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Scary messages don't work

May 26, 2011

Dear Dr. Bob. I was diagnosed 3 years ago in 2008 and I'm actually on treatment and feeling good. I'm 36 years old and I get through all that scary days of the first time when having HIV was a death sentence. Then prevention messages based on fear were necessary to avoid the spread of an illness with no survival chances, a disease on the same level of cancer. I know you were a whitness of those days too. But today HIV has a total different face at least in those countries where treatment is widely available. Do you think that those scary messages still need to be used? Isn't it time to tell the people that the disease if diagnosed early and treated is manageable in the majority of cases? I think the deal today with HIV is mostly psychological and sociological. People are afraid to get tested because they fear discrimination. They don't fear death because AIDS is no more a common issue with new treatments. You'll not suffer AIDS but isolation due to HIV. I'm living this every day. I don't have any side effects and beside of the rejection fears my life is the same as it was before my diagnosis. The message to prevent new infections must change. Treatment today is much more tollerable and since we cannot halt in any way new infections in a real world setting, we must convince people to get tested and treated. Mostly new infections occur in situations where the infected partner is not aware of his or her status. It is unlikely to transmit the virus when on treatment even if no condoms are used. This would add more to the prevention efforts than messages based on fear. HIV is not a big deal if treated early and constantly. The problem is public acceptance and stigma. HIV must be seen as any other illness. It has lost his status as an unstoppable killer. It is not a cancer. Curiously the father of my friend has Hep C and he's actually suffering more than me. His treatment is heavier than mine and even is prognosis is not as good. However no one fears Hep C but only HIV.

Response from Dr. Frascino


Let me directly respond to a few points in your post.

You bring up a good point and one that's often discussed in the HIV/AIDS prevention community. Are "scary messages" useful? My personal view is that having HIV/AIDS is scary enough and all we need to do is tell the truth. Scary messages that are not completely honest are not helpful. I should also mention that HIV/AIDS is not always a chronic manageable condition either. I've blogged about this topic before. See xxx.

As a physician I can also advise that HIV, in addition to being a psychological and sociological issue as you suggest, is still very much a medical issue as well.

I agree with your push for additional HIV/AIDS awareness, testing and early treatment. We now have scientific proof that the treatment can be an effective HIV-prevention strategy by decreasing infectivity.

I disagree with your statement that "HIV is not a big deal if treated early and constantly." Actually HIV/AIDS is a big deal, a very big deal. AIDS may have lost its "status as an unstoppable killer," but in reality it shouldn't have because it remains a progressive and terminal condition. We don't have a cure (yet!).

What I have been advocating is a range of prevention strategies that can be used in various combinations to reach different vulnerable communities. A single prevention message or strategy won't work for everyone. I've discussed this issue a number of time in this forum. Check the archives for a more complete discussion.

Thanks for writing in and sharing your thoughts.

Good luck.

Dr. Bob

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