If you’re aged about 40 or older, you’ll probably have a pretty clear memory of the outbreak of HIV and the early health campaigns that seemed to portray gay sex as a dangerous game of ‘Russian roulette’.
Across the world, the majority of investment in the battle against HIV is spent on prevention campaigns (as opposed to research for a vaccine or cure), but when you look at the statistics, it does seem that gay men are still being infected by HIV at alarming rates.
We spoke with community leaders around the world to get an update on how they were seeing the current status of the fight against HIV - is this the beginning of the end or merely the end of the beginning?
In France, Marc Dixneuf - director of Sidaction - confirms that while there is a national strategic plan to tackle HIV, at the regional level authorities can choose which health priority to focus on - this leads to inconsistencies in approach.
What specifically concerns Dixneauf is that 'although the number of new cases being diagnosed remains the same, if you look at gay men under 25 the rate of new infections in rising.'
For Dixneuf, a key area of Sidaction's focus is to encourage testing for HIV: 'In 2012 we organized our first testing week - it is something we're proud of, delivering testing to gay men in 40 different settings and creating new opportunities for men to be tested.'
Masao Kashiwakazki from the Japan Foundation for AIDS Prevention (JFAP) confirms the Japanese government continues to invest in HIV as a major health priority for Japan, in the current year that investment is ¥6billion ($64million €48million), but the size of that investment is decreasing.
‘Perhaps more concerning,' believes Kashiwakazki, ‘social awareness of HIV as a major health issue in Japan is also decreasing.’
JFAP takes a broad approach in prevention campaigns - providing educational materials and hotline services; organizing training programs for health professionals; running community centers; conducting media campaigns; and providing financial assistance to researchers and NGOs.
Matthew Hodson from GMFA, a UK health charity for gay men, confirms that prevention campaigns around the world have evolved considerably from the early days of the HIV outbreak.
‘Treatment for HIV has moved on considerably, so what we’re seeing now is that treatment for men with HIV is not only having a material impact on their life expectancy, but also their infectiousness.
'What this means from a prevention perspective is that we are still pushing condom messages (as condoms remain a really effective way of preventing HIV transmission), but we’re also seeing increased emphasis on programs encouraging gay men to test for HIV.
‘The improvements in treatment for HIV mean that if you’re taking the treatment then your viral load is reduced - so if you are diagnosed and on medication you are much less infectious. This is important as the data that we’re seeing suggests that around 80% of new HIV infections are as a result of having sex with people who are undiagnosed.’
This link between improved medication and reduced infectiousness for diagnosed and medicated people, has seen the US move to recommend that everyone diagnosed with HIV start treatment immediately.
GMFA’s Hodson believes that the UK is also moving in this direction.
He said: ‘We’ve got much better at dosing for people on HIV medication, so there’s far fewer side effects, plus studies are showing medical benefits of earlier intervention in terms of quality and quantity of life. When you also add that someone who is on medication is less likely to be involved in onward transmission of the virus then it seems a sensible approach.’
In the UK, changes to funding for HIV prevention campaigns is causing concern. I sat down with GMFA’s Hodson on a Friday morning and he looked fed up with the continuing uncertainty surrounding budgets: ‘In the past we’ve always had a combination of national and local funding, however over the last decade the local funding has been reducing significantly.
'Our current contracts come to an end in March and we don’t have any certainty beyond that. It’s frustrating as it limits our ability to deliver prevention campaigns.’
National funding in the UK is now being channeled through HIV Prevention England. Charity Terrence Higgins Trust (THT) has been awarded the contract to deliver four ‘super campaigns’ each year, using local delivery partners.
I spoke with Lisa Power from THT to understand what HIV Prevention England would deliver.
‘We’ll be working with national and local partners to deliver a national set of campaigns over the next two-and-a-half years, with a focus on gay men and African people. We’ll be promoting behavior change (using condoms for safer sex) as well as testing and treatment.’
However Power is also concerned about the reduction in local funding available to support HIV prevention campaigns: ‘Given the number of people living with HIV in the UK there is very little money actually being spent on prevention.
'I’m particularly concerned about services in London as it looks like that from April there will be no pan-London approach for prevention and support.’
GMFA’s Hodson believes that the next focus area for prevention campaigns needs to be HIV-related stigma: ‘The stigma that is attached to HIV prevents people from testing or being open about their status, or prevents people from having sex with people who are open about their status.
'Around the world we’re seeing a lot more people being open about being gay, we need to see a similar sort of openness from people with HIV.’
This is a view supported by THT’s Power: ‘I find it fascinating that we get some kick back from some gay men that we targeting gay men as being at higher risk of HIV, almost as if there’s a perception that respectable gay men don’t get HIV. We can’t allow HIV to be stigmatized or to be seen as our community’s dirty linen.’
Joel Simkhai, Grindr founder and CEO, has recently taken part in the Break The Silence campaign to help raise the public profile of HIV prevention campaigns in the US.
He said: ‘There are still so many myths circulating about this disease and the only way we’re going to eradicate HIV and AIDS is to continue to talk about it and continue to educate people.
'That’s why Grindr strongly encourages our users to engage in safe sex practices, get tested and know their HIV status.’
I quizzed Hodson on the HIV statistics for the UK: ‘You have to look at the number of new diagnoses as a proportion of the number of people being tested. Over the last decade we’ve been successful in getting a threefold increase in the number of people being tested for HIV, but we haven’t seen diagnoses rise at the same rate - so that’s actually good.
‘However these statistics are no cause for complacency - it’s clear from the data that’s being collected that among the newly diagnosed there is a considerable proportion of people that have been recently infected.’
THT’s Power agrees: ‘It’s a difficult tightrope - the improvements in medication can give people a false impression that HIV doesn’t really matter anymore.
'We have to make people understand that HIV systematically disadvantages you across your lifetime - you can still have a long and successful life, but it will be harder for you.’