As older Arizonans living with HIV grows, so does their isolation.

When Marlon Guzman turned 32 years old, his family threw him a blowout birthday party. They thought it was his last.

Guzman, who tested positive for HIV in 1989, stopped taking his medication, and his white blood cell count had plummeted to the point where his viral load—the amount of virus in someone’s body—was, in his words, “off the charts.”

“It wasn’t even a landmark birthday and all my friends came from California and Colorado and I just thought it was kind of weird. And then I find out a year later that my family thought I was going to die,” said Guzman, who is very much alive at 59 years old. 

Soon after his birthday, he moved to Phoenix and started taking his medication again. Today, Guzman is making arrangements for his 60th birthday party. He’s considering hosting it at his church and plans to invite his ex-boyfriend who missed his epic birthday party all those years back. 

Guzman is one of more than 10,000 people over the age of 50 living with HIV or AIDS in Arizona, according to the most recent data from the Arizona Department of Health Services. Today, more than half of the entire population living with HIV in the state– and country–are older adults, according to the National Institute on Aging.

As a way to combat the woes that come with old age—and the added stigma of living with HIV in their golden years—one local foundation created a program that would help ease loneliness, isolation, and mental health issues through socialization and community building. 

THE GRAYING OF HIV

In its infancy, the AIDS epidemic was primarily a young person’s problem. When Guzman received his diagnosis, rates of HIV transmission were highest for people ages 30-39 years, according to the CDC. In that decade, people could expect to live just three years after an HIV diagnosis. 

Today, the majority of people who get diagnosed with HIV younger adults but can live long and healthy lives with near-normal life expectancy with the advancement of medical interventions that even reduce the chance of getting the virus by close to 100%. 

Last year, 17% of people who contracted HIV in Arizona were over the age of 50. 

But the HIV-positive population in Arizona is increasing faster than other parts of the country, including among people over 50 years old.

From 2021 to 2022, the rate of new transmissions overall increased from 11.4 cases per 100,000 people to 13.2 cases per 100,000 people. During the same period, the total number of transmissions increased by 123 to a total of 975. The biggest jumps in incidence rates were in rural Navajo County and Cochise County, while urban Maricopa County had the highest total number of transmissions. 

While the majority of new diagnoses are for people under 25 years old, older adults are far from immune. Drugs like Viagra and Cialis have allowed older men, specifically, to have longer sex lives and some studies suggest that they have stopped using condoms. Last year, 17% of people who contracted HIV in Arizona were over the age of 50. 

“There’s a lot of discrimination against older folks in some spaces, in addition to the general stigma and discrimination when it comes to living with HIV." — Stacey Jay Cavaliere, executive director of Aunt Rita's Foundation.

The increase continues despite major advances in HIV prevention, including pre-exposure prophylaxis, or PrEP, which reduces the risk of getting HIV from sex by about 99% and reduces the risk of contracting the virus from injection drug use by at least 74%, according to the CDC. The most common way to take PrEP is through a daily pill sold under the brand name Descovy or Truvada but there are also generic pills available for cheaper and an injection that provides similar protection when administered every two months. 

PrEP usage increased nationally by 17% from 2022 to 2023, according to data compiled by Emory University’s Rollins School of Public Health and over one-third of people who would benefit from the drug are now taking it, according to the CDC.

But in Arizona,  uptake of the medication has been unsteady, leading to significant health disparities. Black Arizonans represent 16% of new HIV cases but make up only 3.5% of PrEP users while Arizona’s Hispanic population represents 45.5% of new HIV cases but makes up only 28.4% of PrEP users. White people, on the other hand, make up 64% of PrEP users and only 31% of new HIV cases. 

Increasing PrEP usage for at-risk individuals is critical to ending the HIV and AIDS epidemic, according to Stacey Jay Cavaliere, the Executive Director of Aunt Rita’s Foundation, an organization which distributes free Home HIV oral test kits through GetTestedAz.org and provides vouchers for confidential clinical testings at 100 Safeway stores and Sonora Quest locations statewide. 

He advocated for investing in public service announcements to dispel myths about the drug, improving sex education statewide to increase awareness of HIV prevention strategies, and providing education to medical providers who are unfamiliar with the latest advances in HIV prevention.

But the focus on getting PrEP in the hands of people has been limited to younger gay men, leaving people in their older ages less likely to receive services. 

ENDING THE STIGMA

For those who are diagnosed with HIV, the stigma attached to the virus through decades of misinformation can result in loneliness, which studies have shown can reduce life expectancy. For older Americans living with the virus, isolation and depression are more acute. 

To combat the stigma, Cavaliere and his team oversee Experienced Escapades, a free monthly outing for individuals living with HIV who are 50 years or older. 

“There’s a lot of discrimination against older folks in some spaces, in addition to the general stigma and discrimination when it comes to living with HIV,” said Cavaliere. 

Every month, around fifty seniors living with HIV go to the movies, play mini golf, share a meal, or enjoy a night at the theater. 

The Experienced Escapades program is showing signs of progress. In a 2022 survey, participants said the program reduced their loneliness and improved their quality of life. While Aunt Rita’s Foundation offers a much-needed social outlet for seniors living with HIV, many of their other needs still go unmet.

“Many of them are experiencing difficulty with housing, food insecurity, mental health, disability rights, all of those major things,” said Gaby Martinez, a program manager who oversees the Escapades program. 

“DIDN’T WANT TO TALK ABOUT IT”

Guzman grew up in Arizona but spent some time living in Long Beach, California. And while living in the Valley, he remembers getting drinks at Wink’s Cabaret, the birthplace of Aunt Rita’s Foundation.

“I used to get drinks with my cousin and his partner at Wink’s,” said Guzman of the bar. “It was just a fun little social place. People used to say it was for old people, but it wasn’t.”

In 1986, during the height of the epidemic, a group of activists organized a bake sale at the gay watering hole to help people living with AIDS pay their rent, their medical bills, and, all too often, their funerals. The inaugural bake sale was a huge success, according to Cavaliere, earning around $5,000– over $14,000 in today’s dollars– and a new annual tradition was born.

 When Clayton McKee, a former nationally renowned George Michaels impersonator, started working as a DJ at Wink’s in the nineties, he helped emcee the event which was part drag show, part auction, and part bake sale. 

“There were several chefs in the area who worked at a bunch of nice restaurants here in town, and they would bake very fancy, nice cakes,” said McKee, who moderates a Facebook group dedicated to the long-shuttered bar. “Other people would just bake a Betty Crocker cake in their kitchen, ice it, and it would also sell.”

Over his tenure DJing at the bar, McKee remembers losing many of Wink’s regulars to AIDS – including many who he considered close friends.

“You kind of knew who was sick. It wasn't really talked about,” said McKee. “And then there were others that you never knew about. And then all of a sudden, you're like, ‘hey, where's Scotty? Where's so-and-so?’ Then you find out four or five months down the road, oh he died. He was sick, but nobody knew it.”

Today, the bar where Phoenix’s LGBTQ+ community came together during its darkest hour to raise funds for its sickest members is long gone, having shut its doors for the last time in 2004. 

For McKee, stepping inside the building that housed Wink’s is simply too painful to consider.

“I've lost so many friends over my 30 years of being out in Phoenix,” said McKee. “They were all in that bar at one time.”

For Guzman, the bar still holds happy memories. Despite a life-changing diagnosis and a battle against addiction, Guzman has found peace in this latest chapter of his life.

“Both of my gay brothers are gone now,” said Guzman. “One from the same disease I got and the other from diabetes, and I'm still here."