Starting All Over? Really?

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First Generation
by Chuck Willman

Starting All Over? Really?
We must continue to transform prevention know-how into prevention action

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I’m pretty sure that I can assume most of us infected with HIV—better known as GRID or “the Gay Cancer” back when this virus began its ruthless appetite for an entire generation of gay men in the early eighties—watched Larry Kramer’s masterpiece, The Normal Heart, despite how difficult it may have been to relive.

I’m sure those of us in that “First Generation,” the first wave of terrified, ignored, and truly hated “victims,” probably experienced more emotions in one sitting than we have in a long time. I know I cried for the countless friends I’ve lost, not to mention my own fear and agony when no one really knew what was happening, what to do about it, or if we would even survive a few weeks or months. Eventually—and it took some time—we realized we had to fight for ourselves. And once we galvanized a movement together from scratch, OUR loud voices demanded care, medication, and assistance. We continued the fight for more research and medication, and, after years of absolute HELL, HIV/AIDS became a somewhat manageable illness. With the development of protease inhibitors and all of us taking some sort of cocktail, we no longer felt the need to update our Last Will and Testaments every other month.

A lot has changed in the fight against HIV/AIDS since the first buried headlines about a “gay cancer” began appearing in gay newspapers, then becoming headline news as the virus claimed the lives of famous celebrities, which helped to put a real and more urgent face on the disease. Cries for a vaccine and a cure grew louder. Now there are research facilities around the world solely working on finding a vaccine and/or a cure for the virus that has taken millions of lives around the world—both homo- and heterosexual—in thirty years. Many of us in the “First Generation” are still alive, despite what the disease stole from us in the beginning. And as new medications hit the market, everyone with access to these medications lived longer, productive lives.

Those newly infected (and there are approximately 6,000 NEW infections every day—still!), have the luxury of combinations of these new drugs in one pill, and have been spared the horrible side effects we dealt with. In the “old” days, we were kept chained to a toilet, and, unfortunately, while happy to be alive, our bodies were re-shaped, giving us a hump on our back or making us look like pot-bellied stickmen!

SO WHY WOULD ANYONE WANT TO TAKE THE RISK JUST TO GET LAID?!

There has been a shift toward condomless sex in the face of new prevention strategies: men who have sex with men are serosorting (having sex with men of the same serostatus) and/or seroadapting (adopting practices based on serostatus); using PrEP in isolation; knowing that PEP is available if they feel that they have been infected; and taking the Swiss Statement—which has been interpreted as saying that a positive person whose viral load has been suppressed due to antiretrovirals is not infectious—to heart.

It’s important to note that the Swiss scientists made it clear that they did not mean that transmission wasn’t possible. And recently French scientists have discovered something that might—might—present a problem for those who are thinking about going condomless, whether it’s due to the promise of PrEP (as of right now, that means Truvada) or Treatment as Prevention (TasP).

Due to my limited space here, I cannot give you all of the clinical details and findings of countless tests, most of them from Europe. But I can wrap them up into a few sentences that are very important.

French researchers analyzed 306 semen samples in men who were all taking antiretrovirals (ARVs) and had an undetectable viral load for at least the previous six months. A series of tests were performed and the researchers detected HIV in at least one sample from seventeen of the men, comprising nineteen percent of the study group. It was not clear if the detectable virus in the semen posed a significant risk for transmission. Research would suggest that this is unlikely.

NO TRANSMISSIONS IS NOT THE SAME AS ZERO CHANCE OF TRANSMISSION. That’s an important sentence. The researchers calculated the ninety-five percent confidence intervals for the results seen. What this means is that they calculated the odds of zero transmissions being the “true” figure and what the maximum possible risk of transmission was, given the results seen.

As I said, there’s much more detail to these studies, including the prevalence of sexually transmitted infections (STIs) among gay men.

So, what is my point?

We have been down this road before! Just when the gay community thought we were finally getting some control over the number of HIV/AIDS infections/cases, we are thrust smack dab in the middle of it all over again! The rate of infection is once again reaching staggering numbers, which means gay youth and women of color (who are usually infected from a male partner/husband) are not paying attention—AGAIN!!—to the life-saving warnings of SELF-PROTECTION. They are not listening to those of us who had NO warnings in the late seventies and early eighties, when HIV/AIDS first began swallowing an entire generation of gay men at an alarming rate.

Had we listened to doctors, the healthcare community, and activists back then, maybe many of our buried friends would still be walking this earth with us. But we have a chance to listen to them NOW! While something like Truvada as PrEP may be an effective tool to help fight HIV/AIDS, we must look at our own BEHAVIOR, TOO; we must not rely on ANY pill (used with or without a condom) to throw caution to the wind.

With the new research that proves “undetectable viral load” doesn’t necessarily mean what we thought it did. TAKE A MOMENT AND THINK!!

Is the risk worth your or your partner’s life?

Along with being a contributing writer for A&U, Chuck’s had other work published in journals, magazines, anthologies, and e-books.