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Rural White HIV America Declares: Boots On!

November 23, 2016

rural snow scene

Credit: Matt Ebert

It has happened. What could be worse? I'm not sure.

We have in President Trump a promise to roll back Obamacare. We have in his administration and in the House and Senate the right-wing activist politicians who seek to destroy Medicare and Medicaid. We have a promise to defund Planned Parenthood and roll back funding for global AIDS initiatives. We have a looming catastrophe, something not seen since the 1980s: A dangerous, biased, authoritarian is in control, and an ideologically impure political class seeks to destroy everything we have built to save and protect vulnerable populations from HIV/AIDS.

But this is a great opportunity for activists to build consensus and common ground. As rural voters lose health insurance and social services, we must be willing to reach out to them and offer solidarity. It will be difficult for many of us to forget whom they voted for. Be brave, willing and open-minded -- talk about the need for universal health care and a renewed Democratic party. As Republicans eviscerate health care, we will find swing voters, and we will need them to turn back Trump's red tide.

Clinton Offered a Wedge, Not Plaster or Mortar

I am a rural white cisgender gay man, so my perspective on this election focuses on my population here in the country. I saw what many of my urban liberal friends did not. I saw the country go for Trump first. Hillary Clinton barely made a move out of the cities. She would send surrogates such as Joe Biden and Elizabeth Warren to do her bidding. That was a terrible mistake. It was imperative she reach out to rural voters and sell her policies, including Obamacare, but she didn't.


Obamacare is not a working-class policy; it will not fix West Virginia's problems. Obamacare was always perceived as taking hard-earned taxpayer money and showering it on the urban poor. Rural white voters were the people who fell through the cracks during the great recession of 2008. They'd been tapped out bailing out the big banks and were not ready to support identity politics, Obamacare and urban progressivism. They had their own problems such as deindustrialization and an opiate epidemic running rampant with little federal relief.

Instead of plaster or mortar, Clinton offered a wedge; she was a deeply divisive candidate at a time when we needed solidarity. Her loss was no surprise here. Trump/Pence signs are still dancing in the breeze across the rural swath of rust belt states and the greater heartland. I never saw a Clinton/Kaine sign here. Rural Democrats like me were in a tight spot, defending a candidate whose record on rural issues was pretty abysmal. More than once, I found myself on the losing end of the argument.

You may think I am wrong, but this was more about the economy than race. Racism fanned the flames, but the economy was the engine. White working- and middle-class voters who never recovered from the great recession, who were foreclosed on, watched the banks recover -- and the bankers recover -- with taxpayer money. It is a population still reeling from that long con; how can we expect them to vote for a candidate who pledges consistency with the current administration's laissez-faire attitude toward the bankers who ripped them off? A candidate who gives speeches at Goldman Sachs and receives massive campaign contributions from the same banks does not have their interests at heart. Urban liberals and Democratic elites recovered from the recession -- rural voters did not.

Rural white voters threw a fist at Washington, and that small Trumpian fist landed squarely in the White House. Exit polls indicated immigration was the number-one concern of the GOP voter. Many of my urban, liberal friends see that as proof of racism. But regionally speaking, immigration is an economic issue too. That is an important distinction, and something worth remembering when we tar them all as racists.

When I asked my old boss in Pennsylvania, a dairy farmer who voted for Trump, why immigration is so important to him, his answer surprised me. He wants cheap labor, so he doesn't want them deported, and he supports a pathway to citizenship rather than the family detention camps the current administration allows. He sees Trump as an action candidate, a better leader for this job. I agreed with him that, under Obama, immigration has become a human rights catastrophe. I disagreed with him about Trump's plan to build a wall.

Worse Than Scraps

A prominent AIDS activist wrote me and said, "We will be fighting for scraps." I thought he was being generous. We face something much worse.

We have a white supremacist in office. So, the HIV apartheid in the U.S., the one that keeps blacks, the poor and transgender women at dangerously high incidence, will grow like a rabid cancer under Trump. Access to care and the cascades of care we know to be effective in stopping the spread of HIV will be eviscerated, line-by-line, by an administration and politicians on the right who seek to marginalize minorities and the most vulnerable among us.

And, we have an administration that is teaching the world to hate you. They are teaching young people to fear you too. Intolerance demands our response. Now, more than ever, the time is ripe for peer-to-peer education, HIV education in schools, support for LGBTQ youth and a renewed commitment to fighting HIV stigma in our midst.

