serious

In the paper.

Two things. First, this article on the state of the AIDS epidemic. Anyone any comment on it?

The other article I can't link to because it's a feature on a book and unsurprisingly they don't want to stick the pictures everywhere. If you can find a copy of the Guardian's Saturday magazine and leaf through it for the photo of the squid, though, I think I can promise you you won't be disappointed.
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There can't be many issues that have to deal with quite so many minefields; racism, homophobia, ignorance, taboo and denial - even religion and international politics. This article seems to be falling dangerously close to some unpleasant views, but may equally be statistically accurate.

The problem is that if you say "AIDS is an 'X' problem" you induce "it can't happen to me complacency". As far as I can see the only way really *is* to say "it's everyone's problem" - anti-HIV precautions will, after all, help against most other STDs. Maybe you can add "group 'X' is at particular risk" in the literature, but it's hazardous to put that in the strapline.

Statistics are useful for analysis of the problem, but won't save any particular person from catching anything.
(Anonymous)
As far as I can see the only way really *is* to say "it's everyone's problem"

Presumably that's what they're trying to do. The thrust of the article seems to be that (in the authors' opinion) it isn't likely to work. I suppose it's slightly undermined by the fact that we haven't had any sort of campaign on this scale for too long.

We could always, I suppose, have a general campaign supplemented by more specific messages more closely targeted. That sounds good to me, at least, although it might sound ridiculous to people who know more about these things.
While I think there is a lot to what's being said about the demographics of Aids and the campaigning, to be honest I think any campaign about sexual health is A Good Thing. From a certain perspective you could say that even though they are unlikely to contract it, scaring the shit out of young white hetrosexual kids with a message of Aids, is worth it if it makes them practise safe sex and protects them from the things they really are likely to get. Maybe it's just because I grew up in the era of the tombstone message, but Aids still has a 'headline scare factor' for me, that other STD's simply don't have. If I were looking to scare someone into being sensible (i.e when I get to talk birds and bee's with Alex), I think I'd be using the biggest scariest sounding threat I could.

Looking at the broader point about targeted messages for those groups likely to be infected (Gay and Black), that sort of thing has to come from within the relevent communities. It shouldn't need to, but it must. Any kind of central government action will get bogged down due to valid concerns that it's going to promote division and intolerance, or be seen as an attack by the community it's supposed to be helping. Maybe there is some way to route central funds to local charities to do it, but I think the path has to be that way.

I think there is also a case to be made for all immigrants (and bear in mind I'm married to an immigrant) to have a series of medical checks for things like Aids before they are granted either ILR or Natty, if not for any non-waived visa. Not just African immigrants but everyone. This is routine in many countries and as far as I'm concerned is not much different from inspecting a potential immigrants finances or criminal record. It seems bizare to me that we'll exclude someone from the country because they are unskilled or poor, but not because they have a fatal infectious disease?
The problem with painting with too broad a brush is that people realise they're being had and start ignoring it. Having said which, pointing out that other things can really screw you over too - syphilis can be fatal if untreated, although that's unusual these days - might work.

that sort of thing has to come from within the relevent communities.

Yes.

a series of medical checks

Well, leaving aside how severe things would have to be to be refused entrance, even jobs have been known to come with compulsory medicals.

Do you know offhand how other governments handle people in this circumstance who have a serious disease?
The problem with painting with too broad a brush is that people realise they're being had and start ignoring it

This is the obvious danger. Saying that, I'm not sure how closely linked the actual risk factor is to how it modifies people's behaviour. e.g. pregnancy. Getting a girl pregnant is several magnitudes more likely to happen than catching Aids (well for hetrosexual sex at any rate), but we still have huge rates of teenage pregnancy. Of course that argument would tend to say all messages are pointless, but I'm wondering if perhaps the best you can hope for is a general high level of awareness. i.e most people of my generation have a pretty indelible image of Aids as a Very Bad Thing. On an individual basis if we are minded to care about it, we have all the information and awareness needed to protect ourselves. If we don't then likely nothing the government could have done would have worked anyway.

Do you know offhand how other governments handle people in this circumstance who have a serious disease?

The only one I know about directly is Australia, as outbound migration is one of the things my company does. To emigrate there is an 18 month+ process that includes detailed background checks and a thorough medical. We have to post the chest X-Rays off to Dimia for our clients. AFAIK, anything dubious will bar you. I don't think it even needs to be particularly infectious, meerly something that could be a serious cost to the health system.

