The nation’s annual HIV report card is out, and the news doesn’t look good. Infection rates are rising. We can quibble about who is doing worse than whom – old, young, straight gay – but the trend is inexorable and well-established.
Clearly, prevention efforts are failing, and have been failing for a long time. Things began to go wrong back in 1999, and apart from a few ‘blips’ on the graph, the trend has been steadily upwards since then.
The other clear trend is inconsistent condom use. Another report showed almost 40 per cent of gay men had unprotected casual sex at least once in 2012. What can we do to get the graph turning downwards again?
HIV/AIDS professionals are keen to get everyone onto anti-retroviral drugs, whether it’s the newly infected, or people who are not yet infected at all. That would stop people getting infected in the first place, and reduce the viral load of the infected to the point where unprotected sex with them would pose only a minute hazard.
These drugs are not cheap: Truvada (to take one example), according to the Pharmaceutical Benefits Scheme website, costs $1530 for 60 days supply. Even if we limit the supply to say, 10% of the 13m Aussies between 15 and 54 years old, that’s over a billion dollars a year. No wonder the drug companies love the idea.
We lost control when messages went from “always use a condom” to “condom use is negotiable according to circumstances”.
Since no-one likes using condoms in the first place, any glimmer of an excuse to ‘forget’ them once in a while was welcome. And since the new prevention messages were complex and nuanced, people only heard what they wanted to. They interpreted these new messages to mean “barebacking’s not as dangerous as we’ve been telling you.”
This has had the twin effect of making people less worried about not using condoms every time, and of making them skeptical of all future safe sex messages. Hence that rising graph.
Some of us have thought this was a mistake. We still do. Sure, the condom-wearing message was becoming a much harder sell, but that should have led to a search to ways to strengthen rather than weaken it. We should perhaps have brought in some savvy advertising agencies.
So what now? Is it too late? Can we put the penis back in the condom? Or must we go down the drug route?
Will that lead to an explosion of other STIs as people abandon condoms? Can we persuade/cajole/threaten/legislate against the drug companies to get the costs of the drugs down, and if so, how?
As Robert Mitchell, president of the National Association of People with HIV Australia, says:
“Australia needs a new National HIV Strategy to replace the current one which is completely out of date.”
Something to think about as we celebrate our stunted unequal temporary state-based same-sex ‘marriages’ in Canberra today.