Mike Pence, no stranger to HIV/AIDS, comes to power despite his role in one of the worst HIV outbreaks in the post-antiretroviral era. If Scott County, Indiana, is our guide, or a window into the consciousness of these new leaders, we can expect outbreaks in some of the most vulnerable counties across America. This is not good news for the rust belt and Appalachia. Where West Virginia, Tennessee and Kentucky meet, we shall see temperatures rise and a fever take hold.

My only hope is that Pence learned a thing or two about syringe exchanges: They save lives and cost nothing. But Pence offers no solace; he is a man of uncommon cruelty, especially to the dispossessed and vulnerable populations of this nation. Like his new boss, he is a man of no integrity, no compassion. He is a punisher and a political hypocrite.

Seize on that: The most vulnerable populations and those seeking affordable health care will be everywhere. Make room at the table for the people who held their noses and voted for Trump, and the rural Democrats who stayed home on election night. We have common ground. We have only to till it like a garden and grow compassion and unity for the cause of universal health and an end to AIDS.

Two Pathways

President Trump's only interest in civil rights and the rights of HIV-positive people is overturning or severely limiting our gains. There are two pathways:

  1. Trump gets his big infrastructure spending bill by trading health care to the libertarian and center right Republicans, Paul Ryan among them. After they dismantle Medicaid with block grants, we shall see incidence rise like the living dead. Whom will it fall on to help these people? Can we embrace health care outreach as a political vessel? Or will our need to disdain and scorn rural voters prevail and dash our hopes for 2018?
  2. After eight years of deficit spending, Trump leaves office with the Republic so bankrupt we can't afford Medicare and Medicaid.

Some version, or a combination of both, will likely be the outcome if he isn't stopped. As Democrats have so little power to intervene, you can expect the worst of it in the next two years.

In the meantime, the message I have for my urban liberal friends is fear less. The alt-right and the neo-Nazi groups that are most vocal do not represent the majority of rural Americans. There is no frenzy of white supremacy voters in the rust belt or my home state of Pennsylvania. These folks wanted change desperately, and they saw in Clinton an oppressive continuum of Obama's legacy -- one that largely left rural voters out of the picture.

Trump promised to take on the drug companies, but can he really do this? Gilead Sciences and Donald J. Trump seem more like allies than adversaries these days. Trump's talk about negotiating drug buys will be, like his "lock her up" rhetoric or his Mexican wall, moot if he doesn't act. If Paul Ryan gets his way, we won't have anything to buy drugs with.

What does that mean for us? Action! Activists are already talking about overseas generic drug buys, and a renewed vigor in targeting Gilead Sciences is revving up too. There is nothing like an oppressive regime to inspire the left. Targeting Gilead will continue to be a priority under Trump. He's already made a campaign promise to take on drug companies, and Gilead will be a golden opportunity to force him to make good on that promise.

National Institutes of Health spending, vaccine research, pre-exposure prophylaxis (PrEP) and prevention rollout in the age of Trump? Don't count on it. We have in this administration white men who will spend the money on curative gay therapy; churches will get funding for abstinence counseling, and communities at risk will not see any additional protections from violence. Under these socio-economic conditions, which do not improve under Republican leadership, HIV/AIDS will flourish. Do you have your combat boots on yet?

Boots On, Do Not Wait

If you ever wondered what it's like to be an activist, this is the time to find out. This is the time to join the human march for social justice. Do not wait; this is the time to caucus with your leaders and the HIV/AIDS community. Boots on: This is the time to march on Washington, the time to roll out the AIDS quilt and recite the names of the dead, again. This is the time for an AIDS activist revival: boots on, banners waving and fists pumping the air.

With bullhorns and placards, this is the time to rip down Trump's wall. HIV/AIDS apartheid must not be allowed to flourish and broaden across the borders of our bodies. We have seen bigotry before, and it is deadlier than the virus. This cold, white, stone of a man -- and the party he leads -- means boots on. This is a time like none I have seen since the days of Ronald Reagan.

We must return to the activism that saved us and the community it created. Once again, we face an oppressive government, and greed and indifference still kill. This is the time to rise up, ACT UP and fight back to end AIDS. As Trump moves forward on wrongheaded policies to "make America great again," the likes of which we haven't seen since the Reagan era that also brought us the plague, we must march forward and not back.

Read Matt's blog, Kick Rocks.

Copyright © 2016 Remedy Health Media, LLC. All rights reserved.

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