Medical Notes: The plague has ended. After Aids, what next?

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LIFE, WE are constantly reminded, is a risky business. A recent broadcast of Equinox proposed that we should make an accurate calculation of the risks in our everyday lives, and respond accordingly. The programme urged caution against prognostications of doom. Herein lies the paradox of risk: it is about danger and hazard, but equally (in a free market economy) it concerns opportunity. Risk seduces us towards harm and achievement.

Social theorists explore the notion of the "risk society", with particular attention to it as a defining feature of late (largely urban) modernity. With the demise of traditional social and political institutions (lifelong married monogamy in the two-parent family; permanent jobs; the welfare state) we are thrust back on our own resources in determining the courses and meanings of our lives. We are ever having to make choices, rather than our cultures and histories determining these for us.

Two characteristic responses to the lack of modern role models are detected - a retreat into reinvented "traditional" forms, notably new religious fundamentalisms, and a variety of political defences of the family; or a creative move forward to pluralistic models of society, largely explored through identity politics and the new "direct action" movements.

Aids is a phenomenon which forcefully illustrates our current anxieties over social normlessness. It has been seen as a full stop to the permissiveness inherited from the Sixties, or even as a plague on those who stray from the normal and the good. It has made sex risky in unprecedented ways. More than any other contemporary phenomenon it has been made to symbolise a boundary between the acceptable and the unacceptable (behaviours, values, individuals, communities).

Yet, contrarily, it has been the rallying point for those who resist the normalisation desired by those seeking to reinvigorate tradition, a standpoint from which to argue passionately for social pluralism. In Britain it has been the locus of redefinition of the meaning, purpose, and, arguably, ethos of gay community. Other subordinate groups have followed in developing community organizations to lobby for and provide HIV/Aids prevention and treatment services, African and women's groups notably. The emergency of dealing with Aids has forced these diverse constituencies to reflect on their values and the ways they treat people different from themselves. In this one sense Aids has been a force for the good.

It seems, as we enter the new millennium, that Aids may be losing its potency, clinical and social. The new combination antiviral therapies offer the possibility of its becoming a chronic rather than fatal syndrome. Andrew Sullivan has confidently, though controversially, declared that Aids, in the specific sense of a plague, has ended.

Questions remain. The efficacy of the new therapies in perpetuity is not proven (they've only been available since 1996). There is evidence of a rise in the rate of new HIV infections among young gay men. In America, and now here, there is concern over the phenomenon of "barebacking" (unprotected penetrative sex among gay men at sex-on-premises clubs). We are, none the less, at the end of a distinct historical moment.

What might follow? We fear new disease agents, such as prions (the cause of human variant CJD). These may present risks, but they cannot carry the symbolic load Aids had. Aids specifically (and most strongly in the West) linked despised sexuality with disease and death. Awfully, it linked a perceived decay, and decadence, of modern society with culprits. Such a specific set of associations is, statistically speaking, unlikely to recur. The risk, thankfully, is small.

Dr Philip Gatter is the author of 'Identity and Sexuality: Aids in Britain in the 1990s' (Cassell, 15 April, pounds 45)