Q Health: AIDS at 30
The year 2011 marks the 30th anniversary of AIDS, and what a wild 30 years it has been. The waves of change with this epidemic have come and gone, but as we reach 30, it is clear that the wave is back and it is a big one. The current wave seems to be strengthened by increasing drug use within the gay community, continuing attitudes of complacency where HIV is concerned and sexual networks, which in reality is a fancy way to say multiple sex partners.
When we look at the trends, newly diagnosed cases of HIV initially peaked in the late 1980s and started to show a real decline in the 1990s. It took a while for the medical and public health community to really understand how HIV was transmitted and frankly we all were caught with our pants down, no pun intended. Without that understanding, it was extremely difficult to give rise to effective prevention efforts. The “unknown” regarding HIV also drove a lot of fear and judgment.
Initially, HIV was referred to as G.R.I.D. or Gay Related Immune Deficiency or simply the gay cancer. These initial monikers were given because the first recognized cases occurred among clusters of gay men in California and New York. We knew that it impaired the immune system and we knew it was infectious, we just did not know the exact route of transmission.
In the early years of HIV, the average life expectancy after diagnosis was two to three years. During that time it was pretty easy to identify those who were infected; the facial wasting made it hard to miss. The role of the clinician was primarily to provide palliative or supportive care and to help prepare the patient for death. As we began to realize that this disease was transmitted through unprotected sex, the community itself rallied to educate and protect itself. The social-sexual paradigm within the gay community was safe sex; unprotected sex was taboo. Condoms were being passed out at bars and restaurants throughout Castro Street in San Francisco. By the early 1990s we were well versed on how HIV was, and was not, transmitted.
The early and mid ’90s brought the onset of effective HIV anti-retrovirals, in the form of protease inhibitors. We eventually came to realize that a multi-drug approach was more effective and the HIV cocktail was born. The early generations of anti-retrovirals came with many side effects, and although newer generations of drugs show much fewer side effects, we continue to recognize that long-term use of these drugs are leading to other health conditions. We continued to be vigilant about protecting ourselves in the 1990s and rates of new infection slowed dramatically through the ’90s and early 2000s.
So, here we are 30 years later; a lot has changed, and a lot is the same, compared to the early years. The life expectancy after diagnosis has increased dramatically due to effective drug therapies. These drugs are incredibly expensive and the amount of federal and state funding available has decreased since they first came out. Many newly diagnosed people are not currently able to access medications, and those who were getting full coverage for years are now expected to pay up to half of the cost.
We know much more about HIV transmission and we know how to teach people about protection. Yet, social attitudes have changed and many don’t seem to fear this infection anymore. Unprotected sex is the new social paradigm within much of the gay community. People are living longer with HIV now, and they are more likely to want to have sex. You can no longer tell by looking at someone if they are infected. Many HIV-positive individuals no longer feel the need to protect their partners from infection, and are more likely to engage in unprotected sex and pass the infection to others.
We have HIV testing available where results are available within 15 minutes; in the early years results took almost a week. The majority of new infection in Salt Lake County is occurring within the gay community; this has not changed in the past 30 years. The average age of diagnosis has decreased and is currently most often infecting men in their 20s and early 30s. Many young gay men are being diagnosed in their teens. Despite a 10-15 year decrease in new HIV rates during the middle wave of the HIV epidemic, HIV rates are on the rise again.
The Salt Lake Valley Health Department will be offering free HIV testing on June 27 at the Pride Counseling Center at 124 S. 400 East from 5:30-7:30 p.m. Results will be available within 30 minutes. For more information, call 801-534-4666.