“This. Is. Everything.”
Every time I see that written somewhere, I know I am about to be assaulted by an oversimplification and a crazily superlative view of whatever topic is being discussed. Either that, or I’m being led from Facebook to one of those endless click-through lists that ends up being more disappointing that entertaining. When it comes to HIV, though, this whole “In with the new, out with the old” attitude is not doing anyone any favours.
Let me be clear about my enthusiasm for the new stuff: PrEP and the knowledge that undetectable viral loads mean no more transmission are the best news we have had since we first got treatment that worked in the mid-1990s. But that is not a good reason to put all the other tools away in favour of the new ones for everyone all the time.
My outrage over this issue started innocently enough a few months ago. I went to a play that had been written by some students based on interviews they had conducted about the history of a local HIV/AIDS organization. I recognized all the usual elements — explaining the bad old days, the hope of treatment, the importance even now of a supportive environment populated by peers — and then came the kicker in the form of a comment by one of the characters. She said something about “old fear-based strategies like condoms.” Wait, what?
Like I said, I’m all on board with PrEP, but we are adding it to our arsenal of tools and strategies, not filling our toolbox with only that. I get that there are people for whom condoms have never been a preferred strategy, even when it was the only thing we had beyond abstinence, but fear? And how do we explain the large number of gay and bisexual men who have used the condom strategy, sometimes in joyful and prolific sex lives, and are still HIV-negative after all these decades? They don’t seem very afraid either.
But that wasn’t the end of the assault on reason. No, I had another WTF moment reading a CBC report on the situation in rural Indiana. It seems that they are having a significant explosion of HIV cases that are related to injection drug use in the state and their big solution has been to invite people from the BC Centre for Excellence on HIV/AIDS to come help them set up a treatment as prevention program to stem the infections.
To understand why I would find that approach odd in the context, you have to know that Indiana had outlawed needle exchanges and that going back on that decision in a meaningful and lasting way was not a part of their response to the new crisis. They temporarily reinstated some needle exchange services in limited locales, but they decided to put all their eggs in the treatment as prevention basket.
I don’t blame the BC people — their strategy has always been much more comprehensive and my objections to the “treat early” crowd went away with the arrival of the proof that early treatment also has positive impacts on the health of the people taking it. No, my target has to be the Indiana officials who have stumbled upon the information that treatment as prevention works and have decided that nothing else is necessary.
To be more concise, the new stuff is not everything. It is, however, a great addition to the rest of the things we already had.