This is an article and interview that was posted on thebody.com
www.thebody.com/content/co...t45012.html

It addresses a issue in HIV prevention that I think often gets overlooked in the media and presents what I consider a far more logical plan for reducing HIV transmission rates. It specifically coins the phrase "community viral load". I was pretty excited to read those words because of the fact that most HIV transmission occurs when 1 partner does not know they are positive. If you look at the statistics, the rate of transmission from a person who knows they are positive, is on meds, and who has an undetectable viral load is minuscule. Its the unknowns or the people who falsely believe themselves negative and who have very high viral loads that cause the majority of M2M transmission.

I've long felt that the focus on HIV education should be on knowing your status and not the Nazi-esque focus on safer sex every time. I'm not saying this to de-emphasize the importance of safer sex, because it is enormously important...but I'm a realist. Safer sex among gay men is not happening every time and when you factor in drugs and alcohol it happens even less than people remember it happening. How many times have we heard the "the BEST way to prevent the spread of HIV is to use a condom"? I'd like to hear "the BEST way to prevent the spread of HIV is to know your status".

I also like how this discussion refuses to demonize the gay men who are still getting infected and who may have grown up knowing the facts about HIV. No one deliberately sets out to becoming infected with HIV... no matter who much the media loves to hype the idea of "bug chasers". I personally feel that most gay men are pretty responsible about having safer sex, but that mistakes happen and 100% adherence to safer sex practices is an unrealistic goal. The basic gist of this argument and the article is that to reduce new HIV infections you need to reduce the number of people with undiagnosed HIV and the sky high and consequently, highly transmittable, viral loads that go along with lack of testing and treatment. I really agree with the idea that the cumulative level of a community's viral load is a better indicator of how to reduce new HIV infections.

I'm a big fan of the "harm reduction" model of social services of which needle exchange is the classic example. It just refreshing to hear the idea being discussed in major HIV/AIDS conferencing and that it may filter down to a local level. I really feel that sero-sorting is a legitimate method of reducing HIV transmission rates. The reasoning behind this is because its looking at the idea of REDUCING and not eliminating new infections. I'd like to see self testing reach the point where its cheap enough and wide spread enough to become a natural part of getting reading for a night out...a tab under the tongue while doing your hair...that kind of thing. If this were coupled with wide spread, 24hr support for newly infected people I think you would see a significant drop in new infections.

Anyway, the article is a interesting read so check it out.

thanks,
dig