The plague is over, let's party

by Elizabeth Pisani in Prospect

Pisani is an epidemiologist and the author of The Wisdom of Whores (on the IRMA reading list - look to your left). Check out her blog by the same name here.

This blog featured Pisani in this post - "The unspoken truths about Aids" - and she has been stirring the pot on the IRMA listserv lately with some of her commentary.

Below is another provocative essay, this one about HIV/AIDS and gay men in Britain.

What do you think?

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An HIV diagnosis in Britain is no longer a death sentence—
thanks to costly new drugs.
But as the spectre of death fades, so do the
most visible reasons to avoid risky behaviour.

Now the Aids prevention industry has a whole new set of problems .

I'm in a bar in Soho. A message flashes up on the plasma screen on the wall behind me: "Tom, I want to nibble your biltong." A guy leaning against the banisters makes a show of putting his mobile phone away while making eye contact with a cute blond boy at the bar. Cute blond blushes. Soon, they're smooching in a corner. How Tom's biltong fared that night I don't know, but I can guess.

This is London's gay scene in a world without Aids. Since treatment for HIV became available in the mid-1990s, Aids has all but evaporated in rich countries. Annual deaths among gay men in Britain have crashed from a peak of over 1,162 in 1994 to just 153 in 2007. "Aids? I've never met anyone with Aids," says Tim, an engineering undergraduate who's sitting under the plasma screen, nursing a nasty pre-mixed drink. When I ask how many of the guys around us might be infected with HIV, he looks shocked. "That's not a nice thing to talk about. I don't know, 4 or 5 per cent?" Actually, the government estimates that around 9 per cent of gay men in London are HIV-infected, against 5 per cent elsewhere. But we're not looking at all gay men in London. We're looking at guys in a pick-up bar at 1am on Friday night; I'm probably the only person here who will leave without being propositioned. Many of the men eyeing each other up are in their 30s; they've had plenty of time to get infected. My guess is that 25 per cent of the men in this room have HIV, possibly a lot more. In 2006, 2,640 gay men were diagnosed with HIV—making up nearly two thirds of the total diagnoses of HIV infections that were acquired in Britain.

You don't have to be an epidemiologist to work out that if 2,640 people are diagnosed with an incurable disease and only 153 die, the number of people known to be living with the disease will rise. The number of gay men living with HIV in Britain is probably around 31,000.

But these days you never see a cadaverous looking 35 year old in an armchair surrounded by friends trying not to notice that his face is covered by the black splotches of Kaposi's sarcoma, a cancer that feeds on people weakened by HIV. And as Aids disappears, so does the most visible reason to avoid unprotected sex. Just under half of gay men say they had some unprotected anal sex in the last year, up from under a third in 1996, when treatment became widespread. But if HIV isn't fatal any more, does it really matter if lots more people get infected?

The relationship between HIV treatment and prevention in the gay community is not straightforward. Virology, psychology, drugs and gay activist ideology play their part. Let's start with the virology. HIV is not very infectious. It is only easily transmitted when there's a high "viral load"—lots of free virus in the blood or genital fluids—and that is usually only for the first couple of months after a person gets infected, and then, years later, once they get sick. That means 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. And gay men are far more likely than straight people to have lots of partners at once. A recent study of people who go drinking and clubbing in nine European cities found that gay or bisexual men were four times more likely than even out-to-have-fun heterosexuals to have had five or more recent partners.

Read the rest.