This is apparently the official 30th anniversary of the AIDS epidemic, and it is, quite naturally, a big front page story in this morning’s SF Chronicle. When I moved to The City in 1992, the epidemic was at full roar, and it was God awful to behold.
Things are much better now, but the monster remains a mortal threat. The anniversary story focuses on new forms of prevention that are helping. From “AIDS at 30: Strides in Care, Focus on Prevention:
Doctors now have ways to prevent new infections in every type of demographic group most affected by AIDS - gay men, heterosexual men, women, minorities and drug users. In the past year, studies have shown that HIV-negative men who take an antiviral drug can significantly reduce their chances of becoming infected, assuming they take the medication daily. Other studies in the past two years have shown promising results for HIV protection in women who use an antiviral gel before and after sex. Five years ago, studies in Africa showed that male circumcision could cut the risk of HIV infection in half.
Most recent, a major international study showed that early antiviral drug treatment - like the policy recommended in San Francisco - can dramatically decrease the chances of passing HIV from an infected person to his or her uninfected partner. That means people who start early drug treatment aren’t just protecting themselves, but their partners too.
“Thinking broadly about the prevention field, it’s really an amazing time,” said Dr. Robert Grant, a UCSF professor and a researcher with the Gladstone Institute for Virology and Immunology who is leading studies into using antiviral drugs to prevent HIV. “In every way that HIV spreads, we have something new to offer that is highly effective in blocking the spread of the virus,” Grant said. “We can envision now a time when HIV transmission no longer occurs, or only occurs in rare circumstances.”
On one level, this is encouraging. But the drugs are not without serious side effects and taking them pre infection is not without risks. Circumcision can reduce but not prevent infection, and in any event, isn’t an answer at all in with regard to some sexual behaviors.
This is what I find discouraging: All of these new methods assume that people who have contracted HIV will not change their sexual or drug using behaviors, nor will those who could endanger themselves through their own conduct. I mean, rather than act differently, take strong—and expensive— anti viral drugs and risk serious side effects? Indeed, there’s not a word in the story about abstinence, mutual monogamy with uninfected partners, or not doing needle-delivered drugs. These may not be “new,” but they still remain true. Just not enough people apply them to prevent the steady state rate of new infections (about 40,000 new infections a year, and one in 5 urban gay men having HIV).
Here is the politically unmentionable truth: Part of the problem with controlling this epidemic has been a reluctance to appear moralistic, and instead, focus on prophylactics that can reduce—but not prevent—infection. I have heard that chalked up to realism, but if so, my point is proved. I see no evidence in these “new methods of prevention” story that this dangerous attitude has changed.