‘Safe-sex fatigue’ as HIV rises

IT was an image that sent adults packing to the chemist to buy condoms and gave children watching evening TV nightmares.

IT was an image that sent adults packing to the chemist to buy condoms and gave children watching evening TV nightmares.The grim reaper AIDS advertising campaign of the late 1980s was designed to shock and that it did.Featuring a black-cowled grim reaper who bowled down men, women and children, the message was blunt: AIDS kills and it’s (in the 1980s) at epidemic proportions.(AIDS is the acronym for acquired immune deficiency syndrome. Someone who is HIV-positive does not have AIDS until the symptoms develop.)Despite recent criticism that the campaign demonised gay men, the result was inarguably effective and HIV/AIDS in Australia has dropped steadily since 1994.Until this year.HIV infections recorded in 2002 rose markedly in Queensland (20 per cent), NSW (13 per cent) and Victoria (7 per cent) a national hike of 8 per cent.While Victoria’s infection rate has increased slightly for the past three years, this was the first time NSW and Queensland returned such results. Last year there were 239 new HIV infections in Australia, compared with just 140 only four years earlier.And adding to the woes of Australian health workers is the increase in sexually transmitted infections (STI), with gonorrhoea, syphilis, chlamydia and herpes all making a comeback in both homosexual and heterosexual groups.It is almost 20 years since the grim reaper campaign, and some experts fear Australians have lapsed into “safe-sex fatigue”.There is now a new generation of sexually active Australians who were too young to have heeded the stark safe-sex messages of the grim reaper campaign.And with sex education at schools remaining an optional program, not all teenagers are exposed to healthy sex messages, despite a recent Australian sexuality survey confirming that teenagers are having sex younger than ever, at an average age of 16.Earlier this month, the deputy director of the Centre for Adolescent Health at Melbourne’s Royal Children’s Hospital suggested the Victorian Government consider making condoms available in high schools in a bid to counter increased rates of STIs and unplanned pregnancies among teenagers.Professor Susan Sawyer made the remarks after a study published in the American Journal of Public Health dismissed fears that access to condoms would only encourage children to have sex earlier.The study revealed that students who had access to condoms at high school were not sexually active any earlier than those at schools that did not provide them.The Vatican didn’t help the safe-sex cause much either.In April, it issued a new 900-page Lexicon On Ambiguous and Colloquial Terms About Family Life and Ethical Questions, warning against safe sex and claiming that condoms do not protect against STIs.Those at the coalface in the war against HIV/AIDS say the safe-sex message is not getting through.Sydney man, Justin Brash, 48, contracted HIV 18 years ago through unprotected homosexual sex and has since battled the virus using strong anti-retroviral therapy.”I’m from the older vintage. I come from the perspective of the days when HIV and AIDS were a death sentence,” Brash says.”There are a group of kids coming through who haven’t watched their friends or partners get sick or die; they haven’t been to the funerals, and I think this, potentially, is a big part of the problem.”I say to people, ‘Look, if you get HIV, you have to take these toxic drugs and practise safe sex for the rest of your life, so you may as well just do the safe-sex part now’ I tell them HIV changed my life, and I can’t say it changed for the better.”The Australian Federation of Aids Organisations president Bill Whittaker points out the rise in HIV infections is biggest among 30- to 39-year-old males men who were either children or teenagers during the days of the grim reaper.”The grim reaper campaign was useful at the time.It had the purpose of telling people what AIDS was and making the community aware of the epidemic, but I don’t think the grim reaper campaign is relevant 20 years on,” Whittaker says.”This is not a glitch. We have seen increased rates of unsafe sex, a rise in STDs (sexually-transmitted diseases, also called STIs) and all of these things have pointed to that fact that we were vulnerable to a rise in HIV infections.”The Australian rates are mimicking an international trend of HIV and STIs, particularly among gay men.Despite declines of these infections during the 1980s and 1990s, the Britain, the US, Switzerland and Canada have all recorded recent increases in HIV and STIs.Last month, HIV/AIDS campaigner and singer Sir Elton John lamented that young people were “throwing their lives away” as official figures confirmed the huge rise in sexually transmitted diseases.”All I can say to people, especially to young people, is get tested and have safe sex because with the way the disease is spreading at such an alarming rate along with other sexual diseases, people are throwing their lives away and that is such a tragic thing,” he says.Nearly one-in-five Australians have had a STI at some stage. Since 1996, Australian cases of chlamydia have almost doubled and the rate of gonorrhoea has also increased significantly in the past nine years. Experts suspect that up to 80 