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Why the War Against HIV Rages in the South

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There are numerous reasons HIV is more prevalent in the American South, with racism being top of the list.

Southern HIV/AIDS Awareness Day (SHAAD) is a national awareness day to rewrite the narratives of those living with HIV in the South. For me, SHAAD is a day that I recognize all the intersections I live within, being a Black, same-gender-loving, cisgender man living with HIV in the south in Texas. To navigate my life through those intersections, I have to first recognize the targeted stereotypes from one another while dismantling the systems that created them.

In my experience in the South, speaking on health concerns is not acceptable outside of the household, even conversations that could save lives.

I have the privilege to be on both sides of HIV prevention and care in the South, and have seen how the region is getting better at acknowledging its outsize impact on the spread of HIV. As a Black man living with HIV in the South while working within the Black LGBTQ+ community, I see public health work from a dual lens as a provider and client. As a client, I have been transparent with my care team so they receive the cultural sensitivity they need to serve their clients better. As an HIV linkage care worker, I have been able to assist clients in their understanding, knowing their rights as a client, and receiving equitable health care. With every person I encounter, both personally and professionally, there is a sense of longing to be seen fully no matter their HIV status.

While doctors can provide information on HIV, they may not have the cultural sensitivity to effectively communicate key messages to their clients. For clients, there tends to be gaps of updated knowledge for effective prevention. A few small studies suggest that improving communication with medical providers about sexual orientation may promote preventive screenings. However, men who have sex with men (MSM) may be reluctant to disclose to providers as a result of concerns about confidentiality and/or discrimination.

Statistics reported by the CDC report "about 3 out 4 Black/African American gay and bisexual men who received an HIV diagnosis were aged 13-34 " or "Black/African American gay, bisexual, and other men who reported male-to-male sexual contact are more affected by HIV than any other group in the United States and dependent areas." But why is the Black man more likely to contract HIV? I believe it is because of the many decades of compartmentalizing us into risk. To be clear, it is not the type of sex Black men are having, as studies have shown Black gay men have less sexual partners and more condom usage compared to their white counterparts. It is ultimately due to the systems and structures that have continuously failed Black communities, especially Black men.

We can explain it through the lack of reliable data, the lack of information provided to the most marginalized, or the access to care, but it all points to structural barriers. I recommend that the data collection be more focused on storytelling and capturing the concept of the individual person, not just the "number." Ten Black gay men can live different sexual lives and their "risks" of HIV can be different even if they interact in the same spaces. To stop HIV, you have to recognize and eliminate the barriers that directly increase the risk for HIV.

Living with HIV in the South, I have met a lot of people who are misinformed about HIV and still see HIV as a death threat. Many hold a mistaken belief that they can catch AIDS, and think they are not susceptible to HIV if they are the penetrating partner (a top). All of these narratives are false. The lack of knowledge is rooted in the lack of representation, access to services in specific communities, and other social determinant barriers. To end the HIV epidemic by 2030, we have to continue speaking the truth, hearing from the communities and make functional changes to the representation of HIV in the South.

There are tangible action steps that individuals can use to be more involved in SHAAD. For those living or visiting the greater Houston area, The Normal Anomaly is currently the only Black queer-led and focused organization with a physical space in Houston. The Normal Anomaly provides HIV testing but is actively increasing resources for the community such as sustainable employment, transportation services, and empowerment groups. AIDSUnited is a resource to stay informed on the federal legislation, facts around HIV and dismantle the myths. GLAAD works through entertainment, news, and digital media to share stories from the LGBTQ community that accelerate acceptance for those who prefer media-driven resources. To actively end the spread of HIV, all regions, especially the South, need to be knowledgeable about PrEP and what Undetectable equals Untransmittable means.

Jordan Edwards is program coordinator for The Normal Anomaly Initiative.

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