Here’s what I want: I am going to ask you a question, and I want everyone to give me their answers in the form of a comment. Here’s the deal, there are NO wrong answers, but there are answers that will be examined to determine where their epistemological background stems from. No one will be attacked (by me) for their answers, and a follow up post will be posted with a reaction to the consensus.
Ready?
Here’s the question:
If you could describe the state of HIV and AIDS today, how would you describe it? Things to consider: the history of HIV/AIDS, the fact that we are 30 years into the epidemic, treatments available, people that are open about their status, social stigma, the face of AIDS, personal experience with the disease or with people with the disease, life with the disease: better, worse, ?, risk of infection, societal response to the disease, what HIV/AIDS means to you, etc.
Nothing is taboo with regards to what you should consider to answer that question, you can say whatever, and I really want you to be honest; I really want to know what people think about HIV/AIDS right now.
Alright. Give it some thought, but PLEASE give me your opinion. I look forward to your responses!
UPDATE: 3:00pm, perhaps the lack of any response is a testament of how unimportant HIV/AIDS is to people these days? Just a theory, but an interesting one… Still, I hope to get some opinions. No pressure…
This isn’t really about the state of things, but you said there were no wrong answers, so here ya go.
The most troubling bit for me is fact vs. Hollywood. Based on recent (real, not sensationalized) reports, the spread of HIV in Africa of late is due primarily to a lack of basic plumbing (sewage contaminating water) and has very little to do with those GD “go red” ads.
My blood pressure goes up every time I see one of them, knowing that the amount of miseducation about AIDS in Africa (and at home, and abroad) is being perpetuated by clever marketers and ignorant celebrities.
In a conversation with the director of the Jerusalem House last fall she told me the group on the incline for infections these days is actually folks over 60. It’s our grandparents in nursing homes now, thinking they’re not at risk.
It’s been 30 years and we’re still not being honest about it.
You don’t want my opinion…
I wouldn’t be a good one to ask. I mean, I read the news (well the highlights) but current events get me down and I really have trouble when I think about things too much. I can get myself really upset. So I tend to escape through books or music. (you know, I never seem to respond if things get too political here…) and I probably should be more aware but sometimes just getting through the day is hard for me and I just need to get home and get away. I would like to think that people are living longer and people are getting better. I would like to say that I think it had a higher profile in the eighties and you saw more stories about it and they included it in things like books and Tv, but now it seems that they are back to not talking about it as much again. Characters on TV still sleep around like there is no tomorrow and they never mention safe sex. And it seems to me that people keep having sex younger and younger and the young are not immune. The media should be more responsible.
Medical advances have made it more bearable in the eyes of many. I think it is therefore less feared, as evidenced by the many “bear backing” ads you see and on-going promiscuity. I often wonder what is going through these peoples’ minds.
I think all-around awareness of the disease–the mainstreaming of information about it–has helped keep infection rates of the 80s and 90s from increasing. Though obviously not every one listens to the advice provided.
There is overall a lot of complacency. This is intolerable, especially in the young, and they need to be taught better.
I think we may be a few medical advances away from a cure or vaccine, at some point in our lives.
My post only dealt with AIDS in the US. The state of AIDS in Africa is too stupid for me to discuss.
Maigh, you are wrong! LOL Just Kidding… but you are wrong about one thing, what you are saying is totally about the state of HIV/AIDS today. Basically, I think that you are pointing out that the pathetic attempts of public figures to throw some money at a red ipod and call that truly affecting change in the epidemic isn’t cutting it; in fact, it is putting a band-aid on the problem, and introducing more complacency, by never showing the true face of the disease. You totally represent the fact that AIDS is still as prominent today, yet we don’t pay as much attention, and even fool ourselves by providing misleading “education” to those at risk. Great input!
Stu, honey, I DEFINITELY want your take. Especially because I know your personal experience with a cheating boyfriend, and I would like to have your take on the state of the epidemic. So tell me!
Doug, you are the perfect one to ask; you are affected by HIV too, and you are at risk, all of us that are sexually active are. Therefore, you have an opinion about the epidemic, regardless if you read the news or not; and I say this with certainty, because you prove your are very aware by your comment. Less attention, people getting better, less responsibility by the media; all of these things are exactly what I want to know about how people see HIV. This is exactly what I was looking for, thanks!
Bugboy, let me just say this first; thank you! The Bugboy I remember is back! I am so glad that you so eloquently described your perception of the epidemic, and you are exactly right about AIDS in Africa, that really wasn’t what I was seeking, as things are just too nuts with that situation for me to even make sense of how far our hear is in the sand on that one. Thanks for your perspective!
