Rising HIV Cases in Arizona

In Arizona, there has been a noticeable increase in new HIV cases over the past four years. The figures jumped from 665 new cases in 2020 to 964 last year. This shift comes after a period of decline from 2018 to 2020, and the numbers had remained fairly steady since 2014.

To explore the reasons behind this trend, Dr. Ann Khalsa, a clinician at Valleywise Health McDowell Clinic, shared her insights. She has been working in HIV care since the late 1980s at this specialized clinic.

Insights from Dr. Khalsa

Dr. Khalsa: There’s certainly no reduction in new HIV diagnoses here in Arizona. We are, so to speak, among the hotspot counties in the U.S.

This increase aligns with the county’s growing population, particularly among younger, sexually active adults, where the transmission of HIV remains an ongoing concern.

A significant issue lies in the lack of community education and awareness regarding available preventive methods. There are highly effective drugs and treatments to prevent HIV, but individuals need to know about them and actively seek healthcare to benefit from these options.

This disease is preventable; there’s virtually no reason for new cases to arise. However, it’s also crucial to remember that those who may acquire HIV often already have the virus.

Mark Brody: You mentioned that the population is somewhat younger. Perhaps many of them weren’t around during the peak of the crisis in the 80s and early 90s, so, are they just not thinking about this?

Dr. Khalsa: That’s a significant factor. Most of the new infections are among people in their 20s and 30s. They didn’t experience the same fears associated with HIV, probably because they haven’t seen the harsh realities of AIDS, at least not in the same directly impactful way.

Brody: So, does this mean there’s less concern now compared to earlier times? For instance, public figures like Magic Johnson have shown that living with HIV is possible.

Dr. Khalsa: Yes, that seems to be the case. Many young people don’t appear particularly worried about dying. They might think, “I had gonorrhea once; it’s just another STD.” But the reality, which I witness firsthand—a reality gained from years of working with patients—is more complex. People living with HIV age differently than those who are not infected. The virus remains in the body, and although treatment can suppress its activity, it stays in certain immune cells. When the immune system is activated, it can lead to instances of low-level viruses re-emerging in the bloodstream.

Brody: What can we do to address these rising numbers? Can we replicate the successes we’ve seen in the past?

Dr. Khalsa: Indeed. For over a decade, there have been international objectives to end the HIV epidemic. One pivotal goal is to ensure everyone is tested for HIV and, for those who are positive, to get them on effective medication so they don’t progress to AIDS and can’t transmit the virus.

The original target was 90-90-90, which has now shifted to 95-95-95. This means that 95% of individuals should be tested, and of those with HIV, 95% should be aware of their status, under care, and adhering to medication, sufficiently suppressing the virus.

For those who test negative, the aim is also to link 95% to preventive care. Unfortunately, funding cuts could dismantle these vital programs. This reduction in support is disheartening and could lead us back to what we saw decades ago.

Brody: What does this mean for Maricopa County and Arizona at large, especially given these funding challenges?

Dr. Khalsa: Sadly, we anticipate an increase in cases. And, well, we might see a rise even more due to these changes.

Brody: Do you have an estimate of how significant this increase might be?

Dr. Khalsa: It varies depending on the population and their funding sources. Patients who are uninsured and rely on alternative funding for prevention or treatment could account for about 10% of the population. Cuts to Medicaid could impact up to a third of patients. This means around 40% of individuals either lose access to prevention or treatment.

Brody: So this really implies that more individuals may end up contracting HIV, especially among those who might not have access to necessary therapies.

Dr. Khalsa: Yes, absolutely. Although there are treatments available, if we lose access to care, we could see people becoming very ill again, reminiscent of past crises. This is indeed a concerning prospect for the future.