On February 5, 2019, President Trump announced in the State of the Union Address a plan to decrease the number of new HIV infections in the US by 75% in 5 years and by 90% in 10 years, thereby ending the United States HIV epidemic by 2030. The details of this plan were recently discussed in a Viewpoint1 that pointed out that the tools are already at hand to accomplish this goal in the form of prevention and treatment modalities, notably, antiretroviral therapy for individuals with HIV infection and preexposure prophylaxis (PrEP) for people at increased risk of HIV infection, as well as access to needle and syringe exchange programs and treatment of opioid use disorder when needed. Implementation of these tools in the demographic and geographic hot spots of infection will be critical to the success of the plan. However, an insidious threat to the achievement of this goal is a growing risk factor for HIV transmission—opioid injection in rural areas of the United States—that involves demographically and geographically distinct populations from those seen earlier in the HIV epidemic.
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Lerner AM, Fauci AS. Opioid Injection in Rural Areas of the United States: A Potential Obstacle to Ending the HIV Epidemic. JAMA. 2019;322(11):1041–1042. doi:10.1001/jama.2019.10657
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