As I mentioned, once there have been several responses, I will compile a follow up post, and address the things that I see in people’s opinions. Keep them coming, and thanks for the input that has already been received!
Advances in treatments are great, and certainly offer many sufferers the opportunity to live long and healthy lives, but not in the way the drug company ads would have you believe. HIV/AIDS is still a debilitating disease, and although we no longer see the horrifically thin AIDS sufferers paraded through the press, that is still the reality for people with this disease. The perception of HIV as manageable leads to increases in risk that are just intolerable. Others have said it here already.
I don’t think there will be a cure for HIV in our lifetime. I also don’t think there will be a viable vaccine any time soon (the current vaccine trials are only showing a 30% efficacy, which is just not enough to make it the saving grace we are all hoping for). I do think there will continue to be advances in treatments (this is where the money is for the drug companies, and the investment in treatments far exceeds the investment in seeking a cure). I hope I am wrong. I want to be wrong.
I think we will continue to see the development of post-exposure one-time treatments, better and more effective cocktails, and advances in highly active antiretroviral therapies. Still, even in the post-HAART era, there is an alarming increase in the rates of drug-resistant strains, so it will continue, I believe, to be an uphill battle to keep this a manageable disease for at least 70% of people who have it.
i also think we need to talk about co-epidemics - of alcohol and drug abuse (illicit and legal, like Viagra) that so often accompany high risk sexual behavior, and of the alarming rates of other STDs that mirror increases in HIV and suggest across the board reductions in safer sex practices. Especially among gay and bisexual men. Even with skyrocketing increases in HIV in other communities, the gay community still bears the brunt of this epidemic and has done so since the beginning. We need to do more than just test and retest men as if knowing your status were enough, and more than just hand out condoms at gay pride. We need to start looking at syndemic patterns, at underlying epidemics, and at social barriers to sustainable behavioral change.
I think the out of control rates in minority communities will force us to think differently about how we approach HIV prevention. We certainly need to come to grips with the epidemic in minority communities and be prepared to face all of the issues we find there (like stigma, lack of trust in the medical establishment, barriers to cultural acceptance, lack of access to resources and services, and so on). Recent trend data suggests 70% incidence rates in young African American males in some cities and over 50% incidence in women. Entire communities are at risk. This is unacceptable, and we need to engage the African American community at all levels to reverse this.
I also think we need to abandon abstinence-only education in schools and minimally, provide abstinence-plus education. Young people have sex (check out the recent behavioral risk factor survey). Lets give them the tools they need to NOT end up a statistic. I think, in general, we don’t see HIV in the media the way we used to, and we hear about the reasonably steady national rates and we get lulled into thinking that not much is going on, that it is not really a problem anymore. That couldn’t be further from the truth…it is just moving around, shifting into new behavioral niches. Our inner cities face the same kind of epidemics as Botswana and South Africa.
I also think we do need to talk about Africa, and Southeast Asia, and Russia, and Latin and South America, and recent emerging players, like China. We won’t escape the consequences of a pandemic on our world market. We did it for smallpox, and we are doing it for polio. We need to find a way to do it for HIV.
BTW, I love your effort to do public health blogging! Did you go to that talk?
AIDS/HIV is really bad in third world countries because of improper sanitation, lack of healthcare, etc..
Most people in the US, Canada, Europe, and other industrialized countries have access to treatment.
Industrialized countries keep it from spreading as rapidly.
I would not have a problem eating/drinking after someone with HIV, but I would not have sex with an HIV patient, protected or otherwise.
Most HIV patients in the US are junkies, whereas most HIV patients in third world countries are children who have been infected by their parents.
These statements pop into my mind when I read the question. I’m really niave.
To reply sort of to Maigh’s point…. An organization I believe in and am involved with is Blood:Water Mission. They’re doing something about the lack of clean water in Africa, (which as Maigh pointed out is a huge contributer to the mortality rate from AIDS, as well as infant mortality and public health). It costs approximately $1,500 to $3,000 to drill a well in Africa, depending on location. (Some areas of the Sudan are drastically more expensive - $15k to $30k.) But for many people suffering from HIV the difference between dying and living with HIV is as simple as water.
Their site: http://www.bloodwatermission.com/
You can donate a dollar, learn how to sponsor a well with a group of friends (what I did), or just read more about the connection between water and AIDS in Africa.
This page specifically addresses the connection between unsafe water and HIV/AIDS.
link
If it hasn’t touched our lives personally and since it has been 10 years (or so) since Magic Johnson got it, I don’t think most people give it much of a thought nowadays.
