Category: English

Source: The Conversation – USA – By Seda Saluk, Assistant Professor of Women’s and Gender Studies, University of Michigan

Pregnant women crossing borders to get an abortion. People who miscarry facing jail time or dying from infection. Doctors who won’t perform lifesaving procedures on a pregnant patient for fear of prosecution.

For years, this was the kind of thing that happened in Poland, Nicaragua or El Salvador. Now, it’s headline news in the United States.

As a scholar who studies the relationship between reproductive rights and political regimes, I see the U.S. mirroring a pattern that has happened in authoritarian regimes around the world. When a government erects barriers to comprehensive reproductive care, it doesn’t just cause more death and suffering for women and their families. Such policies are often a first step in the gradual decline of democracies.

Yet, the U.S. is different in a meaningful way. Here, abortion has historically been framed as a personal right to privacy. In many other countries I’ve studied, abortion is viewed more as a collective right that is inextricably tied to broader social and economic issues.

The American individualist perspective on abortion can make it harder for people in the U.S. to understand why banning abortion can serve as a back door for the erosion of civil liberties – and of democracy itself.

Autocrats target abortion first

Restricting reproductive rights is a hallmark of authoritarian regimes.

From Benito Mussolini’s Italy in 1926 and Josef Stalin’s Soviet Union in 1936 to Francisco Franco’s Spain in 1941 and Nicolae Ceaușescu’s Romania in 1966, the first move most 20th-century dictators made after seizing power was to criminalize abortion and contraception.

Initially, for some of those autocratic leaders, limiting access to abortion and contraception was a strategy to gain the approval of the nation’s religious leaders. The Catholic Church held great power in Italy and Spain, as did the Orthodox Church in Romania. At the time, these faiths opposed artificial birth control and still believe life begins at conception.

Restrictions on reproductive rights also aimed to increase birth rates following two world wars that had stamped out some of the population, particularly in the Soviet Union and Italy. Many political leaders saw procreation as a national duty. They designated women – white, heterosexual women, that is – specific roles, primarily as mothers, to produce babies as well as future soldiers and workers for their regimes.

In the past two decades, countries in Europe and the Americas have been following this recognizable pattern. Nicaragua and Poland have both banned abortion. Hungary, Turkey and Russia have all clamped down on access to it.

Restricting reproductive freedoms has helped Hungary’s Viktor Orbán, Russia’s Vladimir Putin and Turkey’s Recep Tayyip Erdoğan stoke lasting political divisions within society that help them consolidate their own power.

These leaders invoke a threat of moral and demographic decline, claiming that child-free women, queer people and immigrants pose a danger to national survival. In doing so, they portray themselves as defenders of their respective nations. It’s a way to regain and retain popular support even as their policies deepen poverty, erode civil liberties and increase corruption.

These politicians have also taken power away from a significant portion of the population by reinstating earlier, fascist-era restrictions on bodily autonomy. As feminist scholars have pointed out, strong reproductive rights are central to functioning democracies.

Restrictions on reproductive freedoms often necessitate other kinds of restrictions to enforce and maintain them. These might include free speech limits that prohibit providers from discussing people’s reproductive options. Criminalizing political dissent enables the arrest of people who protest restrictions on reproductive freedoms. Travel bans threaten prison time for individuals who help young people get abortion care out of state.

When these civil liberties weaken, it becomes harder to defend other rights. Without the right to speak, dissent or move freely, people cannot engage in conversations, organize or voice collective grievances.

Putting the US in a global context

In 2022, the U.S. joined the likes of Poland and Hungary when the Supreme Court overturned Roe v. Wade, ending 50 years of federal abortion protections.

President Donald Trump was not in power when this happened. Yet the Supreme Court’s conservative majority was shaped during his first term.

Since then, both the second Trump administration and many states have enacted their own regulations or bans on abortion. This has created a divided country where in some states abortion is as restricted as it is under some of the world’s most autocratic regimes.

Yet, there’s a key difference.

In the U.S., abortion is viewed by the law and the public as a matter of individual rights. The debate often boils down to whether a person should be allowed to terminate their pregnancy.

In many other contexts, reproductive rights are understood as a collective good that benefits all society – or, conversely, harms all society when revoked.

This perspective can be a powerful driver of change. It’s how, for example, women’s and feminist groups in places such as Argentina, Colombia and Mexico have successfully pressured their governments to decriminalize abortion in recent years.

