HIV Rates May Soar in the Future

In a disturbing article in Advocate.com, researchers at the University of Pittsburgh are expecting HIV rates to skyrocket in North America and Europe in the future.

The report projects that while only 1 in 12 gay men were infected in their 20s, 1 in 4 of this generation will be HIV+ when they turn 30 and 58% of these same gay men will be HIV+ at 60! The projected stats for people of color are even more grim. On the whole, HIV rates have been rising at about 2% per year since 2001.

While projections like this tend to be on the high side, it is still cause for serious concern. This study is like a tornado watch--the tornado may not happen, but the conditions are right for it to happen, so watch out.

In 2006, twenty-five years after the AIDS epidemic first made its appearance, I still hear things like: "Can you get it from kissing?" or "Can you get it because some cum got on my chest?" or "you look healthy so you don't have to use a condom with me." After hearing comments like these, I have to conclude that a major part of the problem is widespread mis-education.

It is often said that "this isn't the '70s" and so we have to just accept that the sexual landscape has changed. We can no longer have "carefree" sex anymore, some say. Use a condom everytime, HIV prevention specialists say. And they are right--indeed, the sexual landscape has changed and if you are going to have anal sex, USE A CONDOM.

But what HIV prevention specialists also have to take seriously is that this is also not the late '80s and early '90s. Since 1996, anti-retroviral drugs have significantly prolonged the lives of people who are HIV+. Furthermore, the antibody tests have become far more sensitive and now, with the fourth generation antibody tests you can actually know whether or not you are positive only six weeks after a risky encounter! The CDC still recommends three months, but in the state of Massachusetts, six weeks is considered definitive.

With the window period for testing getting smaller, the antiretroviral drugs getting more effective and side-effects becoming more manageable, we may be seeing more incidents of unprotected sex because people are becoming more relaxed and experimenting with new ways to keep themselves safer--e.g. serosorting. People are using "trial and error" to negotiate the changing effects of HIV. But unfortunately, with a lot of "trial" comes a lot of "error" and the rate of new infections continue to rise. That means that there does need to be some leadership and guidance from prevention specialists.

Unfortunately, many of our prevention specialists are still acting as though this is 1988 or 1992 when they need to be ahead of the population at large and creating prevention strategies that take into account the new HIV landscape. "Use a condom every time" is no longer an effective message. The same idea needs to be expressed differently and with some understandings of the complexities of people's lives.

Some say that in the old days (late '80s, early 90s) the fear of getting sick and dying was what kept people in line. So, the logic goes, if we want to stop the spread of HIV, we have to recreate that fearful environment. As a result, some prevention specialists are intensifying the use of fear-mongering and scapegoating to deal with the problem. A recent prevention ad aimed at the black community with the picture of a black man in the crosshairs asking, "HIV: Have you been hit?" is a great example of what's wrong with some HIV prevention strategies. Many critics commented on the ad's most egregious and blatant outrage--racism (as if blacks can only understand the language of violence and guns). The other problem with the ad is the very insinuation that HIV positive people are like snipers! It only reinforces the stigma associated with HIV and encourages people to do the very opposite of what the ad suggested--that is, get tested. Who wants to find out they're a potential sniper?

Fear and scapegoating do not promote testing or safer sex; they produce guilt and shame--which lead to lies and infection. Instead of resorting to fear tactics we need to take on the issue of HIV prevention holistically and address the various social, economic and psychological dynamics that are at the root of the epidemic. That may mean that we reevaluate things like social priorities (what government money gets allocated where), the political and financial priorities of the LGBT movement, etc.

First, it is clear to me that even twenty-five years after AIDS first hit, many, many people simply do not understand how the virus works. Everyone needs to understand that HIV usually means a significant reduction in quality of life--even with anti-retrovirals. Thanks to the pharmaceutical industry's advertising campaigns, the imagery of people who are on HIV-meds is skewed and unrealistic.

Also critical is that people know how HIV is transmitted without obfuscation and fear-mongering. The fact that people are paranoid of infection because they gave someone a blowjob is indicative of widespread mis-education. Sometimes transmission statistics are unclear, but we need to be as clear as possible and allow people to make informed choices.

Second, and most importantly, many prevention campaigns assume that people care enough about themselves to actually take steps to protect themselves. Most of the campaigns say, "Use a condom" and the subtext (and sometimes even the overt message) is if you don't use a condom you're stupid or evil. That's the wrong message. People make mistakes sometimes. Others get to a point in their lives in which they no longer want to live because they feel that their lives have no value--so why would they take steps to keep themselves safe? Some desire so much to fit in or to be loved and accepted that they put the desires of others over their own safety. As someone who works with HIV-positive people, I have heard all of these scenarios multiple times. To say "put on a condom" or "practice safer sex" to people who are hurt and alienated is putting the cart before the horse.

Is it really that inconceivable that people don't take steps to protect their own life if they believe that their life has no value, or they believe that their life isn't going anywhere? I have never seen an HIV prevention ad that says things like: You're special. Your life does have value. You are loved. You're not a slut, you're a good person.

Until we decide that we are ready to treat HIV as something that involves social, psychological and political dynamics, the spectre of rising infections will continue to haunt us.