The number of Latinos who are diagnosed with HIV is on the rise in Arizona. But getting this population the education, care and treatment they need can be tough due to stigma. One ASU researcher aims to change that.
Angel Algarin is with the Edson College of Nursing and Health Innovation at ASU.
He says the stigma surrounding HIV, as well as that of traditional gender norms, means many Latino men are not getting tested or treated — let alone talking about it.
Algarin is working with researchers who are creating an intervention that helps improve a person’s resistance to stigma.
“They would go through this intervention, building skills on resistance and how we might resist stigma in our day to day lives, whether it's resisting within ourselves and telling ourselves that we're doing that we don't believe in that stigma, or how we go into the community and resist stigma by educating our community members,” he says.
Algarin says they use Latino art to talk about barriers and access to care.
“They are able to have skills to potentially fight back against the stigma that's happening within themselves, within their interpersonal relationships and then also within their community,” he explains.
According to a 2023 annual report from the Arizona Department of Health Services, Latinos accounted for nearly half of the 975 new cases of HIV and AIDS in 2022. Algarin says they plan to evaluate the data from the resistance intervention early next year.
This is a service hosted by partners at Aunt Rita's that can help people find HIV-related services. For more HIV-related services, visit Aunt Rita's Foundation at hivaz.org/.
LAUREN GILGER: More Latinos are being diagnosed with HIV in Arizona. Even though an HIV diagnosis is no longer a death sentence today, there's stigma and barriers to care for many in our state — specifically Latino men and other men of color.
Well, our next guest is out there working to get more of them tested. Angel Algarin is an assistant professor in ASU’s Edson College of Nursing and Health Innovation, and he serves on the city of Phoenix's Fast-Track Cities Ad Hoc Committee that works to strengthen the city's efforts to combat the spread of HIV and end AIDS.
But he told me with recent funding cuts and fear within the Latino community, they have a long way to go.
ANGEL ALGARIN: I identify as a gay Latino scholar, grew up in Ohio in a very small conservative town. And so during that time in my life, really saw the homophobia in that area. And because of that homophobia, didn't really have a lot of sexual health education to prepare me. So there was this sort of constant fear of how people acquire HIV, because you had no awareness or education on the topic. And so because of that stigma and because of that fear growing up, I said, well, I want to do something about that. And so that's kind of what I got into public health. It's kind of like me-search in a way.
LAUREN GILGER: I like that, me-search. OK. So definitely up your alley and a personal topic to you. But let's talk a little bit about the landscape that you're doing this work in right now, right? Because HIV is not a death sentence anymore. It's a disease that you're going to live with, though, for the rest of your life. So it sounds like prevention in terms of spreading it is what's key in the work that you do, right?
ANGEL ALGARIN: Yes, 100%. So right now, with the advances that we've had, we have something called pre-exposure prophylaxis or as people colloquially say it, PrEP. ... At first, when it came out, it was a pill taken once a day to prevent the acquisition of HIV by over 90%, and actually some studies say up to 99%. So very effective. ...
Now we have — they advanced to long-acting injectable PrEP. So that was once every two months was the initial long-acting injectable. And now they have one that's once every six months. ... So you can see that they're rapidly improving.
LAUREN GILGER: So the technology here, the treatment has improved dramatically, but you're still seeing people be diagnosed with HIV every year. Give us a sense of how prevalent it is today.
ANGEL ALGARIN: Yeah. So in Arizona in 2023, we had 967 reported cases of new HIV infections. ... And then in Maricopa County in particular, we had 636 reported cases. ... We're seeing this largely driven by men in the age range of around 25 to 34 years of age.
LAUREN GILGER: So younger men, that's interesting.
ANGEL ALGARIN: Yes, yes. So younger men. And then we're also seeing disparities really around Hispanic, Latino and Black men who have sex with men. So in comparison to their white counterparts, they make up a disproportionate amount of new HIV incidences in comparison to their white counterparts.
LAUREN GILGER: OK. So the share of cases in those populations is growing, and that's kind of what you do your work on in general in terms of Latino men, right?
ANGEL ALGARIN: Correct.
LAUREN GILGER: Let's talk about why that might be. Like, I know stigma is still a word that's talked about a lot in the HIV world. Is it more prevalent? Is that a bigger problem among Latino men in particular?
