Unsafe sex fear after success of Aids drugs

THE transformation of Aids from a death sentence to a treatable condition is raising a new spectre among doctors: that it will encourage carelessness about sex and a resurgence of the epidemic.

The extraordinary success of the Aids drugs introduced in the past four years in cutting the death rate from the disease has radically changed patients' lives. But as the threat of full-blown Aids and death recede for those infected with the HIV virus, they are increasingly demanding to know whether they can return to unprotected sex and start families.

The progressively more intense anti-retroviral drugs with which they are being treated dramatically reduce the amount of virus present in the blood. Testimony to their success is contained in a study in the New England Journal of Medicine, which shows that among more than 1,200 patients with the severest immunosuppression caused by HIV infection, the incidence of Aids decreased by 73 per cent and deaths by 75 per cent between 1994 and mid-1997.

In New York, Aids deaths fell 29 per cent between 1995 and 1996 and by 44 per cent between 1996 and 1997. Similar falls have been recorded in Canada, France, Germany and Switzerland. One HIV activist quoted in the journal said: "Instead of classes on how to write wills we now need classes on how to find employment."

But if treatments reduce the amount of virus in the blood, they also reduce it in genital secretions. Does this mean that "unsafe" sex can be safe again? Doctors are unsure. In an editorial, Bernard Hirschel and Patrick Francioli of the 12th World Aids Conference, Geneva, say: "Patients seek our advice about their infectiousness but we are unable at present to provide clear answers."

They warn that Aids campaigns must highlight the limits of current treatments to prevent carelessness and a return to old sexual habits.

The new treatments also raise a new dilemma: when to start the drugs. They are powerful agents with side-effects that can be shrugged off in life-or-death situations but which acquire greater importance as survival prospects improve. Although their effectiveness is proved beyond doubt in patients with severely affected immune systems, in others the balance of advantage is less clear.

The side-effects, which include loss of fat from the body and an excess in the blood, "are likely to matter to young asymptomatic [without symptoms] patients who care about their body image and who may worry about the risk of heart disease in the years ahead."

Drs Hirschel and Francioli say that the treatment which is now saving lives in the West is an "inaccessible dream" for most Aids sufferers who live in the developing world because of its cost: $12,000 (nearly pounds 7,500) a year. "Nothing is likely to bridge the gap between the rich and poor countries. Only prevention and perhaps some day a vaccine are likely to make a real difference," they say.