I grew up in Arizona, and although I've not lived there in over 30 years, it still holds a place in my heart. The state's famous for the Grand Canyon, scorching eggs-cook-on-the-sidewalk summers (but it's a dry heat!), radical Republicans (Goldwater, McCain, and that crazy Trump-loving Sheriff Arpaio), and the best Mexican food this side of the proposed border wall.
But you don't hear a lot about Arizona when it comes to HIV.
I guess that's because the focus is always placed on major cities and regions, like the South, that have big jumps in HIV infection rates. Following national trends, the rates of HIV infection in Arizona are rising among Latinos, American Indians/Alaska Natives, and African Americans and are much higher among men who have sex with men. According to the Arizona Department of Health Services, Arizona has over 17,000 people living with HIV in the state (as reported in 2016), with infection rates jumping among minorities and over 85% of the HIV-positive population being male.
I recently reached out via phone to the folks at the largest AIDS service organization in the Arizona, the Southern Arizona AIDS Foundation (SAAF), to find out how they're combating HIV in the Southwest. SAAF (which they pronounce as "safe") is located in Tucson, which is about 107 miles southeast of the capital city of Phoenix and home to the University of Arizona.
Since I didn't know anything about the organization, I asked executive director Wendell Hicks for a little background. "Like many organizations, SAAF started out very grassroots," he said. "In 1997, three organizations that were non-profits, the Tucson AIDS Project, PACT for Life (which was the People With AIDS Coalition of Tucson), and Shanti, merged." These organizations had been providing separate services to the community since the beginning of the AIDS crisis. "The three organizations merged in order to better serve the clients," Hicks said.
Program director Luis Ortega added, "I think that the history of these three organizations merging together is quite rare. They really looked at how they could combine resources and reduce overhead and create a system for clients to reduce barriers for them." Ever since they merged into SAAF, they have been striving to serve people living with HIV, as well as leading HIV prevention efforts and HIV education in the state.
While SAAF is based in Tucson in Pima County, it has offices all over the state. "We have offices in Tucson, obviously, and we have offices in Bisbee, Arizona, which is about two hours southeast of where we are. We also have offices in Yuma and Flagstaff," Ortega said, "so we're really covering a large portion of the state."
Despite the numbers of Latinx in Arizona with HIV, only 32% of SAAF clients identify as Hispanic. Fifty percent identify as white, 13% black, and the rest comprise Asian, Pacific Islander or Hawaiian, Native American, Alaska Native, or multiracial/other. SAAF is currently working on a strategic plan for 2018-2021, addressing the disparity. "We're looking into why Latinos aren't coming to our agency and what are we doing to reach them," Ortega said.
Hicks added, "We are so close to two Native American nations, and we're so close to the Mexican border. That has a great impact on a lot of the things that we do."
With the current presidential administration's stance on immigrants, undocumented people needing HIV care might be frightened to reach out to a service organization like SAAF.
Ortega said that SAAF doesn't turn people away. "As long as they are residents of Arizona, we can treat them," he said. "We don't request or need any type of proof of citizenship or legal status." He continued: "That's a message that's sometimes hard to get out and into the community. We know that folks who are undocumented don't seek out services. They're scared that INS [the former U.S. Immigration and Naturalization Service] is going to come knocking at their door, you know? But it's not a barrier to receiving HIV care from organizations [like SAAF]."
Like a lot of AIDS service organizations around the country, SAAF provides its racially diverse clientele with more than just HIV testing and services: It helps with housing, food services, case management, support groups, and more. It also has one of only two needle exchange programs in the state, open three days a week providing clean needles and behavioral health services.
"Oh my God, it's a word of mouth thing!" Hicks said. "The first year [I was here], I think we gave away over 178,000 new syringes. People come from around here, but also from literally two and three hours away. We'll serve anyone, regardless of where they live."
SAAF has also created a drop-in center, to which people can come out of the scorching Arizona heat.
"We serve people who are homeless, who are on the streets," Ortega said. "We want to give them the tools they need to stay healthy, but we also need to understand that they need to be hydrated, they need to come in out of the heat for an hour or two. So, we have a small drop-in center. There's a couple of computers [for clients to use]; there's water; they can relax for a little bit."
"It's really about building trust with our clients," Hicks added.
SAAF also partners with the local behavioral health organization, making sure that representatives from agencies are onsite to connect people with treatment and services right away, for those that express the need.
Another amazing part of SAAF's mission is its commitment to HIV prevention and education and outreach to Arizona's youth. In a conservative state such as Arizona, it's been a challenge to get schools on board with HIV and harm reduction programs.
"We expect initial pushback," Ortega said. "A lot of it has to do with relationship building, building trust, making sure we're not going to go and do something that parents are going to be up in arms about." He continued: "There's a fine line. But ultimately, it's about finding someone who will advocate on our behalf to the administrators of the school." In the last year, SAAF has been able to expand its reach in schools, providing programs to youth ages 13-17 in both charter and public schools.
"Our programming has expanded to include other things that affect people's decision making," Ortega said. "Suicide prevention, substance abuse prevention, sexual assault prevention work, it's a variety of topics, sometimes." But it's also a way to talk about sexual health and HIV prevention, provide HIV testing, and even provide access to condoms and pre-exposure prophylaxis (PrEP).
Another aspect of SAAF's outreach has been its recent acquiring of the LGBT community center. "They were at risk of closing, and so they approached us about an acquisition, and so we did that at the end of 2014," Ortega said. The acquisition expanded SAAF's reach further into the community.
"When we took over the center," Hicks explained, "we did a lot of focus groups to see what the community needed and would support, and what we found was, we've really got to take care of these kids." They created an LGBTQ youth center as a safe place for kids to drop in, do homework, be creative.
The center is also looking into providing therapy and other psychiatric treatments to the community's kids. That way, any issue that a kid may bring with him or her to the center, whether it's sex, HIV, drug or alcohol issues, etc., all those problems can be tackled immediately, right at the center.
"We're looking forward to collaborating with behavioral health organizations to provide other programs that we don't have," Hicks said, "and I think it goes back to the foundation of who we are. SAAF is courageous enough to put people's self-interests aside and say, 'What's best for our client?'"