The reverse process to emigrate to the UK can be done in four hours flat. I know this because that's what Laurelei did! While I think there is some valid criticism that the Aussie way of doing things is over the top, I think the sensible middle ground is a fair distance from our current system as well.
When I entered this country as a resident (after J & I got married in the US) the first thing I had to do at customs was go into a room at Heathrow and get a chest x-ray to make sure I didn't have TB.


I didn't ask at the time, but I assume I wouldn't have been allowed in if I had it. Maybe TPO is right and AIDS should be checked as well.

(Anonymous)
I doubt that would actually have been a killer. There's a lot of screening for TB, and positive results aren't that big a deal. It's surprisingly common, for a start.
Pah. Me again. My current firefox version is quite unreliable, and has to be killed, so I have to keep relogging in. Inevitably, I forget.
(Anonymous)
It can be (and the problem is getting worse), but AFAICT most strains are still normally vulnerable to antibiotics. Assuming the drugs are available and the patients are able, willing, and organised enough to take them, of course.
Me again. This is getting past a joke. I need to start paying attention.
Hmmm, mainly gays and Africans eh?
Heteros? I can see it being on the climb there, there are a good few people in our scene alone who sleep around/have several partners and admit to not practising safe sex. They claim to be all sensible and grown up and worldly wise about it all too. Lord knows what those who aren't behave like! But publishing things that more or less say if you go out and get laid by a random white UK resident at the weekend you'll be highly UNlikely to get infected is just plain irresponsible IMHO. It's sending the wrong message. There's not just HIV to worry about out there either.

OK, so they say most infections take place when someone goes abroad and sleeps with an infected person on holiday etc or infected people come here and pass it on blahdeeblah. Well, unless someone's been educated into "taking care" it's unlikely to be something that springs to mind in the heat of the moment as it were.

I think the hysteria about HIV and AIDS in the 80s stuck in my head because it was scary. I'll not get that close to anyone unless there's been mutual clear tests for EVERYTHING and protection is used. Perhaps I'm a little psychotic when it comes to these things! It only takes one time to get infected, better safe than sorry.

I think the "scare" bypassed a lot of our younger friends and as a result they appear to be less aware or just plain ignorant? But of course, again, they are low risk aren't they? So why should they worry?

I'm all for a strong and shocking campaign.
I don't think it's a waste of money at all.
I think they wanted a differently targeted campaign rather than no campaign. However, it's likely to have ads with white, black, gay, straight or whatever as the implied targetted group, so I don't see that it would do no good even assuming they're entirely right.

there are a good few people in our scene alone who sleep around/have several partners and admit to not practising safe sex

Well, I know there are people who are frighteningly relaxed. People as old as me who do remember the big campaigns in the Eighties.

But publishing things that more or less say if you go out and get laid by a random white UK resident at the weekend you'll be highly UNlikely to get infected is just plain irresponsible IMHO.

A difficult one. I've seen - not recently - articles with the main point that straight people weren't at risk of AIDS. This one had (relatively speaking) a minor mention buried in the text.

But of course, again, they are low risk aren't they?

They're in Edinburgh. AIDS capital of Europe, as was. Times change, of course.
AIDS capital of Europe, as was. Times change, of course.

That was presumably around the time Edinburgh was (or at least was supposed to be) the heroin capital of Europe as well? I'd guess it was a direct correlation?
Indeed, although there was also a contribution from a contaminated batch of Factor 8 given to local haemophiliacs.

Edinburgh junkies used to share needles a lot more than other places. I think there was some reason why usable needles were scarcer here than other places, but I can't remember what it was now.
Some bigwig in the Edinburgh police was very anti-needle exchanges, I believe.
I believe Edinburgh junkies were also more likely to user needles in the first place - I recall reading an article contrasting heroin-related HIV infection rates in Edinburgh and Glasgow, and one finding was that Glaswegian heroin users were more likely to smoke or snort than inject.
If the impression is created that a certain group of people are at very low risk, there is the problem that if circumstances change - such as white straight people going abroad and having sex - then they may be more likely to have unsafe sex thinking that they are still not at risk; which of course is just the situation the article describes.

