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When Push Comes to Shove ... How Far Would You Go to Eradicate HIV?

By Dave R.

June 23, 2014

This article originally appeared on PositiveLite.com, Canada's Online HIV Magazine.

It always seems pretty weak to begin an article with a disclaimer; as if you don't really believe in what you're writing. Well in this case, I genuinely don't know what to believe. My instinct says that governments who force people to do things are always a bad thing but I can't find a reasonable argument to defeat the premise of this post. Maybe readers can give me something more than a moral objection to the question posed here; maybe a moral objection is enough but the point is, I think we should at least talk about it.

There is mounting evidence that someone who is on HIV medications and has a healthy immune system and an undetectable viral load is in fact incapable of passing the virus on to someone else. The current hot question around the HIV Internet asks: is "undetectable" then the new "negative"?

Maybe, but what's the significance of this? In effect the end of HIV could be in sight, we just have to test everyone and treat those who are found to be carrying the virus. HIV would be history in twenty years tops!

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A Dutch professor and renowned HIV specialist, Kees Brinkman, said recently, "HIV medication can be used in a preventive way. If all HIV+ people used medication then the rate of new infections would drop dramatically."

Can you spot the word "condom"? No, me neither. This represents a sea-change in official thinking but only in small pockets of the medical and political world. The vast majority of medical organizations still adhere to the "condoms solve everything" train of thought. Unfortunately, the vast majority of HIV organizations, comprising people who should know better, are so fearful of losing their funding that they still tag along too, despite new evidence. This means that people at risk of contracting HIV are being led into so many cul-de-sacs that real progress in halting the spread of the virus is being severely inhibited. Condoms are neither popular, nor have they brought a stop to HIV, so young guys are reverting to barebacking because the fear of imminent death is so much less in 2014. Lust trumps reason at every turn. Meanwhile, the virus chunters its merry way through our populations, not so much at epidemic levels but enough to keep the status quo alive and the numbers of new cases stable.

If barebacking (okay, "unsafe sex" if you want to be demure) is really the mot du jour and as common as people are suggesting, you would reasonably think that the virus would be exploding at 1980s rates wouldn't you? The reason that it's not, is very likely to be because more and more people with the virus are achieving undetectable viral loads and are therefore statistically virtually impossible transmitters. The new cases that are still emerging at a stable rate, are most likely to be people unaware of their status, infecting others in the same boat. HIV transmission will never be reduced to zero until those people are found and treated -- common sense no?

It doesn't have to be that way.

So here's a suggestion spat by the cat at the flock of pigeons: make HIV testing compulsory and matter-of-fact for the whole sexually active population; find those who are unwittingly already carrying the virus, treat them, get them to undetectable ... problem solved! Or am I deluded?

For the average, hormone-charged, Joe on the street, it'll become a question of: fuck first, find out, freak out, face facts and learn to live with the medication ... but they won't die and there's the sugar pill! Within a generation, providing everybody gets tested and the funds are there to treat them (they are; there can't be that many!), HIV will crop up now and then but will largely be a thing of the past. Remember, we're trying to stop the spread of the virus and we know that nobody, not one single case, of somebody with an undetectable viral load, has ever passed HIV on to someone else. What's the problem then?

Well, some of the problems are blindingly obvious, even to me. The world-wide cooperation and resources necessary to test everyone on the planet at the same time, are nightmarish. Forget the resources, achieving a universal political will is practically impossible!

Then you have the civil rights people who will strongly object to anything compulsory at all. The idea that everybody would be forced to be HIV tested and treated if infected, goes against individual freedom of choice. I get that but what do people really have to be frightened of? I repeat, we want to remove HIV from the medical spectrum don't we? Nobody wants it to stay. If you have it, you must surely want to know; after all you can be treated and live a more or less normal life span. Who wouldn't want that, when the alternative is eventual illness and death? So why would you object to being tested, for the benefit of yourself, your family, your partners and humanity in general?

