The South is ‘the epicenter’ of a new HIV crisis. Medicaid expansion could help.

 

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The South is experiencing a surge in HIV cases, with the U.S. Centers for Disease Control and Prevention identifying it as the "epicenter" of an emerging crisis. This crisis is particularly affecting seven states, ranging from Texas to North Carolina.

In the lead-up to the recent gubernatorial election in Mississippi, a state with the sixth-highest rate of HIV diagnoses in the country, community healthcare workers were hopeful that Medicaid expansion could be a potential solution. Medicaid is the primary source of health insurance coverage for adults living with HIV, and expanding the program could provide additional funds to hospitals in the South that treat HIV patients. A September poll revealed that 90% of Mississippians wanted to improve the struggling hospital system, with 70% in favor of expanding Medicaid.

However, Republican candidate Tate Reeves, who argued that the state could not afford Medicaid expansion, emerged victorious over Democrat Brandon Presley. Presley, on the other hand, believed that Mississippi could not afford to ignore the opportunity to expand Medicaid. This election was a closely contested one in an otherwise predictably red state, with Reeves winning by a narrow margin of 51% of the vote, thus avoiding a runoff. His re-election has diminished the likelihood of a swift decision to expand Medicaid, and it also reduces the chances of Mississippi and other states meeting the Department of Health and Human Services' goal of reducing HIV infections by 75% by 2025.

If Mississippi, along with the other six southern states affected by the HIV surge, were to expand Medicaid, the program would provide more federal funds to support the poorest individuals. This would include making pre-exposure prophylaxis (PrEP), a highly effective daily pill for preventing HIV, more widely accessible. However, the decision to not expand Medicaid in Mississippi and other parts of the South, despite it being the nation's largest public health insurance program for low-income individuals, has become entangled in a complex mix of politics, including the divide between red and blue states and urban versus rural areas.