August 14, 2013
'What ifs ...' are a glass half empty, late night go-to for many a positive person, but of course each 'what if' is really only a salve for the soul; it doesn't provide answers. They're essentially self-pity mechanisms but end up only reminding you of wrong turnings and mistakes made. We've all been there though and many people will have asked themselves at least once. What if HIV never existed? How would my life look now? Irrespective of its relevance to your personal situation, it's an interesting conundrum and one which can certainly make you think.
So, what if ... HIV really had never happened?
To begin with, you have to look back to the last point in time before you were diagnosed. I suppose that really depends on whether you are 'PH' or 'PrH' (well, they're giving acronyms to everything else: Post-Highly Active Retroviral Therapy (HAART) or Pre-HAART). Then again, if you are Post-HAART and HIV has never happened then you disappear from the time-space continuum anyway; so maybe it's better to concentrate on people who were infected before HAART came along.
Then you have to ask the question: Would the party have just continued deep into the 21st century because make no mistake, there was a no-holds barred, all you can eat party, from the late '60s until HIV came along and spoiled the fun.
"Life is not a journey to the grave with the intention of arriving safely in a pretty and well preserved body, but rather to skid in broadside, thoroughly used up, totally worn out, and loudly proclaiming -- WOW -- What a Ride!"
Attributed to Bill McKenna (motorcycle rider), Anonymous and a Nissan ad. There are less polite versions!
The above is a proclamation that appears on so many internet profiles. It reflects both the pre-HIV joy in gay sexual liberation and the post-HIV determination to live life to the full anyway. It more or less insists that "what ifs" are a waste of energy and HIV should only be seen as an impediment and not a road block. I wonder though how many people truly believe their own war cry. It reeks of bravado rather than reality.
Of course, the reason why LGBT people were partying to excess was due to the social and sexual revolutions begun in the 1960s. It was the newly-grown up, post-war generation who, sickened by wars and the ever present threat of nuclear extinction, created women's lib, women's contraception (the Pill), gay lib and black power amongst other forms of emancipation for minorities. People had had enough of the sexual repression and dourness of the '50s and spontaneously spoke out for the freedom to do what you wanted with your own body. It was a liberating feeling and you felt immortal.
I was 18 in 1968 and believe me, although not everybody enjoyed sexual freedom (my theory being that those who were cramped by convention, now run the political and corporate worlds), millions did, myself included. Parents, puritans and Popes were shocked rigid but nobody really believed Pandora's Box could be closed again. It was plus/minus a decade where sexuality was explored and re-invented and the morals and social restrictions of previous generations were discarded. Nothing new in this really; if you look back through human history, it has happened again and again before repression returned to spoil the fun.
However, not repression but HIV/AIDS arrived and parents, preachers and politicians did their "I told you so" dances right down the aisles.
Conspiracy theorists point to the arrival of HIV as being anything but accidental and it's wickedly tempting to think that the plague was brought about by deliberate "intervention" but of course until a new Edward Snowden pops up with shocking revelations, there's not a shred of evidence. Politicians, church leaders and traditionalists may have wanted to invent a means of stopping the LGBT sexual revolution in its tracks but even a born cynic like me can't imagine that the men in grey suits actually employed chemical warfare to root us out; they wouldn't ... right?
So looking at that point in history before patient zero, what would have happened if HIV had never emerged? Would something else equally devastating have taken its place?
To evaluate that possibility, you really have to look back at the history of sexually transmitted diseases. If humanity has a record of deadly, sexual viruses or bacterial infection, then you might reasonably assume that if it hadn't been HIV then it would have been something else. The thing is, that HIV is actually the first known deadly virus to be transmitted sexually and other viral STDs (Hepatitis A, B, C; Herpes, HPV and Human T-lymphotropic virus Type 1 (HTLV 1) linked to simian HIV strains) are also relatively modern. That's not to say that they definitely haven't appeared earlier in human history; only modern diagnosis techniques have been able to identify viruses with any degree of certainty, so they just may not have been recognized as viral infections in the past. We also know that HIV isn't the first deadly STD. Syphilis often proved to be a slow killer before the discovery of antibiotics and what's more, it was easily passed on from parent to child. Syphilis however, is caused by the bacterium Treponema pallidum and is not a virus.
Looking back at the sexual medical history of mankind, it can be divided roughly into three sections:
The other main viral STD problems we face today are Hepatitis, Herpes and HPV (human papilloma virus). Herpes simplex, which is responsible for genital herpes, has only really been a widespread problem since the 1960's. Again, that's as far as is known; it's perfectly possible that it has existed for hundreds of years but was identified with other sexual diseases. It was certainly mentioned by a French doctor in 1736, and in the 19th century, it was often seen as a side effect of syphilis or gonorrhea.
Similarly, it's difficult to imagine that HPV, (responsible for genital warts and now linked to genital cancers) has only emerged in the 20th century. It seems logical to assume that advances in science have resulted in its identification as a separate viral sexual problem. HPV also has various different forms and only the most modern techniques can diagnose them and their consequences.
Once again, modern science has been able to identify the different strains of hepatitis and diagnose them as viral, although hepatitis as a disease has long been recognized. Certainly the consequences and potential threats of hepatitis are now much better appreciated than a century ago.
So for the fun of it, let's take HIV out of the picture; imagine it never happened, where would we stand both medically and socially?
The medical world without HIV would be a much simpler place. Sexual diseases are actually quite straight-forward and limited in number. They're either bacterial, viral, or fungal and haven't seemingly changed that much over the centuries; they've just been identified much better in the last hundred years. It's not as if STDs have mutated hundreds of times and caused worldwide sexual plagues along the way. Syphilis 500 years ago is still the syphilis we know today; it's just that we can cure it now so it's not nearly as lethal as it used to be.
