December 2nd, says the diary. The day after World AIDS Day (WAD), an occasion I’ve sometimes been cynical about in the past. So nice for the world to worry about AIDS for a day so we only have to worry for the other 364!

This year I’m not cynical, because HIV has been extraordinarily in the news in the last month, since well before 1 December. This in turn seems to have stimulated a new seriousness and engagement in the press coverage of HIV, from Cherie Blair speaking out against criminalisation in the Elton John-edited Independent to the National AIDS Trust anatomising the UK epidemic in The Times.

Much of this has been because of good news, as we say in Another weapon against HIV. The world epidemic is shrinking; the Pope countenances condom use; we prove that HIV drugs can prevent HIV.

Coverage is also due, however, to a renewed anxiety about how the world’s response to AIDS is going to develop in the future.

Some of this concerns the world epidemic. We need new prevention tools (like PrEP) precisely because the reduction in HIV cases globally is only slight and the number of infections still outstrips the number of people put on treatment. But how on earth, when we can’t afford (or don’t want) to pay for pills for positive people, can we pay for pills for HIV-negative ones too?

The picture in the UK, however, is what gives rise to the greatest concerns here, and is the subject of the main feature in this issue (The whether forecast).

Here we face a UK epidemic that continues to grow, increasingly due to infections in gay men (ones in Africans are decreasing here, as they are in Africa), unprecedented public service cuts, brutal efficiency savings in the NHS and a wholesale revision of health administration.

I must have known something, in mild early November, about the forthcoming weather when selecting this title, as I write this a month later in snowbound London. I was expecting to find a similarly grim forecast from those most likely to be in the know about what will happen to our services. Instead, I found something even more disconcerting: amongst even civil servants and policy experts, what HIV services will look like next spring was and is still as unclear as what the weather will be like then.

Will we be going to our GPs for our HIV meds or to a handful of elite super-clinics? Will everyone with HIV on benefits be hauled in for medical exams or only a few? Will HIV prevention services stay the same or be handed over to a slick new agency with a tougher line? The picture so far is getting no clearer, even as we approach crunch time, and experts continue to disagree.

Just as uncertain, and a continuing concern, is our personal ‘whether’ forecast: not only whether we live to a ripe old age but whether we have a healthy one (The prescription for old age).  

HIV services and the ageing population are probably the two biggest issues in the British HIV scene, so we’ll return to them in the new year. In the meantime, we wish you warmer times, warmer climes, friendship and health for 2011.