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[00:00:30] John Salak: HIV still rages in the U. S. and worldwide. In fact, it's [00:00:36] estimated that approximately 1. 2 million Americans are infected and as many as 13 percent of these people are unaware that they have the virus. The good news is that infections are declining, down by more than 10 percent annually since 2017. Beyond this, treatments are more effective than ever, allowing those with the virus to live longer and healthier lives.

Yet, the HIV threat remains real, significant, and deadly. More than 30, 000 Americans are still diagnosed every year with the virus. Infections are all so [00:01:12] Still more likely to impact gay and bisexual men, as well as certain other racial and ethnic groups more than others. Finally, thousands are still dying from HIV.

In 2021, the last year of records, almost 20, 000 infected adults and adolescents perished. All this begs the question of why the epidemic has retreated from the proverbial front pages. It is probably a combination of factors, including the relative decline in infections and deaths, The growth in prevention awareness, the positive impact of new treatments, [00:01:48] and sadly that HIV in many ways has just become old news.

Unfortunately, this relative lack of attention is sad and potentially dangerous. While advances in the battle have been made, HIV remains a national and global threat, a threat that is all the more challenging because it remains shrouded by misconceptions and stigmas that all help to prevent the problem from being eliminated.

Our next guest is here to help us refocus on the problems, treatments, and solutions that may eventually eradicate HIV.

Welcome to this portion of What the Health. The best [00:02:24] portion of our podcast is when we interview someone with great insights and knowledge about important topics. And today we're speaking with Professor Angel Elgaran of Arizona State University. The Sun Devils based in Tempe.

We're talking about a very serious issue today. And really where public perceptions of that issue have evolved in the last well, 20, 30 years. And that of course is HIV and the AIDS epidemic. So I'd like to welcome Professor Algaren to the broadcasts.

Professor Elgaran, give us a little bit of background on your study and research focus.

[00:02:57] Angel Algarin: My major focus is on social [00:03:00] epidemiology and how stigma is a fundamental driver of HIV health inequities. Particularly, I mostly look at men who have sex with men and sexual and gender minorities specifically among Latinos.

[00:03:12] John Salak: And we're going to get into that in a little bit. I mean, the focus on Latinos, cause I think that's an interesting perspective for many people.

But there seems to be not as much general focus on HIV and AIDS, at least in the general population. At Would you agree with that? And if so, why?

[00:03:29] Angel Algarin: So generally I work with HIV AIDS every day. So for me, I get to hear about this all the time. I'm kind of in [00:03:36] my own echo room. But when I go out into the community I tend to agree with what you're saying. I think that conversations surrounding HIV have really lessened. And for some reasons that is a good thing.

Because it's no longer that pressing public health issue. And so by that I mean the reason I think that these conversations have lessened a little bit is because we have effective treatment for HIV. And so when people are living with HIV on their antiretroviral therapy to reduce their viral load they can live long and healthy lives with HIV. We also have other preventative [00:04:12] measures like pre exposure prophylaxis or condoms. Condoms are still effective, but pre exposure prophylaxis is a pill that folks that are at higher risk for acquiring HIV can take once a day to prevent the acquisition of HIV by more than 90 percent and some studies even estimate this to be as high as 99%.

So we have Effective biomedical interventions that are being implemented right now to reduce the HIV epidemic in the United States.

[00:04:42] John Salak: The group, was focused on men who are having sex with men or people who are picking up HIV from [00:04:48] infected needles. Are these groups as active as they used to be or as out in front? Is that a factor? The Advocates for Protection.

[00:04:55] Angel Algarin: I think that is a huge factor. We still have our advocates out there that are really driving these conversations that are part of the community and talking about HIV. And a lot of the times. There may not be on social media or they might not be interviews like like this one but they are talking within their communities and really leading those conversations for the people that need to hear those conversations the most.[00:05:24]

[00:05:24] John Salak: And that brings up an interesting point. For someone who wouldn't be in a community or demographic that may seem at high risk. Is it important that these individuals also be aware of , the continuing issue and problems surrounding HIV and AIDS? Or, it's obviously significant, but how significant, I guess, is what I'm saying.

