Far from the ocean and Puerto Rico’s famous beaches, narrow roads wind into mountains not unlike the country roads of our home, West Virginia. After hours of driving we reach a rural community in the island’s center called Tetuan Tres. Like so many places in rural Appalachia, you don’t come here accidentally.
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The 10 counties in the United States most at risk for an HIV outbreak are all in Central Appalachia, a ccording to a 2016 report by the Centers for Disease Control and Prevention. Compiled after a 2015 outbreak of the disease in southern Indiana, the report found that places with a combination of high poverty, low access to health care, and rampant intravenous drug were mostly likely to experience a similar outbreak of HIV and hepatitis C.