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They are right but it’s more of a testimony to lack of adequate healthcare in rural America. In general people in rural areas don’t get as many checkups, don’t see the doctor when they should and ignore potentially serious symptoms.  The biggest difference now is that the opioid epidemic is bringing it to light because of unsafe injection practices.  
 

doctors in rural America aren’t going to think about things like prep, or even hiv testing, and frankly why would they? Those areas already have high rates of smoking, obesity, diabetes, and other chronic heath problems. HIV doesn’t manifest itself as symptomatic for a long time where those other conditions are often very apparent. 
 

now, I don’t agree with that but again health care in the US is pretty messed up.  

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