This week on Nevada Week , in recognition of World AIDS Day, we explore the efforts underway to reduce startling HIV statistics in the Silver State.

♪♪♪ Support for Nevada Week is provided by Senator William H. Hernstadt.

Welcome to Nevada Week .

I'm Amber Renee Dixon.

According to the state's Ending the HIV Epidemic Plan, Nevada has the highest rate of new HIV infections in the western United States.

Additionally, the CDC estimates that only 41% of Nevada's population has ever been tested for HIV.

Joining us with perspective on those statistics and on this year's theme for World AIDS Day are Antioco Corrillo, Executive Director at Aid for AIDS of Nevada or AFAN, and Dr. Rosanne Sugay, a physician with UMC's Wellness Center.

Thank you so much, both of you, for joining us on this important topic.

Dr. Sugay, in a conversation that we had off camera, you stressed the importance of differentiating between HIV and AIDS.

And that's where I want to start.

Why is that important?

(Dr. Rosanne Sugay) So it's really important because I still get patients who come to me when they're first diagnosed, and they're talking about, Oh, I have AIDS, and I'm going to die.

And it's different.

So HIV is actually the virus that somebody acquires.

And it doesn't necessarily mean that you have AIDS.

So AIDS is what happens when the HIV virus starts to attack the person's immune cells.

And when the immune cells of a person drops low enough, they're not strong enough to fight off other infections and other conditions.

And that's when you get AIDS or Acquired Immune Deficiency Syndrome.

-And the danger in someone coming to you and saying, I have AIDS, when they simply have HIV at that point and they think it's an automatic death sentence, what is the danger in that?

(Antioco Corrillo) The danger is anxiety, depression, and all kinds of mental health issues that are seen specifically because their life changes automatically.

Many years ago in the 1990s, I used to be the crisis manager for-- -Right.

- --the testing center, where anybody was tested positive, they used to send them to us because I used to do therapy.

And it was all about, I have AIDS, this is a catastrophe, my life is over.

And it was only a diagnosis.

It was only they were exposed to the virus, you know, a year before or six months before, and you were able to manage all of that.

But the perception has always been, you know, This is-- This is the end, I'm diagnosed with HIV, and now I have to look at all those movies that we used to have, like Philadelphia , and I'm gonna be in a wheelchair, and I'm gonna... That was what was happening in their mind.

And still, in a lot of people still, that's a possibility.

And then the other thing is, is guilt and shame-- -Right.

- --because, I did something wrong.

I brought this on myself.

And as we know, you know, that's part of, you know, understanding and adapting into a new reality until everything is addressed.

-It is no longer a death sentence.

The CDC reports that in 2020, Nevada's HIV diagnosis rate was the fifth highest in the country.

Why is Nevada ranking so high, Dr. Sugay?

-We have to recognize this endemic of other sexually transmitted infections to add to your statistics.

Nevada is number one for syphilis, or in the '22-'23 for gonorrhea and chlamydia.

And so, you know, all those sexually transmitted infections, you get one, it's a little bit easier to acquire a different infection.

And we know that social determinants of health push some of that.

We've seen it as well with COVID, where we know that education, homelessness, poverty, lower income levels all contribute to higher risk for acquiring these infections.

-And those are all present in Nevada.

-Correct.

-Anything you would add to that as to why Nevada is so high?

-Well, it-- Specifically, I think there is a little bit of stigma and, you know, people still reluctant to get tested.

You know, they find that there is stigmatization in all the census.

It doesn't apply to me, you know?

My behavior is my behavior.

It doesn't apply to me because I'm not gay or because I'm not a drug user or because I'm not...

Some of that also still keeps people from getting tested.

To me, I think that that's part of the challenge that we see is that people are not thinking of getting tested, you know, when it's important like for the rest of individuals.

It should be like-- Getting tested should be like-- -Like getting a colonoscopy or a mammogram?

-Exactly.

-It's standard screening.

It's actually a USPSDF standard screening to screen everybody for HIV at least once in their lifetime from 15 onwards.

-So why is it not happening in Nevada like it is in other states?

-It's the stigma.

I mean, I don't know.

In terms of pregnancy, it took us a while to get pregnant women-- -Tested.

