Poor sex education and outreach is to blame for HIV increase in Arizona, advocates say.

A state health department report released last December shows that HIV transmissions in Arizona have grown to alarming numbers, bucking national trends where the virus is declining across most of the country. And while advocates and health providers say there needs to be more work done on the ground, experts working in the field almost unanimously believe that the state’s poor sex education curriculum is playing a heavy-handed role in the trend. 

Since 2020, overall transmission rates increased by 20% last year with new HIV diagnoses disproportionately affecting Black and Latino populations. The increase in people diagnosed with HIV or AIDS was mostly among men who have sex with other men, but the state department's data showed there was also an increase for Black and Hispanic females, a demographic that long has been seen as “safe” from the virus.

Craig Crabtree, an HIV care continuum manager for Maricopa County at Valleywise Health, said in order to make meaningful strides in reducing HIV transmissions there needs to be better education surrounding sexual health. He also said that governments and health providers need to be knowledgeable about treatments available to suppress HIV in patients to undetectable levels—which is when transmission of the virus is almost impossible. 

“The HIV rates just continue to climb,” Crabtree said, adding that Phoenix is one of 33 areas across North America designated as a Fast Track City—a global initiative overseen by the United Nations to reduce HIV’s spread through direct funding at the city level. 

The designation isn’t new for Phoenix, which has been included in the program since 2016, but the increase reported by the state follows a relatively static era when there were fewer transmissions in previous years. 

Beyond outreach, HIV experts interviewed by LOOKOUT said that Arizona’s legislature—which is controlled by Republicans in both the House and Senate—is partially to blame, as state laws have restricted teaching comprehensive sex education. And if school districts and parents opt-in, teachers are required to provide an abstinence-only curriculum.

The Numbers

Every year, the Arizona Department of Health Services releases their analysis on the status of HIV and AIDS across the state. The most recent 2023 report revealed that in the year prior, Arizona’s Latino and Black populations experienced a notable rate increase in transmissions when compared to their population levels, which sits at 32% and 4%, respectively. 

Despite being the smallest population, Arizona’s Black population had higher transmission rates than others. In 2021, the group had a 31% rate increase. Last year, it increased again by more than 15%, the report showed. 

In the same time period, Arizona’s Hispanic population also saw transmission rates increase by more than 10%. The Hispanic population has experienced a 181% rate increase in new HIV transmissions since 1988, while White populations saw their numbers drop by 59% in the same time period, according to AZDHS.

Eddie Moreira-Orantes, HIV prevention manager for the Arizona Department of Health Services, said the data illuminates where outreach and education are needed the most. 

“In 2021, we noted that the Black and African American community accounted for about 16% of incidents but they represent only about 5% of Arizona’s population.” he said. “They’re disproportionately affected.”

HIV trends locally are going the opposite direction to the nation where HIV transmissions have declined in recent years, dropping by 4% between 2020 and 2021, according to data available on America’s HIV Epidemic Analysis Dashboard.

Organizations tasked with reducing HIV in marginalized communities have said the challenge has been getting into economically poor areas to provide testing and preventative medicine. But local health experts say cultural stigma is a more profound influence on HIV’s spread and further underscores the need for educational efforts.

A “Huge Eye-Opener”

Cynthia Estrada, a social worker with Chicanos por la Causa, isn’t shy about how unsettled she is with the increase in HIV infections across the state. She cites fragmented or stifled prevention efforts, cultural stigma, and incomplete education as to why just under half of new HIV infections in Arizona are among Hispanic individuals.

“That is a huge eye opener; Not just as an organization, but a huge eye opener for the entire state,” she said. “To me, that’s not just because of the stigma, but also the lack of knowledge and lack of education. We need to focus more on the colored community.”

She said she’s seen commercials for preventative medicine, which she applauds, but she hasn’t yet seen one in Spanish. And she doesn’t understand why.

“Why are they not showing more advertisements in Spanish as we see the rates? Why are we not targeting them?” she said. 

And, when it comes to younger individuals testing positive, she looks to schools as a main contributor in not stopping the spread. 

“I’m seeing 18 and 19-year-olds getting diagnosed,” she said. “We have to get education across the school systems and get that information to them young. We all have to work together and break the stigma and educate.”

Tracy Pedrotti, an adolescent health program supervisor with Affirm, agreed. She said reproductive health and sex education are vital components of overall well being. And in Arizona, school-aged kids aren’t being taught complete or accurate information on sexual health that involves risk, she said. 

“There’s this idea that an abstinence policy is going to prevent unwanted pregnancies and sexually transmitted diseases. But we believe it’s education and access to care that gives people knowledge to make decisions for themselves,” she said. “A lot of these stats are a reflection of our state not providing access to that education for its young people. It’s health. It’s part of health. It shouldn’t be so taboo for young people.”

Connecting At A Community Level

Outside of proper sex education, health providers say there needs to be more outreach and information on preventative treatment, such as PrEP or PEP. 

PrEP, which stands for pre-exposure prophylaxis, is considered a “highly effective” prescription regimen for the prevention of HIV, according to the Centers for Disease Control. PEP is a post-exposure prophylaxis for those who may have been exposed to HIV. Both have been available for at least a decade, and if patients take it correctly they can reduce transmission by more than 99%. 

Two daily pills—Descovy and Truvada—are the drugs primarily used for the PrEP regimen. Both of those drugs use components of other pharmaceuticals that have been used for HIV treatment since the 1990’s. In 2021, the Food and Drug Administration approved an injectable form of PrEP called Apretude. The drug is given to patients once every other month through a doctor. 

But awareness surrounding the efficacy and availability of the medications is lacking among those who may benefit from them and also among those who are able to prescribe them. 

Andrew Rascon, outreach and community engagement manager for the Southwest Center, said he has been trying to take a more fun approach to PrEP education with a Taylor Swift-inspired ask at festivals: he questions if people are “in their PrEP era.” 

While most people will pick up the pop culture reference, many miss its linkage to HIV prevention. 

“A lot of these communities are not ready to have these conversations, so we’re trying to meet them where they’re at, so we’re not scaring them off,” Rascon said. “A lot of folks still don’t know what PrEP is. We get a lot of folks who didn’t even know this existed. They don’t know we have preventative measures now.”

Hedda Fay, community outreach manager for Northland Cares, keeps the medications on hand in case one of her Yavapai County clients needs it. She feels like she has to, she said.

“It is a challenge up here in a rural community because pharmacies don’t carry it and think, ‘Not in this community,’” Fay said. “Some people think we’re in this bubble and think it’s a big-city problem and not a rural problem.”

Fay said mistrust of the medical community is also an obstacle that is still profoundly prevalent among some ethnic and racial populations, such as Black and brown or indigenous communities. And those groups’ sensitivities require a nuanced approach. 

“We have resources for HIV to make it livable,” she said. “But if people don’t know about it, they’re still going to die.