Since 2018, the movement known as Latin America’s Green Wave, or “Marea Verde” for their green protest bandannas, has deliberately and strategically reframed abortion as a human right and used that assertion to expand reproductive rights.

The Latin American feminist activists have also documented how restricting abortion intensifies authoritarianism and worsens both individual and collective rights.

In a region where many citizens remember life under military dictatorship, highlighting the relationship between abortion and authoritarianism may be particularly galvanizing.

Limits of framing abortion as an individual right

Roe v. Wade in 1973 recognized abortion as a private medical decision between “the woman and her responsible physician” up to the point of fetal viability − roughly around 24 to 26 weeks − and that framing has stuck.

This was basically what the mainstream pro-choice movement advocated for at the time. White feminists saw abortion rights as a personal liberty. This framing has real limitations.

As Black and brown reproductive justice advocates have long pointed out, Roe never served women of color or poor people particularly well because of underlying unequal access to health care. Their work has, for decades, illustrated the strong connection between racial, economic and reproductive justice, yet abortion is still largely regarded as solely an individual issue.

When debates about reproductive freedoms are framed as fights over individual rights, it can engender a legal quagmire. Other entities with rights emerge – the fetus, for example, or a potential grandparent – and are pitted against the pregnant person.

Recently, for instance, a pregnant woman declared brain dead in Georgia was kept alive for several months until her fetus became viable, apparently to comply with the state’s strict anti-abortion law. As her mother told the press, her family had no say in the matter.

Narrowly focusing on abortion as an individual right can also obscure why banning it has societal impacts.

Research worldwide shows that restricting reproductive freedoms does not lead to fewer abortions. Abortion bans only make abortion dangerous as people turn to unregulated “back alley” procedures. Maternal and infant mortality rates rise, especially in marginalized communities.

Simply stated: More women and babies die when abortion and contraception laws become more restrictive.

Other kinds of suffering increase, too. Women and their families tend to become poorer when contraception and abortion are hard to get.

Abortion bans also lead to discriminatory practices in health care beyond reproductive health services, such as oncology, neurology and cardiology. Physicians who fear criminalization are forced to withhold or alter gold-standard treatments for pregnant patients, for example, or they may prescribe less effective drugs out of concern about legal consequences should patients later become pregnant.

Lifesaving procedures in the emergency room must await a negative pregnancy test.

As a result, abortion bans decrease the quality and effectiveness of medical care for many patients, not just those who are pregnant.

Defending reproductive freedoms for healthy democracies

These findings demonstrate why reproductive rights are really a collective good. When viewed this way, it illuminates why they are an essential element of democracy.

Already, the rollback of reproductive freedoms in the U.S. has been followed by efforts to limit other key areas of freedoms, including LGBTQ rights, freedom of speech and the right to travel.

Access to safe abortion for pregnant people, gender-affirming care for trans youth, and international travel for noncitizens are intertwined rights – not isolated issues.

When the government starts stripping away any of these rights, I believe it signals serious trouble for democracy.

This story is published in collaboration with Rewire News Group, a nonprofit newsroom dedicated to covering reproductive and sexual health.

Seda Saluk does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Banning abortion is a hallmark of authoritarian regimes – https://theconversation.com/banning-abortion-is-a-hallmark-of-authoritarian-regimes-265459

Source: The Conversation – USA – By Susan D. Daggett, Professor of the Practice of Law, University of Denver

Removing parking requirements for new buildings could help thousands of Coloradans who struggle to afford housing.

There is a shortage of over 106,000 homes across Colorado, according to a recent study by the Colorado State Demography Office.

Nearly 90% of the lowest-income households in the state spend over one-third of their pretax income on rent or mortgage payments. That means they pay more on housing, as a percentage of their income, than is considered affordable.

The cost of providing parking – borne by developers and passed on to residents – helps push prices up. Parking minimums may be mandated by city ordinances or demanded by lenders. Some renters prefer apartments that come with dedicated parking.

Structured parking can cost as much as US$50,000 per parking space, according to Denver’s Community Planning and Development office. Off-street surface parking, though cheaper to construct, requires dedicating valuable urban land to parking lots.

We are a law professor and urban planning scholar who worked with data scientists at the Terner Center for Housing Innovation to model how parking requirements affect the development of multifamily residential housing in the city and county of Denver.

