HIV after Aids

In her essay for Prospect this month, epidemiologist Elizabeth Pisani tells the story of the changing relationship between HIV and Aids in Britain's gay community, and the changing behaviours associated with it.

Today, with new antiretroviral treatments available on the NHS, infection with the HIV virus is not the death-sentence it was even a decade ago. HIV-positive people can expect to live long and relatively normal lives without ever developing Aids, or the secondary conditions associated with it. It is overwhelmingly among Britain's homosexual community that the change is being felt. Annual deaths among gay men in Britain have crashed from a peak of over 1,162 in 1994 to just 153 in 2007—and behaviours are changing to match, with fewer precautions being taken by fewer people.

All this means that, although Aids infection rates are falling, the rate of HIV prevalence is steadily climbing: the number of gay men living with HIV in Britain has more than doubled in the last decade, from around 14,400 in 1998 to over 31,000 today. Does this matter? Yes, argues Pisani, both socially and economically: the treatment of HIV is hugely expensive, while the virus itself is constantly threatening to mutate beyond the capabilities of even the most modern drugs. So what should HIV prevention look like in a post-Aids world? It's a question, as she explains, whose complexities will be being experienced for years to come.