Maricopa County is a hot spot for HIV. This doctor says Trump funding cuts will make it worse

Arizona has seen an increase in the number of new HIV cases over the past four years. Since 2020, the state has gone from 665 new cases to 964 new cases last year. That follows a drop from 2018 to 2020, and relatively stable new case numbers dating back to 2014.

To find out what may be behind these numbers, Dr. Ann Khalsa, a clinician at the Valleywise Health McDowell Clinic spoke with The Show. Where Khalsa works is a specialty clinic; she’s been working with HIV case word since the late 1980s.

Full conversation

ANN KHALSA: We certainly have not seen a decrease or control of the rate of new HIV diagnoses in Arizona. We are one of the hot spot counties, so to speak, in the U.S.

Part of it is, parallel with the population increase in the county. But part of it is we have a young population with sexually active adults, and HIV continues to get transmitted.

And the real problem is we haven’t had adequate education and awareness in the community to be utilizing preventive tools that are now available. We have medications — both as pills and shots — that are up to 100% effective to prevent HIV acquisition. Of course, if someone is aware that they should be using it and has health care to get it and stays on the treatment or on the medication, then it’s completely effective.

This is a preventable illness. There’s no reason for new cases to be occurring. But the other half of the equation in acquisition of HIV is folks who already have HIV need to stay on medication.

MARK BRODIE: You mentioned the population is maybe a little younger. Is this maybe just folks who weren’t alive during the ’80s and early to mid-’90s and maybe just aren’t thinking about this the way that the people who were around then would?

KHALSA: That’s a large part of it for sure. A lot of the younger people and the majority of people who are newly acquiring HIV are in their 20s and 30s. So yes, they weren’t around back then. And they’re not hearing it in the news. And they’re not seeing people dying of AIDS. So it’s just not in their mind.

BRODIE: Well, I also wonder if there’s some measure here of AIDS not being as much of a death sentence as it was. You have people like Magic Johnson, for example, very publicly announced when he acquired HIV, and he’s still going. So I wonder if it’s maybe less of a concern for people than it used to be.

KHALSA: Yes. I think that is also the case. I think a lot of the younger folks who come in are not really upset or scared of dying. It’s like, “OK, yeah, I’ve had shots of penicillin for syphilis. I got syphilis as an STD, and OK, well, yeah, now I’ve got HIV, so give me a pill.”

And that’s true for a large part. But what people don’t know — and what I now see as someone who’s been treating this for decades — is I’ve got an established patient panel personally, and they’re aging along with me.

And the process of aging with HIV is unfortunately not the same as aging without HIV, in that the virus is still present in the body. And the problem is, even though our medicines control active viral reproduction in the body, there is still virus present in the immune cells that are resting in our bone marrow and lymph nodes, etc.

And when our immune system is called upon to react to a strep throat or a flu infection or whatever, the virus that is contained within those cells is reproduced or replicated. And so for brief moments in time, you will actually have low levels of virus circulating in the blood.

And those low levels of virus keep the immune system activated to help fight that virus, which that immune system activation causes chronic inflammation, which causes premature aging.

BRODIE: What is the way to bring these numbers down? I mean, can you do the same things that you did in the past this time?

Valleywise Health

KHALSA: So yes. There has been a goal now for more than a decade internationally to end the HIV epidemic. And one of the programs is to try to get everyone tested so they know if they have HIV or not. And if they do have HIV infection already, then get them on medication so that one, they don’t die of AIDS, and two, they can’t transmit it to others.

So the goal has been and was initially 90-90-90. Now it’s 95-95-95, which means get 95% of everyone tested. And everyone who already has HIV, get 95% of them tested, so they know they have it. Get 95% of them linked to care and on medication, and get 95% of those who are prescribed medication, get them stably coming back for clinic visits.

And with 95% rate among that population, a viral suppression. So that way, one, they’re not again dying of AIDS, but they’re virally suppressed, and they’re not going to transmit.

The other half of that scenario is you start with the point of testing. Now, for those who test HIV negative, we have the same goals: Get 95% of them linked to a prescriber to give them prevention.

What’s happened unfortunately, recently is there are current as well as planned reductions in all of this funding. And so this whole program, three-pronged program to end the HIV epidemic — which means end new cases of HIV occurring — that whole program is being dismantled.

And yeah, we’re going to go backwards. We’re going to roll the clock back a good couple of decades with what’s going on right now, which is very unfortunate and very sad for all of us to see.

BRODIE: Well, what does all of this mean, do you think, for Maricopa County especially and maybe the rest of Arizona, with the numbers already going up before some of these programs and the funding are being cut?

KHALSA: So unfortunately, we’re already anticipating and planning for pending increases.

BRODIE: Do you have a sense of by how much those rates might go up around here?

KHALSA: It really depends on the populations we’re talking about and what their funding sources are. So for patients who currently don’t have insurance and have been receiving prevention or treatment through these additional funding sources, that’s at least 10% of the population, if not more. And then we also anticipate with pending Medicaid cuts, that may be up to a third of our patients.

So now again, either prevention or treatment. So you’ve got a third plus you’ve got 10% of patients with no insurance. So we could see 40% increases.

BRODIE: Well it also kind of sounds like in addition to more people acquiring HIV, it sounds like for at least some of those patients, if they don’t have health insurance anymore, they’re not going to have access to the kind of medication that keeps them from getting really sick and potentially dying.

KHALSA: You are totally correct. AIDS still absolutely can kill just like the old days when we didn’t have meds. And so if those two pieces fall apart, yeah, we may see sick people again. So yeah, it’s scary times in the future that we may potentially see again.