A group of Americans at high risk for HIV turn out to be Trump voters—and they aren’t gay Republicans or other men who have sex with men. In fact, they’re mostly white heterosexuals who are rural and poor.

Here’s the story. In 2015, nearly 200 people contracted HIV during an outbreak in rural Scott County, Indiana, the result of injection drug use fueled by the opioid epidemic (a significant proportion were coinfected with hepatitis C, MedPage Today reported). Earlier this year, hoping to curtail a repeat scenario, the Centers for Disease Control and Prevention listed the 220 counties in the United States most at risk of similar outbreaks. More than half of the counties—56 percent—are located in Kentucky, Tennessee and West Virginia, with clusters in Arizona, Utah, Missouri, Michigan, Maine, Montana, California and other states.

Looking at the voting records of those counties, Vocativ has found that 216 of the 220 counties voted for Donald Trump and Mike Pence; the GOP received 71 percent of the total vote in those counties. In other words, 98 percent of the counties most vulnerable to an HIV outbreak supported Trump.

This raises a lot of interesting questions, but as Vocativ points out, Trump was quiet about HIV/AIDS policy on the campaign trail, so it’s a challenge to predict how his administration will handle the situation. But we do know that Vice President–elect Mike Pence was governor of Indiana during the 2015 HIV outbreak and that policies based on his conservative religious views have been linked to HIV cases. For example, he opposed syringe services and Planned Parenthood, which offers HIV testing—Pence cut funding that led to the closure of the only Planned Parenthood facility in Scott County, the epicenter of the outbreak. We also know that Trump’s team has promised to end the Affordable Care Act, or Obamacare, and privatize Medicare. 

“Because of its historical ties with advocacy by LGBT groups, advocacy for HIV prevention might appear to be a progressive, left-leaning issue,” writes Vocativ. “And it’s true that those hit hardest are still the black and LGBT communities. But on the particular issue of sudden outbreaks, where many are infected at once, the highest risk has shifted to rural, predominately white communities where syringe drug use has become more common and HIV awareness is lower. In other words, it’s the same overlooked population that helped drive Trump’s upset victory.”

To read more POZ articles about the opioid epidemic and syringe services, click here.