Cutting parking boosts construction

We found that cutting minimum-parking requirements would likely boost housing construction in Denver by about 12.5%, translating into roughly 460 more homes per year.

This is a surprisingly high-impact result for a single, relatively simple policy change. We published our findings as a white paper with the Rocky Mountain Land Use Institute in July 2025.

In August 2025, the Denver City Council eliminated parking minimums for new buildings.

Denver followed the lead of other cities such as Boulder, Longmont, Austin and Minneapolis that have all recently abolished parking minimums.

In 2024, the Colorado legislature also removed parking minimums near transit hubs statewide in order to increase housing supply. However, that effort has been challenged in court on the grounds that the state mandates infringe on local government prerogatives. This legal tug-of-war underscores the importance of Denver’s decision.

Parking can be expensive

Before the policy change, market-rate apartments in Denver were required by law to provide as many as one parking space per unit. In a 200-unit building, parking could add millions of dollars to the developer’s costs.

Parking requirements are often determined by a formula. Based in part on an outdated view that modern cities should be car-oriented, cities around the country, including Denver, passed zoning codes in the 1950s and 1960s that created legal requirements for the number of parking spaces that new housing projects must include.

Land is expensive in high-demand cities like Denver. Dedicating part of a building’s footprint to parking imposes both a direct cost – because developers must pay to build the parking – and an indirect cost, because it leaves less space for housing. These development costs are passed along to renters and owners, decreasing affordability.

Reducing parking requirements lets developers build only the parking spaces that residents want or need.

Eliminating parking minimums

We built a simulator that estimates the total number of apartments expected to be built in multifamily, market-rate rental developments in Denver in one year. It then allows for a comparison of possible outcomes based on changing policy assumptions.

Our predictions factor in:

• Building size and allowable unit counts for parcels.
• The type of development and corresponding number of units that are likely to be financially feasible.
• The probability that parcels might actually be developed in the future based on a statistical analysis of historical Denver development data.

Following guidelines developed by the Lincoln Institute of Land Policy, we modeled 75 scenarios. They included five potential parking policies tested across five economic environments and three sets of assumptions for developer-driven parking inclusion.

Changes would bring hundreds of housing units

Our prediction that eliminating parking mandates in Denver could result in approximately 460 additional multifamily units per year is based on three assumptions:

1. Somewhat unfavorable economic conditions, including high interest rates and relatively low margins for developers.
2. Elimination of all regulatory parking mandates.
3. Voluntary construction of 0.5 spaces per unit near light rail and 1.0 spaces per unit away from light rail.

We find that eliminating parking minimums creates more options for developers and renters. Developers will still build parking where needed or demanded by city residents.

Eliminating mandatory parking requirements offers several additional benefits.

The city will save labor costs associated with enforcing parking requirements, reducing housing costs.

The policy change frees up land for more economically productive uses and for desired civic infrastructure such as sidewalks or green space. Developers freed from building parking are also more likely to invest in beautifying their building for residents and pedestrians.

Removing parking minimums can increase the flexibility to use small undeveloped or underdeveloped parcels for “missing middle” forms of housing, such as duplexes or triplexes. These forms of housing provide “gentle density,” meaning they do not significantly alter neighborhoods but still make them more affordable for lower- and middle-income people and increase the city’s overall housing supply. It can also allow for the adaptive reuse of historic buildings that may have been built before the city required on-site parking.

And finally, eliminating a requirement for surplus parking spaces allows more compact, efficient forms of development, which results in more walkable cities and more connected neighborhoods.

Susan D Daggett has received a teaching stipend from the University of Denver’s Executive Certificate in Affordable Housing Program, which is partially funded by a donation from the Colorado Housing Finance Authority and the Simpson Family. She serves on the Board of Smart Growth America and Transportation Solutions. She is married to Senator Michael Bennet, a Democrat from Colorado.

Stefan Chavez-Norgaard previously worked as an in-residence scholar at the Lincoln Institute of Land Policy, an organization mentioned in the article.

– ref. Denver study shows removing parking requirements results in more affordable housing being built – https://theconversation.com/denver-study-shows-removing-parking-requirements-results-in-more-affordable-housing-being-built-263889

Source: The Conversation – USA (2) – By Kate Hua-Ke Chi, Doctoral Fellow, The Fletcher School, Tufts University

Fossil fuels still power much of the world, even though renewable energy has become cheaper in most places and avoids both pollution and the climate damage caused by burning coal, oil and natural gas.