Hey, I love your use of the blog to cover social issues. I agree with Deb that schools need to stop the “political BS” and teach kids about sex. Give them the information they need BEFORE they have unprotected sex. Kids do not wait to have sex until they marry - those that do are few and far between. My district has an abstinence-only policy and the state backs them. I tried for 3 years to teach a parenting and child dev class to 9-12 graders without saying a word about protection of any kind - male or female - to save my job. I just gave up and asked to teach something else. I would say that 28 of the 30 each semester were girls. One third of the total girls for the year would get pregnant for either the first time or in some cases have numbers 2 or 3. I was teaching the class as a parenting skills class not as a class to enter the workforce as a daycare provider. Point being - we need to do a better job with the younger kids. I’m talking not only about getting pregnant but about the risk of HIV/AIDS. In the health classes here the topic of HIV/AIDS can only be referred to as an adult issue - sex after marriage. Why not tell them the truth and provide them resources to get more information if they choose to have sex - I won’t even start on the HIV/AIDS problem in this county (high school on up).
Before I started working in the West Village in NYC I believed that HIV was becoming less and less of an issue in the US. I have since realized that it is just that it is no longer ‘big news’. I also used to believe that with medical treatment, people didn’t need to die from it (ok, I am a complete idiot). These days I see many many patients in our hospital’s halls who have become walking skeletons. I am sure they are not all suffering from HIV, but that *is* a patient population we target for services. For each of these very ill that I see, I assume (likely incorrectly) that there are 6 or 7 in the halls where it is not visible.
I appreciate all of your opinions, but I do want to ask one thing; STOP saying that your opinion doesn’t matter, or that you are stupid because you have heard this or that! Seriously, we all have a stake in this problem, and the only way to help this epidemic is for all of us to get together, talk about it, educate each other, and move forward.
Don’t ever let anyone, especially yourself, convince you that you are stupid and that your opinion doesn’t matter; sometimes you may be misinformed, but identifying the potential ignorance in what you have heard is the easiest and BEST way to change it. If you think that you are not right, then doing what you have done, coming forward and saying what you have heard will allow you an opportunity to see if what you have been told is right or wrong.
That is crucial in this battle to give all of us the right information; which is hard in a day and age that money talks, and can greatly overshadow the truth. Again, thanks you guys! I really appreciate this input! Main post forthcoming!
1980’s Joke:
Question: What’s gay stand for?
Answer: Got AIDS yet.
Complacency and ignorance are too easy an answer.
It’s a white-washing politically correct scapegoat for more complicated issues such as condom fatigue, sero-sorting, higher rates of depression among gay men, the abundance of positive imagery of people living with AIDS (PLWA), and generational differences between gay men.
First and foremost, our current methods of educating the gay masses (and everyone else) in safer sex practice and HIV/AIDS exposure/infection prevention aren’t working anymore. They’re not working like they used to. I think we can all agree on that. Our current model of promoting condom use as an infection deterrent sounds more and more like the abstinence-only sex-ed fodder young kids get fed now-a-days. It’s become a one-dimensional argument that’s left plenty of disenfranchised gay men of all ages that feel their already restricted sexual options are being further limited.
Some years ago Larry Kramer wrote a great piece for Out or The Advocate chastising us for the positive imagery we’ve put out there of PLWA countering the ‘death sentence’ mis-conceptions associated with having HIV/AIDS. He hit the nail on the head… and he hit it hard. We went from frightening images of dying people in isolated hospital beds resembling skeletons that scared the living daylight out of us to healthy happy images of PLWA leading normal productive day-to-day lives where HIV/AIDS didn’t control them, but they controlled it. No good dead goes unpunished… and here we are. The initial shock and horror of AIDS that we experienced early on in the epidemic is gone. We now recognize those PLWA as our friends, our co-workers, our lovers, and our family. And therefore… we have little to fear.
Though it’s beginning to sound like complacency on our part to the threat HIV/AIDS still presents us, it’s really a symptom of our prevention methods not keeping up with public perception that there are new treatments out there, that infected people are living longer lives and not dying, and that having HIV/AIDS doesn’t carry the same negative stigma it once did. And rightly so! Once more I’ll have to say that this isn’t complacency or ignorance on the public’s part, but an everyday reality of this disease being accepted. Even if people believe HIV/AIDS isn’t as big a concern now as it once was with recent medical advancements in treating the disease, they’re still thinking about it. And that’s the important part. We may disagree with what they’re thinking, but at least they’re thinking. We’re at a different crossroad 25 years after the first HIV/AIDS cases started popping up in SF and NYC.
