It’s been thirty-four years since the first patient was diagnosed with what we now know to be HIV/AIDS. Last week, UNICEF reported that AIDS-related infections are now the single biggest killer of adolescents (15-19) in Africa, and the second most common worldwide. Most were born with the virus, and are the last generation for which HIV-positive pregnant women didn’t receive anti-retrovirals to prevent transmission to their babies. Many won’t even have known they were HIV-positive until they fell sick.
When we think about HIV/AIDS, too often we forget that the pandemic is still ongoing. On World AIDS Day, people in the west usually look back to generations lost; to gay men in New York and San Francisco and London and Manchester; to those in their forties, fifties, and sixties who lived through the dark days when their friends were dying all around them, not knowing what was killing them, how it was transmitted, or who would be next.
Although we still haven’t found a cure, we have come a long way in thirty-four years. With the right medication, most people who contract the virus can expect to live a normal lifespan, their viral loads often undetectable (and virtually uninfectious). With new advances in Pre-Exposure Prophylaxis (PrEP), serodiscordant couples can have unprotected sex without transmitting the virus. Early studies have found zero cases of transmission when the positive partner has an undetectable viral load and the negative partner is taking PrEP. Now more than ever, the possibility of eradicating HIV looks to be tantalisingly within reach.
Yet worldwide, there are 26 new infections every hour for adolescents aged 15-19. While most are in Africa (half of all people worldwide living with HIV come from just six countries: South Africa, Nigeria, Kenya, India, Mozambique, and Tanzania), the CDC reports that in America, new infections among 13-24 year olds increased by 22% between 2008 and 2010 alone. That group comprised 16% of the US population as a whole, but accounted for 26% of all new infections in 2010.
The more we look back, the more we reinforce the narrative that HIV was a threat to the last generation, not the next, and we do so even as the number of new transmissions rise among certain demographics. 2012 saw a record high in the number of men who have sex with men (MSMs) being diagnosed HIV-positive in the UK, despite HIV transmission rates overall falling. More alarmingly, in the UK over half the adults newly-diagnosed in 2012 were already at a late stage of infection (and new infections are the most infectious and need to be caught fast to prevent further transmission).
Early diagnosis is more crucial now than ever, but as the conviction of Tiger Mandingo proved, knowing your status can leave you open to prosecution from ex-partners. He was sentenced to 30 years for transmitting HIV by a Missouri judge earlier this year. As others have noted, he’d have served less time if he’d committed murder.
This World AIDS Day, I’m not looking back. I’m looking forward to a time when archaic laws like Missouri’s are repealed, when people are encouraged to know their status and receive appropriate treatment early, and go on to live full and healthy lives. It’s in our power to eradicate HIV within a generation, but first we have to eradicate the stigma and misinformation which goes hand-in-hand with it. This year, let’s move on.
“In this world, there is a kind of painful progress. Longing for what we’ve left behind, and dreaming ahead.”
— Angels In America