The country seems to be having one of its periodic fits of morality. Witness the recent hoo-has about binge drinking, so-called feral teenagers, obesity, factory farmed chickens and global warming. One common thread in many of these debates is the use of some sort of coercive measure which it is assumed will solve the problem – raise taxes on booze, bring back National Service, put them out in a field - the chickens, not the teenagers - and build wind farms and it’s all sorted. While I don’t dispute the problems I have to wonder about some of the solutions. Surely it’s not that simple, is it? Perhaps the appeal of these arguments is less their intrinsic value as solutions, and more the value they have in reassuring us that the world isn’t out of control and can be sorted if only someone would just get on with it.

If the tabloids decide to jump on this we could see a lot of nonsense about how this is going to give those ‘AIDS fiends’ the excuse to go around inserting themselves roughly into random strangers with the single purpose of not caring whether they pass on a fatal infection…”

It’s been interesting as it’s let people with HIV off the hook for a while, but I suspect it won’t be long before we’re back under the spotlight. Not long ago there was a piece of news that has sort of slipped under the papers’ radar. It concerns an announcement from a group of Switzerland’s most eminent HIV doctors that people on successful HAART effectively become sexually uninfectious after six months of sustained viral suppression. This sounds like very good news on the surface and insofar as it adds to our understanding of the circumstances in which HIV can be passed on, it is. But it’s considered controversial because there is a fear that such a message will undermine HIV prevention efforts.

There is a cynical part of me that would dismiss those objections as another attempt to scare people with HIV into taking all the responsibility for onward transmission, but another part says we do have to think carefully about what is being said and what wider consequences a misunderstanding might have. What the authors of the paper are saying is that people on HAART as we now define it become effectively uninfectious once all three of the following criteria are met: 1) they must be fully adherent to their treatment 2) their viral load must be undetectable over a period of six continuous months as evidenced by repeated viral load tests; and 3) they must have no other STIs. In fact, they expressly go on to recommend that people with HIV who meet these criteria continue to take all the usual safer sex precautions in casual encounters. They also say that this knowledge has ramifications for people with HIV in long term monogamous relationships with negative partners who might feel able to decide to stop using condoms with each other, but they are at pains to stress that this could only be a successful strategy for avoiding infecting the negative partner if the criteria above continue to be fully met. There are a lot of strands to this debate, things like HIV not being as suppressed in semen as it is in blood, and the possibility of viral load blips, and that’s what the six month thing is about, but it’s all said with the qualification that it’s impossible to prove a negative – that’s why I said ‘effectively uninfectious.’

It highlights two things for me though. Firstly, it represents a shift towards making safer sex for positive people first and foremost about our health rather than about the danger we pose to others and that’s a welcome change. Secondly it points out just how complex this whole business has become, assessing what is risky and what isn’t. In fact it always has been if we’re honest, but the messages have had to be simplified because it can make your brain ache trying to understand all the detail even if you have HIV, never mind if you don’t.

Now, if the tabloids decide to jump on this we could see a lot of nonsense about how this is going to give those ‘AIDS fiends’ the excuse to go around inserting themselves roughly into random strangers with the single purpose of not caring whether they pass on a fatal infection, and that Western Europe is on the verge of a plague that will make the Black Death look like an outbreak of food poisoning from a dodgy fast food shop. It’s hard enough to get them to understand that the treatments mean that most people with HIV who take them are not going to die horribly, never mind how those treatments can prevent HIV from being passed on. What the authors of the paper are NOT saying is that anyone on treatment is uninfectious and can now have unprotected sex with anyone without worrying about it, but for some quarters it’ll be much easier to stay stuck in the absolutes – they sell more papers for one thing – but that isn’t going to be an option for long, especially if this ends up in front of a judge at some point, and it’ll be us that end up having to do the explaining. Ah well, add it to the list. PN