Life after AIDS

We’ve all known for ages that there are essentially two HIV epidemics in the world: a heterosexual epidemic in East and Southern Africa (some would say all of sub-Saharan Africa) and an epidemic driven by drug injection, sex between men and commercial sex in the rest of the world. Now there’s another distinction, too. There are HIV epidemics that lead to AIDS epidemics, and there are those that don’t.

I’m not joining the ranks of the AIDS denialists, here. I’m just recognising that in countries with very good access to antiretroviral medicines, AIDS has all but disappeared. The same can sadly not be said for HIV. Indeed HIV is rising as AIDS vanishes. The UK’s influential political monthly Prospect asked me to write about this phenomenon in the gay community in the UK, and the more I looked at it, the more worrisome it seemed. In the article, The plague is over, let’s party!, I argue that HIV continues to spread among gay men in part because “AIDS survivors” are setting standards of risky behaviour that are being adopted by a younger generation that has never known AIDS. I’d be interested to know what others think of this thesis.

This post was published on 29/05/08 in Good sex and bad.

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  1. Comment by the zak, 29/05/08, 07:32:

    A thought experiment… Imagine a diseases of the future. If you don’t have sex you die with an organism both parasitic and canabalistic. So A calls B, “You’ve got to come over!” B says, “I can’t. I’m going over to C’s.” A cries, “You’ve got to come over now. It’s beginning to gnaw at me!”

  2. Comment by Chuck Bird, 30/05/08, 02:41:

    Elizabeth, you say you are interested in what others think. Does that include those who disagree with some of your opinions? You have not responded to my previous posts. I have read the thesis and I agree with most of it but it ignores the true effectiveness of condoms. Have you got a source for your 98% figure? The Ministry of Health in New Zealand puts the figure at 80% in relation to the transmission of the HIV virus.

    Incidentally, have you read “Sexual Ecology” by Gabriel Rotello?

  3. Comment by elizabeth, 30/05/08, 11:18:

    I’m sorry, I thought I had already responded to you by e-mail. Studies of condom effectiveness vary greatly. In absolute terms, condom slippage/ breakage can, indeed be up to about 18 percent (so close to the 20 percent you suggest). BUT more careful analysis shows that the great majority of these “accidents” occur in a very small minority of couples. See Steiner et al 1994, Steiner et al 1993. You can find a useful factsheet here:

  4. Comment by Roger, 30/05/08, 04:29:

    I don’t think it is a generation think. I would just say it is gay men being desperately hopeful.

    Desperate because they know very well they are more at risk to get infected than the general population and that one day it will happen.

    Hopeful, because so far many have not been infected (or don’t know they are) and even if they have, let’s face it, treatment is “one pill a day”.

    To date even if life expectancy is reduced for people infected by HIV, it still remains very long, 25 years from infection says a recent Danish (?) study. If you are a young gay man you are not very much concerned by what will happen to you in 25 years, especially with the prospect of being an “old gay man” (the one you rarely see in the magazine found in Soho!). If you are old, you’ll be dead of old age before dying of an AIDS-related disease. In both cases, condom use becomes all very relative…

    A recent study in the UK (will email it to you) as shown that men who repetitively test negative for HIV either feel comforted that their behaviour is okay, or that HIV is not that easy to catch and that occasional slippage is okay.

  5. Comment by Chuck Bird, 01/06/08, 01:30:

    Elizabeth, thank you for your reply. I have looked at your source. I note they checked couples. That is a lot easier checking on than those who have multiply partners often under the influence of drugs and/or alcohol. There is probably no way of checking the highest risk group – the promiscuous homosexual.

    In an ideal setting say a high class brothel where the prostitutes are not under the influence of drugs or alcohol it may be possible to achieve the high rate of condom effectiveness. In a homosexual bathhouse or public toilet this is highly unlikely.

    You had not said if you have read “Sexual Ecology” by Gabriel Rotello? If you have not you should if you want to be really informed on this subject. Rotello is himself a homosexual and looks at the issue from a practical rather than a moral or politically correct point of view.

    As long as homosexuals believe the myth that condoms will protect them from HIV infection regardless of how many partners they have they will continue to be greatly over represented in HIV and AIDS statistics.

    Condoms have their place but misrepresenting their effectiveness in real life situations does far more harm than good.

  6. Comment by C Men, 05/06/08, 04:03:

    There is a question posted on the Prospect piece. Would you care to answer on this blog?

    C Men



    C Men wrote:
    June 3, 2008 at 8:43 am

    Pisani wrote: “that people who have unprotected sex with several people in a three-month period are far more likely both to contract and spread HIV than people who have the same number of partners over a longer period”.

    I understand how a newly infected guy is more likely to transmit HIV when newly infected. But can Pisani explain how in a stable epidemic a guy with three sexual partners in a week is more likely to acquire infection than another with three partners over a month? Huh?

    C Men


  7. Comment by elizabeth, 05/06/08, 11:37:

    That’s arithmetic. Three partners a week = 12 in a month. Four times the chance of encountering an infectious partner over a month.

    I’m being disingenuous, of course. I should not have said “contract and spread” You are quite right, from the point of view of contracting the virus, the risk depends on the number of partners, not the timing. Unless they are so closely spaced that there is increased penile or rectal trauma in the later encounters.

    Sorry and thanks for pointing out the error.

  8. Comment by Katherine, 05/06/08, 11:57:

    Good piece that hits on many of the issues.
    One thing that is missing from your argument is the effect of a lack of education for young gay men at schools. There is an interesting article this month in Attitude by Johan Hari, that touches on the effect of Section 28 on HIV. 20 years ago the UK government passed a law making it illegal for schools to teach about gay issues. It was repealled by worth considering the effect it has left today.

    In his argument Johan says:
    “And so a generation of gay children were left to be bullied and in ignorance of the terrible threat of STDs. We will never know how many people contracted HIV as a result – but we know there are some.”

    Unfortunately it’s not online yet, so can’t link to it but worth a read.

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