The booming oil camps of conservative North Dakota are not usually places HIV prevention specialists chat about around the water cooler. But lately, they are sitting up and taking notice.

At the end of 2012, North Dakota had just 254 people living with HIV/AIDS, one of the lowest rates of any state in the nation. Less than two years later, that number has more than doubled, to 638, health officials say.

Specialists think the oil camps of Williston, North Dakota, may be impacting HIV transmission. The oil camps, also known as “man camps,” sprouted up almost seven years ago when oil companies rushed to the state to suck “black gold” out of the ground. These communities, filled with rows and rows of modular, trailer-like houses, have by some estimates nearly tripled the population of Williston to as many as 33,000 people.

The camps house young men making up to $100,000 per year at the dangerous jobs associated with drilling for oil. It's no secret that many of them like to go out and have fun when they're not working. Businesses designed to serve these new workers have flourished. CNN Money reported in 2011 that strippers can make up to $3,000 a night working in Williston.

But while the oil boom has fueled an explosion in North Dakota’s economy, it has also brought challenges for state public health officials like Kirby Kruger.

Kruger, the state’s director of disease control, acknowledges that the oil boom has fueled an uptick in HIV cases. But he stresses that they’re not all coming from the camps. He said he does not know exactly how many cases are among people who came to the state for reasons directly related to the oil boom.

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About 50,000 new HIV infections are diagnosed in the United States each year, most among men who have sex with men. Modern medications have made HIV as manageable as diabetes, but only if they are taken as directed.

Just last week, the U.S. Food and Drug Administration approved two new HIV medications, Vitekta and Tybost. Antiretroviral medications have become increasingly powerful and well-tolerated, and they often come in single-tablet regimens.

Oil Companies Send Health Workers Packing

Kruger's staff is trying to spread HIV prevention messages and do rapid testing at area bars in Williston, but there is no established gay community there, Kruger said. Kruger said in the early days of the HIV epidemic he served as a liaison for the public health department to the gay community. He said gay men and women rallied to help him get the word out about HIV prevention.

“We could use that group to reach into the gay community,” Kruger told Healthline. “We are struggling to identify those individuals who would be willing to work with us.”

He said companies involved in the oil industry don’t want public health officials inside the camps talking about HIV. They feel that such a message would stereotype the majority of men living in the camps as being at risk for HIV when that is not the case, Kruger told Healthline.

Kruger said the state attorney general has also acknowledged problems in the state regarding human trafficking for purposes of prostitution. A report by National Public Radio earlier this year described the nightlife in Williston and the possible human trafficking involved.

Other statistics point to the fact that risky sex in general is on the rise in the area. Chlamydia cases jumped to 237 in 2010 from 145 in 2008, the Associated Press reported.

Kruger said that when it comes to adapting to boomtown growth, transportation infrastructure such as roads tends to get priority over public health. Plus, part of North Dakota now boasts the highest cost of living in the nation, Kruger said, making it difficult to hire nurses and other medical staff who can live there on a public health wage.

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Big Challenges for Public Health Departments

The situation in Williston highlights the way stigma can erode public health efforts to control HIV. A report released last week by the U.S. Centers for Disease Control and Prevention shows that half of HIV-positive gay and bisexual men (MSM) in America aren’t getting proper treatment for the disease.

That’s partly driven by stigma, the study authors concluded. “Lack of health insurance, stigma, and discrimination might influence whether MSM access medical care, which has implications for each subsequent step along the continuum of care,” they wrote.

The study analyzed data from 19 states and communities representing about 42 percent of the nation’s population of HIV-positive gay and bisexual men.

While the jurisdictions included bicoastal gay meccas such as Los Angeles, San Francisco, and New York, it also included Midwestern states such as North Dakota, Michigan, Iowa, and Illinois. 

The analysis found that among 10,093 gay and bisexual men diagnosed with HIV in 2010, 77.5 percent received care within three months of diagnosis.

However, among more than 174,071 gay and bisexual men living with HIV at the end of 2010, the study found that just 51 percent were receiving regular care.

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