Saturday, March 29, 2008

When Good News Makes for Tough Choices

I know, it's been a while. But at least I brought a new look for spring!

One of the reasons I've been away from blogging has been that my volunteering for the local AIDS center has kept me busier than usual. Other than looming budget cuts we had to deal with a bit of potentially very good news for millions of people living with HIV.

EKAF, the Swiss National AIDS Commission published a report in the Schweizerische Ärztezeitung (Swiss Journal for Medical Professionals) stating that research shows that HIV positive patients whose viral load has been undetectable for more than 6 months as a result of the usual combination therapy no longer seem to be passing on the virus to their sex partners (if they are free of other STDs). You can read an unofficial translation of the article here.

To clarify things for those not overly familiar with the subject matter: The combination therapy is not a cure. Once you go off the meds, the virus comes back with a vengeance.

I am still not quite sure how I feel about that publication. On the one hand, I have friends whose partners are HIV-positive while they are not, and this must be a huge relief for each half of those relationships. Heck, most people with HIV would have a burden lifted from them.

On the other hand, I have quite a few questions.

First of all, the research seems to be mostly based on heterosexual intercourse. As anal sex has long been known to be the riskiest for transmission,how sure are we that the results can be translated to the gay population?

Secondly, a doctor working at the local Chronic Infectious Diseases clinic told me a couple of years ago that almost all new infections they see are with virus strains that already have a level of immunity against some of the drugs being used in combination therapy. That means that at some point in the chain of infections, this virus was transmitted by a person who had received anti retroviral medication for quite some time. Are we to believe that all those people showed bad compliance with their medication regimens to remain infectious? And wouldn't infection rates actually go down instead of up as they have in recent years?

And finally: How do we prevent these news from filtering down to "Condoms aren't necessary anymore" in too many heads?

I'd like to see more research into this. As usual, we should avoid the easy answers. Neither going on with the same old prevention message nor calling off the dogs is in any way advisable here. If the results from the Swiss study prove accurate, we need to get more people tested and get infected people on medications sooner. We need to fight even stronger to get those with HIV in developing countries access to medication as it would not only add years to their lives and life to their years, it would actually slow down the spread of the disease.

As for all of us individually, I'd listen to this advice that the late Mary Wells is dishing out in one of my favorite songs by her: