On not using condoms

Martin Delaney, founding director of the AIDS advocacy organization Project Inform, often finds himself at odds with ACT UP San Francisco, arguably the most militant of the HIV-doesn’t-cause-AIDS groups in the US.

“It’s frustrating when you see them convincing young gay men that they don’t have to worry about safer sex,” he says.

Delaney laments the amount of time and energy he has to spend countering the arguments of these HIV denialists.

Denialists? Don’t they usually call themselves dissidents? Delaney says he and others started using the term denialists earlier this year.

“We don’t let them accept the title of dissidents. That is a proud title.” Indeed, Delaney speculates that it was the dissident label that has attracted South African president Thabo Mbeki to the views of people like Peter Duesberg, a professor of molecular biology at the University Of California At Berkeley.

Delaney was in Toronto this spring at Canada’s first National Conference On Women And HIV/AIDS.

“I worry that things [the AIDS epidemic] will stagnate where they are right now, sort of a half solution, and that AIDS will quietly continue to pick people off – not in the vast numbers each year that it once did, but in steady numbers of time – and that it will still be a life threatening condition for those who have it.”

The protease inhibitors have been very useful “for pulling people out of the fire, but the thought of keeping people on them for 30 or 40 years is inconceivable. These are radical chemotherapy. What we’ve got here is a respite. There is no cure on the horizon and if anything the eradication stuff has faded, not grown.”

Meanwhile, Delaney points out that there is a general sense that “we’ve put the epidemic behind us.

“The media is not interested in the story. A large portion of people are doing well on treatment and they want to get on with their jobs and their lives. But it isn’t over.”

A major issue right now is the decline in AIDS activism and loss of group memory, Delaney says. “So many people being affected by AIDS now have no link to the 1980s and don’t know what it was like in the early days. That can lead to some mistaken knowledge or understanding of what is going on now. I think one of the reasons the denialist movement can grow is that people don’t remember a time before the drugs, and so they think the drugs cause the disease.”

One of the most alarming trends that Delaney sees is the shift of the epidemic into minority communities and women.

“This is enormously dangerous. You’re talking about marginalized communities that already lack access to health care. For many of these people, HIV/AIDS is but one of many life crises. It was one thing with gay men, who were able to take on the epidemic with resources, activism, experience and the support of friends and sometimes families. Now we’re looking at places where that doesn’t exist, where there is poverty, gang violence drug addiction and often general hopelessness.”

And there is an urgent need for research on things like AIDS drugs and their interaction with women’s monthly cycles, with pre- and post- menopausal women

“All kind of assumptions are made based on how the drugs act on men. We have to demand that a statistically significant number of women be present in all drug trials.”

Delaney says that when it comes to women and HIV/AIDS in the developing world, he often finds a troubling conflict between being culturally sensitive and tolerating the abuse of women.

“I think we have to stand with activists in those countries and say, ‘Women can’t be treated this way; your culture is wrong, it abuses women.’ There is a huge confluence between the concerns about AIDS and women’s rights in many of those countries.”

The task in serving infected groups outside the gay community is to avoid paternalism while supporting other affected communities.

“What worked for the original AIDS organizations was the empowerment that came with creating our own groups, services and support…. We either help them [more recently affected communities] take over our organizations or help them start up their own in their communities.”