June 2- 8, 2005

city beat

Obstacle Source

AIDS educators face awareness, funding hurdles.

by Doron Taussig

Last summer, Philadelphia's buses were adorned with pictures of virile models wearing soft, pensive expressions. Accompanying text explained that the people in the ads were young, beautiful — and infected. The campaign was intended to communicate the universality of the HIV threat: You can be young and beautiful, and still be infected. But at the same time, they illuminated a trend that is a growing reality and, sometimes, a prevention obstacle: You can be infected, and remain young and beautiful.

June is the 11th annual AIDS Education Month, and Philadelphia FIGHT, a local AIDS service organization, will host several events to mark the occasion. When experts gather at the Convention Center for a June 9 Prevention Summit, they will have to discuss a difficult paradox: Advances in treatment have made HIV less scary than it once was, and that has made prevention more difficult. Yes, there is still no cure; yes, millions continue to die; and yes, in Philadelphia alone, approximately 8,000 of an estimated 30,000 infected people receive no treatment at all. But as Gary Bell, director of Philadelphia-based Blacks Educating Blacks about Sexual Health Issues, says, "People used to refer to AIDS as a death sentence. For some people, that wasn't a deterrent. But for some, it was." Now that many see AIDS as a manageable illness, that deterrent is gone.

Perhaps the most important contributing factor to this development is the improvement in HIV medications. "Pill taking has gotten easier," says Dr. Ian Frank, associate professor of medicine at the University of Pennsylvania. "It used to be, a lot of people were on handfuls of medications, three times a day," and suffered significant side effects. Now, "we have combination pills that are easier to tolerate." The effectiveness of treatment has improved, too: The proportion of people living with AIDS to those dying from AIDS in Philadelphia has been increasing steadily, according to the Health Department.

Last week, political blogger Andrew Sullivan (who has been arguing for some time that improved treatment has become an obstacle to prevention) started an Internet debate by contrasting the experience of HIV treatment with a disease like diabetes.

"Compare the kind of medical ramifications of testing positive for Type 2 diabetes with testing positive for HIV. Your life is not as definitively shortened with HIV as it is with diabetes; the treatment is far less onerous; the lifestyle changes are fewer, compared with daily injections, monitoring your diet, and so on," Sullivan wrote.

Others responded that some strains of the virus remain resistant to treatment. This is true, but the fact is that for many people who can access treatment — and in Pennsylvania, says Hassan Gibbs, a consultant with FIGHT, it is available to most people — AIDS is a gentler disease than it once was.

Of course, on an important level, this is good news: Many people with HIV are living longer, more comfortable lives. But the flip side is yet another barrier to effective prevention. On top of nihilism, immediate gratification, intoxication and peer pressure, we can now add another reason for people to avoid safe sex: the perception that HIV just isn't that bad. That goes both for people worried about contracting the disease and for HIV-positive people concerned about spreading it.

"I've had people say to me, if I get HIV, I'll just take a pill," says Bell. "There's this perception that it's easily treatable."

Gibbs says there may even be some truth to the perception.

"We will probably outlive our relatives," he predicts. "We will go to the doctor every three or four months. Some people haven't been to the doctor in 10 years. We have our livers monitored, our blood sugar level. I've heard people that actually said they know people who got HIV on purpose, just to get the benefits."

As a result, "people have sort of dropped their guard," says Dr. Frank. They "have this false sense of confidence."

Jane Shull, the executive director of FIGHT, disagrees with some of her counterparts over the extent to which prevention is affected by this trend. "It's probably true that there is something being said among middle-class gay men, that it's not as bad as it was," she says. "[But] I doubt it has anything to do with the epidemic in poor communities."

However, she points to another problem: The fact that HIV is less frightening to middle-class people means there is less money being channeled toward dealing with the disease.

"HIV was a disease that was popular among people who donated in the '80s. There's been somewhat of a pause I think the reason is that fewer middle class people are dying."

None of the prevention workers City Paper spoke to had a clear recommendation for how they might adjust to the changing face of HIV. But this much, they say, is clear: Scare tactics have never worked well, and they work less now. New prevention messages have to offer some immediate reward, rather than a distant threat.

"I don't know what the message is," Shull says, "but I think that everything we do has to take that into account."