Successes and Challenges Facing HIV Service Providers in Maricopa County
We spoke with Rocko Cook, outreach manager at the Southwest Center for HIV/AIDS in Phoenix, who was diagnosed with HIV in 2002.
Rocko Cook: I've been outreach manager here since last year and before that was director of prevention outreach since early 2017. Before that, I was in marketing, but prior I worked at the Columbus, Ohio, department of health as a prevention program manager, and before that I worked with AIDS Volunteers of Lexington, Kentucky.
The Southwest Center started in 1990 as Phoenix Body Positive, founded by Kirk Baxter. There weren't a whole lot of other services happening at the time, and he wanted a place for people to come and find others who were HIV positive. About five years ago, we became the Southwest Center because we were doing some clinical trials, and we also became an integrated health care center. We're right in downtown Phoenix, and our annual budget is $4.8 million.
Our clinic last year saw more than 8,000 people, and overall we outreach to about 30,000 people a year. Our client breakdown is 40% white, 38% Latinx, 17% African American, 3% Asian, and 2% Native American. The agency employs about 40 people, mostly white, with about nine Latinx staffers and five African Americans, including our entire medical case-management team. About half the staff is LGBT, with about four trans or nonbinary staffers.
Tim Murphy: What services do you provide?
RC: We have a wellness clinic with primary medical care, nutrition, a vitamin shop, medical case management mostly in conjunction with Ryan White, and a behavioral health team of counselors. I oversee prevention outreach, which has five different programs. One is the TEA (Teaching Education and Action) Mpowerment program for MSM ages 18 to 29. One is our PrEP program, which is the largest in the southwest. We see roughly 700 people a year at this point, and about 75% of those we first see opt into PrEP and stay on it for at least a month.
Then there is the IGNITE Your Status program, our most visible outreach arm, that goes out and does HIV testing and counseling in bars and other venues. They bring with them the Condom Bar, a signature thing of ours that has as many as 12 towers with three rows each filled with different kinds of condoms and lube. We give out about 10,000 condoms at Phoenix's monthly Art Walk.
Then we have Nice Package, our statewide condom distribution program, in which anyone can have 12 condoms sent to them once a month for free. We're also the bulk distributor for condoms to counties around the state. And then we have the TRANS navigation program for folks who are trying to figure out transitioning, for whom protecting themselves from HIV might not be the highest priority. So we try to bring harm reduction into it.
We also have free clinical HIV and STI testing Monday through Friday. We test about 10,000 people a year. Our primary care clinic is accessible for all, regardless of insurance or immigration status, then we figure out how to pay for it. Fundraisers by local organizations help us pay for anyone who can't pay for services, or we'll offer a sliding-scale fee.
Phoenix was the 11th city to sign on to the 90-90-90 pledge (to get 90% of people with HIV knowing their status; among them, to get 90% on treatment; and among them, to get 90% to undetectable). We do a Rapid Start program here, where our goal is to get someone newly diagnosed with HIV on meds as soon as possible, usually within 48 hours.
TM: What are the county HIV stats, and what's the big-picture headline?
RC: There are about 7,222 HIV cases in the county, about 3,537 of them white, 2,500 Latinx, 1,154 African American, and a small number Native American. Most of the cases are in MSM. Latinx cases are going up. African-American cases were going up but have taken a steep decline in the last three or four years. White cases have been going down steadily since 2009. In 2014, Latinx cases exceeded white cases, to the point of being up to 40% of all new cases in 2017.
I'd say the headline is that cases are still rising -- and we need to pay attention. Many Latinx people are afraid that if they access health services, their name will be put on a list [for immigration detention and deportation].
TM: What are you proudest of at your agency?
RC: Our PrEP program is one of the best in the country. When we do HIV and STD testing at the bathhouse, the person may be nearly naked, but we're drawing their blood and talking to them about PrEP. And our TEA program for young MSM is a very energetic, motivated group of young guys who meet several times a week in a beautifully done "safe space" where we show movies and play video games in collaboration with the Phoenix Gaymers. Also, our nutrition department is stellar. We have a fairly high homeless population, but if someone is on Ryan White, we can help them get food via gift cards to local grocery stores.
TM: Where do you feel frustrated or stuck?
RC: The agency once focused on gay, cisgender white men, and it's taken us a few years to really point the ship in the direction of the biggest need, which is MSM of color. We have limited resources and have to balance between taking on this new role while not ignoring the white population. Having said that, there are people of color–specific agencies in Phoenix, like Chicanos Por La Causa and Ebony House, which is primarily for African-American women.
TM: Where do you need more money?
RC: For outreach and testing at various community centers. For example, to reach Latino MSM ages 18 to 29, you have to go where they are, such as gay bars, but also where it isn't just them, such as shopping centers.
TM: Tell us some stories.
RC: We had a client, a young Hispanic MSM, who came into the center and tested positive, then was linked to services and received meds within a day or two, then became involved in the TEA group and found a kind of family and a home he'd never experienced before. So now he's getting certified to do HIV testing and has found a passion for reaching out to others, putting his own HIV status to good use. I'm also thinking of a client who was homeless and doing survival sex and came in and tested positive. We helped them address the root causes of being homeless, get a job, get connected to housing services, and get back up on their feet again.
Positive POV: Anthony
Anthony (last name withheld), 23, from Phoenix, is a nursing student and Southwest Center TEA member. He was diagnosed with HIV in 2018.
Anthony: I had a lot going on, and I wasn't taking my PrEP sufficiently and wasn't using condoms. I ended up getting a very brief but intense flu-like illness, so I decided I should get tested again for HIV at the Southwest Center, and it was positive. Even though I knew it might be HIV, I still couldn't believe it. I was so angry and felt like I was completely to blame because I'd gotten a little bit careless. I knew there was effective HIV treatment, but I still cried. I was in denial. I kept telling myself that it was a false positive because I'd just had the TB vaccine.
I got on treatment within three days. The Southwest Center did everything for me, told me about community resources, helped me get insurance, and provided me a place to mourn and cry. I live with my family and didn't want to be at home dealing with this. I didn't even tell them until I became undetectable. The only people who knew were the Southwest Center people and two friends. The center offered me counseling, but I was already in counseling with an outside therapist. I'm back in school for nursing; I want to be a psych nurse and help adolescents.
I've gotten involved in the center's TEA group, which has become like a brotherhood for me, a group of friends who support each other. It's all Latino and men of color, so I feel more comfortable there than I would in a predominantly white group, even though I'm light-skinned. We had an event recently with the Arizona Sisters of Perpetual Indulgence where we watched a movie -- whose name I forget -- about a guy dealing with his HIV situation. It was very emotional, and it sparked a conversation after, during dinner. The TEA group understands what I've been going through. We're a very sex-positive group as well. Not until I met this group of guys did I feel comfortable talking about sex. I trust them all.
TM: What's the HIV situation like in Phoenix?
Anthony: We have a lot of resources here if you're HIV positive or sexually active. There are so many free condoms, but it seems these days most people want to have sex without condoms, and PrEP has definitely played a role in that. I think we need more outreach to high schools. I wish I'd had more info when I was younger. I don't remember getting that.
TM: You were diagnosed less than a year ago. How are you doing overall, and what are your goals?
Anthony: I'm still trying to get more confident talking about my status. I don't mention it on my profile on the hookup apps. I'm not dating at the moment, but when I do, at what point will I bring up my status? I'm not sure. I also want to get more involved in the gay community. Being diagnosed with HIV opened up that door for me. And the more I talk about having HIV, the easier it gets.