Hello, I'm Catherine Anaya, and welcome to Horizonte.

A major breakthrough in HIV prevention could change the way we protect communities most impacted by the virus.

For Latino LGBTQ communities, barriers to care, cultural stigma, and lack of awareness can still stand in the way of prevention.

But a new twice a year injectable is offering another option beyond the daily pill.

Joining me to talk more about what this could mean for Arizona's Latino LGBTQ community is Mark Moeremans, CEO of Spectrum Medical Care Center, an LGBTQ healthcare clinic serving our community.

Mark, its so nice to see you.

Thanks for being here.

Thank you so much for having me.

So let's talk a little bit about Latino communities and how they continue to experience this disproportionate impact of HIV.

What do the latest numbers reveal about what's happening here in Arizona?

The numbers are fairly staggering.

Actually, here in Arizona, there's always a data lag from latest public health reports and testing.

And so for the latest year that we have on record, 2022, there was almost 1000 new HIV cases in the state of Arizona.

Almost half of those, about 42% were in Latino communities.

And so they're the number one demographic that is receiving new infections of HIV.

And it's a huge challenge and public health opportunity to really work with these communities, with our community, to make sure that they are aware and receiving the prevention options that they have available to them.

Those are significant numbers.

So when you look at those numbers, what do we need to understand about this disparity?

Is it related to access, awareness, stigma, rather than a lack of effective medical tools?

There's a host of reasons why we continue to see new infection rates rise, or stay close to all time highs.

The good news is there's a ton of new options available for HIV prevention.

And so PrEP, which has been around for over 13 years at this point, is 99% effective in preventing HIV transmission.

Historically, it's been a once a day pill.

And as you mentioned, we're now seeing new innovations in that area in the injectables front.

So you can get two month injectables, six month injectables, so you don't even have to take a twice a day pill.

Unfortunately, the things keeping people from adopting these new innovations or medications isn't isn't always access.

There's cultural reasons, there's awareness, there's education, there's stigma, there's culture.

And so part of our role at Spectrum Medical Care Center is to inform and make available information and access to these HIV prevention drugs for all communities.

And I think a lot of people probably assume that, well, if you have medical insurance, then that should not be a problem.

But that's not always the case in getting the care they need, especially in these vulnerable communities.

So can you talk to me a little bit about what barriers can LGBTQ Latino patients still face, even when they are insured?

So it can be challenging to find a doctor who is comfortable prescribing this medication, even having conversations with the medical provider about your sexual health and sexual history can be uncomfortable for a lot of individuals, especially in certain communities.

And even with insurance, there are some insurers that are still slower to cover some of these new injectables that are available.

But what I want to tell the people is that if you're seeking this type of medication, there are clinics available to you, whether it's through drug manufacturer coupons and rebate programs, whether local FQHCs or safety net hospitals or culturally competent care centers like Spectrum Medical Care Center, there are places where you can receive access, whether you're insured or underinsured or uninsured.

But let's talk specifically about some of these barriers that you referenced when you talk about language, previous negative experiences, cultural awareness, you know, how can that impact somebody's ability or even desire to seek treatment or prevention?

The relationship you have with your doctor is one of the most intimate, private, vulnerable relationships that you have.

You're talking about your health, your lived experience, what you do in private moments.

And a lot of people, even on the clinical side in training, aren't prepared to have some of those intimate or vulnerable conversations.

And even when they do, they don't know all of the tools and drugs and innovations available.

Every clinician should be talking to their patients about PrEP, the HIV prevention drug.

They should feel comfortable asking about sexual history and sexual relationships.

That is a core part of your primary care.

It's a core part of your health.

I think culturally, both broadly in the United States and particularly in certain subsets and demographics, that is an uncomfortable conversation to have.

And so finding a clinician that you feel comfortable with, whether it's someone that offers bilingual clinical services, whether it's someone that removes shame or stigma from the conversation, is able to openly discuss different types of sexual activities or illnesses or ailments or medical concerns, the more comfortable you are with your provider, the more open and honest you can be to get to the best result for you and your health.

And so at places like Spectrum Medical, we want to provide that comfort, that safety, that cultural competency, so that people are open to have those conversations.

It's not just about HIV prevention.

There's other STIs and STDs that are rampant in Arizona right now that are going undocumented, that are going unseen and untreated.

Well, you talked about how important that is, having to talk about some things that are very personal for people, and it's important to have a provider who can relate to you in some way to make you feel not ashamed.

So our providers being trained effectively, and, you know, we're talking about beyond Spectrum, but just in general, are they receiving the necessary training for situations like this?

Not really.

So the truth of the matter is that Arizona broadly has very low health literacy.

From a patient perspective, for sure.

And that has to do with some of our education system, K through 12 and beyond, and even at the clinical level in med school and things like that.

Topics like LGBTQ health, gender affirming care, HIV, sexual health, if they're in the curriculum at all, it's typically kind of a one day seminar, a lunch and learn.

There's very little emphasis placed on it.

And at a time when we see HIV rates consistently staying near all time highs, it is crucial and critical for education programs to make that more a part of the process.

I think we've done ourselves a disservice by sort of separating sexual health from primary care.

And so it's Spectrum Medical Care Center, we really combine the two because it's all a part of our primary care.

And we work with clinicians that are trained on how to have those conversations that make it a part of every conversation.

And we're also starting to work with other academic institutions to further that education, so that the future of health care is more comfortable to have those conversations as well.

Well, speaking of the future of healthcare, let's talk about this injectable because it is one of the most exciting developments in HIV prevention.

It's an injectable that can prevent against HIV with just two doses a year as you mentioned.

