June 2, 2008

More on Boredom and AIDS

Ok, not exactly boredom, more like success induced complacency, but certainly related to an earlier post on boring prevention ads leading to a rise in HIV infection rates in Utah.  This article in The Prospect does a good, sobering job of sketching out the impact that successful antiretroviral treatment is having on rising infection rates among gay men - and if you've ever perused a British tabloid you know that this can't be blamed on tame PSA's.  Here's a quote:
Well-monitored antiretroviral treatment can now bring HIV in body fluids down below levels that are associated with heterosexual transmission. There was much excitement about this in the late 1990s—mathematical modelling showed that if behaviour stayed the same and infected people got treated, HIV transmission would trickle to a halt. But the models didn't factor in the possibility that you need less virus to get infected in the more dangerous act of anal sex. They also forgot that humans don't behave like mathematical models. Gay men who have lived for 15 years in the shadow of a fearsome and disfiguring plague are especially unlikely to behave like mathematical models. In fact, gay men breathed a collective sigh of relief, hit the dancefloor and threw their condoms to the winds. Well, not to the winds exactly—48 per cent of gay men in Britain still use condoms all the time, which is more than can be said for straight men. But in 1996, just like everywhere in the world where HIV treatment became available, the proportion using condoms started falling. And so our hopes that getting everyone on treatment would squash viral load and slash new infections have been dashed. Viral load may be lower, but risk is higher, so new infections are motoring along nicely. And because so few people are dying, the number of people with HIV is climbing. In the last decade, the number of gay men living with HIV in Britain has more than doubled, from around 14,400 in 1998 to over 31,000 today.
Pomeroy has talked about this before but I'm still perplexed as to how to understand it.  Are we really heading for a world in which HIV is a slightly more lethal asthma - a pain to deal with but with proper treatment it won't affect your life all that much?

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