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Gus Cairns

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HIV at 30 - The Unfinished War

Posted: 01/12/11 00:00

I can't quite claim a full three decades with HIV. It was in 1984 that I turned up at a clinic with a crop of throat ulcers so impressive the doctor had a photo taken. In retrospect, they were my first HIV symptom. I tested positive a year later.

It's hard even for those of us who were at the Ground Zero of AIDS to recall the horror of the next 10 years. We were losing a war against a remorseless biological cyborg.

Like war, AIDS had its benefits: we gay men found, in our suffering and anger, a dignity we'd lacked before.

Nonetheless, by 1996 - the hinge point of the epidemic - I'd lost a third of my body weight. My guts were ravaged by parasites, cancers blotched my skin, I had icy fevers and intractable pain.

I wrote my funeral service.

Then it all changed. I got combination therapy. The diarrhoea I'd lived with for half a decade dried up within two weeks.

And here I am now, a 55-year old juggling two professions with pot belly, greying hair and grumpy-old-man demeanour, and I am so grateful for this old age.

We used to say "One day HIV will be manageable, like diabetes." I have a friend with diabetes who, at 38, has already had a stroke. I, studies show, stand a fighting chance of living a normal lifespan.

So all has changed for the better?

Yes, in one way. In another, not in the slightest. About two years ago there was a rash of deaths, seven in four months, amongst HIV-positive acquaintances, after none for years. Four died of cancers and heart attacks.

The other three killed themselves.

While the physical reality of having HIV may have got immeasurably better, the personal experience of it may have improved little.

Why? The stigma.

Much is due to engrained cultural prejudice against 'the type of' person who catches HIV.

A lot, though, is due to ignorance - especially ignorance that, if people take successful treatment, their HIV is not only no longer a serious threat to them, but to anyone else either.

Being on successful treatment means that I might transmit HIV once every half-a-million times I have sex.

Don't take my word for it; this summer, a study called HPTN052 proved it. In this, giving people HIV treatment cut the infection risk to their partners by 96%. Other studies show that attempting to use condoms every time cuts the risk by 85%.

This is not yet understood, including by the criminal law. In Denmark, for instance, you still run the risk of being jailed for 'non-disclosure without suitable protection' where 'suitable protection' means condoms - but not pills.

Two weeks ago, Hillary Clinton, mentioning the HPTN052 trial, said that "combination prevention" using HIV drugs was the best way to achieve an "AIDS-free generation."

The reason I as a person with HIV care at least as much as Hillary about treatment as prevention, is that it could lift from us some of the burden of being seen to be a danger to others.