HIV - which is the simplest and most obvious truth 25 May 2003
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Stephen T. Green,
Consultant Physician
Royal Hallamshire Hospital, Sheffield S10 2JF

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Re: HIV - which is the simplest and most obvious truth

I do despair of the human race when I read some of the comments to date in this debate. I can see the appeal of denying that HIV is a problem and is sexually transmitted - you can have as much unprotected sex as you like with whoever you like and all you will ned is the occasional shot of penicillin !!

So ! What if HIV does not cause a nasty disease and cannot be transmitted from person to person through the sexual route ? If this is not the case, I do wonder what killed the many patients I have worked with over the years who would have chosen life had they had a choice. Strangely enough, the introduction of drugs which act to diminish the reproduction of this retrovirus seem to stop HIV-positive people dying so quickly.

A thought struck me. If there is no problem, I wonder how many of those individuals who dispute that HIV is (a) a problem and (b) sexually transmitted would be happy to have regular unprotected sexual intercourse with an another human being who they know to be HIV-antibody positive and has a measurable viral load ? Let's have a show of hands.

Should they do so and subequently develop antibodies themselves to HIV and a measurable viral load, perhaps they might still continue to deny that this virus is associated with the development of a disease and avoid taking treatment, side effects or no side effects.

I have a suspicion that not too many sensible people would dispute that their chances of dying an unpleasant death with chronic diarrhoea and a mouth stuffed full of Candida albicans in about eight to ten years time would have been enhanced somewhat.

Or should I be changing the advice I give to my patients ? Perhaps I should advise the ill African patient in whom, this week, I found HIV antibodies that it is of no consequence, that they can have sex as often as they like with their HIV-negative partner, and they shouldn't bother taking any of the pot pourri of daft medications I have on offer. Lets introduce new, helpful, slogans like "Condoms suck - toss them out". I have to say that I suspect that I would be certified insane and struck off the medical register if I were to do such a thing - that is, if I had survived being trampled afoot in the rush by the (sensible) patient wishing to get the hands on the medications. Whether they work or not, I am quite satisfied with the weight gain patients with advanced HIV disease manifest and the very useful level of immune reconstitution which accompanies their taking these drugs, whether they work or not !. And I am quite happy to advise HIV-positive individuals to practice safer sex for their own sake, so as to avoid picking up another strain of HIV which might be resistant to more drugs than their current strain.

Perhaps we should all be looking outside molecular medicine for a bit of common sense - to quote Leo Tolstoy (1828-1920) "..I know that most men, including those at ease with problems of the greatest complexity, can seldom accept even the simplest and most obvious truth if it be such as would oblige them to admit the falsity of conclusions which they have delighted in explaining to colleagues, which they have proudly taught to others, and which they have woven, thread by thread, into the fabric of their lives".

So, all we need to do is decide which of those put forward here is the simplest and most obvious truth !. Debate on.

Competing interests:   None declared