Trump broke his promise to deal with the opioid epidemic. Now, the states that voted for him are dealing with the fallout.

As a candidate, Donald Trump promised to bring an end to the opioid epidemic that experts have described as the “defining public health challenge of our time.” With an estimated 150 Americans dying from drug overdoses every single day, the crisis is producing a death toll equal to September 11th every three weeks.

Yet since he took office, Trump has let the opioid epidemic sit on the back burner, even ignoring the urgent pleas from his own advisory committee.

Now, the same areas hardest hit by the scourge of opioid addiction are facing an entirely new crisis: a brewing HIV epidemic.

According to a new report, the next HIV epidemic to hit America is likely already underway in rural towns and counties across the country, most of which are still in the grips of the nationwide opioid crisis. But due to underfunding and limited HIV screening in many rural counties, health officials don’t even know how the bad the problem is.

They point to Scott County, Indiana, which in 2015 suffered the worst HIV outbreak in state history — a wholly preventable disaster that was sparked by cuts to public health funding and an unwillingness to implement risk-reduction programs like needle exchanges. The funding cuts shuttered the county’s only Planned Parenthood clinic, which had provided HIV testing and preventive care to the 28,000 residents in the county.

The result was unprecedented: 20 new cases of HIV were being diagnosed each week at the height of the epidemic. A study examining the outbreak, which happened under the leadership of then-Gov. Mike Pence, concluded that the crisis was preventable and warned that other U.S. communities were at risk for nearly identical outbreaks.

“The nightmare that wakes me up at 3 a.m. is a Scott County-level HIV outbreak happening here in Alaska,” Jay Butler, director of the Division of Public Health in the state’s health department, told Politico.

Late last year, the Centers for Disease Control and Prevention (CDC) identified at least 220 counties at high risk of a spike in HIV infections related to intravenous drug use — and the vast majority are in red states that voted for Trump.

According to several analyses, Trump’s focus on the opioid epidemic helped boost him to victory in key states like Ohio, West Virginia, and Pennsylvania. Counties with the highest rates of opioid overdoses overwhelmingly voted for Trump, meaning that his base includes many of those who are most vulnerable to the coming HIV epidemic.

Many of these areas also lack the public health infrastructure to deal with such a crisis, and despite warnings from the CDC, the Trump administration isn’t doing anything to address that.

In early August, Trump pledged to declare the opioid epidemic a national emergency, which would open up new lines of funding and give states more flexibility to implement programs such as HIV screening initiatives and drug treatment programs.

But more than two months later, Trump still hasn’t taken any of the necessary steps to make an official emergency declaration.

On top of that, the website for the Office of National AIDS Policy was shut down just days after Trump took office, and nine months later, he still hasn’t appointed anyone to lead the office. As many HIV/AIDS activists have warned about for months, it appears that Trump doesn’t even have an HIV/AIDS prevention strategy, not to mention the will to implement it.

“It pretty much says that’s not something that is on their radar,” said Lucy Bradley-Springer, an infectious disease expert and former member of the Presidential Advisory Council on HIV/AIDS. She was among six experts who resigned from the panel this year in protest of Trump’s policies.

Trump often claims that he won the election by listening to the forgotten needs of voters in rural counties across America. Yet now, in their time of greatest need, Trump is nowhere to be seen.


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