈥� meaning many people don鈥檛 have a primary care doctor, let alone , which can be used to prevent HIV infection.

It鈥檚 also one of聽 under the Affordable Care Act. So, even if more people were tested for HIV, getting those who need it into treatment wouldn鈥檛 be easy, Salvaggio said.

Health care in Oklahoma is underfunded, she said, and couldn鈥檛 cope with a sudden influx of new patients. 鈥淚 don鈥檛 know what we鈥檇 do with all those new patients,鈥� she said. 鈥淲e don鈥檛 have a facility to see them in, and we don鈥檛 have [the] providers.鈥�

This story is part of a partnership that includes , and Kaiser Health News.