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Opinion: AIDS - an epidemic of complacency?

According to the Public Health Laboratory Service (PHLS), last year there were 2457 newly diagnosed cases of HIV - the highest for a decade. Concern at the increase has been heightened by the revelation that, for the first time ever, the number of people who apparently contracted HIV through heterosexual sex (1070) was higher than those infected through homosexual sex (989). The remainder was accounted for by intravenous drug-users inclined to share needles.

The Health Education Authority leapt on these figures, claiming that they back its own research among the heterosexual community - that outside the gay community people sometimes do not appreciate 'the very real risk of HIV transmission'. And throughout the health promotion industry there is increasing frustration at people's resistance to 'safe sex messages'. Where there was once a great fear of AIDS, the new drugs that make the disease more treatable have apparently led to an outbreak of complacency. Today's teenagers are too young to remember the ludicrously alarmist, but memorable, awareness campaigns of the 1980s; and contemporary youth just isn't concerned about HIV.

But is this a problem? Arguably no, because HIV is rare and difficult to catch.

Dr Angus Nicholl is head of the HIV and sexually transmitted diseases division at PHLS, which is responsible for the collation and publication of the HIV statistics. He admits that an increase in the number of newly diagnosed HIV cases does not mean that HIV infection is increasing. Rather, he explains, 'Much of the increase is the result of initiatives to encourage people to get tested, such as the government's new policy of offering universal antenatal screening for women'. He also confirms that 'the majority of those heterosexually acquired infections affect people who are from, or who have spent time in countries with a high prevalence of HIV, in particular sub-Saharan Africa'. Look at the figures carefully and you find the scrap of information that is of real relevance to most people here - in 1999, the number who contracted HIV through heterosexual sex in Britain was 62 in total.

This should not really be a surprise. With only 30 000 people in Britain believed to be affected with HIV, the chances of Wendy from Worcester or Ben from Bristol picking up an infected partner is pretty remote. And, even if they were that unlucky, they are unlikely to contract HIV despite the encounter, because HIV is pretty difficult to catch. One of the least reported statistics in the Social Exclusion Unit's discussed-to-death report on teenage pregnancy is that the risk of contracting HIV from a single act of unprotected sex with an infected partner is a mere one percent. To put this into context, the report quotes your chances of catching herpes from an infected partner as 30 percent and gonorrhoea as 50 percent.

So in a nutshell, to contract HIV from a heterosexual partner you have to be doubly unlucky - unlucky enough to find yourself in bed with one of the 30 000 people in the country thought to be infected and unlucky enough to be that one in a hundred.

In the 1980s the health promotion industry could generate a panic about AIDS because it was the great unknown. We were told that by the end of the decade we would all know somebody with the disease. But we don't and we won't, and there is something a little ridiculous in the attempt to 'scary up' the prevalence statistics each time they are published - as if to keep the AIDS issue alive in our minds. After all, the reason why young people are increasingly cynical about (or bored with) discussions about HIV is not because they are woefully ignorant about the threat - but because they react to the reality of life around them. They do not know anybody with HIV or AIDS.

The new data should inspire those genuinely concerned with preventing and treating illness to focus their attention on the small identifiable higher-risk groups for whom HIV is a real issue. Unfortunately this is unlikely to happen. The government's sexual health strategy team is already muttering about the need for lifelong sexual health education, and you can bet the price of a gross of condoms that the risks of HIV will be in there somewhere.

Ann Bradley

Reproduced from LM issue 128, March 2000



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