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Fear no more -our health, our right!

Updated: Mar 29, 2019

Henning Mikkelsen, is a Danish gay and HIV activist, now consultant for UNAIDS, and has worked since 1988 for the international response to AIDS with WHO, the European Commission and UNAIDS.

“And don’t forget your condoms!” You have heard it forever, and probably practised it quite a bit- European gay men are among the most experienced condom users in the world. Indeed, condoms are a blessing, they have stopped millions of HIV and sexually transmitted infections.  


But condoms alone don’t do it. For the last ten years, HIV has been on the rise among gay, bisexual and trans people in Europe, particularly fast - by more than 300% - in the countries in Central, Eastern and South-Eastern Europe. The countries which were spared from the first ravaging wave of the AIDS epidemic in the 80ties.  


“Well, couldn’t you just remember those condoms?”, your gay friendly straight doctor might say, looking you sternly in the eyes. While you may think, when was he last using a condom? Did he always remember? Or, did he, like you, at times ended up in situations when the condom was not, where it should be - for reasons of love, lust, dope, or booze? Maybe they were simply not at hand, when needed, or you were not in position of control.

Many of us are paddling through our sexual lives, using condoms regularly, but also encountering the exceptions, leaving behind the fear- before, during and after sex - hanging like a Damocles sword above our heads. Is it now that HIV will become my life companion? - bringing along buddies of stigma, discrimination and isolation, eventually disease and death?  


Better not to think, better to push away- so we forget the regular HIV testing, difficult to get anyway in many places. Far too many - 38 % of gay men testing positive - are diagnosed too late for optimal treatment, at a stage when their immune system is already weak.

Such misery! But listen, it does not have to be! Today we have new knowledge, tools and experiences that can effectively stop HIV. Only, many of us do not know about it, and European governments at large are failing to introduce these new tools and approaches.

Firstly, treatment works! Today there is no reason why people living with HIV should not live a full life, as long as anybody else, especially if they start treatment early. Living with HIV is still no walk in the park, though. The pills only works as a brake, for now they have to be taken daily and lifelong. And the ugly buddies are still around.  


Secondly, effective treatment blocks HIV transmission. In 2018 the huge PARTNER study investigating 77,000 condomless anal sex acts between HIV negative gay men and positive partners in effective treatment found zero cases of transmission Still, this important news - now campaigned as Undetectable (of virus) = Untransmittable - remains a secret for many.   


A recent US survey found that the majority of HIV negative gay men and one third of HIV positive gay men did not consider this message accurate. Likely the situation is the same In Europe, where most public health authoritieshave been remarkably shy in sharing this important knowledge, why?  


Certainly, if you are negativeandlooking fornewsex partners, this knowledge may be of limitedvalue. After all, youcannot see whether people are undiagnosedor in effective treatment. So better stay with condoms only, or the more dubious sorting of partners into perceived HIV positive and negative?  


Wrong! In 2015 studies in the UK and France showed beyond any scientific doubt that the PrEP pill effectively can block HIV transmission. PrEP stands for pre-exposure prophylaxis. It has a less effective twin called PEP, post-exposure prophylaxis, where you start a course of treatment soon after a risk of HIV infection.  


PrEP works - provided that you take the pills, on a daily basis, or on demand, following a recommended schedule. Just as condoms work well, when they are on. But condoms must be used in the heat of the moment. The pills you can take, when you are most in control, for example at breakfast.  


Does that make condoms useless? Certainly not, for many they work well, and unlike the pills, also prevent many sexually transmitted infections, some quite nasty. The pills, like any medicine, can have side effects, even if they are few and modest. And PrEP may not be for everyone, always. For most PrEP may be preferred during some parts of their lives, at other times condoms will work best.   


No more fear - we are entering a brave new world where we again can be in full control and enjoy our sexual health and sexual pleasure. Where the sorting of people into positives and negatives becomes futile - as many PrEP users experience.   


We are, however, only at the threshold of that world. What has kept us from entering is politics. European governments have been slow and reluctant to introduce the new tools and approaches - easy access to HIV testing, PrEP, immediate treatment for those found positive, screening for sexually transmitted infections. They are only in the recent year becoming mainstream, but access remains patchy and is far from uniform across Europe.

Consequently, new data on HIV among gay and bisexual men bring further evidence on the growing divide between ground breaking declines in new HIV diagnoses occurring primarily in the western parts of the European Union (EU) and rapidly expanding epidemics continuing un abated mainly in the eastern parts of the EU and in South-Eastern Europe. 


The LGBTI movement in Europe has been remarkably slow in recognising and reclaiming our right to a sexual healthy life, free of HIV infection. It is high time, we speak about sex, our health and pleasure and make it a political priority. If we do not, who will? Some are fearing a new wave of promiscuity - do we really accept that a disease should define who we are and what we do? 



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