- --to kind of get tested, right-- -Yes.

- --and to pass the regulations and all those things because of the stigma.

People don't perceive themselves to be at risk.

-Right.

I mean, we've done focus groups on this, and it's patients don't see that they're at risk.

And then there's this added layer of, I don't want to find out I have AIDS, because, again, the whole difference between HIV and AIDS.

But this fear that, You're gonna give me a diagnosis and I'm going to die and I don't really want to know about it, so... -It's best if I don't know.

-It's best if I don't know, yeah.

-So then the education, is that not the same in Nevada as it is in other states?

I'm still trying to figure out why Nevada.

-Why Nevada?

-Yeah.

-So if you look to ending the HIV epidemic, the federal government actually targeted 48 counties where more than 50% of new HIV infections are found every year, right?

So Clark County is one of those counties that they targeted.

But what you see is most of them are actually kind of in the southern states as well.

And education does matter to the highest risk populations, and the highest groups of new infections are young adults.

And so if they don't know what their risks are, they're not going to do anything to mitigate those risks.

-I teach at the university, and I teach undergrad.

And I asked individuals about the risk factors, and, inevitably, every single one of the students has had a risk factor over the last six months.

And they don't see what we saw, and they don't see the challenges that we used to have before we had the medication, so they don't think about that.

And I asked them about, you know, what the risk factors are, unprotected sex and, you know, all those things, and they're like [shrugs shoulders].

And we're talking about people in their 20s.

-Right.

I mean, they've said, I mean, we've-- When I've talked to students, it's, Is that even still a thing, HIV?

-Really?

-Yes.

-You brought up the medication.

How well understood do you think it is that there is medication to prevent HIV?

-Well, it's not well known outside the community that has been affected.

You know, we're talking about PrEP, pre-exposure prophylaxis, right?

-Right.

-And we're talking about ensuring that people that are not HIV positive take pills to reduce the risk.

But we're not talking about allowing people to behave the way they're gonna behave, because they're gonna behave the way they want to behave, it doesn't matter.

We're talking about ensuring that people have the option in different layers of protection during-- in their own lives.

And the challenge that we have in the community at large is that if you start-- If you're not HIV positive and you start taking those pills, that means you're doing something, you know, dirty.

That means you're engaging in some behaviors that maybe you shouldn't.

And in a matter for public health, we believe that that's just increasing the layer of safety that anybody can have.

-Definitely.

There's no downside to offering all various options for prevention, right?

So I kind of liken this to birth control pills or birth control, right?

There's different methods of contraception, and you-- some it's don't have sex at all, and for some it's get a depo shot.

And so in HIV with PrEP, we also have those tools, right?

And in fact, now we even have a long-acting injectable treatment for PrEP that just came out.

-Yes.

-Which just increases options for patients.

-Yeah.

And it's a stigma.

-Well, the stigma that if you're taking it, you're doing something wrong?

-Absolutely.

And we know-- And, you know, in the past, I've had board members that when we talk about that, it's like, Wow, we don't want to talk about that.

And it's, But that's a matter of public health.

That's like, Wait a minute, you're giving them license to do other things.

No.

And then I give them examples of zero count and clients and couples that we have.

But one is HIV positive, one is HIV negative, and you want to be able to make sure that both of them are protected on top of using condoms and protection, that the other layer of protection is the medication where in the event of an accident, then the other person is not at a risk of getting HIV.

-I have a friend who takes PrEP, and he has insurance, thankfully.

If he were not to have insurance, would he be able to afford this?

-Yes.

So the federal government actually has something called "Ready, Set, PrEP," which navigates patients to have access to medication.

They just need to be able to ask for it.

-How do you go out doing that?

-You can ask any-- -And you get it for free?

-Yes, you get access to it, and you get it for free.

You can-- If you want it, it's available to you.

Our challenge as providers is that-- -Having patients ask or having the providers offer it to the patients who need it?

So that's the other piece.

-Right.

Why is it not being prescribed at the rate it should be?

-Because this is recently a new phenomenon, right?

Recently, we're talking over the last few years.

And we always feel that we are behind the times with the rest of the country for whatever reason, because there's not a lot of providers, there's, you know, all kinds of things.

