Toxic shock

Two recent stories in the New York Times make depressing reading for the New Year. New HIV infections among young gay men in New York City rose by a third between 2001 and 2006, very probably because condom use has been falling. Over roughly the same period, the number of people aged over 50 with HIV has risen by over three quarters. This ought to be good news – it means people are living longer with the disease. But the paper goes on to ask what it calls a heretical question: At what cost? People who have been taking antiretroviral medicines for the last decade are feeling their bodies fall apart under the assault of these toxic life-extenders.

This makes the link between the Times’s two stories all the more poignant. One of the reasons young guys are having more unprotected sex is that they don’t think HIV is such a big deal any more. And looking at all the happy, healthy guys climbing mountains and sailing yachts in Big Pharma’s ARV ads, it’s not hard to see why. To a generation that hasn’t spent every Saturday at a funeral, to 20-somethings that have never felt the hush that falls on a room when a skeletal figure with a blotchy face shuffles in, HIV must seem like diabetes. Inconvenient, perhaps, but not the end of the world. The true cost of long-term treatment with antiretrovirals is only now beginning to be counted. But we know for sure that it will turn out to be higher, in both financial and in human terms, than the cost of preventing infections in the first place.

The gay community in the US led the world in developing effective HIV prevention. They’ve dropped the ball, and it is time they picked it up again.

This post was published on 07/01/08 in Science.

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