In 1996, the deaths stopped coming as often. Those who were very sick and frail quickly regained their strength and health. The years of terror appeared to be coming to an end.
In fact, 1996 was a milestone year in our war on AIDS. After years of ongoing struggles to fight this disease, an approach was discovered—combine a new class of powerful medications, known as protease inhibitors, with two other classes of HIV antivirals, and the disease could be contained. It was not a cure. It is still not a cure. However, the use of this triple combination approach, a “drug cocktail”, known originally as HAART (Highly Active Antiretroviral Therapy) transformed the disease from one that was terminal to one that was chronic and manageable.
Many who have survived those trying times lived to tell me their stories, which I share in my book, The AIDS Generation: Stories of Survival and Resilience. I have come to understand my generation—those of us who came of age in the 1980’s and early 1990’s as The AIDS Generation. Regardless of whether we were infected or not, regardless of our sexual orientation, race, gender, social and economic class, or hometown—our formative years were shaped by this epidemic. It was all around us.
Three years ago, we experienced another victory in the war on AIDS. Researchers showed that Truvada, one of the antivirals used to treat HIV, could prevent an HIV-negative person from acquiring or becoming infected with HIV. Taking this pill once a day, in a manner similar to the workings of birth control pills, could prevent an individual from becoming infected even if exposed to the virus. This approach, known as PREP (Pre exposure Prophylaxis) holds great potential and has provided sexually active individuals with a tool other than condoms to keep themselves safe.
It is within this landscape of biomedical advances to fight HIV, including HARRT and PrEP that a new generation, the Millennials, come into their adult lives and more importantly their sexual lives. For them, AIDS is no longer the death sentence it was for us, and powerful tools are available to prevent and fight HIV infection.
Despite our advances, HIV/AIDS is still a health burden in our country. President Obama recognized that reality and become the first president in the history of the disease to put forth a national AIDS strategy.
In the United States, some 50,000 new infections occur annually. While this virus can infect anyone in the United States, there are specific populations that are most affected and burdened by HIV/AIDS—gay men and African Americans. It is true HIV does not discriminate and can affect and infect anyone, but to not fully acknowledge the populations in which it wreaks its greatest havoc would disrespect the struggles gay men and African Americans- especially in particular, African American gay men, face in combatting this disease.
My own work for the last 20 years has attempted to disentangle the factors that drive the HIV epidemic in gay men. In the last several years, my attention has been focused on HIV in the lives of gay men who are Millennials. I was directed by a belief that the reality of HIV is very different in lives of gay men who are Millennials from those of the AIDS Generation. Thus, to be best equipped to continue to fight this disease in the gay population, we must develop tools that are relevant to a new generation of gay men- since both the epidemic and the life experiences of gay men have changed, and since the first cases of AIDS were reported in the summer of 1981.
It is within this evolving context that HIV must be understood in the lives of Millennials. Some of my generation have argued that young gay men aren’t afraid of HIV—that they are not worried about the disease. That is an unfortunate speculation which does more harm than good.
My own work shows that young gay men are worried about HIV, but it is not the primary worry in their lives. Perhaps because of our biomedical advances, they are well within reason to feel this way.
In one of our studies, known locally as P18, we asked young gay men to rate their level of concern regarding several aspects of their lives including their concern about HIV. Of some 500 men we have surveyed to date, worrying about HIV ranked somewhere in the middle of the pack. Greater concern was associated with finances, finding a job, and prospering in one’s career, as well as prospecting the future. This should come as no surprise given that these young men are coming into their adult lives at a time of great economic downturn and uncertainty. For many us in the 1980s, the possibilities of success and wealth seemed within our reach.
This data tells us something very important–HIV is a concern and one with which many young gay men grapple, but it is a different struggle than it was for my generation. To expect HIV to be the primary presenting problem of the Millennials, as it was for the AIDS Generation of gay men, is simply unrealistic. In effect, to combat this epidemic that continues to affect the lives of a new generation of young gay men, we must first accept this assertion. Thereafter, we must address this ongoing disease within its context and develop messages and programs for Millennials which respect their own set of realities of the 21st century. Innovative community based agencies understand this notion and embed their HIV prevention programming within other programs, such as resume building and cooking. The topic of HIV is nested within a boarder context of overall well-being –an approach which may resonate more effectively with this generation of Millennials.
As we move forward in fighting the HIV epidemic, we must keep all of this in mind. We must evolve our thinking and approaches in fighting HIV, as well as other diseases that may afflict Millennials. We must act quickly, for soon enough the approaches we formulate for them may be too outdated as Generation Z emerges into adulthood.
By Perry N. Halkitis, PhD, MS, MPH