But we do know that if we had the opportunity right now to end the epidemic, we could do it.

If everybody that has a level of risk of being infected begins to understand what PrEP is and how that can change his or her life, we can do this.

We can end the epidemic as we do it now, right?

-Right.

And on the other end of that spectrum, if people who are living with HIV actually get tested and identify that they have HIV early, we can get them on treatment, which improves their health outcomes.

But also now we have this concept of u equals u, undetectable is untransmittable.

So we know that patients who are virally suppressed cannot transmit their virus with or without condoms to their partners.

-Wow!

-That's the added prevention layer.

-The theme for this year's World AIDS Day is, quote, Putting Ourselves to the Test: Achieving Equity to End HIV.

So it's encouraging people to globally unite and eliminate the disparities and inequities that create barriers to HIV testing, prevention, and access to care.

What inequities, if any, exist here in Nevada when it comes to HIV, Antioco?

-Well, There's always a constant assessment of the services we provide with our community partners, with their funders.

And it's always about trying to ensure that we reduce any barrier, whether it's, you know, an office that is open 9 to 5, and people, you know, are not able to access services because that's when they work, and modify and things like that, whether it's having information in other languages other than English and Spanish and Tagalog, other languages that-- We are an international city, so we have clients that speak almost any or every language that you can possibly imagine.

And so ensuring that the information gets to the communities that really need it, the African-American community, the Hispanic community, and ensuring that they have access to not only the information, but also services in their communities.

And I think that we have not been able to achieve that, which is the opportunity that we have as we move forward.

-Right.

And so we know that there are disproportionate share of populations who are infected with HIV.

12% of our general population in Nevada are black, and yet almost 40% of new HIV infections are in that population.

And so again, this is increasing access points, improving education, and, again, all those social determinants of health.

We know they matter.

We know that income levels and poverty levels and things like that will impact patient's health.

-And access to care.

-And their access to care.

So we're fortunately.

We're an expanded Medicaid state.

So that certainly helps, but having healthcare coverage does not equate to having access to providers.

Nevada is doing what it can.

We are now testing at all our Quick Cares, so patients just need to ask for the test or schedule an appointment for HIV screening.

And it's a point-of-care test; you'll have an answer in a minute.

-Will you tell me that again?

"Healthcare coverage does not mean..." What did you say?

-Access to care.

So just because I have Medicaid doesn't mean I'm gonna get to see that doctor in a day, right?

So-- -Why?

-Because of scheduling conflicts, because of lack of transportation, because of accessibility.

-Nevada, we're number 48 for physician to resident ratio.

So the number of providers we have versus the number of people we have in our population, we're number 48 in the US.

-Will you talk about the Latino population being affected by HIV in Nevada?

How prevalent is that?

-It is.

I think the percentage is in the 30%, right?

-Yeah, it's about 25-30%.

So it's still a little, again, disproportionate share.

Still a little bit higher than the general population for Latin folks.

-Obviously it's mistrust, it's mistrust to pass, you know, government, you know, imposing or finding their status about immigration or anything like that.

It's a variety of reasons.

But the other one that I find always the more common is the lack of, you know, information in Spanish for the community, in general.

We still get people that come, and they still think that, you know, HIV does not affect them because, This is a disease that affects only Americans, white people, not the Hispanics.

It doesn't affect us.

-Really?

-Yeah, there's still that stigma, especially immigrants.

And so a lot of information in Spanish that should be just blasted out into the community, that is part of what we're looking at.

And unfortunately, the prevention message or the prevention methodology has changed.

And the idea of doing and sending HIV prevention messages as we used to do it in the '90s doesn't happen.

It just, now prevention is about treatment.

It's about medication, right?

-Correct.

-I want to make sure we touch on the stats from 2020.

The CDC says to exercise caution when you're looking at them because of what COVID did to access to testing and care and services.

What did you notice?

How did COVID impact HIV in Nevada?

-So definitely, we had to close down testing in a lot of places in the community.

And you're going to see the stats in Nevada.

We're usually at about, on average, 450 new cases of HIV a year.

More than one a day, right?

And you will see that drop in 2020.

We were under 400 cases.