To understand this paradox, it helps to look at how countries – particularly major greenhouse gas emitters, including the U.S., China and European nations – are balancing the pressures of rising electricity demand with the global need to reduce greenhouse gas emissions that are warming the planet.

US embraces fossil fuels

The United States makes no secret of its fossil fuel ambitions. It has a wealth of fossil fuel reserves and a politically powerful oil and gas industry.

Since President Donald Trump took office in January 2025, his administration has been promoting oil and gas drilling and coal production, pointing to rising electricity demand to justify its moves, particularly to power artificial intelligence data centers.

Reviving the “drill, baby, drill” mantra, the Trump administration has now embraced a “mine, baby, mine” agenda to try to revive U.S. coal production, which fell dramatically over the past two decades as cheaper natural gas and renewable energy rose.

The Department of Interior on Sept. 29 rolled out a plan to “unleash American coal power” by opening 13 million acres of federal land to mining. The Department of Energy also pledged US$625 million to try to make coal competitive. It includes lowering the royalty rates mining companies pay and extending the operating lifespans of coal-fired power plants.

However, these initiatives further lock communities with coal plants into a carbon-intensive fossil fuel. Coal’s resurgence would also have public health costs. Its pollution is linked to respiratory illness, heart disease and thousands of premature deaths each year from 1999 to 2020 in the United States.

The Trump administration is also ceding the clean energy technology race to China. The administration is ending many renewable energy tax credits and pulling federal support for energy research projects.

I work in the Climate Policy Lab at The Fletcher School of Tufts University, where we maintain a suite of databases for analyzing countries’ energy research budgets. The Trump administration’s 2026 U.S. budget request would slash funding for energy research, development and demonstration to $2.9 billion — just over half the budget allocated in 2025. These energy research investments would fall to levels not seen since the mid-1980s or early 2000s, even when accounting for inflation.

China’s clean energy push – and coal expansion

While the United States is cutting renewable energy funding, China is doubling down on clean energy technologies. Its large government subsidies and manufacturing capacity have helped China dominate global solar panel production and supply chains for wind turbines, batteries and electric vehicles.

Cheaper Chinese-manufactured clean energy technologies have enabled many emerging economies, such as Brazil and South Africa, to reduce fossil fuel use in their power grids. Brazil surged into the global top five for solar generation in 2024, producing 75 terawatt-hours (TWh) of electricity and surpassing Germany’s 71 TWh.

The International Energy Agency now expects global renewable energy capacity to double by 2030, even with a sharp drop expected in U.S. renewable energy growth.

However, while China expands clean energy access around the world, its production and emissions from coal continue to rise: In the first half of 2025, China commissioned 21 gigawatts (GW) of new coal power plants, with projections of over 80 GW for the full year. This would be the largest surge in new coal power capacity in a decade for China. Although China pledged to phase down its coal use between 2026 to 2030, rising energy demand may make the plan difficult to realize.

China’s paradox — leading in clean energy innovations while expanding coal — reflects the tension between ensuring energy security and reducing emissions and climate impact.

Europe’s scramble for reliable energy sources

The European Union is pursuing strategies to reduce its reliance on fossil fuels amid the ongoing geopolitical tensions with Russia.

Russia’s invasion of Ukraine exposed many countries to supply disruptions and geopolitical turmoil, and it triggered a global energy crisis as countries once reliant on Russian oil and gas scrambled to find alternatives.

In June 2025, the European Commission proposed a regulation to phase out Russian fossil fuel imports by the end of 2027, aiming to enhance energy security and stabilize prices. This initiative is part of the broader REPowerEU plan. The plan focuses on increasing clean energy production, improving energy efficiency and diversifying oil and gas supplies away from Russia.

Renewables are now the leading source of electric power in the EU, though natural gas and oil still account for more than half of Europe’s total energy supply.

The EU’s fossil energy phaseout plan also faces challenges. Slovakia and Hungary have expressed resistance to the proposed phaseout, citing concerns over energy affordability and the need for alternative supply sources. Hungarian Prime Minister Victor Orbán said Hungary would continue importing Russian oil and gas. Cutting off these supplies, he asserted, would be an economic “disaster” and immediately reduce Hungary’s economic output by 4%.

