Is AIDS dead? Could we ever ‘end HIV’?
Facilitated by writer Dion Kagan, and featuring long-term AIDS activist Colin Batrouney and epidemiologist Elizabeth Pisani, these were the questions addressed in the provocatively titled session ‘AIDs is Dead! Long Live HIV!’.
But what do these questions actually mean?
To answer we need to start with some quick statistics. As pointed out by the panel, in Australia in 2012, only nine people were reported to have died of AIDS. This contrasts markedly with the many hundreds who were dying of the disease only twenty years ago. As AIDS deaths have dropped however, HIV infections are once again on the rise - with stark increases reported in Australia over the past years. AIDS is slowly disappearing as a public health issue, whilst HIV seems to be coming back with a vengeance.
This reality, however, remains largely undiscussed in our public sphere - and it is easy to see why. Despite recent publicity over the AIDS2014 conference in Melbourne this year, HIV/AIDS has largely dropped off the public agenda. Batrouney described this perfectly, noting a discussion he once had with his hairdresser. Telling him he worked on the issue his hairdresser responded with, “Oh AIDS! Whatever happened with that?”
This is particularly true for those who are most ‘vulnerable’ to contracting the illness - particularly young gay men. Living within the gay community I see at times a significant lack of understanding regarding the issue, and more importantly an increase in the numbers of those who no longer see HIV, in particular, as a major risk to their sexual health.
For many, the story of HIV/AIDS has been completed. It the beginning there was the discovery of an illness that shocked the world, then the horrifying consequences of a global pandemic and the campaigns that arose around that, and then, with the development of an effective treatment that has meant it is no longer an issue, it ended. HIV/AIDS became a thing we no longer need to worry about - a horrific story of the 1980s, but one that is no longer a concern for many.
It is easy to understand how this has become the case. Effective anti-viral treatment means that contracting HIV is no longer a death sentence - in fact, with the right drugs, you can now live a long life in relative health. This treatment has contributed significantly to the drop in AIDS deaths we’ve seen over the past twenty years. New ‘PREP’ treatments - which could effectively amount to the equivalent of the pill for HIV - are now seen as potentially providing a ‘silver bullet’ for prevention of the disease. As these treatments have become more widely available the public health message has become much more difficult to deliver - we are struggling to convince people that HIV is still an illness you do not want to catch.
As Pisani said, during this session, this is a very good thing! We should be celebrating that effective treatment means we can no longer run the sort of ‘scare campaigns’ that say that if you don’t wear a condom you are going to die. Those campaigns would be patently false today and that is a sign of the success of our movement.
Yet, as this panel pointed out, it also creates a quandary. Despite the progress, the impacts of HIV are still real - whether it is the long-term health risks, the potential side effects from drugs, or the very real threat of the development of drug resistant strains (i.e. strains of HIV that don’t respond to treatment). And that doesn’t even take in to account the costs to our public health system. HIV is still real, and very serious.
Yet, our perception has gone the other way. As AIDS has started to die the story has been seen as completed - leaving those who are living with HIV, and those who at risk of catching it, in many ways left out in the cold.
This is the enduring challenge we are left with. The era of AIDs may be leaving us, but the era of HIV seems - at least for the moment - here to stay. The question is how do we deal with this shift? How do we convince people that the story is not yet over?
This panel didn’t answer these questions - in the short time they had they hardly managed to scrape the surface. But they got us on the right path - they got us asking the right questions. And in this new era of HIV that is exactly what we need.