And that's-- I wish I could say it was because we did a whole lot of good in terms of prevention and treatment, but I think it's because people weren't testing.

You don't test, you don't find it.

-Yet, Nevada was still fifth in the country in 2020.

-Yes.

-And the risk factor is still there.

They were still there.

And let's not forget a lot of what we're seeing in the clients that we have and the low socioeconomic status that they-- where they are.

People that are on the verge of being homeless, people that are having problems with the-- with the crisis that we have right now in terms of housing.

You know, we get clients that come to the office, and they don't have an address.

So we can't reach them.

And, you know, our focus has always been to get clients into the system and to ensure that they stay within the system, that they don't fall out of care.

And that is-- That was particularly challenging over the last two years when we faced a lot of the challenge of the COVID, right, because we couldn't track them.

They were not able to come in.

And if we open-- If we offer services online, or however we did it, they don't have a phone.

They don't have a way to just do what we want.

So those are the-- -Or even a private space to talk.

So we offered telemedicine when COVID hit, and it's-- It was still, I don't have a private space to talk, and, again, the stigma layers into it where, you know, they don't want to disclose their status to whoever else is at home.

And so there are all these challenges.

-How much of a step back did we take in terms of HIV progress because of COVID?

-I don't want to make predictions, but I do know that we really have to catch up over the next couple of years.

We really need to start working a little harder to ensure that we were at the pace that we were before COVID.

-Correct.

-Correct, okay.

We talked about men who have sex with other men being the population that is most affected by HIV.

But there is another demographic that is being impacted, and that is African-American women.

Why?

-So again, disproportionate share of population.

Even in the men who have sex with men, black men are also very high on that list.

Like I said, 12% of the population versus 40% of new infections.

And so when you think about communities you trust and the social networks people have, that is where some of that transmission occurs, right?

-We need more providers that are African-American.

We need more providers that-- -So there's the trust in the community, yeah.

-Yeah, that they can trust.

And unfortunately, we're not able to just, you know, all of a sudden, just, you know, have contracts where people that can open clinics in places with a population of African-Americans and Hispanics.

You know, I still get nightmare scenarios from Hispanic clinics, where they don't know what to do with HIV.

They get tested and somebody's positive, Okay, I don't know what to do with-- -They're getting the phone calls-- -Yeah, I don't know what to do, you just need to go to the Health District because I don't know what to do with it.

These are professionals.

So there's a lot of work that still needs to be done with providers, acquiring providers, ensuring that providers reflect the population that they serve, and that has always been a challenge.

-Right.

So I mean, there's historically a lot of medical mistrust in terms of the populations and people of color.

And it's not unwarranted, right?

You have Tuskegee, and that's like-- That was in the '40s and '50s where they had syphilis experiments in Alabama on African-American men.

-Right.

-So it's not unwarranted that there is that medical mistrust.

And certainly having people who are like you as your providers helps.

So you just need more providers in Vegas.

-Yeah.

-There is a new needle exchange program at the Southern Nevada Health District that recently opened, providing sterile syringe kits in hopes of reducing the transmission of hepatitis C and HIV.

The Health District acknowledges, yes, these are going to be used to inject illegal drugs.

For that reason, there's a federal ban on funds for the purchase of needles for this purpose.

But what do you think about that idea that this is just promoting bad behavior?

-So it's not, right?

So again, this is that paradigm shift, even in medicine, where we talk about harm reduction and risk reduction.

It's incremental steps.

People jaywalk all the time, right?

I don't know if you've ever jaywalked.

And it's, you know, it's-- They might not stop doing that, but you talk about wearing a white shirt or wearing something new and looking left and right before you do it.

And it's the same thing.

It's giving patients a toolbox.

If they're not ready to stop using drugs, and sometimes it's not a choice.

Substance abuse is a complex issue, right?

You give them the tools necessary to stay safe, right?

Let's not have skin infections.

Let's not spread HIV or acquire HIV or hepatitis C, which we see more with needle exchange.

Same thing with PrEP.

-I have to stop you there.

We have run out of time, but thank you both so much.

A nonprofit providing housing and emergency financial support for people living with HIV/AIDS here in Southern Nevada is Golden Rainbow.

Maria Silva joins us in studio.