[00:05:46] Angel Algarin: I think this is for two reasons. 80 percent of people living with HIV know that they're living with HIV in the United States. But that leaves a 20 percent margin of people that don't know that they're living with HIV . And so, [00:06:00] as part of one of the CDC's recommendations, it's recommended that people get tested for HIV at least once in their lifetime.

And then for other risk behaviors, you should be tested regularly. And so we should be having these conversations because HIV indeed affects everyone. It does tend to focus primarily on men who have sex with men who make up two thirds of people living with HIV or with new diagnosis in the United States.

more highly affects people who are injecting drugs. And so, It's important for us to have these conversations with everyone for the first part because people need to [00:06:36] get tested or should be tested, at least by recommendation. And then secondly, you may know somebody within your social network that maybe falls under one of these demographics.

And it's important to have these conversations of I want to have this conversation with you because you're somebody I love. And have you thought about using PrEP and having that open and honest conversation?

[00:06:57] John Salak: Are people still reluctant to get tested for HIV? Is there a stigma , around getting tested? And God, HIV, AIDS, I know they're incredibly serious, I'm not undermining it. People tend to not want to know if they're sick, or at least there is an element of people not wanting to know if they're sick in [00:07:12] general.

But when you Talk about something this dangerous. Does that also have an impact on why information awareness is so critical? Those are sort of two different questions.

[00:07:24] Angel Algarin: So, address your first question around is the stigma still there to get tested for HIV? And I still think that the stigma within getting tested for HIV is not so much the testing aspect of it, but it's the, if I am positive, that there's gonna now be this stigma against me because I'm living with HIV.

And in some ways [00:07:48] that stigma should really be unfounded because we now know that undetectable equals untransmittable and that people that are taking their antiretroviral therapy , if they're taking it effectively and taking it every day and they become virally suppressed, that they can no longer effectively pass on the HIV virus.

But still that stigma remains with people who are not living with HIV or maybe a little bit not as informed about the advances in HIV science.

[00:08:18] John Salak: Do you think people who are at high risk, they're obviously, I would assume, it's [00:08:24] always dangerous to assume, but I would assume people who are in high risk groups, are more aware of the dangers. Do you think that's accurate?

[00:08:31] Angel Algarin: I would say that for some that is accurate, and I think that reflects in who is accessing interventions biomedical interventions like pre exposure prophylaxis. When we're looking at some of the rates between the different racial categories. Those who are eligible for PrEP are people that have indications for a higher risk category for acquiring HIV.

Among those who are white, 78 percent were actually prescribed pre exposure prophylaxis. [00:09:00] But when we're looking at our African American and Black population and our Hispanic Latino population, only 11 percent of those who are eligible for PrEP and 20 percent of those who are eligible for PREP respectively were prescribed pre exposure prophylaxis.

So there you can see an over 50 percent difference of who is accessing PrEP, and I think that some of that disparity is made up because of the lack of health communication efforts that target these populations.

[00:09:30] John Salak: That's obviously part of the focus of your work or one of the projects you're working on. Really addressing the intersectional [00:09:36] stigma through coping and resistance and resilience to various products.

Is that a function among other things of economic disparity too? And health care and how that relates to health care for those groups.

[00:09:48] Angel Algarin: Yeah, I would say that economic disparity definitely does have a stigma attached to it but in this project we're primarily focused on identity based. We're really looking at how sexuality, how masculine presentation and how racism may intersect to create more deleterious environments for people to access HIV [00:10:12] biomedical interventions such as pre

[00:10:13] John Salak: Can you boil that down a little bit more for the layman?

