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!
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?