Wed Feb 27th, 2008 at 09:45:53 AM EST
AIDS remains a dangerous pandemic around the globe. The image of AIDS is defined by massive media coverage on the suffering in the states of sub-saharan Africa. The rates of infection in the so-called Third World are devastating and can make one speechless in the face of such a wholesale destruction of the social fabric of the affected nations.
Still, AIDS is not a purely African problem. But what is the face of European AIDS? What are winning strategies against it, and if it did, how did it change?
This diary is based on the experience of two years of work on the board of the Lower Saxon AIDS-Hilfe - the state-wide association of local and regional agencies working on AIDS prevention and counseling. I just want to give you some perspectives on it. I think that the question of health is one of the important issues for every generation.
Diary rescue by Migeru
AIDS hit Western Europe in the early 80s. Since then it has mostly affected three main groups: gays, immigrants and drug users. At least in Western Europe, and especially Germany, there was a strong early reaction, and after an intense debate, the consensus to invest in prevention - meaning education and the distribution of condoms - was reached. In Germany, there has been an impressive movement, stemming from the gay and lesbian movement, to create self-organized centers for care, which took over the prevention in the most affected groups.
This has not been easy. Sexuality has many more sides than what the average politician is willing to acknowledge, and thi meant in a way to accept all kinds of different lifestyles to be effective in prevention. Thus in a lot respects, the Anti-AIDS campaigns contributed to a general movement towards anti-discrimination of gays in Germany. It was not before 1994 that the last remnants of anti-gay legislation (§175) were finally abolished.
Throughout the first years, the challenge was to deal with a disease that was incurable and led to an awful amount of death and despair. Campaigns draw a lot of strength out of the imminent fear of death associated with an AIDS infection. At the end of the 1990s, things changed dramatically. The invention of ARTs - a combination of medications able to reduce the number of viruses and extending the life span of the infected person significantly - changed the way AIDS could be dealt with.
Today, one can assume that an AIDS-infected person ,if provided with medicine, can achieve a normal life-span. AIDS, though incurable, seems manageable like a lot of other chronic diseases. First, this is a step forward, especially for those who are already infected. Second, it creates a number of challenges for those who are trying to prevent infections.
Right now, we are seeing an across the board increase of infections in Germany. Some of it is probably a statistical effect, some is due to a testing campaign, but there is an underlying trend: More people, especially among gays, are infected.
The reasons are manyfold and complicated: First, with the death rate dropping, the number of newly infected persons has risen from 12,000 in 1997 to over 60,000 in 2008 in Germany. Second, the image of the dying AIDS-infected person faded away in the public consciousness. Awareness of the new therapies also seems to have added to an "end of fear".
Sometimes you read in the media about "barebacking", meaning people who have sex without condomsdeliberately. Some reports even write that people are deliberately looking for infections. That is nonsense. Barebacking exists, but there is no evidence whatsoever that people are doing it to get AIDS.
What we are actually seeing is a kind of risk-management. People who want to have unsafe sex are looking for a partner who has the same AIDS status as they themselves (positive or negative). Actually around 80 percent of gay sex is safe, which is an amazing number. Most people who are interviewed about their infection state that they tried to protect themselves but something got wrong.
The "New AIDS" is as dangerous as the old one, but can also be perceived as a chronic disease. Fighting it, and this remains necessary, means to adjust strategy:
- First, one needs to accept the changing face of AIDS and communicate it honestly to the target groups. Thus the message is not: you'll die soon, but rather, how the constant use of medication will in fact alter the life.
- Second, base the campaign on the idea that you need to empower people to be able to feel secure enough to say no to unsafe sex.
- Third, refresh the knowledge constantly. There are a lot of myths out there on AIDS. One of the most easily believed is that the active participant of unsafe sex is less at risk than the passive one. That is actually not true. Both are a at risk. A great site in German is Sexrisiko.de, which actually deals with a lot of the myths and wrong ideas in a very open and down-to-earth way.
- Fourth, one has to inform society as well. What I found most striking is how much the idea of AIDS is shaped nowadays by the African experience. 25 years of education and campaigns, yet one can still safely assume that an employer or a public official will be unaware.
Thus, let me make it clear: an AIDS-infected person can work any, I repeat, any job, except maybe pilot (some meds change vision). When I give presentations on the subject, I am often asked, but what about restaurants?
Would you eat in a restaurant if you know the cook is HIV-positive? If you answer that question honestly, you will get an idea on how much anti-discrimination work needs to be done upon you :-)
To tell it loud and clear: Food is not a way of transmitting AIDS!
I feel strongly about this because so many people have the wrong fears, instead of the right ones. People should discuss their sexual wishes and fears openly with their partners instead of being afraid of an HIV-infected nurse.
In Lower Saxony, I organized a training for people working in the Arbeitsagentur (Agency to get unemployed back to work) so that they get an understanding of what a potential they may have overlooked so far.
As for drug-users, things can be done. First, the golden rule is: the more clean needles are available, the less people infect themselves. This is especially true for prisons. I think there should be a European campaign for free and clean needles in prisons. The right argues that ideally, there should be no drugs in prisons, hence no needles are necessary. Yet, as long as there are prisons with people in them, there will also be drugs.
In general: For our lifetime, unless there is a dramatic development in the medical research, we will live with an AIDS-infected part of the population among us. We should embrace, not reject them. As the European societies grow older, a lot of chronic diseases will challenge the ways our social fabric functions. AIDS will be one of the most challenging.
What we do not need is fear, we need good information and a reasonable discourse about risks.