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The haves and have-nots of HIV (March/April 2004)

A couple of contrasting studies of the life expectancies of people with HIV appeared recently.
One was from Denmark. It found that people with HIV on treatment there have achieved something that was once, not too many years ago, cited as a wild hope. “One of these days, HIV will become a controllable long-term medical condition, like diabetes,” we used to say.
Well, it’s come true. The Danish study found that HIV positive people on treatment had exactly the same average life expectancy as people with insulin-dependent diabetes.

Like diabetics, as we age, we may expect to get more illnesses of certain types, such as heart attacks and some kinds of cancer. But we are well within the range of ‘normal’ life expectancy; not as we used to be, a generation doomed to an early death. If we live in a prosperous northern European country with minimal social inequality and a public health system, that is.
The other study came from another prosperous country, the USA. It was of women with HIV in the northern cities of the world’s hyperpower.

It found that their life expectancy didn’t change at all between 1993 and 2000. To these women, the HIV drugs - which became available halfway through that period - made no difference at all. In 1993 they were 15 times more likely to die than their HIV negative sisters. In 1999 they were still 15 times more likely to die. Deaths due to Aids-related conditions went down, yes. But all other causes of death, ranging from dirty-needle blood poisoning to murder, went up.

Why? Because, the study found, American women who get HIV tend to be poor. And black. And either use intravenous drugs or are dependent on others like crack. And sometimes rely on sex work to pay the drugs or just to survive. And slip through the gaping holes in the US health system. That’s why.

And, as we pointed out last month, if the UK goes down the road of refusing HIV treatment to disenfranchised, undocumented, invisible immigrants, it will happen here too. And, as Crusaid points out in this issue, it may also start happening among the young, often black, often homeless gay men their hardship fund is finding it increasingly hard to support.
There is concern that the World Health Organisation’s push to get three million people with HIV on treatment by 2005 will end up with the pushiest, most educated three million of the 10 million who need it getting treatment.

And then Aids will become exactly what Thabo Mbeki, for all the wrong reasons, says it already is: a disease of the poor.

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