the future hold? That seems to be the question that links the pieces in this
too long ago in some memories that having HIV was a matter of staying alive
right now, rather than planning for the future. Even for the newly diagnosed,
finding you have HIV can have a paralysing effect on life plans, not least
because – in the popular imagination – it often still means illness and early
is slowly getting through, though, that life expectancy in people on effective
HIV treatment is approaching normal. Being positive for HIV can still allow you
to be positive about your future.
One of the
most fundamental decisions anyone makes about their life is whether and when to
have children. Until recently, people with HIV faced daunting barriers to
achieving this aim, especially people in different-status relationships, who
would be put through – or put themselves through – a sequence of decidedly
unsexy procedures – sperm washing, artificial insemination, test-tube
fertilisation – in order to have a child but not infect their partner.
In the last
two years we've discovered how successfully HIV treatment can prevent
transmission; the chances of an HIV-positive person on effective treatment
infecting their partner now really are pretty slim.
Joanna Moss discovers in "How are we
going to have a baby? I’m positive and you’re not", so-called
discordant couples may be getting discordant advice from different specialists
about how to reconcile safer sex with conception. Fertility help may still be
needed more often for people with HIV, and some couples may want a 'belt and
braces' prevention approach that adds in other measures, but the current
situation is unsatisfactory and we are eagerly awaiting the publication of new
fertility guidelines, which recognise the role of treatment as prevention.
In most of
our futures is our old age – an old age many of us thought we would not see. HTU has reported before on research
conducted with older people with HIV, which found high levels of isolation,
poverty and depression in people who had never planned to get old. How can we
fend off such miseries and ensure our autumnal years will be as long and happy
as possible? In A healthy – and happy –
old age with HIV we talk to a couple of people who are over retirement age,
and to their doctor, to get their advice on maintaining health and contentment.
In The generic generation, we discuss not
our own future, but that of our treatments. The advent of cheaper, non-patented
HIV drugs could be a tremendous opportunity to save a lot of money, to put that
money into maintaining healthcare standards in the era of cuts, and even to
spare some for research. All that will go to pot if the pressure to save money
results in some people staying on regimens that don't really suit them. It's
not that generic drugs are worse than branded ones – they are just as good –
but that we must never let cost dictate inappropriate treatment.
One way to
fend off that slippage of treatment standards is to try and formulate minimum
ones. The new BHIVA standards for HIV care, summarised in The bottom line in clinical care, are an attempt to set, in the
hardest stone available, a set of minimum treatment standards that should be
applicable for the next half-decade, no matter what contortions the NHS goes
through and wherever we get our pills. We welcome this document as a contribution
to, in an age of uncertainty, securing our future.