Aids: a silent killer that fashion forgot

By MICHELE HEWITSON

On the 17th of this month, the annual Hero parade will make its merry way down Ponsonby Rd. There will be the crowd-pleasing marching boys, the acres of bare flesh, the leather, the whips, the cheers and, more than likely, a profile-seeking politician or two.

Remember, shouts the official Hero Festival programme, "the parade is about maintaining visibility, celebrating our uniqueness and uniting in our fabulosity."

Fabulosity? Well, fine. A city can do with all the fabulosity it can get.

It is easy to get caught up in the frocks and the froth and forget that Hero started out, in 1994, as an Aids Foundation project. This is supposed to be a parade with a safe-sex message.

Why shouldn't we just sit back and enjoy the show?

Last week in Ward 9C at Auckland Hospital, there was just one person sick with an HIV-related illness. And in New Zealand the number of new notifications of Aids is at an alltime low: last year 27 people were diagnosed as having Aids, the lowest figure since 1986. Last year, 88 new cases tested positive for HIV; in 1986 the figure was 125.

We don't hear so much about Aids-HIV in this country these days. Aids was that 20th century disease. The hysteria and homophobia that raged in 1984 when the first New Zealand case was diagnosed have mostly gone back underground.

Remember when there was a widespread belief that you could catch Aids from a towel or a toilet? When some flagged Aids as God's punishment for gays? And remember when, once things had quietened down a bit, it was reported, with depressing monotony, that a cure was just around the corner?

HIV, says Adrian Knowles of the Aids Foundation, "has, big time, gone off the boil." He believes that the heterosexual community "still think it's the homo disease and it's never going to touch them."

The reality is that it is now just as likely to be thought of as "that African disease."

Our attitude has not changed, Mr Knowles says. "For the average Kiwi it's one of those weird, exotic things that happens to someone else."

Aids has not gone away - it has just gone over there. Sub-Saharan Africa has become, says Worldwatch magazine, the equivalent of mid-14th century Europe in t+he grip of the Black Death.

In 1996, the Joint United Nations Programme on HIV-Aids predicted that by the year 2000 over nine million Africans would be infected. They were out by a long shot: the number turned out to be 25 million. In South Africa 500 children are infected with HIV through mother-to-child transmission every day.

There is concern, too, at increasing rates throughout Asia. In China, a country of 1.3 billion, the unofficial figure of those infected is around a million. Aids researchers suggest that the number of HIV carriers will reach 10 million by 2010. India is estimated to have 4 million people with HIV - just 0.4 per cent of its population. These figures, compared with the Sub-Saharan nightmare, are low.

But there is concern that the epidemic will reach pandemic levels in China as a result of lack of funds, increased intravenous drug use, the blackmarket in blood and lack of education - censorship meant that in December 1999 an ad promoting condom use was taken off air after two days.

It is all very tragic but, as Mr Knowles says, from our smug distance "it's poor black people."

In any case, what has a pandemic in far-off developing countries got to do with a country with a population of 3.8 million which might rightly be in congratulatory mode given our declining rate of infection?

We might do well to look to North America where, four years ago, the Aids epidemic was declared to be all but over. This month it was reported that in San Francisco the rate of new HIV infections has more than doubled since 1997. After a decade of stable or declining figures, 2.2 per cent of the uninfected gay population is projected to contract HIV this year, up from 1.04 per cent in 1997.

It is not only Mr Knowles' "average Kiwi" who risks the complacency of the "never happen to me" attitude. Of the 25 people found to be infected with HIV in the second quarter of 2000, nine were women and 15 were reported to have been heterosexually infected - all except one from an overseas encounter.

The San Francisco experience is evidence of a growing complacency among young gay men who have never seen the effects of Aids. The images of wasted men in wheelchairs, their faces blotchy with Kaposi's sarcoma, are images of the 1980s. The gay community, say American health experts, is dropping its guard.

Also of concern is something of a political and cultural backlash on the fringes of the gay community against safe sex campaigns. The most extreme, and worrying, are private clubs in that gay pride city devoted to "barebacking," a term used for unprotected anal sex.

The important public health message, says Dr Jason Eberhart-Phillips, of the Aids Epidemiology Group at the University of Otago Medical School, "is not "Oh great, we can forget about Aids now, it's disappearing."

"It's all the more important. The virus is circulating in the community at ... record levels so that the individual risk that comes from practising a behaviour that could result in transmission is greater than it's ever been."

That is one of the awful ironies of Aids. Infected people live longer and lead healthier lives thanks to the development of drugs which will inhibit, but not cure, the virus. Aids has long been known as the unseen killer, now even its effects are all but unseen.

People are sick of it, says Mr Knowles. "We expected at the beginning of this thing that it would be over. It would be terrible, but we would fight the good fight and it would be over."

He now finds himself in a situation where he is seen as "the Aids police." Trying to sell safe sex to 17-year-olds is like trying to sell safe driving.

"It's about being 10 foot tall and bullet proof. And [that's] a healthy part of human development."

For gay men of Mr Knowles' generation (he is 38), condom use represented a sort of rebellion: "Condoms were quite subversive, they were hip and cool."

Subversive became establishment. The people who were handing out the message became Government-funded institutions. To the young, gay outlaw, such institutions look suspiciously like authority.

Rex Halliday, who works in the field of Aids education and who will be chairing a discussion on unsafe sex at a Herotics seminar at the Auckland Town Hall on February 10, says that there is evidence that prescriptive safe sex campaigns have a tendency to create a backlash.

He says that the issue of "barebacking," while rare in New Zealand, is certainly a concern. It is a problematic debate on a number of levels, he says, not least that while young gay men are being told that monogamy (or at least limiting partners) is desirable, there are no role models for them to emulate.