Many might object on moral grounds; claiming that they live such pure lives that there's no possible chance they could be infected. Well we know how many have ended up with nasty surprises in those circles and if you're so sure you sit on the higher ground, a simple blood test will only confirm your divinity won't it! Many others will fear their status becoming public knowledge (never mind how it would affect your insurance cover!) but sensible legislation should prevent that and once again, what's the alternative; do you really want to be unaware of the fact that you are carrying HIV? Do you want to deny yourself effective treatment?

The pharmaceutical companies would rejoice because the newly discovered cases would ensure even more obscene drug revenues and they could still push on with finding a vaccine or cure (not that that's been a great success so far).

The condom industry and its supporters can continue to promote its use as a prevention against pregnancy and other STD's but its relevance to HIV will become redundant.

Am I being a complete idiot here? Given that we'll never achieve world agreement to eradicate HIV via compulsory testing, it doesn't mean that we can't start somewhere. Believe me, I'm as against totalitarian regimes making our decisions for us as the next man (my hippie leanings still emerge out of the idealism closet quite frequently) but when it comes to HIV and the misery it causes, I'm prepared to surrender a small part of my freedom to achieve its demise. Of course, I would say that, I'm already HIV+ but I don't want anyone else to contract the virus. I'm also aware of the current criminal status and personal dangers associated with having HIV in some lands. There are civil liberties dangers, no one is denying that but success in reducing HIV transmission in one area will inevitably lead to changes in others. It won't be easy, or happen quickly but we have to look at other strategies, given the failures to destroy HIV so far.

So, take one developed land, insist on universal testing and subsequent treatment if necessary and see what the effect on the HIV statistics will be. If one land won't do it, begin with a region, or a city, whatever and watch the transmission rates drop. There will always be cross-infection from outside but that will be tiny in comparison to the current progress of the virus.

After that, the generations of those who are HIV positive will die natural deaths (at a ripe old age, barring accident from other sources); end of HIV; end of story.

That all said, I'm fully aware that I don't know everything and never will. This article is meant to stimulate debate and ask for counter-arguments. Let's at least talk about whether compulsory testing and treatment is either desirable or effective. If you feel strongly that this is just airy-fairy theorizing and fantasy, please tell me why and put forward your own arguments. From all the evidence so far, reaching undetectable status makes you a safe sexual partner (with or without condoms) as far as HIV is concerned. Is it too much to suggest that the new aim should be to get everybody with the virus to an undetectable level? And is it too radical to suggest that maybe, compulsory testing is the only sure way of getting there?


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Reader Comments:

Comment by: fogcityjohn (San Francisco, CA) Tue., Jul. 29, 2014 at 12:23 am EDT
This is a very interesting idea, and it's one that shouldn't be rejected out of hand. Not even here in the United States, where people are violently allergic to anything tagged "compulsory." In fact, though, blood testing is compulsory for heterosexual couples wanting to get married, so the idea isn't completely foreign here.

That said, I think this post could only have been written by a citizen of a country that has universal health insurance. Here in the U.S., we still have large numbers of people without health insurance despite passage of the Affordable Care Act. Without insurance, I don't see how people who test positive will be able to afford HIV medication. We have programs like ADAP that would help some, but America's safety net is so shredded that many people would end up being tested and yet still be unable to obtain treatment. So maybe this is an experiment that will have to be conducted in a country more advanced and enlightened than America. I wish you the best of luck persuading the folks in Ottowa to take this on.
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Comment by: Dave R (Amsterdam, Netherlands) Tue., Jul. 29, 2014 at 12:31 pm EDT
Thanks you for your very reasonable comment and you're absolutely right that I do speak in fact from a position of strength, living in a country where even if you aren't able to pay your insurance premiums, you will still receive any basic required treatment (including medication). It's the only civilised way but that said, even here, we're rapidly moving towards American style situations where the insurance companies have all the power and can make health decisions based on cost. I hadn't fully realised the implications of what you say myself but if such a political decision were taken (compulsory testing)then the politicians reponsible would have to create a safety net for those eventually requiring life long treatment. You couldn't have one decision without the other. There are many practical problems in the way of universal testing but the principal remains the same because the logic of what would happen if everyone with HIV were treated, is just too obvious to be ignored. Surely the money-men can see that by getting everybody with HIV onto treatment, there are savings to be made and not losses. Treatment has to be cheaper than dealing with the inevitable illnesses caused by unsuppressed HIV but apart from that, the chance to eliminate HIV from the medical spectrum is of the greatest of personal and human benefit to the world. It shouldn't be a question of cost, or political will but it is, so making the right decisions and using all the available options to almost eliminate HIV is an obligation that politicians can't ignore.


