Despite effective treatments, HIV rates remain highest in the American South due to a clash between culture and public health efforts.

The Southern United States continues to report the highest HIV rates in the country, representing over half of all new HIV diagnoses in 2023. This occurs even though effective preventive treatments, including pre-exposure prophylaxis (PrEP), have made living with HIV manageable and largely safe. When taken correctly, PrEP reduces the risk of HIV infection by more than 99%.

However, in cities like Jackson, Mississippi, and Memphis, Tennessee, uptake among Black men who have sex with mena highly affected groupremains low. Less than 20% of eligible individuals in these areas currently use PrEP.

Past federal policies have also affected prevention efforts. While some resources and data previously removed have been restored, the long-term effects of these disruptions disproportionately impact Southern communities already facing high HIV rates, according to public health researchers.

The Cultural Divide

Research involving interviews with healthcare providers and Black men who have sex with men in Jackson, Memphis, New Orleans, and Atlanta revealed that cultural factors strongly influence PrEP uptake. Out of 12 people interviewed, 8 were Black men who have sex with men and 4 were healthcare providers, 3 of whom also identified as men who have sex with men.

Participants reported that physical access to PrEP was rarely the problem. Instead, social norms, religious beliefs, and family expectations heavily shaped decisions about using the medication. One participant from Jackson described the tension: "In church, youre taught to love your neighbor, but theres always an asterisk when it comes to who you love. If youre gay, youre either ignored or silently judged."

The Black church often plays a dual roleproviding crucial community support while simultaneously reinforcing stigma and discouraging open discussions about sexual health. Many participants learned about PrEP from friends or healthcare providers but hesitated to start treatment due to fear of stigma or uncertainty about necessity.

Gaps in Education and Prevention

Sex education in many Southern schools remains abstinence-focused and often excludes LGBTQ+ topics, leaving young people uninformed about HIV risks and prevention. Condom use and other risk-reduction strategies are frequently influenced by cultural norms rather than scientific guidance, increasing vulnerability to HIV.

Trust as a Key Barrier

Mistrust of the healthcare system emerged as a major obstacle. Black men reported concerns about being judged, outed, or receiving substandard care. Systemic racism, historical mistreatment, and prior negative experiences with medical professionals contribute to this wariness, making even accessible treatments feel out of reach.

Community Networks Provide Hope

Despite these challenges, informal social networks have proven effective in spreading PrEP awareness. Participants often learn about treatment from friends or peers, creating a trusted space for discussions that formal campaigns sometimes fail to achieve. Healthcare providers who share their own experiences with PrEP can also reduce stigma, making the medication feel normal and approachable.

Culturally Sensitive Approaches Are Crucial

Experts emphasize that increasing PrEP use in the South requires more than access; it demands culturally affirming care, trust-building, and community-led education. Integrating sexual health into everyday conversations in barbershops, churches, and community centers, along with offering discreet delivery options like telehealth and mail-order services, can improve uptake.

Supporting peer educators and valuing community knowledge helps normalize PrEP, empowers individuals, and strengthens public health efforts. In the fight against HIV in the South, culture is not just a challengeit can be part of the solution. Care that respects identity, experience, and values transforms healthcare from merely available to genuinely empowering.

Author: Connor Blake