New data released by Public Health England showed that HIV diagnoses across the country had fallen by 18%. Confined to just gay and bisexual men, the drop was 21%; narrow it even further to just gay and bisexual men in London and it was 29%.
The message is loud and clear: Combination HIV prevention works. Increasing testing and early access to treatment, plus adding PrEP to condom use as a safer sex strategy, gives us the power to send HIV into retreat. Why has it taken us so long to get here? The first scientifically rigorous study of PrEP reported that it was effective way back in 2010. The knowledge that HIV treatment could reduce transmission risk has been known much longer than that.
Back in 2001, I worked on a GMFA campaign called ‘Enjoy Fucking’ (see below) which told HIV-positive men that there was ‘less chance of passing HIV on if you have a low viral load’. Although condoms remained at the heart of GMFA’s safer sex campaigns, we always acknowledged that there were other ways to prevent transmission. We weren’t going to judge men who wouldn’t, couldn’t or sometimes just didn’t use condoms. The important thing was that men were equipped with the best information they could get.
As more data came in that told us that an undetectable viral load was even more effective at preventing HIV than using condoms alone, GMFA made sure that all resources reflected that. We stopped saying that condoms were ‘the best way of preventing HIV’ because we knew that it simply wasn’t true. When those of us with HIV are on effective treatment we can’t transmit the virus to our sexual partners. Undetectable equals untransmittable (#UequalsU).
GMFA also was an early supporter of PrEP, helping to design the recruitment materials for the groundbreaking PROUD study.
Could we have done more? Probably. But every time we strayed from the ‘use a condom every time’ message we had to face calls saying that we were undermining the safer sex message, as if there were just one way to have safer sex. Funders too were nervous about anything that strayed beyond a ‘condoms only’ message. The condoms message was important – it still is. Condoms have prevented tens of thousands of HIV infections in the UK. Limiting our conception of safer sex to ‘use a condom’ however wasn’t enough to prevent the HIV diagnoses creeping up year on year.
For some men condom use was easy. For others, the loss of sensation, intimacy or spontaneity was too high a price to pay, perhaps particularly on occasions when their judgement was clouded by alcohol, drugs, lust or love. HIV prevention was never going to be effective if it ignored the needs of men who didn’t use condoms.
I’m delighted that the combination prevention message is now broadly accepted. It’s taken us years to get this far, let’s not waste any more time. The steep drops in diagnoses are concentrated among urban, well educated gay men. Many gay men, women and heterosexual men still aren’t benefitting, while the sexual health needs of trans people are all too often ignored entirely.
The long-awaited PrEP trial is currently set to recruit numbers roughly equivalent to those who are already self-sourcing PrEP – unless the numbers who ultimately use PrEP continue to increase, we won’t be able to build on this success. We need to apply pressure to ensure that all those who will benefit from PrEP can access it. We’re heading to the end of 2017. We’ve had all the knowledge and all the tools that we need to halt HIV for at least seven years. We’ve proven that combination HIV prevention works, spectacularly, now we need to apply force to ensure momentum is maintained.
Here’s the goal: no new HIV infections, no AIDS related deaths, no HIV stigma – not just for gay men in the UK but for all people, everywhere in the world. Ambitious? Yes – but let’s not be limited by the extent of our own ambitions. Let us not falter or hesitate, let’s end this.
This article by Matthew Hodson prevously appeared at FS Magazine, here.