[My friend and one-time health care provider, AIDS hero and visionary Dr. Joe Sonnabend, shared with me his thoughts on all the hoopla generated by the Swiss. Nice to have his voice added to the online debate over the report.]
Dear Michael,
Thanks for sending material on responses to the Swiss report.
It is a very reasonable, cautious and absolutely appropriate set of recommendations. They are based on studies that have been accumulating for about 8 years, some by US researchers. So the very interesting question is why was it left to the Swiss to make this absolutely reasonable comment on material that has been available to all of us? To me as well. Why did none of us, myself included, not see the important implications of the studies on which the Swiss report is based. Studies that have been in the literature for some time?
The Swiss did not make a discovery, they just saw something important in material that has been around for some time, and even if some of us had noticed the implications, as they did, we remained silent. Curiously we – that is US researchers did in fact pay attention to these implications, but in a very different context.
One of the justifications for starting treatment earlier was that, because of viral load reductions, transmission of HIV would be reduced. So they did get the point, but only in so far as using it to argue for an earlier start to treatment – with no interest in the implications regarding condom use.
I suppose I’m trying to say that all of us, myself obviously included, might have raised questions and initiated discussions on reconsidering the circumstances of condom use in response to studies we have seen for many years. I must admit that this lapse does make me wonder about my own ability to see important implications of study results. Again, why did we have to wait for the Swiss report?
The report is absolutely reasonable. There are caveats and cautions in it, and since I can see no reasonable objection to them, we have to look elsewhere to try and understand why the report has provoked such a furious response. I know it is a bit pedantic and pretentious but I’m going to add a quotation that is over 100 years old that recognizes that scientists can be as irrational as anyone else (especially about sex), Here it is:
In Man Adapting, Rene Dubos notes that:
“The presuppositions on which medicine operates are thus conditioned by the general philosophy of the social group as a whole” and adds the words of Oliver Wendell Holmes in 1860:
“The truth is that medicine, professedly founded on observation, is as sensitive to outside influences, political, religious, philosophical, imaginative, as is the barometer to the changes in atmospheric density”10
I would bet that some who have commented have not even read the cautious Swiss text, and have allowed their prejudices, and squeamishness about sex in general, maybe specially about gay sex, to surface at the very mention of sex without condoms.
The Swiss authors do deserve some recognition for their courage. There are circumstances in which it is not irresponsible to have sex without condoms. And even for those for whom these circumstances do not apply, the knowledge of the possibility of sex without condoms will be an encouragement, in at least two ways. To continue using condom use when this is necessary, and a support with treatment adherence and monitoring.
I say these things as someone who had something to do with the original introduction of condom use for gay men in 1983, and until now thought – as probably most did, that it would be forever.
Knowing that this is not necessarily so is a tremendous encouragement and I believe this thought alone will help our prevention efforts.
All the best, Joe
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