Fear motivated us back then, but what about now? Could you imagine if we started putting photos of PLWA in late-stages of the disease on prevention materials? Ever see someone wasting - it’s not a pretty sight. The public outcry over such cruelty? When Erasure’s Andy Bell came out a few years ago as recently HIV and wanting to put a positive face on the disease for young gay men - was there any backlash against him for promoting an ‘AIDS is OKAY’ stance? I don’t remember one. Touchy subject isn’t? How do you tell someone now-a-days that having AIDS isn’t OKAY? Larry Kramer has been doing it for years from his own death bed and all he gets for it is bad press from the people he’s trying to help. Remember actor Yul Brynner’s self-made video that aired post-mortem on tv following his lung cancer death where he warned people not to smoke because they’ll die like he did? Can you image an AIDS version of such a message getting publicity? What do you think; applause or outcry? 25 years into HIV/AIDS, how do you tell the public that this disease that in their mind is now on the same playing field as other diseases is still dangerous especially when it continues to revolve around a marginalized population that is often villainized?
The public is right in its perception that HIV/AIDS is no longer the threat it was years ago. How could they be ignorant of it when they recognize the ever-improving drugs and treatments available for it that make it a manageable disease with the infected living longer and longer? What really needs to change are the messages that the medical/prevention establishments are using to raise awareness.
At this hour I’m under-caffeinated. More of my long winded ranting tomorrow morning on CONDOM FATIGUE.
ARE YOU SICK AND TIRED OF USING CONDOMS AFTER 25 OF SENSATION DIMINISHING ‘SAFER’ SEX THAT YOU JUST WANNA PUKE? I KNOW I AM. AND I KNOW A LOT OF OTHER GAY MEN WHO ARE TOO. NEITHER OF US WANT TO DIE, BUT WE BOTH ARE PSYCHOLOGICALLY AND PHYSICALLY EXHAUSTED FROM THE PROCESS OVER SO LONG A TIME. …just something to think about.
Brilliant Trash…
“Even if people believe HIV/AIDS isn’t as big a concern now as it once was with recent medical advancements in treating the disease, they’re still thinking about it.”
I’ve been in HIV prevention for over 10 years, and I am not seeing it. Maybe the gay community is still thinking about it, but there is still a complete ignorance among other communities taking on the new face of the epidemic.
I totally hear you about condom fatigue. Any thoughts on how to make prevention more effective without boiling it down to ‘just use a condom’? I would seriously like your suggestions.
(Deb & Duane… this comment of mine appears to have gone way of a spamfilter so here goes again… It’s a day dated, Deb, but it addresses just the question you asked about sero-sorting)
Deb…
You and I are probably approaching the subject of people’s ignorance and complacency from two different vantage points. Your’s being of prevention through education and mine through the Mae West school of thought that goes something along the line of, “don’t worry when they’re talking about it (even when you don’t like or disagree with what they’re saying), start worrying when they stop talking about it.”
There are things in life that have shaped people’s perceptions of HIV/AIDS that aren’t going to change through telling them to use a condom. There are indeed segments of the population that are open to such talk about preventative behaviour , but how do you tell a group of people to the same who don’t perceive HIV/AIDS as their problem versus someone else’s especially when it’s retribution or a product of who they are? A portion of the black population (add your generalizations, political correctnesses, and saving graces here…) believes that being gay is white thing and therefore blacks can’t be gay. And those that ‘are’ gay either don’t exist or are race traitors. Touchy subject? You’re right! I live uptown in Manhattan’s Sugar Hill section of Harlem that has a growing 10 year old 30-something gay white male population and a very large number of black males on “the down-low”. Take a guess at how many of those “down-low” guys I’ve seen online on gay sex hook-up sites? And how many of the openly gay 30-somethings do I see? Do you think either group talks much to one another? What about the openly gay 30’s who aren’t white, but black or hispanic - where do they fit in here? What about the economic differences between us - The $1200 1BD’s we gentrifying homos can afford versus the black & hispanic family’s struggling to pay that to house a family of four? This would be a sign of ignorance if we ignored these kinds of economic and cultural experiencial differences that shape people’s perception of gay men, homosexuality and HIV/AIDS associated with them. Don’t believe that some of these locals aren’t resentful of the new money that happens to be gay moving into their neighborhood? Think again. Think it doesn’t shape people’s opinions of their neighbor’s when new HIV/AIDS services start popping-up in the hood? I don’t think the closeted guys on the “down-low” are knocking down the door’s of these clinics seeking services as much as they’re staying far away from them (drive the problem further underground) to not be labeled a faggot or deal with the negative cultural and religious connotations. We’re a long way (if ever) from disassociating HIV/AIDS as a gay disease. It may affect us all, but it started with homos and that connection is always going to be there. We can run and hide from it, but that connection that shapes the public opinion is going to go away. And I almost forgot… what about those Jehovah’s witness coming to my door looking to save me from my sins? Do you think they believe safer safer sex will save me from God’s judgment? I don’t think so on either count. I don’t think they’re ignorant on AIDS, they simply don’t share your view on the matter and they share that with their choir just like you and I do trying to convince the other who’s right and who’s wrong.
