According to a release by the Journal Of The American Medical Association:
...all adult patients, regardless of CD4 cell count, should be offered antiretroviral therapy (ART), according to an article in the July 25 issue of JAMA, a theme issue on HIV/AIDS. Other new recommendations include changes in therapeutic options and modifications in the timing and choice of ART for patients with an opportunistic illness such as tuberculosis.
This follows the "treatment as prevention" model, based on the scientific research that people with HIV on antiretroviral therapy - with an undetectable viral load - are 96% less likely to pass on the virus.
This seems to be very good news. If you have HIV, you should find out early, get on meds and you'll have a better chance of living a longer healthier life.
So what's the problem? The problem is twofold:
- People at risk aren't being tested: 20-25% of all HIV-infected people don't know they have it.
- People at risk are still not being tested: Gay and Bisexual men of all races are the most severely affected by HIV
That's not a typo - they're basically the same reason, but there's a difference. Any guesses?
Hint: It's probably why most gay men won't even read this article.
20-25% of all people with HIV don't know they have it. Why not?
Here's my take: Denial is one of the strongest mechanisms in the human psyche. It is fed by lack of information, by avoidance and by a strong desire for an alternative reality. If you've had unprotected sex, you've probably engaged in the process of denial. You've probably downplayed the risk, probably lied to yourself a little. You may have even gone over and over it in your mind, seizing every opportunity to deny the possibility of trouble.
"He looked okay"; "He didn't seem sick"; "He pulled out"; "He would have told me if he had HIV", etc, etc, and etc.
Well, we all know where that goes... As individuals, we're not facing facts. If we were, we'd be getting tested.
Gay and Bi men of all races are the most severely affected by HIV. Of course. We know that. Don't we?
Again, denial applies. Gay and Bi men aren't talking about HIV anymore. Our friends aren't dying, so there's no reason to be concerned. People with HIV aren't out - aren't well-known in our communities. Why? I was once told "You don't need to harp about HIV all the time - it's not that big of a deal." Except that it is.
HIV has complicated my life in ways many people can't believe. I am on catastrophic health insurance through the state - almost three times as expensive as my partner's insurance. I get assistance for my meds - which cost about $25,000 a year- but (crazily), I can't make more than $30,300 and still qualify for the program. I have joint pain, sleep issues, battles with depression, fatigue and a body that is aging at several times the normal rate - most probably due to inflammation - the hallmark of HIV disease. And yet, if I talk about this to friends or family, I'm seen as a whiner or someone trying unnecessarily to worry people I care about. It's the "shut up - at least you're not dying" defense. I know several HIV+ people who haven't told anyone of their status, mostly because it's "uncomfortable".
As a community, we're not facing facts. If we were, we'd be talking to our friends about the importance of maintaining our health. We'd be talking about the hard reality of HIV.
But we're not. Denial still holds sway, both individually and as a community. We're lying to ourselves - we're lying to each other - and infection rates stay the same.
We have a chance to change this trend. But only if everyone with HIV starts treatment, gets into care. This recommendation of the AMA may help with that. But it's not up to doctors, nurses and social workers, it's up to us.
We're being tested, both as individuals and as a community. The problem is, we're flunking.
Because we're not showing up.