[00:10:17] Angel Algarin: Yeah, for sure. So we're really looking to see how Your different social identities can make an environment that is either more beneficial to you or less beneficial to you. So if I am a black gay man going into a healthcare setting, I have the opportunities to be stigmatized against because of my race or because of my sexuality.

And there may be even a heightened sort of affects that scenario because just [00:10:48] historically, the sexuality stigma that occurs among the black population, those cultural nuances, may even be heightened among black men who have sex with men, versus if somebody who is White and heterosexual was walking into their doctor's office.

They don't really have to worry about facing stigma due to their sexuality, and they don't have to worry about facing stigma due to their skin. And so, these are the types of things that we're starting to look at and break down.

[00:11:15] John Salak: Your work specifically references the Latino community. I'm assuming you're saying that might be the same for an African American male or anyone in an [00:11:24] African American community and a Latino male. Is that fair to Say, or is there differences?

[00:11:28] Angel Algarin: Yes, I mean, I would definitely say that there are differences just based on the nuances of the different sort of cultural aspects, but largely the racism that Black and African American and Hispanic and Latino folks face are operationalized similarly, but on different cultural aspects.

[00:11:47] John Salak: People make great mistakes assuming there's one single Latino or Hispanic culture. Obviously there isn't. There's a same thing with African Americans, but within the African American Culture, and that's large.

And within, , the Latino culture or [00:12:00] Hispanic culture, are there cultural elements that make it even more difficult within those communities to address or deal with HIV or AIDS?

[00:12:09] Angel Algarin: Yeah, 100%. So we're talking about black and African American folks, the wrongdoings of previous scientists medical professionals have really had longstanding effects on black and African Americans trust in our medical system. So when we look back at the Tuskegee trials and really one of the examples of how our medical community had failed the black and African American community.[00:12:36] It's no wonder that this still continues to linger and black and African American folks continue to mistrust our system. Also, when you look at the medical professionals that continue to make up our workforce it's primarily people who identify as whites, And so they don't have maybe somebody who looks like them, who understands and has lived those cultural experiences that is talking with them within their office.

And so I think that's also another large asset. Aspect of that, that also breeds medical mistrust among this population. We're talking about Hispanic and Latino [00:13:12] folks. We also talk about different cultural aspects primarily too when we're talking about language proficiency and, having materials and providers that are able to effectively communicate in Spanish with people who identify as Latino, that's just one of the many aspects, but,

[00:13:30] John Salak: Within these communities in general, is there more stigma attached to being HIV positive than there would be, let's say, in a white community?

[00:13:40] Angel Algarin: I would say, it depends on your social surroundings, but there has been evidence to show that among black and African American [00:13:48] communities when really looking at the heavy involvement in the church and a lot of these studies have happened in the South that there has been suggestions that this attenuation of religious affiliation and HIV status may be having some sort of an impact and really attenuating the effects of HIV stigma and the stigma that these folks are feeling.

[00:14:09] John Salak: So that's an incredible challenge for these individuals to face. Not only just Dealing with the potential disease, but dealing with the cultural barriers or challenges they face within their own localized communities.[00:14:24]

[00:14:24] Angel Algarin: A hundred percent. I think this is just something that anybody could really resonate with is when you're thinking about your church community, these are the people that you love, that support you and that you feel really supported in this environment if you're going and then now you have an HIV diagnosis and you're hearing from the pulpit or perhaps from other folks within the church the people that you knew and that loved you and, you have this sort of internalized like, Oh, I can't come out as living with HIV and share this message of, prevention or going to get tested and why that's important because you don't want your [00:15:00] support system to now deteriorate.

[00:15:02] John Salak: We see, or at least from the statistics I've seen, and these perhaps may be a little dated, there's about 40 million people worldwide who have HIV and we've also seen infection rates decrease in the U. S. at least recently in the last seven or eight years. One, do you believe those statistics? Do you think they're accurate? Do you, and we see also a balance of, I think it's black and Latino communities, have disproportionately high infection rates compared to white community.