Comment by: Barry Atwood (Davenport, Iowa) Thu., Jul. 10, 2014 at 1:41 pm EDT
What you say seems so obviously true that I can't find a reason to argue against it. I too am totally against being forced to do things against my will by any official organisation but there is an undeniable logic behind what you say. Why wouldn't we all want to be tested? I've got two young children and I think this would be in their best interests in the future. Maybe through simple mass testing HIV will be one less thing for anxious parents to worry about. If treatment is making people safe as sexual partners then it's a no brainer that everybody with HIV should be on treatment - why wouldn't they want that!
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Comment by: marta (harrisonburg, virginia) Mon., Jun. 30, 2014 at 9:42 pm EDT
I can't contribute much, because I totally agree with compulsory testing. I think an issue that would arise after compulsory testing would be compliance with treatment - to that, I suggest support groups. Ultimately, HIV testing should be as common as getting vaccines. However, we all know how that is going... increase in vaccine preventable illnesses due to parents opting out. So, the way our country is set-up makes anything compulsory nearly impossible, I think there should be a real dialogue about sacrificing this freedom of choosing to not partake in preventable health measures for the greater good of our communities, country, world, and children.
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Comment by: JoLonda Marie (Liberty City, GA) Sat., Jun. 28, 2014 at 5:24 am EDT
Yesterday was National HIV Testing Day.Kudos to The Body for letting us read a slightly different angle among all the hype.
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Comment by: Joe Wilkes (Miami FL) Tue., Jun. 24, 2014 at 1:13 pm EDT
No, no never! No government is going to tell me to get tested for HIV. I'll do it if I want to not because some pen pusher or self importnat blogger is going to tell me to. This is America. We've got minds of our own.
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Comment by: Celia Brownlea (St Petersburg Fl) Thu., Jun. 26, 2014 at 2:18 pm EDT
Have you read the article?? Dave R is not forcing anyone to get tested, he's just opening up the discussion and asking what would happen if testing was made compulsory. If you don't want to get tested I take it you're okay with having HIV and not knowing it then? This sort of America is the land of the freedom of choice nonsense is exactly why kids are killing each other in our public schools. It's not okay to talk about controlling guns, so it just goes on. It's the same with HIV.If we don't talk about forcing people to get tested, all those walking around with HIV, not knowing it and having sex will continue to spread the virus. Get over yourself guy. Saying you're an American and noone can tell you what to do, just closes your mind to open discussion about the facts. The Body is also not an American site, it's world wide and the same goes for HIV!


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Dave R.

Dave R.

English but living since 1986 in Amsterdam, the Netherlands. HIV+ since 2004 and a neuropathy patient since 2007. I've seen quite a bit, done quite a bit and bought quite a few t-shirts if you know what I mean; but all that baggage makes me what I am today: a better person I believe, despite it all.

Arriving on TheBody.com, originally, was the end result of getting neuropathy as a side effect of the medication, or the virus, or both. I found it such a vague disease and discovered very little information that wasn't commercially tinged, or scientifically impenetrable, so I decided to create a daily Blog and a website where practical information, hints, tips and experiences for patients could be gathered together in one place.

However, I was also given the chance to write about other aspects of living with HIV and have now contributed more articles about those than about neuropathy. That said, neuropathy remains my 'core subject' although one which unfortunately dominates both my life and that of many other HIV-positive people.

I'm not a doctor or qualified medical expert, just someone with neuropathy and HIV who has spent the last few years researching the illness and trying to create information sources for people who want to know more.

I also have my own personal website and write for PositiveLite.com.


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