ANGEL ALGARIN: Yeah. So I wouldn't necessarily say that HIV stigma is more prevalent among Latinos versus whites versus those who identify as Black.
LAUREN GILGER: It's everywhere.
ANGEL ALGARIN: It's everywhere. But what I can say is we talk about it's called intersectional stigma, right? So how different types of stigma based off of health condition and/or your identity, so whether that's being Latino, whether that's being gay, whether that's expressing your masculinity in a different way, that those stigmas can compound and create a more deleterious environment for health and health seeking. Because sometimes it's not about HIV, but, "Hey, I'm afraid to ask my doctor about PrEP because I'm afraid that they will assume that I'm that I'm gay." You may have stigma of HIV, but you have other stigmas that are also creating this environment.
LAUREN GILGER: Right. This idea of traditional gender norms is going to be challenging in that world. So what does that result in? Like Latino men being not tested? Like how do you reach them?
ANGEL ALGARIN: Yeah, no. So this definitely results in folks not wanting to go get an HIV test, because they're afraid of what happens after that test comes back and if it says that they're HIV positive. ... And then it also is, you know, how do I tell my family? Who do I need to tell about my HIV diagnosis? How do I tell my sexual partners? It's the fear, it's that anticipation of what might happen after that HIV diagnosis.
LAUREN GILGER: I know I see because I live right in the Melrose District there, and I know I see because there's a couple of clinics there that do this kind of work in particular, but they'll have like buses out sometimes at the bars, and like you go to the people where they are, right? Sometimes that's what the work looks like.
ANGEL ALGARIN: Out in the Melrose District is a great example. They do a lot of mobile units, so you'll see them going out to different bars within the community — and not only just the ones in the Melrose District, but, you know, you have Karamba, which is closer to downtown, which is a lot of Latino influence that happens there. It's great. I have fun there sometimes, too. That's a great strategy.
I will say that due to our political climate, there is a fear of accessing healthcare services. Anecdotally, people are afraid to go get tested — seek any medical treatment, really, because of just like the state of affairs. And so just adds on to the even previous barriers that we've had surrounding lack of language access in our healthcare system. So even though clinics are required to have translation services, often those translation services are not like culturally translated. So like you can match language, but you're not necessarily matching culture or understanding.
LAUREN GILGER: You're not saying the same thing.
ANGEL ALGARIN: ... Yeah, you're able to communicate, but you're not saying the same thing, sort of thing. ... So these are some of the things that are serving as barriers. But our community partners are really doing a lot. They recognize the growing epidemic among Latinos and Black men who have sex with men in particular, and they're flexible.
LAUREN GILGER: Is cost, access to care part of the problem here?
ANGEL ALGARIN: Yeah, you know — and this is actually a large problem. You know, we often talk about the cost of the medication. Well, you know, insurance largely covers the medication. The makers of PrEP, Gilead, offer copay cards, which help cover the extra costs that might not be covered by your insurance. So largely the medicine is fairly accessible.
It's all those hidden costs that you don't really see, right? It's the transportation and how we get to the clinic. It's the time that it takes and whether you're able to take off work and sacrifice those extra hours of pay. It's the hidden copays for the tests that you have to get to receive PrEP that you weren't expecting, but then you get the $20 to $50 bill in the mail, and you're like, "Where'd this come from?"
LAUREN GILGER: Yeah. So I know under the Biden administration requirements were passed that that PrEP be covered, as you're saying, by Medicaid, by insurance companies in general. Are you seeing though the kind of organizations, the nonprofits that are out there kind of doing this work on the street level seeing cuts under the Trump administration?
ANGEL ALGARIN: Oh, yes. Yeah. I mean with the clinics that I do work with, after the initial slash to CDC funding, we saw our partners that I've been working with and in conversations with and how we, you know, advance research, they're not even able to talk about research. They're scrambling to sort of figure out who they can keep on board at their clinics and who's going to be left after the CDC cuts, you know, take their full effect.
And so these cuts affect far more than just the practice that's happening within the clinics. It's also affecting the research that is going to move us forward into continuing to address the HIV epidemic in this century. So the cuts had far-reaching effects.
LAUREN GILGER: Angel Algarin, joining us, assistant professor in ASU's Edson College of Nursing and Health Innovation. Angel, thank you very much for coming in. Appreciate it.
ANGEL ALGARIN: Thank you for having me.
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