And, Maria, the entertainment community started this organization during the height of the AIDS pandemic.

(Maria Silva) Amber, there's no doubt that the entertainment community is a tight-knit community.

And back in 1987 they mobilized after one of their fellow performers, due to all the fear and stigma associated with the AIDS epidemic back during that time, was forced to live and eventually die in his family's garage, vowing to never let that happen again.

They knew something had to be done, and that's how Golden Rainbow was born.

So they thought, Let's put on a show, raise money for housing, and they did.

The first show was in '87.

Huge success.

-35 years later, Ribbon Of Life remains one of the most successful HIV/AIDS annual fundraisers in Nevada.

Singers and dancers from up and down the Las Vegas Strip.

-Golden Rainbow Executive Director Gary Costa says the funds raised at Ribbon of Life are needed now more than ever, as rent prices continue to rise.

-The average client who lives on disability, which the majority of our clients do, they receive an average of $725 a month in benefits.

Housing starts at $1,100 a month.

So right off the bat at the beginning of each month, clients start off in a deficit.

-The nonprofit organization quickly putting measures in place to address the disparity.

-We know the answer to that is actually having more and more real estate that our organization actually owns and controls so we can determine the price and make it truly affordable for the clients who are living there.

-For clients like Antonio Lopez, finding out about Golden Rainbow shortly after his HIV diagnosis, life saving.

(Antonio Lopez) Yes, that's the main thing.

With housing, I couldn't afford it.

I'd be homeless.

I'd probably be dead.

(Darnell Delaney Hodges) Golden Rainbow's services go beyond housing assistance.

-We have wellness workshops I've created with chakra balancing, along with art therapy candlemaking, to online yoga workshops.

-Client Programs Coordinator Darnell Delaney Hodges and his team also work tirelessly to make sure clients who are not virally suppressed get the proper medications they need.

-"Virally suppressed" means that the the virus in your system is so low, where it's undetectable.

So meaning that you cannot pass this virus on to your partner or to anyone else while you are taking your your medications daily.

-Reaching out to at-risk populations, a top priority.

-Our Latino men, black men, black women, our minority populations, even on our indigenous people.

So there has been some initiatives on everyone's end.

I know HUD and also the Ryan White program, HRSA, they are putting funds set aside for Minority AIDS Initiatives.

We call it the MAI funds.

-For the hundreds of clients Golden Rainbow helps each year, the small but mighty staff of four, along with their kind volunteers, not only give clients a place to call home, they give them a sense of community, pride, and for many like Antonio-- -Golden Rainbow.

- --a family and hope.

-It's definitely-- It's definitely one of the big reasons why I'm still here.

I feel I have a future.

-He definitely has a bright future.

Now, Antonio is a survivor, Amber, in every sense of the word.

Not only is he dealing with his HIV diagnosis, he also survived four strokes.

So of course, we wish him the very best.

He definitely has a bright future ahead.

-I'm so happy you brought us his story.

The client programs coordinator there at Golden Rainbow mentioned that the groups they are prioritizing, the most at-risk groups include Latino men, black men, black women, and indigenous people.

Who else are they prioritizing?

-Well, Gary, the executive director, did tell me that now, due again thanks to the advances in medicine, people are living longer.

So people with HIV, now the average life span right now is about 72 years old now.

Here in Southern Nevada, that number, he says, 50% of the people diagnosed with HIV here in Southern Nevada alone are 50 plus.

So again, now they have to work really hard to make sure that they have a stable home and that they're taking the medication that they so desperately need.

-Southern Nevada definitely has an aging population.

We had AFAN's executive director on earlier.

Their signature event every year is the Black and White Party.

For Golden Rainbow, it's a little bit different this year.

Their's is the Ribbon of Life.

What's different with that?

-Due to the pandemic, they had to change things up.

So what they're doing is they're doing a Holiday Spectacular, and they're actually remaking some of the wonderful holiday classics.

And of course the strip performers, we talk about a very giving community, they're all donating their time for this wonderful cause.

-Thank you, Maria Silva, our new reporter and fill-in anchor here on Nevada Week .

And thank you for watching.

For any of the resources discussed, including where to get tested for HIV, go to vegaspbs.org/nevadaweek.

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