New HIV cases in Arizona are up. Valley doctor says diagnosis can be prevented
It’s been a long time since an HIV diagnosis was a death sentence. With effective treatment and preventative care many people live with HIV and can prevent spreading it today.
But, new cases of HIV are way up in Arizona — 20% in 2022, according to the Arizona Department of Health Services — and many in the field are concerned about getting the message out to a new generation that HIV is still here — and you can still get it.
Dr. Ann Khalsa has been working to treat HIV for 30 years. She’s the medical director at Valleywise Health’s McDowell Community Health Center. The Show spoke with her more about the latest numbers — and what she’s seeing on the ground today.
DR. ANN KHALSA: On the ground in our clinic since we are kind of the safety net clinic. We haven't actually seen the jump because we've continuously been getting 20-plus new patients per week in our clinic for several years. So it's just continuing for us.
LAUREN GILGER: So what, what's the difference there you said because you're the safety net clinic? What does that mean exactly?
KHALSA: It means patients who get newly diagnosed, who don't have insurance end up coming to us first. And what we're seeing as we'll discuss later is a lot of the new cases are in young gay men of color and frequently they're not currently engaged in health care because otherwise young healthy guys, they don't need insurance. So many of them do end up with us initially. And so that's why our numbers are fairly consistent.
GILGER: Interesting. OK, so what do you make of those numbers though of, of the overall picture being representing a pretty significant jump in cases of HIV here in this state, like what do you think might be behind that?
KHALSA: So indeed, as you said, there's been a 20% increase in the number of new cases reported in 2022 versus 2021. Part of that is because in 2020, testing was way down during the COVID epidemic. But even if you look at the curve and discount that dip that occurred in 2022, the numbers are still going up. That also somewhat parallels the 19% increase that we also have in funding for testing. There is this nationwide effort that's been going on now for several years called In the HIV Epidemic. So part of this increase may be that we have more funding and we're therefore doing more testing.
GILGER: What about demographics? You mentioned a group or two that are more at risk or that you're seeing this rise right now? Where are you seeing it?
KHALSA: Our new cases are parallel with what we're seeing statewide and countywide and 66% of all the Arizona cases occurred in Maricopa County. So we're seeing the same thing and that again is mostly in men who have sex with men, which is 56% of all the cases, as well as in persons born male, which is 86%. So again, it's in the young men, and then the majority of those are occurring in the 25- to 29- and 30- through 34-year-olds. So again, it's young, active, healthy people who aren't taking precautions yet.
GILGER: There's also a trend here. We're seeing right of fewer cases of HIV among white people arising cases specifically in the Hispanic community. Are you seeing that?
KHALSA: We still see high rates in the Hispanic community, less in the white community. That is true. And I think a lot of that is awareness and prep. So the the white gay community, so to speak, has a pretty high rate of, of taking up and using prep, pre exposure prophylaxis, which is covered and available, but it's less known about and utilized in the young men of color.
GILGER: And that's the medication that, you know, you can take every day to sort of prevent contracting HIV.
KHALSA: Absolutely. And that's one of the three pillars that are part of the ending the HIV epidemic program nationwide, which is testing prevention and treatment. And so there is funding for prevention or prep. So even we have a lot of people without actual health insurance and even without health insurance, you can still get the medicine covered.
GILGER: What do efforts look like in terms of like getting the word out there to those communities that don't have it yet that you can get on prep, that you should prevent things in this way or protect yourself in these ways that this still is a problem.
KHALSA: There are campaigns that are out on the connecting apps, you know, Grindr, etc., etc. There's messaging out in a lot of the places where people congregate gay bars, gay pride festivals. I know that public health when people go in to get tested, they are, this is discussed and they are referred for prep, but still we aren't getting down into the actual communities of color enough.
GILGER: I know you said a lot of this conversation still revolves around the gay community, but it's not just people in that community that are still being done, diagnosed and contracting HIV, right.
KHALSA: Oh, no, absolutely. We've got plenty of, of folks who identify as heterosexual or injection drug use. The injection drug use community is often the most marginalized and aren't always treated well in the medical community. You know, they may be viewed with some derision, etcetera, but we've got plenty of newly diagnosed folks who are heterosexual. And so it's really just a body fluid contact illness.
GILGER: So let's talk about the sort of long view on this, which you clearly have, you've been doing this work,, for, you know, 30-plus years as you watch these sort of shifts in trends, like, go up and down, like, there was a point at which HIV and AIDS was killing people. And now we are not in that place anymore, but prevention and getting the message out there still is a challenge in lots of ways. Can you kind of put that into context for us with what it's like watching arise now with your long view on it?
KHALSA: Absolutely. So I think in a sense, it was almost easier back in the day when people were getting sick and dying because there was a sense of urgency. It's like, oh my God, I don't want to die like I just saw my friends die. I'm going to get in and get treatment, blah, blah, blah. But now it's so much taken the back burner that frequently I have people who are newly diagnosed to me, they'll comment that they didn't think it was still a thing. So we don't have enough public attention and awareness of this, that it is an ongoing long term issue. And I think the other thing is because this is an illness that is often linked around sexual activity until we get over our social human hang-up about discussing this, then it continues to, to bite us from behind because we're not being aware of it.
We're not paying attention to it where, what, what we're really trying to do is normalize this to be just another health risk like seatbelts and smoking and cholesterol. And it's just another thing that needs to be asked and tested for. In fact, that's one of the emphasis in the medical field is to try to make HIV testing a routine part of health care. And instead of saying, hey, would you like to do an HIV test? So we can be super complete, reframe it and say, hey, to be super complete, we do testing for everything. We're going to run an HIV test today. Is that OK? And then they have to opt out. But again, we've got to get people talking about it. And even, unfortunately in the healthcare profession, there are many providers who do not want to bring it up because they don't know that it's not a death sentence or they don't want to discuss sex.
GILGER: So even in the health care world, this is a challenge.
KHALSA: Oh, yeah. Oh, yeah.
GILGER: Is it frustrating, Dr. Khalsa, having done this for 30 years to watch the numbers go up by numbers like this by 20% when it's something that, you know, at one point it felt like maybe we had solved.
KHALSA: Absolutely. I hate to see young people come in newly diagnosed because it's so preventable. And I've got three young adult children. Heaven forbid any one of them ever end up in the clinic, it's completely preventable. You just don't need to go down this pathway.
GILGER: Yeah. All right. We'll leave it there for now. That is Dr. Ann Khalsa, medical director at Valleywise Health's McDowell Community Health Center and expert in HIV treatment, joining us to talk more about this. Dr. Khalsa, thank you so much for coming back on The Show. I appreciate it.
KHALSA: Absolutely. Thank you for bringing attention to this.