The path to reducing Europe’s dependence on fossil fuels thus involves navigating internal disagreements and incentivizing long-run sustainable development. Europe does appear to be gaining in one way from the U.S. pullback from clean energy. Global investment in renewable energy, which hit a record high in the first half of 2025, increased in the EU as it fell in the U.S., according to BloombergNEF’s analysis.

Brazil: Torn on fossil fuels as it hosts climate talks

In November 2025, representatives from countries around the world will gather in Brazil for the annual United Nations climate conference, COP30. The meeting marks three decades of international climate negotiations and a decade since nations signed the Paris Agreement to limit global temperature rise.

The conference’s setting in Belém, a city in the Amazon rainforest, reflects both the stakes and contradictions of climate commitments: a vital ecosystem at risk of collapse as the planet warms, in a nation that pledges climate leadership while expanding oil and gas production and exploring for oil in the Foz do Amazonas region, the mouth of the Amazon River.

Thirty years into global climate talks, the disconnect between promises and practices has never been so clear. The world is not on track to meet the Paris temperature goals, and the persistence of fossil fuels is a major reason why.

Negotiators are expected to debate measures to curb methane emissions and support the transition from fossil fuels. But whether the discussions can eventually translate into a concrete global phaseout plan remains to be seen. Without credible plans to actually reduce fossil fuel dependence, the annual climate talks risk becoming another point of geopolitical tension.

Kate Hua-Ke Chi does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Why countries struggle to quit fossil fuels, despite higher costs and 30 years of climate talks and treaties – https://theconversation.com/why-countries-struggle-to-quit-fossil-fuels-despite-higher-costs-and-30-years-of-climate-talks-and-treaties-266993

Source: The Conversation – USA (2) – By Ediberto Román, Professor of Law, Florida International University

Soon after the NFL’s announcement that Puerto Rican rapper Bad Bunny would headline the Super Bowl halftime show, conservative media outlets and Trump administration officials went on the attack.

Homeland Security head Kristi Noem promised that U.S. Immigration and Customs Enforcement “would be all over the Super Bowl.” President Donald Trump called the selection “absolutely ridiculous.” Right-wing commentator Benny Johnson bemoaned the fact that the rapper has “no songs in English.” Bad Bunny, conservative pundit Tomi Lahren complained, is “Not an American artist.”

Bad Bunny – born Benito A. Martínez Ocasio – is a superstar, one of the top-streaming artists in the world. And because he is Puerto Rican, he’s a U.S. citizen, too.

To be sure, Bad Bunny checks many boxes that irk conservatives. He endorsed Kamala Harris for president in 2024. There’s his gender-bending wardrobe. He has slammed the Trump administration’s anti-immigration policies. He has declined to tour on the U.S. mainland, fearing that some of his fans could be targeted and deported by ICE. And his explicit lyrics – most of which are in Spanish – would make even the most ardent free speech warrior cringe.

And yet, as experts on issues of national identity and U.S. immigration policies, we think Lahren’s and Johnson’s insults get at the heart of why the rapper has created such a firestorm on the right. The spectacle of a Spanish-speaking rapper performing during the most-watched sporting event on American TV is a direct rebuke of the Trump administration’s efforts to paper over the country’s diversity.

The Puerto Rican colony

Bad Bunny was born in 1994 in Puerto Rico, an unincorporated U.S. territory that the country acquired after the 1898 Spanish-American War.

It is home to 3.2 million U.S. citizens by birth. If it were a state, it would be the 30th largest by population, according to the 2020 U.S. Census.

But Puerto Rico is not a state; it is a colony from a bygone era of U.S. overseas imperial expansion. Puerto Ricans do not have voting representatives in Congress, and they do not get to help elect the president of the United States. They are also divided over the island’s future. Large pluralities seek either U.S. statehood or an enhanced form of the current commonwealth status, while a smaller minority vie for independence.

But one thing is clear to all Puerto Ricans: They’re from a nonsovereign land, with a clearly defined Latin American culture – one of the oldest in the Americas. Puerto Rico may belong to the U.S. – and many Puerto Ricans embrace that special relationship – but the island itself does not sound or feel like the U.S.

