The American South has the perfect HIV charges within the nation, accounting for greater than part of latest HIV diagnoses national in 2023. That is regardless of rising availability of a extremely efficient HIV prevention medicine that has made it conceivable to reside a protracted, wholesome lifestyles with this as soon as deadly illness.
This medicine – referred to as preexposure prophylaxis, or PrEP – reduces the danger of HIV transmission by means of over 99% when taken as prescribed. But, in Southern towns comparable to Jackson, Mississippi, and Memphis, Tennessee, probably the most susceptible populations – Black males who’ve intercourse with males – are infrequently the use of it, with fewer than 1 in 5 who’re eligible taking the drug.
The Trump management has prior to now frozen and proposed extra cuts to HIV prevention techniques within the U.S. And even if the management has restored one of the federal webpages and datasets it took down in January 2025, it’s unclear what knowledge stays lacking or has modified. Communities within the South that already face the perfect burden of an infection will really feel the best results of fixing public well being priorities.
In my paintings as a public well being researcher, I’ve spent years learning HIV prevention and the social determinants of well being within the Deep South. Via interviews with well being care suppliers and Black sufferers in primary Southern towns, what I discovered used to be {that a} robust conflict between tradition and public well being performs a vital position in why efficient scientific therapies are nonetheless failing to succeed in those that want it maximum. I name this pressure the Southern paradox – the place scientific answers exist however systemic forces block get right of entry to.
The tales of those clinicians and sufferers within the South weren’t merely a couple of tablet: They have been about consider, id, circle of relatives and religion. And their phrases highlighted a posh internet of feelings and reports that regularly pass unaddressed in same old well being messaging.
Southern tradition and sexual well being
In my fresh find out about, I interviewed 12 other people in Jackson, Memphis, New Orleans and Atlanta: 8 Black males who’ve intercourse with males, together with 4 well being care suppliers. 3 of those suppliers additionally recognized as males who’ve intercourse with males.
Many contributors reported that bodily get right of entry to to PrEP wasn’t the problem. As an alternative, what stood in the best way used to be way more non-public and deeply embedded of their surroundings.
“In church, you’re taught to love your neighbor, but there’s always an asterisk when it comes to who you love,” one player from Jackson instructed me. “If you’re gay, you’re either ignored or silently judged.”
Just about all contributors described the South as a spot deeply formed by means of conservative values, particularly the ones rooted in faith and conventional circle of relatives buildings. The Black church emerged as each a protecting issue and a problem. Whilst providing essential network toughen, it additionally regularly bolstered stigma round homosexuality and discouraged open conversations about sexual well being.
Tackling HIV within the South takes a village.
One player from New Orleans shared that he heard about PrEP from his well being care supplier and his pals, whilst any other from Atlanta recalled finding out about PrEP all through his annual bodily. In spite of many times being uncovered to details about PrEP, each described hesitation about beginning remedy. One apprehensive about attainable stigma if others came upon he used to be taking it, whilst the opposite wondered whether or not he “really needed” it. In the end, neither had began PrEP.
In lots of of those communities, intercourse training in colleges remains to be excited about abstinence and regularly excludes LGBTQ+ subjects solely. “You grow up not hearing anything about gay sex or HIV,” one guy from Memphis stated. “So, when you get older, it’s like starting from scratch.”
Even selections round condom use have been closely formed by means of cultural norms. Males described depending on spouse consider, age or perceived cleanliness moderately than research-based tactics to cut back the danger of HIV.
This absence of complete, inclusive intercourse training leaves many susceptible to incorrect information and, in the long run, to preventable infections.
Agree with is the actual barrier
Some of the hanging findings from those conversations used to be the deep distrust that many Black males who’ve intercourse with males really feel towards the well being care device.
“It’s hard to find affirming care for people in the queer community,” stated one Memphis-based well being supplier. Others mentioned fears of being “outed” via their insurance coverage, particularly in the event that they have been nonetheless on a circle of relatives well being plan.
A Jackson-based player confided, “Some people avoid taking [PrEP] because for each prescription you are required to be evaluated. Some people don’t want the follow-up or the screening.” Every other famous how concern of each outright and delicate judgment all through scientific appointments made it more uncomplicated to keep away from well being care altogether.
A welcoming well being care surroundings could make all of the distinction.
Jahi Chikwendiu/The Washington Publish by way of Getty Photographs
Systemic racism compounds those considerations. For plenty of Black males, historic and ongoing reports of discrimination, together with rushed visits, loss of empathy, misdiagnoses or even being denied care altogether have constructed a long-lasting sense of warning.
Even if assets like PrEP are to be had, those therapies regularly really feel inaccessible to Black males as a result of they don’t consider the device providing them.
Social networks step in
Fortunately, those conversations additionally exposed moments of hope.
Many contributors discovered about PrEP from friends. “We talk about it regularly,” stated one player in Jackson. “I have friends who work in public health, along with friends who are taking the medication.”
Within the South, the place network ties regularly function essential protection nets, those social networks can every so often supply extra depended on well being knowledge than clinics or campaigns. Casual conversations in team chats, at area events or all through network gatherings regularly function robust platforms for well being promotion.
One supplier in Atlanta stated he deliberately shared his personal reports with PrEP to cut back stigma. “I have a little soreness,” he stated with a grin, regarding a contemporary injection. “Then I tell everyone, ‘Yup, I just got mine.’ The casualness of that comment made a difference: It made PrEP feel normal, relatable, something for ‘us,’ not something done to ‘them.’”
Those social exchanges, rooted in consider and shared enjoy, steadily did extra to shift attitudes than conventional public well being campaigns. As one player put it, “I trust my friends more than those ads. If they’re taking it and it works for them, that means something to me.”
Making PrEP culturally related
What those conversations display is that for PrEP to paintings within the South, get right of entry to to remedy is most effective a part of the equation. Development consider, cultural confirmation and community-led training are similarly essential.
Public well being messages that transcend scientific information and cope with the emotional, non secular and social dimensions of well being are much more likely to construct lasting engagement with HIV prevention. This contains making an investment in Black, LGBTQ+-affirming well being care suppliers who replicate the communities they serve. It additionally manner integrating discussions of sexual well being into on a regular basis conversations at barbershops, church buildings and network facilities, no longer simply in clinics.
Public well being officers and clinicians can discover selection remedy supply strategies that cope with privateness considerations, comparable to telehealth PrEP techniques, discreet mail-order services and products and community-based distribution issues. Those could make PrEP more uncomplicated to get right of entry to and scale back the stigma related to health center visits.
Most significantly, valuing the data already circulating inside of communities and supporting peer educators as legit public well being messengers can enhance credibility, normalize PrEP and empower other people to take price in their well being.
Within the struggle towards HIV within the South, tradition is not only a barrier. It will also be the answer. I consider that after care is obtainable in some way that honors other people’s identities, reports and values, it turns into no longer simply out there however empowering.