Are those figures accurate? And if so, how do they play into all of this? So I guess there's two questions. Do we see [00:15:36] infection rates decreasing? If so, why? and is the balance shifting into these other communities in terms of disproportionately dealing with a disease?

[00:15:45] Angel Algarin: Yes, in general the HIV rates in the United States are decreasing. But the question really lies in for who? And so I would say that the one of the primary reasons that HIV rates in the United States are decreasing is really with the advent and the continual improvement of access to pre exposure prophylaxis, which I mentioned earlier.

But really [00:16:12] we're talking about who is able to access that. And when we look among men who have sex with men, because that's the population that I work with the most we're really seeing a large decrease among white men who have sex with men. But also at other studies, we also see that white men who have sex with the men also have greater access and use of pre exposure prophylaxis.

So that kind of makes sense, right? But when we're looking at black and Latino men who have sex with men, their rates continue to remain stable. And so, that's why I say the question needs to shift from overall, [00:16:48] are we are we seeing decreases to who are we seeing decreases among and who are we not? Actually one really.

It's a sad statistic, but really surprising statistic is that in our latest 2023 report in Arizona, we've seen a 20 percent increase in new HIV infections. And so, the data is still coming out about who is making up that increase in new HIV infections, but even regionally, we're seeing disparities.

[00:17:16] John Salak: You're saying in Arizona, it's been reported there's been a 20 percent increase in overall HIV infections. And that's over [00:17:24] what a

[00:17:24] Angel Algarin: new HIV infections.

[00:17:25] John Salak: over the last

[00:17:26] Angel Algarin: Yes, since the over the last year. And one of the reasons that they say that this may be occurring is just due to the the way that COVID had suppressed people from coming in to get HIV testing. Now that COVID is starting to ease that perhaps HIV testing has increased.

So, because people are testing more that we may be catching more infections, which is a great thing for, so we can get people on antiretroviral therapy, but we still need to unpack those, and I think because we've seen this higher number, our state and local health departments will be looking into that.

[00:17:59] John Salak: [00:18:00] I would suspect if you see these numbers in Arizona, you're probably seeing them nationally, too. I mean, there wouldn't be any reason we'd see it, maybe to the same extent, maybe to a lesser extent, but it'd be unlikely we'd see a rise in Arizona and not a rise elsewhere for those reasons that you're saying.

[00:18:15] Angel Algarin: Yeah, so I'm really interested to see when the other numbers for the other states come out. I just am really on top of the Arizona numbers,

because

[00:18:23] John Salak: of course, where

[00:18:24] Angel Algarin: yeah, of course.

But when, once the, those other data come out, I would be really interested to see, and probably one of the things that if your listeners are interested, is to keep an eye on.

[00:18:35] John Salak: What about [00:18:36] the social stigma surrounding HIV, how has it changed, but is it a significant change from 5, 10, 20 years ago or is just that we have better treatment, better prevention, a little better awareness so that it's lessened.

[00:18:51] Angel Algarin: Yes, so I would definitely say that it's changed, and really for the main reason that five years after the first discovery of HIV in the United States, people really saw HIV as living with a death sentence, that HIV was just very dangerous.

And even 10 years out, 15 years out, even till now, we've made such [00:19:12] advancements in understanding and creating effective antiretroviral therapy treatments. And also understanding that people living with HIV, when they're on these treatments. And they become undetectable and are vitally suppressed that they can't transmit this virus to other people.

And so, I would say that these sorts of messages and these scientific understandings have really lessened the stigma among people living with HIV. But stigma still remains because while us scientists can sit in our office. And come up with these scientific advancements. It's also important to be able to effectively share these advancements [00:19:48] and this knowledge with communities.

And so, I would say that the majority of the people that I am around probably know that you equals you undetectable equals untransmittable. Full message that this is not really well understood among the general US population. It is probably one of the largest reasons why HIV stigma continues to persist.