How significant is this advancement and who can benefit from it?

This is one of the biggest breakthroughs that we've had in the past decade around HIV prevention.

It makes it easier to adhere to the treatment.

It is proven to be 100% effective in clinical trials.

When taken correctly, it is the most effective defense against HIV prevention.

It is amazingly easy.

And so there's some people because of stigma, because of culture, they don't want a pill bottle sitting around.

Because of lifestyle, they forget to take a pill every day.

Maybe they travel for work.

Maybe it's harder for them to get to a pharmacy every 30 days for a re-up.

All of these things.

This new injectable is trying to remove barriers to adherence.

How do we make it as easy as possible for people to protect themselves for as long as possible?

And injectables are kind of a new frontier in HIV prevention.

I mentioned there's a two month option, this new six month option.

The goal is consistent.

How do we continue to deliver medication in a way that is really easy for people to stick with?

Even people in certain communities, they switch doctors, they move around.

There's unhoused communities or intravenous drug users that are at high risk for HIV.

Those are harder people to support through a consistent medical care treatment.

And so if you get on a six month injectable, you don't have to worry about where you're going to be 30 days from now, 60 days from now, because you've got safe coverage for a very long time.

And I should point out that one of the nice things about having you here is that you're also able to share this information with people as a patient yourself.

You have been taking the injectable.

And this is really a game changer, isn't it?

I have been on PrEP for over 12 years at this point, started with the daily pill and switched to the six month injectable about a year ago.

I've had two of the doses and it has been a game changer for me.

I was someone who struggled daily adherence.

You know, sometimes you're on the go.

You forget to get a prescription refill.

I've tended to travel a lot, and all of a sudden you're in a foreign country and your medication ran out or the time zone mixed you up.

And so there's a lot of reasons for me personally why the injection was a much easier option.

And the best thing about PrEP, I think, especially for the LGBTQ community, is that there's this fear that we have lived with in the back of our minds for so long because of the AIDS epidemic, because we grew up hearing stories about an entire generation being wiped out from HIV.

And so even when I went to the daily pill, the peace of mind that that afforded me, the freedom to just kind of move about my life and my day without always having this fear was huge.

That has happened again with the injectable.

So now if, I don't have to have the fear of forgetting to take it, the fear of running out of medication and that peace of mind, that freedom that this new injection option offers is a game changer for me personally.

And I would encourage anyone who's curious about it to look into it.

Well, when we talk about, you know, an increasingly effective tool like this to prevent HIV, disparity still persists.

So what actually needs to happen to ensure that these advances actually reach the communities that need them the most?

We need to continue to do our part to get into the communities that need it most, to inform and educate in a way that really sticks.

And so, like I said, it's not always necessarily about access.

In Latino communities, it can be very difficult to talk about sexual experiences, sexual health, sexual preferences or sexual orientation.

And so that can become a barrier.

I know that there's still distrust of the medical system and medical environment in certain demographics, in certain communities.

And so we have to overcome those challenges to inform people that this is still an issue, that HIV cases are still consistently high.

This is an issue that affects this community disproportionately.

There is a response to that.

There is an option available.

And here's what it looks like.

Here's how you access it, and here's how we can communicate about it in a way that sticks.

You are a Latino leader, a member of the LGBTQ community, and you do bring your own lived experience to this conversation.

How has that shaped the way you lead Spectrum as a CEO, but also this culturally competent care that I've read so much about that makes it so unique.

So I always tell people the healthcare system was designed with a very specific patient in mind, and we can all probably imagine who that patient is, who the biggest users of healthcare.

And there are many, many groups in demographics that were not included in that ideal patient target.

And so women are often not the core focus of the healthcare system.

Latino communities are not the core focus.

LGBTQ individuals are not the core patient of the standard health care practice.

Culturally competent care is reframing and rethinking the healthcare experience with other identities in mind.

And so at Spectrum Medical Care, we're able to center the experiences and lived experiences and unique healthcare needs that are associated with those lived experiences for the LGBTQ community.

And so I think there's a real opportunity to continue to make people feel more welcome, accepted and comfortable in their healthcare environment, and to create an experience for those patients that mirrors their lives.

We're screening you for things that other places don't even think to ask you about.

Based on your lived experience, we're taking into consideration your cultural history with the healthcare system.

We are navigating you through the process, whether it's intake forms or questionnaires or demographic screens and all of those other things.

There are real differences in how different communities experience health.

And so we want to take those experiences into account and not deliver health through a one size fits all approach.

And that is so crucial in the fight against HIV because every community is dealing with it differently.

The Latino community has its own barriers and stigmas and pieces that we need to be conscientious of that are different than the white gay male experience.

As CEO of Spectrum Medical, who's been on PrEP, who's on this injectable, who is a Latino, I need to lead through being a role model.

And so I want people to know that this is something that I've chosen for myself.

It is something that gives me peace of mind.

I have absolutely no shame or stigma about it.

In fact, I'm very proud that I've been able to protect myself, and I think I have a responsibility to my community, my LGBTQ community, my Latino community to demonstrate and show what being proactive in our own healthcare is and that you can be a successful leader, you can be a CEO and you can be gay.

And on PrEP, those things are not in conflict with one another.

And in fact, I think it just shows the types of leadership roles that we can hold in our community.

Well, you do it well, and I appreciate you being here and sharing so much about not only what you do as a CEO, but also your lived experience.

So thank you so much.

I appreciate it.

Thank you, thank you.

And we will continue having conversations like these because they're important and they matter to you.

I'm Catherine Anaya, thank you for watching.