The news headline today “WHO Says All Men Who Have Sex With Men Should Take HIV Antiretroviral Drugs”, struck a chord with me. To be more accurate, it brought up a mixed back of emotions.
First, what’s the story behind the headline?
In guidelines published today, 11 June 2014, the World Health Organization (WHO) said for the first time that all men who have sex with men should take HIV antiretroviral medicine “as an additional method of preventing HIV infection.” Similar guidelines were issued by the US government earlier this year, in May. The WHO also warned that HIV infection rates among gay men are increasing around the world, implying that a second HIV ‘epidemic’ among gay men is about to ‘explode’.
Although HIV infection rates dropped by a third between 2001 and 2012, Gottfried Hirnschall, the head of WHO’s HIV department, said that infection rates among homosexual men are increasing again 33 years after the epidemic first hit. He added that while images of skeletal men dying of AIDS in the 1980s pushed the world to act, the younger generation of gay men has grown up in an era where drug treatments are available that enables HIV sufferers to live ‘normal’ lives, making them less focused on the prevention of HIV. Hirnschall also said that this group of gay men is 19 times more likely than the general population to be infected with HIV.
As part of its recommendation, the WHO said that taking pre-exposure prophylaxis (PEP) medication, for instance, in addition to using condoms, has been estimated to cut HIV incidence among such men by 20-25 per cent, potentially preventing “up to one million new infections among this group over 10 years.“
Even though the new guidelines focusses on Gay men, it also includes other high-risk groups, pointing out that men who have sex with men, transgender people, prisoners, people who inject drugs and sex workers together account for about half of all new HIV infections worldwide. Promoting condom use, wide-spread voluntary HIV testing, treating at-risk individuals with antiretrovirals, voluntary male circumcision and needle exchange programmes were among the other WHO recommendations for battling the disease.
Those are briefly the facts behind the Who’s new recommendation and my first thoughts were: I don’t like how the WHO played on the fear factor. I also couldn’t help but to wonder if the WHO is not using the rise in HIV infections as a foundation to justify the selling of more HIV drugs… Let’s face it it’s a massive market that can easily be exploited. I wouldn’t put it past them and the drug companies developing these drugs. The Pink dollar and pound means big money…
However, after a while, I realised I felt ill at ease for a number of other reasons too. But before I continue, I want to qualify how HIV impacts me as an HIV negative gay man:
I grew up in the 80s and saw first-hand how the HIV/AIDS epidemic nearly destroyed the gay community. If there is one thing I remember then it is the fear surrounding this new ‘gay cancer’ (words that still send shivers down my spine) that spread like a wild fire throughout the world.
What followed was, in my opinion, a modern-day ‘Gay Holocaust’ — governments dragging their feet to assist dying gay men with basic medical care, turning them away from hospitals and refusing to treat them, vitriolic and hateful homophobic news headlines ostracising our community from society and a reluctance to release drugs that could possibly have helped to treat those infected. People literally died like flies. To add insult to injury, in the late 80s, our community were subjected to homophobic legislation like Section 28 — preventing the intentional promotion of homosexuality in schools. Laws like this, I believe, came as a result partially because of the stigma that surrounded the gay community after the HIV/AIDS epidemic.
One of my first relationships was with someone who is HIV positive and I have lost one of dearest friends to the disease, both of whom took AZT — one of the first government-approved HIV treatments. They both suffered badly from AZT’s side effects. My friend eventually ended up with permanent liver damage years after replacing his AZT with newer and more effective HIV drugs… sadly, he died.
We all paid for HIV in some way or the other. Luckily, times have changed. HIV drugs have changed. They are much more effective and for many sufferers it’s now a question of simply popping a pill and carrying on with life as normal.
And this is where I am conflicted and why I feel the WHO’s new guidelines can lead some of us down the path.
