Saturday 8 July 2000

Pic of the day: Søgne Gamle Kirke.
I was walking along the winding road; the air smelled of ripe strawberries and the wind stroked the grain field again and again, like a caressing hand over soft silken hair. Then, a few more steps, and I faced them: Half in light, half in shadow. The monuments to our faith and our faithlessness. There will be more stones. Too many, too soon.

Paying for the plague

Today is Saturday, one of the two days in the week where Norwegians particularly like to meet and exchange bacteria, virus and the occasional fungal infection in the most intimate way. One virus that is likely to make the jump tonight is the HIV virus, which most people agree is the cause of AIDS, a devastating and so far incurable weakening of the immune system. (Those who don't agree that I have heard of is one scientist, two New Age diet book authors, and the president of South Africa. But that's a story for another day.)

I remember when nobody knew for sure what was the cause of AIDS. I still have the popular science magazines from the time. Some researchers found (not surprisingly) that semen contained substances that weaken the immune system, and supposed this may be the reason why the illness only afflicted male homosexuals. I guess this implies that the mainly American gays who got this disease received more semen than other people, which may not be far off anyway. But then the illness spread by blood transfusion. A few months later, the virus was isolated and scientists set about to make a vaccine. They are still trying.

I remember the graphs charting the future growth of AIDS, based on studies from West Africa and San Fransisco. By 2000, between a quarter and half of the Norwegian population would be infected. Society would more or less break down.

It did not quite happen like that. In Europe and the USA, the main risk groups (promiscuous gays and intravenous drug addicts) changed their tack. The gays started to use condoms, and the drug addicts got free needles. Things calmed down. The disease spread, and is still spreading, but much slower than we feared. At least in these parts of the world. It is now going over the southern parts of Africa as if Death has traded in his scythe for a combine harvester. It seems that much of the young generation is already doomed. And the disease is spreading like wildfire in much of Asia now.

Recent news from San Fransisco say that HIV is spreading again. It seems that a new generation of gays have grown up, who do not fear the virus. They may have a point: With all the new antivirals, it may be possible to live with HIV for decades. Of course, there are side effects to the medication, in fact it is said to be very hard to stick to the schedule. Many patients skip one or more of the components in the medical coctail, and rather take the risk of dying earlier.

***

There may be another hurdle ahead. In developing countries, almost no one can afford the medication that keeps HIV down. In the rich world, the price is still more than many unskilled workers earn. As long as only a few small groups are infected, medical insurance takes care of most of the expenses. Here in Scandinavia, medical insurance is mandatory and is collected along with the taxes. But what will we do when a gradually larger part of the population is infected?

We know that once the disease reaches a certain level outside the gay and drug abuse communities, it starts to spread faster. Common people don't really think they will die from having sex. At least not with someone they know - a schoolmate, a coworker, a friend. But they are wrong. Dead wrong. (In fact, your husband may not be safe, especially if he is doing business travel or working late.)

Last I heard, the cost of treating one HIV-infected person was ca half my gross income. Now let us assume first an extreme scenario, where half the population is infected. This means that my insurance premium would have to rise by ca one quarter of my gross income. Now that would be very noticeable, to say the least. But certainly it won't go that far. Well, it need not. There are other effects.

Firstly, our entire medical establishment is not built to this scale. It's not like you can just diagnose someone as HIV positive and tell her to take these pills daily for the rest of her life. No. There must be follow up tests, because the virus mutates and it is important to catch a new strain and change the medicaton accordingly. Also there will eventually be opportunistic infections - people do over time get more sick than they would otherwise have been. We're already running out of doctors and nurses and hospital rooms here. What will we do when the pressure on our health services increases by 10%, 20%, 30%?

So far the last generations we have seen improved health for all age groups. It may seem like people are getting more and more sickly, but the fact is that they just live longer, and so they also live longer with diseases. In reality, it takes more time now before your health starts to slide. In the future, given a HIV pandemic, many more people will slide out from the workforce and into infirmity. And others who remain in the workforce will be far less productive. As I mentioned above, the medication has some nasty side effects. People may survive for decades, but they may not be able to concentrate on their work all of the time. Or even most of the time. So if my HIV-infected virtual twin drops out of the workforce, he won't be able to pay his own contribution to the health insurance. I will have to pay it too, along with my own. Suddenly, the non-infected populace will be struggling to afford bread, much less a place to live.

Enter the Virus War. Presumably this would happen at a time where the infected were still a minority, but a rather large minority. The HIV negative population would refuse to shoulder the burden of the infected ones. In fact, many people would probably recommend euthanasia. End their suffering, bullets are cheap. That would not go down well with those on the receiving end of the bullets.

Hopefully it won't go that far. Perhaps there will be a vaccine. Perhaps economy of scale will make the medication cheap, and also give the drug companies money enough to develop new and better treatments. Perhaps. But just in case, it may be a good idea to think twice before you take the risk. How about staying sober next Saturday?