Fayth M. Parks, PhD
World AIDS Day reminds us not only to honor those we’ve lost to the epidemic, but also to face the obstacles still blocking progress toward an AIDS-free generation. The United States has set a bold goal: ending the HIV epidemic by 2030. We have the science to achieve this: pre-exposure prophylaxis (PrEP), which lowers infection risk by over 90%, treatments that turn HIV from a death sentence into a manageable chronic illness, and the understanding that people with undetectable viral loads cannot spread the virus.
However, in rural America, a different reality remains. Myths from the early 1980s, when fear and ignorance were widespread, still shape how communities view HIV/AIDS. A recent study of rural healthcare providers uncovered a troubling truth: despite 4 decades of medical advancements, misinformation persists (Smallwood & Parks, 2024).
“It Won’t Happen Here”: The Dangerous Denial
Perhaps the most pervasive myth in rural communities is the belief that HIV doesn’t exist there. Healthcare providers working in rural regions consistently hear variations of “it doesn’t happen here,” “we don’t have those kinds of people,” or “it doesn’t get out here in Appalachia.” This denial creates a false sense of security that prevents people from getting tested, seeking prevention tools like PrEP, or recognizing their own risk factors.
Moreover, rural residents often exclude themselves from risk based on age, sexual orientation, or their choice of partners. The idea that “I’m too old to get it” overlooks the fact that HIV impacts people of all ages. The belief that “I only sleep with clean people” shows a fundamental misunderstanding: HIV has no visible signs, and you can’t tell someone’s status just by looking at them.
Even when people acknowledge HIV exists, they often minimize its threat. Statements like “it’s not a big deal anymore” or “I’m going to die from something anyway” reveal a fatalistic attitude that discourages prevention efforts. Some dismiss the need for condoms or HIV education in schools, believing there are “other things to worry about.” While it’s true that modern treatment has dramatically improved outcomes, this doesn’t eliminate the importance of prevention or the challenges of living with HIV.
More disturbing are the moral narratives that frame HIV as deserved punishment. When communities view HIV as a consequence of “immoral lifestyles,” they create barriers that prevent compassionate care and honest conversations about risk. This judgment particularly harms marginalized groups already facing discrimination.
The confusion about transmission remains staggering. Rural healthcare providers report hearing long-debunked myths about HIV spreading through mosquito bites, toilet seats, sharing utensils, or kissing. These casual contact fears, prominent in the 1980s, continue to fuel unnecessary panic and discrimination against people living with HIV. Meanwhile, other misconceptions minimize real risks, such as the belief that certain sexual positions are safe or that two HIV-positive people can have condomless sex without concern for viral transmission or other sexually transmitted infections.
The Stereotype Problem: Who Gets Erased from the Story
When rural communities think about HIV, they mainly associate it with gay men. Healthcare providers point out that stereotypes portray people living with HIV as “promiscuous,” “dirty,” and “nasty”—judgmental terms that reveal deep-seated stigma. The disease is often seen as affecting only gay men, Black communities, or urban populations, with some myths specifically targeting Black gay men with assumptions about promiscuity.
While it’s true that men who have sex with men face disproportionate HIV rates, this narrow framing obscures the whole picture. Women, particularly women of color, face significant HIV risk in rural areas. People who inject drugs represent another vulnerable population often left out of the conversation. By perpetuating the idea that HIV is “an urban disease” or something that only affects certain groups, rural communities fail to protect everyone at risk.
These stereotypes do not occur in isolation. They are connected to larger societal biases such as racism, homophobia, misogyny, and classism. When HIV stigma intersects with these existing prejudices, it leads to additional harm for people with multiple marginalized identities. The early epidemic’s focus on the “4 H’s”—homosexuals, hemophiliacs, heroin addicts, and Haitians—still influences today’s misconceptions, showing how prejudice gets built into public health stories.
The Treatment Confusion: When “Undetectable” Means Everything and Nothing
Medical advances have given us powerful tools, yet misinformation about treatment persists. Misinformation that persists includes the belief that medications “don’t work well,” “make you sicker,” or are only available to wealthy people—none of which reflects current reality. Some think a vaccine either exists already or is coming “any day,” while others believe the government is hiding a cure or that celebrities like Magic Johnson have been cured.
The concept of viral suppression, or being “undetectable,” often causes confusion. Some see undetectable status as a permanent cure and believe they can stop medication once they reach it. Others, misunderstanding the groundbreaking “U=U” (Undetectable = Untransmittable) science, either dismiss it completely or incorrectly apply it to situations where it doesn’t apply. This confusion can lead to serious issues for prevention and ongoing treatment.
World AIDS Day and the Path Forward
As we observe World AIDS Day, these persistent myths remind us that scientific progress alone cannot end the epidemic. The gap between what medicine can achieve and what communities understand creates real barriers to testing, treatment, and prevention. People won’t seek PrEP if they don’t believe they’re at risk. They won’t get tested if they think HIV doesn’t exist in their community. They won’t support people living with HIV if they view the disease as punishment for moral failings.
The solution requires sustained, fundamental HIV education specifically tailored to rural communities. This means moving beyond one-time awareness campaigns to create ongoing dialogues that openly address myths and provide facts. Trusted messengers matter, such as community health workers who are part of the communities they serve, local opinion leaders who can spread accurate information through their networks, and healthcare providers who consistently challenge misconceptions.
Media and social platforms offer powerful tools for modeling accurate information and prosocial behavior. When people learn from television shows, social media, and community events that treat HIV factually and compassionately, attitudes can shift. These efforts must account for the unique cultural characteristics of rural communities while rejecting the notion that stigma is inevitable.
This World AIDS Day, we can each play a role. Examine your own assumptions about HIV and who it affects. Share accurate information when you encounter myths. Support organizations working in rural HIV prevention and care. Advocate for dedicated resources for education and stigma reduction in underserved areas. The medical tools to end HIV exist; now we must ensure the knowledge reaches every community that needs it. Four decades into this epidemic, it’s past time for our understanding to catch up with our science.
_____________________________________________________________________
Fayth M. Parks, PhD, is a professor of leadership and psychology in the Leadership and Change program at Antioch University. Her work adopts an interdisciplinary approach, combining psychology, public health, and cultural studies to present a more inclusive perspective on mental health care and holistic well-being. Dr. Parks founded the Rural HIV Research and Training Conference and previously served as chair of the American Psychological Association’s Committee on Psychology and AIDS. She is also the president-elect of the National Association for Rural Mental Health.