Living with HIV is not ‘simple’ or ‘normal’. There is the dependency on medication to start with, regular doctor visits and endless — literally ENDLESS — bloodwork being done to monitor your T-cell count… is the virus detectable or not? For some the drug treatment may not work, resulting in a hamster wheel of trial and error to find something that will work.
Apart from all the above, HIV still carries a social stigma… even in our own community. Many of my HIV positive friends struggle to find someone who is prepared to build a loving and caring relationship with them. Guys on dating apps and websites have no qualms stating that they are only interested in ‘disease-free’ guys… That’s a painful thing to hear if you are the one carrying the disease.
Does that sound like a ‘simple’ and ‘normal’ life?
Earlier this week, I went for my three-monthly HIV screening. I used to be filled with trepidation walking down Old Compton Street on my way to 56 Dean Street, the sexual health clinic in Soho, London. I felt a terrible shame.
Until one day when I realised that having my HIV screening on a regular basis is an act of self-care. It gives me assurance that I am healthy and not a risk to others. It’s part of the package of being a gay man, living in a city that is the epicentre of the UK’s HIV infections — London accounts for roughly half of HIV diagnoses in the UK.
While waiting for my test results, I read a chart on the wall explaining how to take PEP — a single pill combining two or three antiretroviral drugs. PEP is the most common treatment given to people who have been exposed to the HIV virus in the past 72 hours.
The chart made it look so easy. You take a pill (unless you need a combination therapy, then there are more pills) twice a day… and there it is, right at the bottom of the chart… the most common side effects: prolonged headaches, diarrhoea, nausea and vomiting… These don’t sound too horrible and if I have the option to either suffer some minor side effects or to prevent an HIV infection, I’ll take the latter.
But here’s the thing… and the chart don’t say this: Early studies have shown that PEP makes infection with the HIV virus a lot LESS LIKELY. However, it doesn’t always work and some people who take it still end up being infected. That’s because some anti-HIV drugs like PEP aren’t effective against certain strains of the HIV virus. The chart also doesn’t mention the fact that some patients may suffer with liver and kidney damage, fatigue, skin rash and kidney stones… side effects that are a little bit more severe than head aches and a runny tummy.
So it’s still a hit and miss scenario… and yet, the WHO does not allude to this fact when making their recommendation. Theirs is a simply a overly positive message of prevention — a blanket treatment rolled out to a large proportion of the population promising positive results. That’s not the full picture.
By no means am I implying that PEP has not been effective in bringing HIV infections down, but I am afraid the Who’s recommendation is a double-edged blade: By not providing the full facts, gay men (perhaps even more so the younger generation who have not lived through the HIV epidemic) will mistakenly think having unsafe sex is ‘safe’ because they are taking a drug that will stop them from getting infected. As a knock on effect this could also prevent them from having regular HIV screenings, thinking that PEP will ‘kill’ the virus, when the truth is that HIV can become resistant to PEP… especially if you keep exposing yourself to the virus.
Can you see how things could go horribly wrong? Practicing unsafe sex, not having regular HIV screenings and not knowing your HIV status all because PEP is supposed to provide some sort of safety net?
Yes, condoms can break and in a moment of weakness (or intoxication) we may forget to use one or allow more than what we usually would when we are sober. However, even if we are mass medicated we will still have to continue with these equally effective methods of prevention: Practicing safe sex and having regular HIV screenings.
There is not a perfect solution to this problem.
The most terrifying thing about HIV is that, for the time being and foreseeable future, it is here to stay. It’s a harsh reality for our community and an even harsher one for anyone who lives with HIV.
It’s great that the fight against HIV continues and it should never stop. However, ultimately, prevention comes down to personal responsibility. Whether you ask healthy Gay men to take a drug daily, or tell them to practice safe sex — they’re either going to do it or not… and therein lies the core of the HIV message. We are all at risk and we are all responsible.
We can own more responsibility for our actions when we know the full facts and looking at HIV through rose-tinted glasses will cloud our judgement… and we cannot afford that.