HIV'S MIXED MESSAGE

For years, Sussex health experts have repeated the message that safe sex and HIV testing offer the best safeguard against Aids.

But while this view is still upheld, focus is shifting away from the public in general, and towards those already infected. The reasoning is simple: target the known "pool" of HIV and you stand a chance of stemming it. In Brighton and Hove, this means getting to the heart of the gay community.

Terry Blair, sexual health programme manager for East Sussex Health Promotion, explains: "There's a joint responsibility in a sexual encounter not to make assumptions about each other's HIV status, but some people are not as careful as we would like them to be. A lot of our work is about creating a culture, in the gay community especially, where we can talk about these issues."

Terry's task is not helped by the fact that attempts to paint a true picture of the HIV rate are fraught with difficulties.

The current system for collating data in most areas, including Sussex, is limited, as it depends on people volunteering to be tested. One alternative is to carry out anonymous HIV tests whenever a patient gives a blood sample at a hospital or clinic.

While this is already done in certain areas, it so far only applies to babies in Sussex. But results from elsewhere in Britain suggest the "real" number of gay men with HIV is 30 per cent higher than the "official" tally suggests.

Despite the limitations of the HIV/Aids statistics, experts believe they have enough knowledge to be able to spot genuine trends.

Sussex, and in particular Brighton and Hove, have always shown an above-average proportion of HIV infections transmitted through sex between men. But while this picture is borne out by the most recent figures, the reasons why sex between men and women is producing relatively fewer cases here than elsewhere are obscure.

In 1997, the latest year for which local statistics are available, 77 per cent of newly-diagnosed HIV cases in East Sussex (numbering 59) were linked to sex between men. The bulk were recorded in Brighton and Hove. Nationwide that year, 57 per cent of new infections (totalling 765) arose in the same way.

The simple rationale used to explain the continuing high proportion of HIV cases among gay men in Brighton and Hove is the towns' relatively large homosexual population. Yet does this alone explain why they still have an HIV rate five times the national average? Does it suggest that gay men especially are being careless in their sexual behaviour?

Or given that HIV largely spreads within monogamous relationships, are there more subtle reasons for statistical idiosyncrasies?

Dr Martin Fisher, consultant HIV and Aids physician at Brighton General Hospital's Elton John Unit, believes so: "Because Brighton has a big gay reputation, a lot of gay men move here irrespective of their HIV status. However, the health authority has taken an enlightened stance towards funding new treatments, so people with HIV may be coming to Brighton because they know it has a good name."

In contrast to Brighton, UK-wide surveys now show a dramatic drop in the percentage of HIV infections spread through gay sex.

In 1985, when the Aids awareness campaign kicked off in earnest, 94 per cent of HIV infections (a total of 1,410) and 95 per cent of Aids cases (237) arose in this way. By last year those shares had both fallen to 54 per cent, although the number of gay sex-related Aids cases (498) was more than twice as great as 15 years ago.

Could the message that HIV and Aids are not merely a "gay disease" finally be getting through, encouraging more straight people to go for testing? Or is the reverse true, and does the rising tide of recorded heterosexual infections indicate growing complacency about Aids outside the gay community?

Terry says there is another reason: "The national figures for infection spread between men and women are rising predominantly because of an increase in the number of people who have been exposed in other countries, particularly immigrants from Kenya, Zambia, Zaire, Uganda and Zimbabwe."

Others believe the emergence of this "imported HIV" reflects the rising popularity of foreign holidays in exotic climes, particularly those where promiscuity is rife.

While the Sussex figures are worrying, recent research has revealed one encouraging trend. The HIV infection rate is high, but the number of cases turning into full-blown Aids is plunging.

In 1995, 20 out of every 100 patients treated at Brighton's acute Elton John Unit developed Aids, 16 of whom later died of it. By last year, those figures had dropped to four and three respectively.

Dr Fisher explains: "If we see people at a much earlier stage of infection, we increase our chances of stopping them dying, so it could be that more people are becoming known to us, by coming forward to be tested earlier. But I believe it is actually down to the impact of new HIV treatments."

KNOW THE SCORE, WARNS SUFFERER

WHEN Mike Nelson caught leukaemia while working in the Middle East during the Gulf War he thought his luck couldn't get any worse.

But five years on, the 35-year-old design engineer found out some of the symptoms he had been putting down to his condition were actually those of HIV.

And to make matters worse he soon learnt his partner had deliberately infected him.

Mike, who lives in Kemp Town, Brighton, explains: "My partner was HIV positive and he didn't want to tell me in case I left him. Instead, he deliberately infected me, so I would have no reason to up and leave him."

While combination drugs have been keeping his illness at bay since 1996, he has experienced severe side effects.

He says: "In my case, feeling exhausted all the time is the worst thing, but constant diarrhoea and vomiting is something you have to learn to live with, and if you have the energy to go out for an evening you have to take a little pill with you."

Despite Mike's scepticism about the wave of optimism surrounding current HIV treatments, he still believes it is important for people to know theirs and their partners' HIV statuses.

He says: "I think everyone who's going to start something with someone should go and get tested. It allows both of you to make your choice."

It was a cruel twist of fate which left Joseph Ridley-Scott, 36, aware that he was HIV positive.

The former nurse took a timid friend down to have an Aids test after an unprotected sexual encounter, and had one himself to prove it wasn't painful.

When he decided to check the result three months later, Joseph was devastated to learn he had HIV.

He immediately realised he had contracted it from a long-term partner with whom he had only ever had unsafe sex once.

Joseph says: "It doesn't matter who you are, what you are or where you come from, HIV can affect everyone."

As Joseph had been diagnosed with terminal blood cancer a year before his fateful Aids test, he feels the impact of his HIV diagnosis was softened.

Joseph's HIV symptoms have been debilitating. His vision and movement have deteriorated severely, and at times he feels he is suffering from "the worst case of flu I've ever had".

But he has a lot to thank the new combination drugs for.

While his immune system is still weak, his "viral load", which measures the amount of HIV in the blood, has gone from a reading of 160,000 to undetectable.

Yet despite Joseph's positive outlook, he is realistic about his prospects.

"The fact that some people with HIV are not going down with as many major illnesses now may mean they can go back to work, but we know we are not going to live to be ripe old men."

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