By: Ranier Simons, ADAP Blog Guest Contributor
Recently, Southern HIV/AIDS Awareness Day (SHAAD), August 20, was commemorated. It is a relevant necessity because, despite medical advances in HIV treatment and prevention, HIV/AIDS is still an epidemic, especially in the South. The region of the ‘Deep South’ is generally considered to be Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Texas (AIDSVu, 2025). Black and brown communities in the South are notably disproportionately affected by HIV.
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Photo Source: ADAP Advocacy |
Judith Montenegro, Program Director for the Latino Commission on AIDS, emphasizes, “During Southern HIV/AIDS Awareness Day, we denounce both the South’s historic neglect of Latinx health and the federal government’s dangerous cuts to healthcare, research, and science. SHAAD is an opportunity for the region to come together with a common agenda to continue to advocate for our communities and stop anti-immigrant legislation, protect Medicaid, and access to HIV testing, treatment, and care.”
According to the most recent complete data, although representing 38% of the U.S. population, the South accounted for 52% of all new HIV diagnoses (AIDSVu, 2025). The South also leads in prevalence and HIV/AIDS related deaths. For clarity, incidence refers to rates of new transmissions, and prevalence is the number of people living with HIV/AIDS (PLWHA). Stigma, issues related to social determinants of health, and funding challenges contribute to HIV’s disproportionate impact on the South.
The AIDS Drug Assistance Program (ADAP), which is authorized under Part B of the Ryan White CARE Act, has been highly effective at linking people living with HIV/AIDS to care and treatment in the U.S. over the last two decades. One notable exception: The South. Many public health programs – including ADAPs – have often fallen victim to cultural, political, and societal barriers that have made it difficult for ADAPs to function effectively in this region of the country. Ten years ago, ADAP Advocacy published a detailed analysis examining the disproportionate impact of barriers in the South, particularly as they relate to access to care.
Battling the HIV epidemic requires comprehensive care and preventative services for PLWHA and those vulnerable to transmission, regardless of the presence or lack of health insurance. The South has the highest rate of poverty and the lowest median household income in the U.S. in 2022 (AIDSvu.org, 2025). Income challenges considerably affect access to stable and quality housing, contribute to food insecurity, and create barriers to maintaining environments that allow people to thrive. Socioeconomic status (SES) research also indicates that low SES can increase the risk of someone contracting HIV and adversely influence PLWHA’s quality of life. Most importantly, poverty can affect one's ability to obtain insurance coverage. Lack of insurance or being under-insured is a significant barrier to treatment, testing, and prevention.
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Photo Source: CDC |
Medicaid is the primary way people with low incomes who cannot afford private insurance can obtain health coverage. According to the Kaiser Family Foundation (KFF), nationally, access to care is similar for adults with Medicaid and those with private insurance (KFF, 2025). However, access to care falls drastically for those who are uninsured. Of the ten states that have not expanded Medicaid, eight are in the South: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, and Texas (Chatlani, 2024). This is significant because 1.6 million people in non-expansion states earn too much money to qualify for Medicaid but not enough to meet the thresholds for financial assistance with an ACA Marketplace plan.
While receiving some federal assistance, Medicaid programs are administered by the states. This is particularly important for states like Alabama, where eligibility for Medicaid requires earning at or below 18% of the federal poverty line, which is $4,678 per year for a three-person household (Chatlani, 2025). When people's earnings meet or exceed the poverty line, they are considered to have too much income for Medicaid. Meeting 100% of the poverty level means eligibility for Marketplace subsidies that would still result in premiums they cannot afford. Regarding the situation in Alabama, Kathie Hiers, CEO of AIDS Alabama, explains, “In Alabama, the barriers in the fight to end HIV as an epidemic are very real. The state has not expanded Medicaid and has one of the worst programs in the nation, with minimal financial eligibility. The state health report card ranks in the top ten worst for almost every disease state, from infant mortality to hypertension to obesity to HIV. Rural areas are particularly hard hit as hospitals close, and people are forced to travel long distances to access medical care.”
