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according to a 2016 CDC report, 90% of the new cases of syphilis and gono were a result of men on men sex. Predominantly men of color. Poverty isn't a factor: when poverty falls, disease should fall but it's increased so we can count that out. Under political hammer of "the birthplace of civil rights" combined with a majority of female-headed households easily swayed politically by activist pastors, there is more widespread cultural acceptance in the South for open homosexuality in general. So, the South became a magnet for gays, whether it be Dallas, Atlanta or Key West. Then there's recently introduced migrants who tend to gravitate to the temperate climate. They come from areas where homosexuality was publicly suppressed and casual encounters are the norm, but here in the US it's like kids in a candy store - a free-for-all with dozens of gay clubs in every urban area. Add in lack of knowledge about STD prevention, a good helping of 'it won't happen to me' and even the not-uncommon "hooker revenge" attitude of 'well if I have XYZ disease, everybody should have it", and we get an epidemic that is uncontrolled and politically incorrect to talk about.