Editorial from The Guide	Editorials Archive

Treatment for HIV infection has advanced dramatically since the 1980s. Back then, contracting HIV meant almost certain death, usually after a series of highly visible, body-ravaging opportunistic infections. Lacking any effective treatments, those with HIV grasped at longshot potential therapies-- teas made from fermented fungus, herbs from the pharmacopoeia of traditional Chinese medicine, procedures to return blood back to the body after being removed and heated, white light visualization and other forms of faith healing. None worked. Treatment advances came only after ACT-UP demanded action by the government, researchers, and pharmaceutical companies-- all of which had been slow to respond to a disease of fags, niggers, and junkies.

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Now, HIV-infected people fortunate enough to have access to treatment have many choices of drug regimens. For most, an effective combination can be found that slows or halts HIV's damage to the body's immune system. As a result, thousands of people who would have wasted away and died are living able-bodied, productive lives.

These wonderful advances have made HIV prevention efforts in the gay community more challenging. No longer are skeletal faces and an unrelenting stream of obituaries frightening those uninfected into safer sex practices. Indeed, some HIV prevention rhetoric now carries a not-so-subtle undertone of regret that a whole new generation of gay men is growing up not fearing HIV the way their predecessors did. Some, in fact, voice explicit worry that HIV-positive people are now often seen as healthy; they downplay treatment advances as though they want the specter of death as an ally in the campaign against HIV.

We need to be on guard against such attitudes, for they are aimed at preventing sex, not disease. No one would think of lamenting the advent of airbags and other technological advances which have lowered highway death rates-- even if such advances make it harder to convince people to consistently wear seatbelts.

To avoid losing credibility, HIV prevention efforts must be reliable and fact-based, and the fact is that HIV infection need not be the same death sentence it was 20 years ago.

But there are still plenty of reasons to motivate people to avoid contracting HIV. Anti-HIV drugs do not work for everyone. They are expensive (even with insurance) and bothersome to take each and every day for the rest of one's life. They frequently have nasty side effects such as diarrhea, elevated fat in the blood, fat accumulations in the belly or neck, facial wasting, nausea, and insomnia. Once infected, one must worry about then infecting sex partners, as well as losing insurance benefits (forget about buying affordable life insurance), travel and immigration privileges (many countries require certification of no HIV before granting visas or residency permits), and some employment opportunities (the military discharges those HIV positive).

And the future remains uncertain for those taking anti-HIV meds, even when they're apparently completely effective suppressing HIV. No one knows what the long-term effects will be on the liver-- the kidneys- the heart-- the nervous system-- of taking new drugs for years and years. Controlling HIV with today's pharmaceuticals may lead to an explosion of new cancers, coronary disease, and vital organ damage down the road.

There are many rational and compelling reasons for those HIV-negative to dedicate themselves to remaining so-- and for those HIV-positive not to infect others. But the fear of immediate and fatal consequences is no longer one of them, and that is cause for nothing but celebration.