What is worrying is the emerging resistance to known antibiotics.
Bacterial STDs should be able to be defeated by antibiotics but the farming and agricultural industries across the world have fed the demand for cheap meats and dairy products by dosing their animals with constant antibiotics to keep them disease-free. This means that antibiotics are being taken by humans indirectly and resistance builds up. It's inevitable and logical but the unstoppable force that is consumerism means that while the demand for cheap meat rises, so does the use of antibiotics in animal foods. The development of new antibiotics can't keep up with the growing resistance to the current ones. Consequently, we're seeing pockets of resistant forms of gonorrhoea and syphilis springing up across the world. If they can't be cured, what happens then?
Similarly, hepatitis C is a growing problem amongst sexually active, LGBT people. Also a virus, there's no vaccine and its treatment can be brutal for the patient to say the least. It attacks the liver and can cause cirrhosis, liver cancer and eventually liver failure.
The implications of HPV and the herpes viruses are just beginning to be understood as more and more links are being found to other conditions, especially a growing number of cancers (throat and anal being especially relevant). HPV vaccines exist (Cervarix and Gardasil) but seem only to be effective if given to young people, preferably before their first sexual contact.
With herpes, the virus remains in the body for life; there's no vaccine and it can recur with alarming regularity and is above all, extremely infectious. It travels through the body via the nervous system (hence awful conditions like Shingles) but perhaps more alarmingly, scientists are beginning to see links with other STDs and health problems. The herpes virus may act as a piggy-back conduit for other viral conditions. Certainly many people on HIV immunosuppressants are well aware that herpes reappears much more easily if the immune system is compromised either by HIV or the medication. The herpes virus that attacks the brain (herpes viral meningitis) is especially worrying and recent, contagious outbreaks in gay circles may yet prove to be a worldwide and potentially fatal problem.
So if HIV had never existed, there's absolutely no guarantee that nothing else would have taken its place. We need to be as alert for sexually transmitted viruses, as those surrounding various sorts of Flu that have scared us silly recently (Spanish flu (killed 19 million people just after the 1st World War), Mexican flu, Bird flu and SARS to name but three). Science is continually trying to stay on top of viral developments but human history has shown again and again that viruses are extremely difficult to predict or control.
Similarly, we need to be much more aware that our antibiotic resources are limited. Finding new ones takes decades and the bio-industry's insistence on force feeding its animal stock with "preventative" antibiotics is a sure fire route to resistance. If that happens and bacterial STDs become incurable, it will start a chain reaction that would be potentially as devastating as HIV has been.
What about the social effects on a world without HIV?
It's safe to assume that the heterosexual world would be facing different challenges if the millions of people lost to AIDS were still here. Humanity is used to plagues decimating populations and recovering but the 20th Century has seen the fastest growth of technological and scientific development since the beginning of time. Where would Africa be now for instance, if AIDS hadn't existed? Would it be a continent even more prone to poverty and starvation thanks to a burgeoning population, or would it have flourished with the input of healthy generations that have been otherwise lost?
You could certainly argue that lost LGBT generations would have had a significant influence on the world today. There would be a much larger "senior" LGBT presence, with all its skills, creativity and experience to make a significant impact on society. This brings us back to one of the original questions of this piece: If the Pre-HIV party had continued, what would the impact on society be now?
In 2013, we have a snowballing, LGBT social integration taking place. Same-sex marriage and adoption; same-sex presences everywhere in TV, film and entertainment; majorities of nations' populations all over the world approving LGBT acceptance and so on. It's patchy and has setbacks but there's no denying its impetus. Would all that have been possible if the sexual revolution had been allowed to run its course and hadn't been stopped in its tracks by HIV? Or would it all have happened much sooner? Personally, I have a feeling that the general population was already feeling uncomfortable about the explosion in sexual freedoms in the late 70s and while some took the opportunity to see AIDS as a natural punishment for excess, many more changed their opinion of LGBT people as they saw the extent of the suffering. Yes HIV was/is frightening and yes people's noses were rubbed in the fact that it was sexually transmitted and had to visualise things they'd never imagined but tragedy is tragedy and a sea-swell of sympathy may have helped LGBT rights to get where they are today.
If the hedonism hadn't been "reined in", you have to wonder what the eventual consequences might have been. Maybe nowadays, we would be far less accepted by society as a whole. Historically, all societies that have given themselves over to sexual freedom and excess have collapsed eventually (look at the ancient Romans) mainly because the majority of the population are not actually part of the fun...living and surviving gets in the way.
Maybe LGBT societies themselves would have turned against the excesses going on around them and demanded moderation and more standard relationships, including marriage. There's only so much sexual fun you can have before it gets boring, though HIV made sure we never found out. That said, there are signs that hedonism is taking root yet again amongst both heterosexual and LGBT youth. Modern society is based on the technological pleasure principle: get as much money as you can, buy as many gadgets as you can and party like it's 2099!
Finally, you have to wonder if HIV is actually only a blip on the human timeline. Societies tend to develop in ever-repeating circles and freedoms are like snakes and ladders; they blossom and decline. That's the way it's been throughout history. Just because the 21st century is more technologically advanced than any other before doesn't mean that people will intrinsically change their basic behaviors. HIV is a plague that has changed human history within the space of 30 years. Whether it has led to social improvements or decline for the groups it has affected, is maybe less important than the fact that it is only 30 years old and after 50 years may be gone completely. Will it even be remembered in the history books of the 30th century? Now that's a worrying thought!