I've no problem with targetting advertising towards groups at risk - but from what the article says, this not only includes gay/bi and black people, but also people who are likely to travel abroad. I dislike the implication that straight people getting AIDS can be ignored because they got it abroad - this is still a problem.

Just as the picture dramatically changes according to whether we consider just "straight people", or consider those who have had sex abroad or not, the picture may be different also if we categorise people in other ways. Eg, conceivably we might get a different picture if we grouped people into whether they had anal sex or not; or whether people had sex with strangers or not.

Although it may be more effective to target advertising, I don't see that an AIDS advert needs to rule out certain groups as being low risk. I feel it's better to send a message of "don't have unsafe sex" rather than "if you're gay/bi/black, don't have unsafe sex". I don't see any reason not to include everyone. People easily forget that the low probability of two straight white people infecting each other is only an average for all straight white people, and may be higher for some certain people: eg, people who have sex with people abroad, or people who mix in circles where there are far more bi/gay people (certainly the number of people I know who are bi is far greater than 1%, yet there are straight people in these groups too, who are presumably more at risk as a result).

I presume that the high rate of AIDS amongst gay people is specifically gay men, and not gay women? I mean, it seems obvious that that should be the case (eg, considering things like anal sex), but often gay people are grouped together as a whole; another example I guess of it mattering how people are classified.
The other issue, of course, is straight men who just happen to have sex with men, but not very much. But they're straight.
The point is that, overwhelmingly, the people here who 'got it abroad' are people who've come from sub-Saharan Africa, not people on an 18-30 holiday to Ibiza.

Yes, nice white non-IV drug using heterosexuals catching HIV is a problem, but it's a very small problem compared to, for example, gay & bisexual men, IV drug users (ignored in the article, but about 4.7% of IV drug users in London are HIV+) and Africans.

So if you're going to splash £50m, it makes sense to spend most of it in those three areas. And in ways that say something other than "use a condom every time" because that doesn't work.

Personally, I'd spend some of it on a "don't run away screaming" campaign, because until HIV- people stop a) expecting disclosure and b) running away screaming if someone does disclose, HIV+ people ain't going to start disclosing.

This applies to relationships too. I can't remember offhand what the proportion of infections is reckoned to have happened in the context of a relationship, rather than "sex with strangers", but it's considerably more than 50%.
I have no idea how on earth anyone can decide what is the right safer sex message to send - it's a classic case of the human mind being unable to deal with small likelihood, really big impact risk analysis.

That said, I'm very sympathetic to the frustration of black community activists who want to make it clear how at risk their community can be without setting off another round of send 'em home nonsense. It's another case where the UK is very confused about how to deal with immigrants and what is and isn't reasonable - like, if we're being taken in as workers, is it reasonable to insist on us having health tests and given how long people can go without symptoms, is it reasonable to bar people on the basis of being HIV+? If they are barred is it really just because of fear of contagion?
Ah, the squid. My first assumption on seeing that photograph was that it was a large foam rubber squid made as a movie prop. I still can't believe that's what they actually look like.

(mmm. calamari)
I've managed a grab of the picture. I may stick it up for the delectation of my flist once I can get the attribution right.
Pooh, I thought I'd commented on this. Oh well, here's Mk II of the comments, a bit more 'bullet pointy' than the first set, sorry.

None of this should be a surprise to anyone.

I think they slightly mistate Ford Hickson's position. He's got an annoying habit of saying "gay men" rather than "gay and bisexual", but his basic point is absolutely right: the statistics about location of infection, for example, have never been hidden but the overall totals have been spun for political reasons, by government and media.

"Although [gay men] constitute 1% of the UK population".

Erm, it's more than that unless you really are talking exclusively gay men.

The figures for risk for individual acts is ishy - oral sex is almost certainly less than 1/4000 and the 3% for receptive unprotected anal intercourse (rUAI) is also the high end of the range accepted by the sexual health sepecialists.

They make it sound as if 'bare-backing' = what I think of as sdrUAI (sero-discordant rUAI) rather than simply UAI.

It's bitterly amusing to see the money spend on gay and bisexual men being treated as an example of excellent targetting. Well, perhaps compared to the African spend, it is, but apart from that...

AZT is still used, albeit usually with a different name, and many people on combination therapy will have it as one of their three drugs.

When you stop ring fencing money and don't set targets, PCTs spend the money on something else, shock.