Inside Arizona’s Unconventional Fight With HIV Rates

The sun set and the disco lights started strobing. Within minutes, go-go dancers climbed onto short black boxes on the patio of Pat O’s Bunkhouse in Midtown Phoenix.

They bounced to the music, shook their butts, and took tips from a sparsely populated crowd sitting at the patio tables. The patrons—mostly gay men, with a few women that night—mingled ahead of the late-night party hours. But the dancers had another mission beyond tips: getting people tested for sexually transmitted diseases.

After performing, they stepped down and approached patrons—especially those who tipped or winked at them all night—about HIV and STD testing. It may have left some people with some sexual frustration, but it’s one of the trade-offs of a public health campaign.

The dancers are part of Ripple PHX’s PUMP! program, which leverages a simple principle—that sex sells—with an attempt to merge it with public health initiatives. By doing so, it puts a familiar face onto a familiar problem that doesn’t have a singular solution.

“Gogo dancers have been dancing on boxes in queer spaces for decades,” said Jeremy Bright, co-executive director of Ripple PHX. “The dancers are able to bridge the gap and bring credibility to HIV services because they're not healthcare workers for folks who mistrust government and medical systems.”

It’s one of several new approaches across Arizona responding to rising HIV transmission rates.

According to the Arizona Department of Health Services’ 2023 HIV annual report, 19,894 people were living with HIV or AIDS in 2022. There were 975 new cases that year, up from 852 in 2021. The incidence rate rose from 11.4 to 13.2 cases per 100,000 residents.

The purpose of PUMP! is to get familiar faces in LGBTQ+ areas to entice people to get tested. For RipplePHX, it's meant an increase in people who go to bars, but may never get tested or are up to date on their sexual health knowledge. Images provided by Ripple PHX.

Most new infections occurred in Maricopa and Pima counties, but rural and underserved regions—such as Pinal County, which had the highest incidence rate at 17.6 per 100,000, largely among incarcerated people—are also affected.

Public health workers say traditional clinic-based testing isn’t enough. To meet the moment, Arizona organizations are adopting strategies used in states such as Louisiana, Mississippi and California—where HIV rates remain among the highest in the country—by bringing testing directly to people who might not seek it on their own.

Out of the Box Solutions Needed

Since President Donald Trump took office this year, HIV advocates have warned that funding for testing, prevention and care could be at risk.

To a large extent, those fears have played out. The dismantling of USAID—an international humanitarian program that supported HIV care abroad through PEPFAR—cut millions of dollars that once helped people start pre-exposure prophylaxis, or PrEP, which can reduce HIV transmission by more than 99% when taken correctly. PEPFAR accounted for about 90 percent of PrEP access in low-income countries, according to Physicians for Human Rights.

Since the cuts, an estimated 149,000 people have died due to loss of HIV services, including about 10 percent who were children, according to the PEPFAR Impact Tracker, an initiative by Impact Counter analyzing the effects of U.S. funding reductions.

In the United States, funding structures have also become unstable. Organizations serving gay and bisexual men, transgender people, and Black women—groups at highest risk for HIV transmission—have seen federal grants disappear as the administration targets public health programs it associates with diversity, equity and inclusion.

This comes alongside broader hostility toward LGBTQ+ communities, especially around health care. This year marked the first time World AIDS Day was not recognized as a federal observance, for example. And grants focusing on transgender people have been scrubbed from websites, with only focuses on “LGB” people.

The proposed 2026 federal budget also aims to eliminate all funding for HIV services—except in the case of Ryan White funding, which provides HIV care and services to those below the poverty level—and instead direct funds only to the cities with the highest case counts. That approach, medical professionals say, leaves behind rural communities where total case numbers may be smaller but incidence rates are often significantly higher—similar to what Arizona is experiencing.

Earlier this year, the problem intensified when the federal government froze a key Centers for Disease Control and Prevention grant that supports HIV prevention and testing nationwide. For groups like Ripple PHX, the freeze meant nearly $150,000 vanished overnight. Although the funding was eventually restored, the disruption underscored how precarious federal support has become—and why local advocates say they must rely on innovative strategies to reach the people most at risk.

Where Are The People At?

“Meet people where they’re at” is a marketing cliché, but in HIV prevention it’s a practical necessity. Fewer young people are getting sex education in school, partially contributing to statewide increases in STDs.

Men ages 25 to 34 have the highest rates, with Black, Latino, and LGBTQ+ communities disproportionately affected. But more alarming for public health workers is how state data also shows rising incidence among people younger than 24.

That means to address that population, it requires showing up in places where young people actually go—bars, sex clubs, baseball games, and gogo bars.