[00:20:10] John Salak: Do you see a rise in anti-gay attitudes given some of the other rises we see and do you see that having any impact on. Stigmatizing people and then stigmatizing those with HIV.

[00:20:22] Angel Algarin: Yeah, I would say [00:20:24] this is more anecdotally, I mean, I identify as a gay Latino scholar. But I would say that there is a bit more a fear of being in public places. But I don't feel comfortable making any scientifically based

[00:20:39] John Salak: no, that's that's fair enough and anecdotally Do you see the students coming in? Are you teaching in your interaction with students? How do you perceive their attitudes? towards HIV

[00:20:51] Angel Algarin: I get to teach it's a culture and health course, and I really love this course because I get to teach our next generation of nurses. I'm in the College of [00:21:00] Nursing and Health Innovation at ASU, and to be able to talk about and break down culture and why it's so important to acknowledge in the healthcare setting it's really wonderful because you get to see the advancement of that first essay or that path.

first short response that students get to write and learn about their perceptions and how their own personal perceptions and their own cultures influence their viewpoint of the world. And then by the end of the course, they get to talk about how Those viewpoints still remain, but that they accept that their viewpoints perhaps are different from other [00:21:36] cultures and how they can separate those two things and still be able to provide the best care possible for people of different cultures.

[00:21:44] John Salak: Is this this type of course fairly common in nursing and medical programs across the states or is Arizona State sort of out in front on this?

[00:21:53] Angel Algarin: would like to say that Arizona state is out in front of this, right? Cause we're number one in innovation. And this is in the last 10 years. And but it should be, and I think it's becoming more common practice that having these courses on culture and health are occurring.

And I hope that they continue to ramp up and [00:22:12] become more accessible to our upcoming health force.

[00:22:17] John Salak: If we have this conversation in 5, 10, 15 years. How would it differ? How would your answers differ? Do you suspect?

[00:22:25] Angel Algarin: like to think of myself as an optimist, I, but with a little bit of pessimism healthy pessimism, right, we have all the tools that we need to effectively end the HIV epidemic, but we're not reaching the people that perhaps need them the most. And I think one of those large barriers is stigma.

I am hoping within the next 5 [00:22:48] 10, 15 years that we've gotten really close to ending the HIV epidemic. Like getting people. Over 95 percent of people tested and knowing their HIV status and 95 percent of those people who know their HIV status are on antiretroviral therapy. And then 95 percent of those who are virally suppressed.

And so, I think once we reach those goals, then we can really start saying that we're effectively ending the HIV epidemic. I'm not sure about cure research. And we've been trying for such a long time and [00:23:24] that's kind of outside of my scope, but I tend to like to focus on the tools that we have now and we Really could end the HIV epidemic if we really put a strong force in what we have right now and getting it, those interventions to the people who need them.

[00:23:38] John Salak: I think I got this clearly. This is what you hope will happen in 5, 10, 15 years. Five or ten years I think you're step towards ending HIV by 2030. Do you think that will happen? And what do you think will happen?

[00:23:53] Angel Algarin: So I think the ending of the HIV epidemic by 2030 is a lofty goal. Do I think it will happen by [00:24:00] 2030? Realistically, I do not think it will happen by 2030. But I think it is something that we should be continually striving to. And I hope I'm proved wrong.

[00:24:10] John Salak: What are the biggest misconceptions as a culture, as a whole when we look at HIV, or the epidemic?

[00:24:18] Angel Algarin: I think two big things is that, well, I guess three big things. One is that people living with HIV can't live long and healthy lives. People can live long and healthy lives. It's no longer a death sentence. I [00:24:36] think the second big thing is that only certain people are getting HIV.

And that's not necessarily the case. Anybody who is engaging in HIV risk behavior, such as sexual contact without a condom whether they are injecting drugs with not clean needles are at risk for acquiring HIV. So it's not only men who have sex with men. It's not only people who inject drugs.