per cent of genital herpes cases remain undiagnosed.Professor Adrian Mindel, director of the Sexually Transmitted Infection Research Centre at Sydney’s Westmead hospital, says safe-sex messages must be re-evaluated.”The trends we are beginning to see indicate there is a need for us to return to more basic safe-sex messages that are not only relevant to a range of groups, but also encompass a broad range of STIs rather than only focusing on those that can be life threatening,” Professor Mindel says.But the success of existing HIV drugs and growing hope for a vaccine could also be fuelling safe sex complacency.Skeletal HIV/AIDS patients, who were the hallmark of safe-sex education campaigns in the 1980s, are no longer the norm and the HIV/AIDs is no longer as obvious.In Justin Brash’s case, daily intakes of anti-retroviral therapy improve his longevity, keep progression of his disease at bay and help him maintain a manageable lifestyle.Post Exposure Prophylaxis or PEP drugs are now available to be taken immediately after possible exposure to HIV or another STI (over a three-month period) and are seen by some gay men as a sort of “morning after” cure to contracting HIV.A new HIV vaccine is being trialed on human volunteers at Sydney’s St Vincent’s Hospital, run by the Australian Thai HIV Vaccine Consortium. But it will be at least seven to 10 years until a vaccine is made available to the public.In the trial, healthy adults aged between 18 and 55 will receive several shots of either the HIV vaccine or placebo.The first two shots of the treatment include the DNA part of the vaccine, which primes the immune system to recognise HIV.A third shot involves parts of the HIV virus inserted into the fowl pox virus, used as a carrier.This is designed to boost the number of cells required to prevent HIV.While quietly excited by the trial, Bill Whittaker is quick to stress there is no “magical cure” for HIV.”Some people have the impression that a vaccine is imminent, but the reality is that any immunisation is many, many years away,” Whittaker says.Associate professor Andrew Grulich, of the National Centre in HIV Epidemiology at the University of NSW, says present treatments, although not perfect, are making a big difference in the onset of the disease.”HIV is now seen as more of a nuisance and an incursion on life, rather than as a death sentence,” Dr Grulich says.In some cases, the drugs available to treat HIV have worked for almost 20 years. However, doctors do not know how long they are able to stop progression of the disease. The most common side-effect of the potent medication is high cholesterol.”fore AIDS became a major health issue, homosexual men used to think, ‘Well, why would you use a condom if you don’t have to protect against pregnancy?’ ,” Grulich says.”Those attitudes changed, but since the mid-90s in Australia and other developed countries there has been an increase in risky behaviour in gay men.”Sitting on the desk of Federal Health Minister Kay Patterson are recommendations for the National HIV/AIDS strategy that health groups had hoped would be implemented from January this year.The recommendations call for an overhaul of the national HIV/AIDS strategy, which first began in 1988, suggesting more subtle and sophisticated safe-sex messages.”I am very concerned about the rise in HIV infections in some parts of Australia,” Senator Patterson says.”This may be caused by safe-sex fatigue in older homosexual people and perhaps misplaced feelings by younger people that HIV/AIDS is no longer a death sentence, as a result of the range of anti-viral treatments that are available.”Patterson rejects criticism that the federal Government is stalling on the review, and that commitment to fighting the disease has waned over the years.In his visit to Africa last week, US President George W. Bush pledged billions of dollars to help fight AIDS and provide better treatment to sufferers.Worldwide, there are 42 million people living with HIV/AIDS. Of these, 38.6 million are adults and 3.2 million are children aged under 15.The World Health Organisation says 5 million new infections of HIV were recorded in 2002, of which 4.2 million were adults. A total of 3.1 million people died of HIV/AIDS-related causes in 2002.While groups such as the Australian Federation of AIDS Organisations say the Australian Government now has a “window of opportunity” to stem the increase in HIV/STIs.Patterson says the Government is determined to take its time redrafting the $48 million national strategy, to get it right.She will soon announce changes to the Australian National Council on AIDS, but is likely to put off responding to the review, because it does not officially expire until mid-2004.”We need to revitalise the national HIV/AIDS strategy,” Whittaker says. “The current one is fraying at the edges; there is a real potential problem here and we can’t afford to lose the progress we have made in the past 20 years.”The commonwealth has a window of opportunity here and I’d remind them to think about the cost of managing people with HIV especially if they have to leave the workforce and be hospitalised for treatment.”This can cost government several hundred thousand dollars per person . . . we need to get on to the problem before it gets to this point.”(Source, The Australian, By Monica Videnieks, July 19, 2003)