Read an interesting article on HIV transmission in a “post-AIDS” world – focusing on Britain. The writer (Elizabeth Pisani) goes through the scenarios pretty fully and then has a few observations…

First she says gays needs to “shift down a gear or two” on drugs-and-sex. At least that’s her hope. While I agree some gay guys need to shift down a gear on drugs, when it comes to the sex part I don’t think she completely gets what it means to be gay or be a guy, but her focus is prevention, so it seems reasonable to her…

As the “survivor” generation ages out of the bars and clubs, as same-sex partnerships become more mainstream, clubs and parties may become less central to gay life. They won’t disappear, any more than getting plastered and getting laid have disappeared from the lives of young heterosexuals. But a sense of social alienation is part of the glue that binds young gay people into a “scene” where risky sex, risky everything, is normal. If gay men felt less alienated – if we talked more about same-sex relations in our families and schools, if we had more openly gay people in our boardrooms and sports clubs – we’d reduce the power of that glue.

While it sounds good, I’m not sure it will work that way… On the drugs side of things, sure, the more gay people feel accepted the less drug use there will be since part of drug use is due to people feeling psychologically inadequate in some way due to society telling them their ‘not right’ – but even that may not have a major effect.

And I guess the more there are relationships, the less sex guys will have, but on that one I’m more skeptical. Gay relationships are less likely to be monogamous. Just take IML this past week – lots of guys were there without their boyfriends having lots of sex (and some with their boyfriends). Gay relationships may mean less sex, but they’re much further from monogamy than straight relationships.

One of the guys at IML was even in a long-term relationship and pretty much bug chasing – he wasn’t taking all loads, but pretty close, and he was somewhat excited about becoming poz. Even though he’s chasing he said his boyfriend will “think it was an accident” when he the guy tells him he’s poz. I don’t think the writer really gets these types of complexities…

Being gay and being straight are fundamentally different on many levels. Sure, some gay guys want to settle down and have kids like straight people. But they’re not typical, and I’m not sure they ever will be.

So I think things are a bit more complicated than the writer thinks… There may be some reduction in HIV as gay men are given full equality, but it’s a tenuous connection at best.

She did say one thing that’s completely true. She calls what we’re seeing in the western world as the “post-AIDS” era. She worries what happens when a “post-AIDS” mentality becomes prevalent in the third world…

Having worked in HIV for over a decade in developing countries, I shudder to think what will happen when the “post-Aids mentality” clashes with the imperfect health systems of poorer countries, where treatment can be intermittent and viral load bounces up and down. But in countries like Britain, the shift to a post-Aids world is manageable. The challenge for the gay community is to prevent the survivor generation’s attitude – “the plague is over, let’s party” – from becoming the norm for a world without Aids.

Again, interesting statement, but if she’s saying it’s the western gay community’s responsibility to prevent a “post-AIDS” mentality from spreading to developing countries then once again I have to disagree with her. Just as I think people have to take the responsibility for their own health, I think the developing world has to take responsibility for their own attitudes – to ensure they’re in line with their own ability to provide care.

Still, it is a bit sobering to think how quickly some countries could go down hill if the thinking we see in the western gay communities became the norm in developing countries. While the situation is “manageable” for us, it’s not in other countries.