By Chris Crain
When I came out in the early '90s, a diagnosis of HIV didn't just feel like a death sentence Ñ it was one. In those very dark years before the drug "cocktail," the gay papers were chock full of sometimes dozens of obituaries each week Ñ men in their 30s and 40s, struck down in their prime by AIDS.
From diagnosis to death was on average between seven to 10 years back then. Safe-sex campaigns left so much doubt about the risk of transmission from even oral sex, getting the virus felt almost inevitable. With so many dying and so many more turning positive, I remember thinking I should get the most out of the next 10 to 15 years, since as a gay man I couldn't realistically count on more.
Now new research confirms that the pipeline of HIV meds has succeeded in dramatically extending the life expectancy of those with the virus. An American diagnosed these days can expect on average to live another 24 years from the time he learns he's been infected.
The new drugs have a new price tag, of course. The average cost of care has skyrocketed to $25,200 per year, or more than $600,000 over a lifetime. That explains why the longer life expectancy is good news limited to First World countries and those with health insurance, public or private.
Despite the upbeat tone from researchers, my reaction was still shock and concern, first for my many HIV-positive friends but also for me as a gay man still at risk of getting the virus. We have become so accustomed to thinking of HIV as a manageable, chronic condition Ñ like diabetes, people say Ñ that we forget it's still a killer. It's not a realistic comparison, considering diabetes can trim five to 15 years off someone's life. If most people are diagnosed with HIV are under the age of 40, then death 24 years later is cutting their lives much, much shorter.
In fact, HIV meds aren't a cure and can be lethal themselves. Despite all the advances, someone diagnosed with HIV is still likely to die from complications associated with the virus or the meds they're taking to fight it.
That's a message that's not getting out there, especially to younger gay men. A 21-year-old who learns today he has HIV can expect to die in his mid-40s. Still sound like diabetes?
Under George W. Bush, the focus of HIV prevention has shifted from public campaigns encouraging safer sex to abstinence and making HIV testing routine and universal. Both policy corrections were needed, although abstinence taught as anything more than a way to delay sex for teens can and does backfire.
And let's not confuse encouraging abstinence to "abstinence only until marriage," as conservatives use federal dollars to teach. The latter is designed more to protect young people from "sin" than HIV, and it's a meaningless message for young gay men barred from marrying their mate Ñ and discouraged by these same conservatives from even attempting a long-term, monogamous relationship.
Universal testing makes much more sense, as nervous as it makes HIV/AIDS groups focused too selfishly on whether they might lose funding justified by their in-house testing operations. They know universal testing is an important way to slow the virus and is long overdue.
People who know they're infected are more likely to start treatment, thereby preserving their health, prolonging their lives and making themselves less infectious. People who know their positive are also more likely to have safe sex, or at least limit their unsafe sex to other poz people. That should help slow the spread.
Still, expanded testing for HIV only acts as a stopgap after infection. That's no effective substitute for powerful public health campaigns that remind people that HIV is out there, it's still deadly and it's preventable.
When is the last time you saw a new and provocative take on teaching safer sex? As the virus morphs to adapt to new meds, so the prevention message must adapt to new attitudes and new complacency. The scare tactic, "just-say-no" approach won't work. People need real information about what practices carry greater or lesser risk.
Believe it or not, legal recognition for gay couples can also have a powerful, preventive effect. Promiscuity only increases the odds of transmission, so conservatives should welcome policies that encourage gay men to settle into stable, long-term relationships Ñ and not with women, as the "down low" phenomenon illustrates.
An HIV diagnosis may no longer mean sure death a decade later, but it still cuts far too many lives tragically short. Thousands quit smoking every year because they're afraid of dying early from lung cancer. Unsafe sex can have the same consequence, with a much shorter fuse and a world of complications along the way.
Twenty-four years is great, but it's not a cure.
{TAGLINE Chris Crain is former editor of the Washington Blade, Southern Voice, and gay publications in three other cities. He can be reached via his blog at www.citizencrain.com.}