The disproportionate effects of HIV in the South are also why governmental funding cuts are so harmful. The Trump Administration’s grant terminations and proposed budget for next year reduce HIV related funding, especially in terms of prevention. The administration's draft plan for the U.S. Department of Health and Human Services proposes terminating prevention funding at the CDC and eliminating funding for the Ending the HIV Epidemic Initiative, which was initiated during the President’s first term. Community-based groups rely on funding to survive as lifelines to vulnerable populations. In Jackson, Mississippi, a nonprofit healthcare group named My Brother’s Keeper is concerned that it may have to shut down its mobile outreach. They have a mobile RV that offers HIV tests to places such as community centers (Maxmen, 2025).
SES, stigma, and lack of insurance coverage also adversely affect the utilization of PrEP in the South. Research shows that increased access to and utilization of PrEP results in significantly better HIV transmission outcomes, even controlling for viral suppression (Sullivan et al.). However, studies show that in the U.S., Black, Hispanic, and transgender people, especially those living in the South, have lower utilization of PrEP compared to the number of people at high risk of contracting HIV (Sullivan et al., 2025). Resources are needed to build infrastructure and programs to reach Black and Latinx populations in terms of education and access to PrEP.
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Photo Source: AIDSvu |
Although the disproportionate impact of HIV in the South is dire, there is hope. Jeff Graham, Executive Director of Georgia Equality, had this to say, “For over forty years, our region has been under-resourced and often ignored. Addressing stigma and educating local communities are the keys to ending the HIV epidemic in the South. There have always been unique challenges to address the bias that women, people of color, LGBTQ+ communities, and those who live in rural or poor areas face every day, but our resilience has kept us going and will continue to be the driving force behind the community-based work that is as important now as it was in the early days of the epidemic. Despite the odds and the challenges, we must continue to educate, agitate, and mobilize as one united community of advocates."
The South continues to be disproportionately impacted by HIV/AIDS, and the region’s cultural, political, and societal barriers contribute to the health disparities. Change begins with raising awareness, and the community activities surrounding Southern HIV/AIDS Awareness Day play a crucial role in highlighting the issue. The work being done by Montenegro, Hiers, Graham, and so many others in the South offers offers hope and resilience.
Editor's Note: The Latino Commission on AIDS launched a Rapid Response Fund on August 20, 2025. Its purpose is to put resources directly into the hands of groups led by and serving LGBTQ+ Latine people living with HIV. These awards, up to $1,500 each, are designed to help organizations act quickly, defend their communities, and continue building local power across the South. Applications are open now and will be accepted on a rolling basis until funds are exhausted. The final deadline is December 15, 2025. LINK: https://form.jotform.com/southevents/hormiguro-rapid-response.
[1] AIDSVu. (2025, n.d.). Southern HIV/AIDS Awareness Day Toolkit 2025. Retrieved from https://aidsvu.org/resources/toolkits/toolkit-southern-hiv-aids-awareness-day-2025/#:~:text=August%2020%20is%20Southern%20HIV,region%20of%20the%20United%20States.
[2] Chatlani, S. (2024, July 19). In the 10 states that didn’t expand Medicaid, 1.6M can’t afford health insurance. Retrieved from https://stateline.org/2024/07/19/in-the-10-states-that-didnt-expand-medicaid-1-6m-cant-afford-health-insurance/#:~:text=The%20Affordable%20Care%20Act%2C%20also,%2C%20Texas%2C%20Wisconsin%20and%20Wyoming.
[3] Kaiser Family Foundation (KFF). (2025, May 20). Medicaid State Fact Sheets. Retrieved from https://www.kff.org/interactive/medicaid-state-fact-sheets/
[4] Maxmen, A. (2025, May 6). HIV testing and outreach falter as Trump funding cuts sweep the South. Retrieved from https://www.healthbeat.org/2025/05/06/hiv-trump-funding-cuts-south/
[5] Sullivan, P., Juhasz, M., DuBose, S., Le, G., Brisco, K., Isley, D., Curran, H., Rosenburg, E. (2025, June). Association of state-level PrEP coverage and new HIV diagnoses in the USA from 2012 to 2022: an ecological analysis of the population impact of PrEP. Retrieved from https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(25)00036-0/fulltext
Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.