Since PUMP started in August 2024, 20% of people who received services at their events have stated that they are “at-risk for HIV, but have either never received an HIV test or haven't been tested in a year or more,” said Bright. “Those are the needles in the haystack we're looking for.”

Spectrum Medical’s Phoenix-based mobile testing unit has a similar program through their mobile testing van. Staff visit high-risk locations multiple times a week, including FlexSpas, OffChute, Pleasure World, universities, as well as cooling centers and ministries that serve those without stable housing. (State data shows that an estimated 13% of all unhoused people are living with HIV.)

A member of Prisma Community Care's outreach team conducts HIV testing at Brick Road Coffee, a coffee shop in Tempe. (Courtesy of Prisma Community Care).

“We’ve seen rapid month-over-month growth in testing volume at evening and pop-up sites,” said Ray Delgado, senior director of communications and community development at Spectrum Medical Care.

Similar to Ripple PHX, Delgado said that a third of the people they test at the mobile van have either never been screened for HIV or have gone longer than a year without an HIV test.

“That is, you know, pretty high,” said Delgado. “Because a lot of people in the community are already on PrEP, or might be getting STI tested. But, you know, these people are new. They're new to this sort of health pathway of getting on the right medications to sort of manage any issues that they might have in terms of their sexual health.”

A Replicable Solution

While much of the focus around HIV testing has been around gay men, there are other approaches that have been effective in broadening outreach beyond LGBTQ+ communities. While men who have sex with men remain most at risk—especially Black and Latino men—other groups are also affected. In Arizona, more than 60 percent of HIV infections among women were transmitted heterosexually, disproportionately impacting Black women, according to Arizona Department of Health statistics most recently updated.

Similar strategies have worked elsewhere to help focus outreach on those less talked about communities at risk. In Los Angeles, for example, testing teams visit barbershops to train barbers on how to talk to young Black men about the importance of getting HIV tested and reducing the stigma around the virus. In New Orleans, the health department partners with beauticians and salons for similar goals.

Those kinds of innovative approaches aren’t always well received. More than a decade ago in San Mateo County, the health department used gay dating apps to initiate conversations with men, posing with stock photos. Once users engaged, officials revealed that the person they were talking to wasn’t real—it was a government employee attempting to discuss sexual health.

But thinking outside the box for addressing the critical moment for HIV care in Arizona is a requirement at this point, say health experts.

Prisma’s partnership with Social Spin Foundation, a nonprofit laundry service in the Valley, brings testing and sexual health education into everyday spaces like laundromats. “By bringing peer support specialists to Social Spin, we can identify intersections of risk, like substance use or housing insecurity, and connect people to resources beyond just HIV testing,” said Michael Greathouse, senior program and medical lead at Prisma.

At Social Spin, Prisma workers offer no-cost rapid testing, peer support, and connections to mental health care, PrEP education, and primary care. According to Greathouse, about 10 percent of people reached through these efforts have started PrEP, the medical protocol that can reduce HIV transmission by up to 99 percent when used correctly.

Better Than Not Knowing

Aunt Rita’s Foundation, meanwhile, has pioneered at-home testing statewide, mailing free kits to rural residents, youth, people of color, and native communities.

“This lets people self-administer a test in the privacy and comfort of their home without dealing with discrimination or stigma,” said Executive Director Stacey Jay Cavaliere. “It gives people the information they need to make informed decisions about their health moving forward.”

Since offering the service of at-home testing kits, they have delivered 1,000 kits each year, Cavaliere said, helping overcome barriers tied to transportation, finances, and stigma.

Those kinds of options have proven to be effective in cities like New York, where the city health department partnered with the gay hookup app Grindr to get people tested with at-home testing kits users could order through the app. In that case, the partnership resulted in a campaign by the app to offer users notifications and reminders for when to get tested.

But at-home testing kits have their limits. For one, it’s difficult to follow up with people if they test positive and get them into immediate care. Though the kits Aunt Rita’s sends out offers follow-up steps in the event of a positive (or negative) test, there is very little that can be done to coerce someone into going into care if they are not in a clinic.

There is also the psychological stress of testing positive without someone around: “It’s an incredibly stressful moment,” Cavaliere said.

None of these programs, alone, are a panacea to the rising HIV rate in Arizona, but altogether they do help solve one of the biggest problems sexual health professionals worry about: people now knowing their status.

Across the nation, of those living HIV, 13% are estimated not knowing their status, according to the Centers for Disease Control’s most recent numbers.

These kinds of programs, at the very least, help mitigate that problem, said Cavaliere: “We would rather have people know their status and supply them with resources than not get tested at all.”

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