Aids: the epidemic that never was

Most of us can remember those hysterical days in the 1980s and early 1990s when we believed we were all going to be swept away by AIDS, whether we were gay or heterosexual, drug takers or not.

Today, it barely warrants a mention in the national press, unless as an aside in an article about health problems in Africa.

So what happened to AIDS in Europe? It's true that the numbers of victims have dramatically declined, but why did it become the epidemic that never was?

Medicine is taking the credit. Researchers at the Royal Free Medical School in London reckon it can be attributed to the introduction in 1996 of HAART (highly-active antiretroviral therapy). To support its claim, it monitored the death rate at 70 HIV centres around Europe since 1994, and found that it fell by 8 per cent as HAART drugs were used. In all, the drugs have reduced the AIDS' death rate by 20 per cent within two years of being introduced, says the study.

The researchers say the drugs have not only lowered the numbers of AIDS deaths, but also dramatically reduced the incidence of AIDS.

These are big claims and, if true, would suggest that the answer to AIDS has been found. But they have to be tempered by the knowledge that the research was funded by the manufacturers of the HAART drugs, although the research team has been quick to point out that the sponsors had no influence over the study's structure, findings or conclusions.

Another report suggests this is not the whole story, however. While AIDS rates have indeed been falling over the past few years, they have suddenly more than doubled in the Netherlands, with over half the cases being among gay and bisexual men. This sudden increase has been attributed to a return to unsafe sexual practices, a pattern that is being repeated in the USA. There a survey discovered that unprotected sex was common among people who were already HIV-positive while, in a separate American study, 42 per cent of gay or bisexual men did not reveal to their sexual partners that they were HIV-positive.

This suggests what we have always known - that AIDS is a lifestyle disease and, as its name suggests, occurs when the immune system is seriously compromised. And a crate-load of HAART drugs won't make that simple fact go away.

(Sources: HAAART study: The Lancet, 2003; 362: 22-9. Netherlands study: British Medical Journal, 2003; 327: 10. USA surveys: American Journal of Public Health, 2003; 93: 949-54).