So what really happened to the Aids epidemic?

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WHATEVER happened to Aids?

Typed out, the sentence seems spectacularly dumb: a sick joke. After all, there's plenty of HIV about; more than enough for everyone, gay, straight or bisexual.

Globally, it continues to kill hundreds of thousands, the vast majority heterosexual. Rates of infection rampage, barely checked, in the Third World; India, Asia and huge stretches of Africa especially.

In America, Aids remains the third biggest cause of death in professional urban women in their late twenties to late thirties and would perhaps even nudge into second place if the cause of death were honestly declared on death certificates.

Amongst young gay men, levels of HIV infection have risen for a fourth consecutive year, perhaps because the young feel invulnerable - it can't happen to me - perhaps because of internalised self-loathing - it should happen to me - or maybe because of sheer impatience: I don't care if it happens to me/I want it to happen to me.

Wanting Aids to be over, one can act as if it is: If I don't practice safe sex then the Tall, Dark, Deadly Stranger will go away. And if that doesn't work, I'll reverse direction. I'll embrace the Tall, Dark, Deadly, Stranger and in that manner remove his sovereign power. I'll log on the Internet, link up with the like-minded, or get my ass to a club where trendy "Bareback" is the thing, condoms are forbidden and sex is unprotected.

"Bareback": this year's Russian Roulette.

Ah, the intricate ingenuity and bountiful if blase homosexual imagination. Routinely and eternally forced to subvert circumstance, some of us can't help but "re-gay" Aids by transforming even the threat of a lingering death into a fashion, a fad, a fetish.

But then the notion of a lingering death has receded since the advent of triple-combination therapies a couple of years ago. This despite the very clear message that combination therapies aren't a cure - a happy hour still years off - but at best a holding operation, and a laborious, side-effect laden operation at that: 20, 30, 40 or more tablets a day, to be taken with saturated fats, before going to bed, cloaked with carbohydrate, whatever. This is not to make light of combination therapies (I have witnessed too many friends regain an almost miraculous semblance of health) but to point out very real short-comings ie Aids still dictates every hour of every day. You could live longer but you still won't be able to leave the house, or, at least, not for long. There are pills to pop and strength to conserve and all those begging forms to the council to complete.

Facts easily and often forgotten: triple-combinations don't work for everyone. And no one actually knows how long they will work for those they currently work for. At present the virus appears contained and cannot duplicate or mutate. But the virus and its multifarious strains are pregnant with shock-horrors and the chemical mixtures themselves may lose effectiveness. We sail the uncharted seas of the human immune system and - let's mix our metaphors - have yet to come to full grips with the implications of Lazarus Syndrome.

If people with Aids are to live longer and might (or might not, given the treatment's side-effects) be able to return to employment, what does this mean at a time when our caring, sharing government appears determined to cut disability and associated benefits? People who live longer cost more money, not less. It might be sensible to prepare for long-term surprises, except optimism and exhaustion are a potent - and potentially lethal - partnership, and there's this ad-hoc unholy alliance emerging that (justifiably and unjustifiably) wants Aids to be gone and refuses to acknowledge reality or possible reversal.

Cultural conspiracy theory - "Whatever happened to Aids?" - is in the air, beyond compassion fatigue and nearer boredom, not that Aids is no longer a rush, a Gothic romance or even a cheap opportunity to sensationalise. Aids may not mutate but it has evolved. It has not merely become (according to some) "survivable", it has also become ordinary. Hence the Daily Mail, tired of queers whinging though whinging itself about "state hand-outs to perverts". Hence the prissy queen who bumps into you on the dance floor and bullies you into replacing your top because your lesions are "spoiling everyone else's fun". Hence the short-sightedness of Kensington and Chelsea and Westminster Health Authority, who on one hand hype combination therapies and yet cut another pounds 1.7m from London Lighthouse's already beleaguered budget. How then to continue providing a holistic service for those who will have to live (longer) with Aids as well as probably die from it? Slapdash irony: London Lighthouse forced to sell off its west London site and with it the residential unit, currently running at 85 per cent capacity, merely to maintain a basic level of day-care services, medical, psychiatric and physically supportive, and all because of ... a hunch. A hunch that combination therapies will always prove successful when there is, to date, no evidence to support that conclusion.

But, of course, we're not talking conclusions (fact). We're talking closure (emotions). Aids is not over or gone, just as herpes isn't gone or over. We simply stopped listening to those who had herpes, handed them the next new, improved wonder lotion and told them to shut up. We'd been there and done that, OK? And we were lucky. So far, no time bombs waiting to explode. We can hope that this will be the case again but really, has anyone thought to tell the bareback riders, the boys in the backrooms and those whose T-cell counts have scant regard for the zeitgeist and pessimistically continue to plunge?

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