It can also be at risk heterosexual. So we need to be broadening that conversation. So folks know that if they are engaging in HIV risk behavior, that they should be getting tested. And then [00:25:12] lastly, the other misconception that continues to linger today is that sometimes people look at other folks and they say, Oh, I think that person is living with HIV just based off of the way that they look. You can't tell if somebody is living with HIV just by the way that they look.

That's why it's so important for folks to go get tested because then you actually have that confirmation of whether you or that other person is living with HIV

[00:25:34] John Salak: How does someone get tested for HIV? They can obviously go to their doctor and ask for a test. Are there other ways? I mean, you're not going to do a home test. I realize that. But is that the best way?

[00:25:44] Angel Algarin: There are a lot of really great community resources [00:25:48] in all communities in the United States. So, here in Arizona, we have, I would say three or four different great organizations that provide free HIV testing. It's as probably easy as going into your, Google and typing in free HIV testing around me and you'd be able to find plenty of community resources to get those free HIV tests.

Another great way, if you're already in with your doctor and and you haven't gotten an HIV test, talk with your doctor about Hey, I would like to get an HIV test. Even if you've never gotten tested the CDC recommends that you get tested if you don't feel comfortable with talking to your [00:26:24] provider about HIV testing or sexual health or these other sort of, I would say, maybe taboo subjects maybe it's time for a new provider.

You should want to talk to your provider and your provider should want to talk to you about these topics. So, definitely don't feel uncomfortable bringing this up with your provider.

[00:26:40] John Salak: Okay. Professor Algaren, thank you very much for this. Ultimately, we see positive developments on this even though there's a lot of work to be done?

[00:26:51] Angel Algarin: I would say ultimately, yes, there are positive developments in this front, but there is a lot of work to be done in who is accessing and who is able to [00:27:00] access these positive developments.

[00:27:01] John Salak: Professor. I will let you get back to the enjoy the warm weather of Arizona but thank you very much for Giving us some real profound insights on where we are today and how stigma still affects our ability to Keep this epidemic under control.

[00:27:14] Angel Algarin: Thank you so much for having me.

[00:27:16] John Salak: Before we move on, we want to again encourage listeners to take advantage of the hundreds of exclusive discounts WellWell offers on a range of health and wellness products and services. These cover everything from fitness and athletic equipment to dietary supplements, personal care products, organic foods and beverages, and more.[00:27:36]

Signing up is easy and free. Just visit us at WellWellUSA. com, go to Milton's Discounts in the top menu bar, and the sign up form will appear. Signing up will take seconds, but the benefits can last for years.

So, the most important thing to realize is that there is no cure for HIV, but there are ways for individuals to protect themselves and to help stop the spread of this deadly virus. First off, HIV testing is critical for everyone, but it is especially essential for those in high [00:28:12] risk groups. Testing will not only identify those infected so they get treatments as soon as possible, it also helps eliminate the possibility of unknowingly passing on the virus to others.

Personal awareness of the risks, precautions, support, and treatments available is also an important component in the battle against HIV. Knowledge, as always, is power. And while there are no cures, treatments now exist that can reduce the amount of HIV in a person so they can lead a healthy life. And that's good news.

[00:28:48] Finally, emotional support systems are also available, which can make dealing with infections, treatments, and long term care easier and more effective. The bottom line to all this, this is not the time to dismiss or shy away from the ongoing battle against HIV. Well, that's it for this episode of What the Health.

I'd like to thank Professor Angel El Gharan. of Arizona State University for his time and critical insights on the HIV battle. For those wanting to learn more, there are numerous online sources of information, including the Centers for Disease Control, [00:29:24] the HIV. gov website, the World Health Organization, and many more.

So, thanks for listening, and we hope you'll visit us again soon for one of our upcoming episodes. [00:30:00]