The second goal is to get every American who is at risk — an estimated one million people — onto pre-exposure prophylaxis (called PrEP), a pill that, if taken daily, protects almost completely against infection.
But reaching those goals will take a huge amount of money — far more than the $291 million Mr. Trump requested in his 2020 budget proposal. Moreover, it will require courageous political leadership, not just from the White House, but from every statehouse and city hall in the nation.
In the last 15 years, the epidemic has shifted into groups that are hard to test and even harder to keep on daily medication: men who are closeted, drug injectors, the homeless, the rural poor, the mentally ill and those with little income and no health insurance.
But the group most at risk comprises gay and bisexual black men and transgender women in the Deep South — Mr. Gibson’s peers and his clientele. More than half of new H.I.V. infections in the country each year now occur in the South, according to the Centers for Disease Control and Prevention, and often in rural areas.