This isn’t defeatist thinking, it’s a harsh reality that there are so many factors that are obstacles in informing/educating the public on HIV/AIDS because they have to deal with the diverse political of economics, race, religion, and every other holy cow out theres. I wish this was more of a one dimensional issue, but it isn’t. Some of what I’ve said above has a lot to do with stereotypes and generalizations, but there’s no denying that they don’t play out an important role in the matter or prevention.
MORE FROM ME LATER ON CONDOM FATIGUE. FOOD FOR THOUGHT ON THAT MATTER FIRST… IF WE GIVE CLEAN NEEDLES TO HEROIN ADDICTS ARE WE ENCOURAGING ILLICIT DRUG USE OR ARE WE SAVING PEOPLE’S LIVES THROUGH INTERVENTION BY OPENING A DOOR TO DESTIGMATIZING THEIR BEHAVIOUR ALLOWING US TO POTENTIALLY GET THEM TO QUIT/INTO TREATMENT? CAN THE SAME BE SAID OF ENCOURAGING GAY MEN WHO HAVE UNPROTECTED SEX WITH OTHER GAY MEN TO CONTINUE HAVING THAT UNPROTECTED SEX, BUT DO SO BY BEING ‘SAFER’ IN SERO-SORTING AND ONLY HAVING SEX WITH THEIR OWN SERO-TYPE? HIV- SEEKING HIV-? HIV+ SEEKING HIV+? DOES THIS ENCOURAGE UNPROTECTED SEX OR DOES IT OPEN THE DOOR TO A DIALOGUE THAT’S BEEN DRIVEN UNDERGROUND BECAUSE OF THE STIGMATIZED NATURE OF HAVING UNPROTECTED SEX? CONDOM FATIGUE ANYONE? DOES THE ARGUMENT THAT USING A CONDOM IS THE ONLY WAY TO PREVENT HIV TRANSMISSION BEGINNING TO SOUND MORE AND MORE LIKE THE ARGUMENT THAT ABSTINENCE IS THE ONLY WAY TO PREVENT PREGNANCY AND STD’S?
Deb, one more thing… Having just reread my comment above, don’t interpret it’s tone as questioning the integrity and conclusions you’ve reached in preventative experience. If it were so easy a subject to address neither of us would probably be here discussing it.
Brillianttrash, I personally think that clean needle exchange programs don’t make more people want to use injection drugs; but, it is exactly that line of thinking that causes many government officials to strongly oppose them (even when they have been proven to reduce risk substantially). But, that is part of the war on drugs that is actually causing the problem, really.
Brilliant Trash - I totally agree (but am not as eloquent as you!).
Duane - I agree, giving out clean needles doesn’t cause people to use drugs…I mean, really, would you start injecting drugs because of a clean needle? It does save lives (and in NYC, reduced HIV rates by 90%…90%…among IDus). I wish evidence like that was enough to soothe the nay-sayers, but I think we know they have another agenda.
I consider throwing condoms at people as the sex risk parallel to needle exchange for gay men, but I think it has a limited impact on sex behavior (although, I recognize that there are huge differences in HIV prevention needs between IDUs and gay men), especially after hearing the same message for 25+ years. The real question is, for me, what moves us BEYOND condoms…which would mean thinking outside of the box as far as HIV prevention goes for gay men. What other messages are there we could promote that could prevent HIV besides condom use? Serosorting when chosing partners, and developing educated hierarchies of personally acceptable risk behavior need to be taken into consideration as HIV prevention tools as well. Why don’t we talk to gay men and ask them what works for them when they don’t have a condom available or have chosen not to use one. Maybe we would learn something. An intervention to address prevention fatigue would be a novel idea! Then, if we find bizarre stuff, we can use it to educate, rather than just bang our heads on our desks in frustrating.
For other groups at risk, who haven’t been inundated with condom prevention for the last 25+ years, we can and should start with condoms. We know they work. But, we need to think beyond condoms for these groups as well, since we also know that racism, discrimination, lack of trust, cultural (mis)perceptions, and other very real issues all impact a persons decision to use a condom, even if they are carrying one in their pocket.