The over 5.8 million Puerto Ricans that reside in the 50 states further complicate that picture. While legally they are U.S. citizens, mainstream Americans often don’t see Puerto Ricans that way. In fact, a 2017 poll found that only 54% of Americans knew that Puerto Ricans were U.S. citizens.

The alien-citizen paradox

Puerto Ricans exist in what we describe as the “alien-citizen paradox”: They are U.S. citizens, but only those residing in the mainland enjoy all the rights of citizenship.

A recent congressional report stated that U.S. citizenship for Puerto Ricans “is not equal, permanent, irrevocable citizenship protected by the 14th Amendment … and Congress retains the right to determine the disposition of the territory.” Any U.S. citizen that moves to Puerto Rico no longer possesses the full rights of U.S. citizens of the mainland.

Bad Bunny’s selection for the Super Bowl halftime show illustrates this paradox. In addition to criticisms from public figures, there were widespread calls among MAGA influencers to deport the rapper

This is but one way Puerto Ricans, as well as other Latino citizens, are reminded of their status as “others.”

ICE apprehensions of people merely appearing to be an immigrant – a tactic that was recently given the blessing of the Supreme Court – is an example of their alienlike status.

And the bulk of the ICE raids have occurred in predominantly Latino communities in Los Angeles, Chicago and New York. This has forced many Latino communities to cancel Hispanic Heritage Month celebrations.

Bad Bunny’s global reach

The xenophobic fervor against Bad Bunny has led political leaders like House Speaker Mike Johnson to call for a more suitable figure for the Super Bowl, such as country music artist Lee Greenwood. Referring to Bad Bunny, Johnson said “it sounds like he’s not someone who appeals to a broader audience.”

But the facts counter that claim. The Puerto Rican artist sits atop the global music charts. He has over 80 million monthly Spotify listeners. And he has sold nearly five times more albums than Greenwood.

That global appeal has impressed the NFL, which hopes to host as many as eight international games next season. Additionally, Latinos represent the league’s fastest-growing fan base, and Mexico is its largest international market, with a reported 39.5 million fans.

The Bad Bunny Super Bowl saga may actually become an important political moment. Conservatives, in their efforts to highlight Bad Bunny’s “otherness” – despite the United States being the second-largest Spanish-speaking country in the world – may have unwittingly educated America on the U.S. citizenship of Puerto Ricans.

In the meantime, Puerto Ricans and the rest of the U.S. Latino community continue to wonder when they’ll be accepted as social equals.

The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

– ref. The real reason conservatives are furious about Bad Bunny’s forthcoming Super Bowl performance – https://theconversation.com/the-real-reason-conservatives-are-furious-about-bad-bunnys-forthcoming-super-bowl-performance-267078

Source: The Conversation – USA (3) – By Brandon Nabors, Postdoctoral Research Associate in Public Health, University of Mississippi

The American South has the highest HIV rates in the country, accounting for more than half of new HIV diagnoses nationwide in 2023. This is despite growing availability of a highly effective HIV prevention medication that has made it possible to live a long, healthy life with this once fatal disease.

This medication – called preexposure prophylaxis, or PrEP – reduces the risk of HIV transmission by over 99% when taken as prescribed. Yet, in Southern cities such as Jackson, Mississippi, and Memphis, Tennessee, one of the most vulnerable populations – Black men who have sex with men – are rarely using it, with fewer than 1 in 5 who are eligible taking the drug.

The Trump administration has previously frozen and proposed more cuts to HIV prevention programs in the U.S. And although the administration has restored some of the federal webpages and datasets it took down in January 2025, it is unclear what information remains missing or has changed. Communities in the South that already face the highest burden of infection will feel the greatest effects of changing public health priorities.

In my work as a public health researcher, I have spent years studying HIV prevention and the social determinants of health in the Deep South. Through interviews with health care providers and Black patients in major Southern cities, what I learned was that a powerful clash between culture and public health plays a significant role in why effective medical treatments are still failing to reach those who need it most. I call this tension the Southern paradox – where medical solutions exist but systemic forces block access.

The stories of these clinicians and patients in the South weren’t simply about a pill: They were about trust, identity, family and faith. And their words highlighted a complex web of emotions and experiences that often go unaddressed in standard health messaging.

Southern culture and sexual health

In my recent study, I interviewed 12 people in Jackson, Memphis, New Orleans and Atlanta: eight Black men who have sex with men, along with four health care providers. Three of these providers also identified as men who have sex with men.

