Masonia Traylor curled up into a ball in the corner of the patient room. “No,” the 23-year-old screamed over and over. She was HIV positive.
It was a surprise for the now 38-year-old from Decatur, Georgia. She developed a relationship at her local gynecology office and always stayed on top of her health as best she could. This included HIV testing; he always wanted to set a good example for his loved ones. A black woman shared her story of almost dying from complications of HIV at a school assembly years ago. Someone who looked like her warned that anyone can get HIV – not just gay and bisexual men. Traylor thought, “You can’t tell the little girl got it. Like, she looks so cute, healthy, everything.”
Despite new developments in HIV treatment and prevention—people can live healthy, long lives with undetectable HIV in their bloodstream—tens of thousands of new cases are diagnosed in the United States each year. And many of these diagnoses occur in certain parts of the country and among certain populations. One group often forgotten in discussions of HIV—despite research pointing to an ongoing crisis—are women of color. Specifically those who live in the south. Why?
“You feel isolated, you feel alone, you feel like no one else will understand,” Masonia Traylor says of living with HIV.
“The convergence of gendered power dynamics, economic vulnerability, and limited access to prevention resources creates a perfect storm of HIV risk,” according to AIDSVu, an interactive online mapping tool from Emory University’s Rollins School of Public Health in partnership with Gilead Sciences. Gilead makes the pre-exposure prophylaxis or PrEP drugs Truvada and Descovy, whose out-of-pocket costs can be in the tens of thousands of dollars (although insurance coverage and other assistance programs are available to make them free or more affordable). The Food and Drug Administration approved the company’s twice-yearly injectable HIV prevention drug lenacapavir (Yeztugo) in early 2025.
In 2023, more than 39,000 cases of HIV in people aged 13 years and older were diagnosed in the United States and its territories; of these, 81% were male, 38% were black, and 51% lived in the South. Black women accounted for half of HIV diagnoses in women, although they make up only 13% of the US female population. However, the total number of cases is far from the worst of the epidemic in the mid-1980s, which saw more than 130,000 cases a year. The number of cases has generally stabilized in recent years.
It’s easy for many, from sexually active people to health care providers, in the United States to dismiss HIV given how many cases have declined. But a decline doesn’t mean it’s gone, and cuts in federal funding for HIV prevention programs are only making the problem worse.
“We’re at a really interesting inflection point because we’ve made amazing progress in addressing the HIV epidemic in the United States, and I think some of that will be eroded given where we’re at with our current focus and the deterioration of our public health infrastructure,” says Athena Cross, vice president and program director at AIDS United.
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‘They’re just a red flag’ for HIV
Men who have sex with men have been the main faces of HIV since the beginning of the AIDS crisis in the 1980s and remain the most likely to take PrEP and otherwise seek sexual health treatment.
PrEP use rose 17% year-over-year in the US from 2023 to 2024. But people of color made up just 12% of PrEP users, and the South overall just 39%. Only 9% of PrEP users are women, according to AIDSVu.
“They’re just a red flag when it comes to risk assessment (for HIV),” says Tori Cooper, director of community engagement at the Human Rights Campaign. She is a black woman who lives in the South and has rarely been offered an HIV test over the years.
Providers still have HIV stigma, as do patients. This is where a quality support network comes in. “You have to find some people who have a non-judgmental view of HIV,” she says. “You have to have people who just love you and support you, and for a lot of people, that’s a challenge.”
Traylor went public with her status after struggling to find support groups for people like her; she longed for a community of people who could shame her. “I can’t take this fear or this guilt. Like, I didn’t do anything wrong, they didn’t do anything wrong,” she says.
Another push? A former classmate of hers who died of complications from HIV.
“I realized that maybe if I had shared my status earlier, that the gentleman who died, maybe he would still be alive,” Traylor says, “because I know exactly how that felt. Like you feel isolated, you feel alone, you feel like no one else will understand.”
Important: Her doctor said her tumor was harmless, common among black women. It was cancer.
“A lot of cultural stigma in the South” with HIV
As of 2023, the South accounted for more than half of HIV diagnoses and 56% of HIV deaths, despite accounting for roughly one-third of the US population.
“The burden of HIV in the South is overwhelming,” says Cross. “Not only are there risks, but there’s not necessarily education and awareness around HIV prevention. There’s still a lot of cultural stigma in the South that prevents people from being willing to access care or even being able to pursue a diagnosis.”
Fewer hospitals and health care providers in the rural South – along with a layer of anti-LGBTQ+ stigma in the region – increase HIV ignorance. “HIV is not an evenly distributed virus. It really impacts some of the most vulnerable communities. And that was true four decades ago and it’s still true today,” says Rashad Burgess, vice president of corporate responsibility at Gilead Sciences.
The concentration of HIV cases in the South makes sense to Cooper. Social and sexual networks are smaller for black people and other people of color, she says, and there’s a lack of reliable information about sex, HIV and other chronic diseases — especially information specific to those communities (many resources focus on men who have sex with men). All this facilitates the proliferation of HIV in these communities.
When black women and HIV are mentioned together, we are only talking about black women with HIV, says Cooper. Even in those cases, you hear about these worst-case scenarios and destroyed livelihoods, which adds to the stigma. “What we don’t hear about are the women who happen to be diagnosed with HIV who are thriving and doing well and supporting people in their communities who are living happy, healthy lives,” says Cooper.
Traylor, now a renowned activist, is the CEO and founder of the nonprofit organization Lady BurgAndy Inc., which helps women and youth affected by HIV/AIDS.
Masonia Traylor went public with her status after struggling to find support groups for people like her.
Other anti-stigma efforts include AIDS United’s Melanated Movement, which supports young women who lead educational programs on HBCU campuses. “It allows young women to create the kind of communication and educational pieces that will appeal to other young women,” says Cross. Additionally, SisterLove is a women’s HIV, sexual, and reproductive justice organization in the southeastern United States that has been in existence for 35 years and more.
The main way this is improving is talking about it and making it clear to people that an HIV diagnosis is no longer a death sentence – with the right and ongoing medical support.
(This story has been updated with more information.)
This article originally appeared on USA TODAY: World AIDS Day: Southern black women get HIV, geography plays a role