3 min

Cheeseburgers & CD4 counts

What's the difference between dying of AIDS and living with HIV?

A local guy in his early 20s who is living with HIV recently told me, “HIV is a manageable, chronic illness. I’m not dying of AIDS and I don’t plan to either.”  Another man told me, “My doctor said that in many ways, living with HIV in Ottawa in 2008 is comparable to living with other lifelong illnesses like diabetes.”

First of all, HIV and AIDS are not the same thing. HIV is the actual virus, transmitted from one person to another, that weakens the immune system. If the immune system becomes weakened to the point that an individual experiences “opportunistic infections” and/or their CD4 count falls below a certain level, we usually describe the condition as AIDS.

On average, the time between HIV infection and the development of AIDS is about ten years. But not all people living with HIV reach this point, which means not all HIV-positive individuals will die of AIDS.

So what do they die of? Well, cheeseburgers. Smoking. Being a workaholic and not finding time to go for bike rides down by the river or make love or take an afternoon nap. Basically, the same stuff most Canadians die of: heart disease and cancer.

But do young poz guys stand a reasonable chance of managing their chronic illness for decades with less and less chance of ever developing AIDS? Well, AIDS deaths are significantly down in countries with high access to HIV meds. And the proportion of gay men among Canadian adults AIDS diagnoses fell from over 75 percent prior to 1994 to 35 percent in 2005. In other words, the odds are looking good.

In a recent must-read New York Magazine article (, Gary Taubes explores “Who still dies of AIDS and why?” and discusses factors that affect the longevity of people living with HIV. Taubes spoke with Michael Mullen, clinical director of infectious diseases at Mount Sinai School of Medicine, who explains that the likelihood of dying of AIDS-related causes does not affect all people living with HIV equally.

People are most likely to die of opportunistic infections if they never go on HAART (Highly Active Antiretroviral Therapy) in the first place or have troubles with adherence once they do. This seems pretty obvious but the implications for prevention and treatment may be less so.

The homeless, those with unstable housing and intravenous drug users are highly represented within this group, which means that ending poverty and reversing the growing gap between rich and poor must remain a top priority if we are to reduce HIV transmission. Increased funding of treatment opportunities for Ottawa drug users would go a long way too.

Also highly represented in this category are individuals who tested for and were diagnosed with HIV only years after their infection. “[I]t is almost certainly undiagnosed early infections that are powering the proliferation of HIV among gay men,” writes epidemiologist Elizabeth Pisani.

Which means that routine HIV and STI testing is essential for all sexually active gay men in Ottawa. So too is ensuring the system bends over backwards to make it easy for high-risk groups like gay men to get tested. The new Thursday night Gay Zone Gaie clinic ( at Centretown Community Health Centre (on Cooper St, just off Bank) is a great start.

But queer health encompasses much more than HIV status. Homos and trannies need queer-friendly doctors, but we also need to speak openly about our lives and the kinds of risks we take. Family doctors must live up to their oath to “do no harm” by working through their own hang ups in order to have frank discussions with all patients about penises, vaginas, assholes, drugs and cum.

But what about the other side of the coin?  Who are the HIV positive men that are least likely to die of AIDS?  Dr. Mullen says these individuals tend to have been diagnosed with HIV after the advent of HAART (from 1996 on) and take their meds consistently.

Is it really that simple?  If I am a gay guy living above the poverty line who tests positive this year, soon after infection, and I faithfully adhere to my meds — will living with HIV be just like any other manageable, chronic illness?  In other words: arduous and requiring daily maintenance, but certainly livable?

Obviously, this is the part of the article where I am supposed to remind you about drug side effects. About HIV stigma. About the toxicity of HAART. About the growing threat of criminalization. About the awkwardness of disclosure.

And all of those things are true, of course. All of those things will make the road for newly diagnosed HIV positive men challenging, at times exhausting, and— on the worst days — saturated in a hypocrisy so unfair it can leave you feeling like society’s catch-all scapegoat.

And yet.

Will Nutland of the Terrence Higgins Trust says: “We’re not living in crisis anymore, but people are still reluctant to say, ‘HIV is not a deadly disease. It’s a serious, manageable health condition.”

For many gay men who test positive, this one, simple fact is going to make a long, long lifetime of difference.