Many participants reported that physical access to PrEP wasn’t the issue. Instead, what stood in the way was far more personal and deeply embedded in their environment.

“In church, you’re taught to love your neighbor, but there’s always an asterisk when it comes to who you love,” one participant from Jackson told me. “If you’re gay, you’re either ignored or silently judged.”

Nearly all participants described the South as a place deeply shaped by conservative values, especially those rooted in religion and traditional family structures. The Black church emerged as both a protective factor and a challenge. While offering vital community support, it also often reinforced stigma around homosexuality and discouraged open conversations about sexual health.

One participant from New Orleans shared that he heard about PrEP from his health care provider and his friends, while another from Atlanta recalled learning about PrEP during his annual physical. Despite repeatedly being exposed to information about PrEP, both described hesitation about starting treatment. One worried about potential stigma if others discovered he was taking it, while the other questioned whether he “really needed” it. Ultimately, neither had started PrEP.

In many of these communities, sex education in schools is still focused on abstinence and often excludes LGBTQ+ topics entirely. “You grow up not hearing anything about gay sex or HIV,” one man from Memphis said. “So, when you get older, it’s like starting from scratch.”

Even decisions around condom use were heavily shaped by cultural norms. Men described relying on partner trust, age or perceived cleanliness rather than research-based ways to reduce the risk of HIV.

This absence of comprehensive, inclusive sex education leaves many vulnerable to misinformation and, ultimately, to preventable infections.

Trust is the real barrier

One of the most striking findings from these conversations was the deep mistrust that many Black men who have sex with men feel toward the health care system.

“It’s hard to find affirming care for people in the queer community,” said one Memphis-based health provider. Others talked about fears of being “outed” through their insurance, especially if they were still on a family health plan.

A Jackson-based participant 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.” Another noted how fear of both outright and subtle judgment during medical appointments made it easier to avoid health care altogether.

Systemic racism compounds these concerns. For many Black men, historical and ongoing experiences of discrimination, including rushed visits, lack of empathy, misdiagnoses and even being denied care altogether have built a lasting sense of caution.

Even when resources like PrEP are available, these treatments often feel inaccessible to Black men because they do not trust the system offering them.

Social networks step in

Thankfully, these conversations also uncovered moments of hope.

Many participants learned about PrEP from peers. “We talk about it regularly,” said one participant in Jackson. “I have friends who work in public health, along with friends who are taking the medication.”

In the South, where community ties often serve as critical safety nets, these social networks can sometimes provide more trusted health information than clinics or campaigns. Informal conversations in group chats, at house parties or during community gatherings often serve as powerful platforms for health promotion.

One provider in Atlanta said he intentionally shared his own experiences with PrEP to reduce stigma. “I have a little soreness,” he said with a smile, referring to a recent 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.’”

These social exchanges, rooted in trust and shared experience, frequently did more to shift attitudes than traditional public health campaigns. As one participant 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 relevant

What these conversations show is that for PrEP to work in the South, access to treatment is only part of the equation. Building trust, cultural affirmation and community-led education are equally critical.

Public health messages that go beyond medical facts and address the emotional, spiritual and social dimensions of health are more likely to build lasting engagement with HIV prevention. This includes investing in Black, LGBTQ+-affirming health care providers who reflect the communities they serve. It also means integrating discussions of sexual health into everyday conversations at barbershops, churches and community centers, not just in clinics.

Public health officials and clinicians can explore alternative treatment delivery methods that address privacy concerns, such as telehealth PrEP programs, discreet mail-order services and community-based distribution points. These can make PrEP easier to access and reduce the stigma associated with clinic visits.

Most importantly, valuing the knowledge already circulating within communities and supporting peer educators as legitimate public health messengers can strengthen credibility, normalize PrEP and empower people to take charge of their health.

In the battle against HIV in the South, culture is not just a barrier. It can also be the solution. I believe that when care is offered in a way that honors people’s identities, experiences and values, it becomes not just accessible but empowering.

Brandon Nabors does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. HIV rates are highest in the American South, despite effective treatments – a clash between culture and public health – https://theconversation.com/hiv-rates-are-highest-in-the-american-south-despite-effective-treatments-a-clash-between-culture-and-public-health-257434