There’s an unusually diverse mix of topics in this issue of HTU. You might say they span the ‘before, during and after’ of the HIV diagnosis experience.

The piece on pre-exposure prophylaxis (PrEP wars) returns to a topic we’ve covered before, but which, as we show, is one of the most hotly debated ideas in HIV right now. Using medicines, including vaccines, to prevent rather than treat disease has always been a controversial issue, from MMR to water fluoridation, because the benefit/risk calculation feels trickier: how can you be sure you aren’t giving people what may harm them, to prevent what they might not get anyway?

Such feelings are often deeply held, not always rational and, in the case of HIV, can reach a particular sharpness. This is partly because advances in the tolerability of HIV medicines have happened so fast that many still see them as toxic drugs no one would take unless faced with death. But it’s also because people ask the obvious question: “Why don’t they use condoms?” – usually followed by a lament for the lack of efficacy of safer-sex campaigns. This isn’t the place to go into why people don’t, but the fact that many don’t means we need more alternatives, and PrEP is a possible – though not unproblematic – one.

Tales of the late diagnosed made me feel angry as I was researching it; so many near-deaths – and a tragic case of someone who died of AIDS, but could have been saved any time in the previous three years if only she’d been given an HIV test. No one is specifically to blame, though: as the piece makes clear, patient awareness, doctor awareness, testing availability and the fear of HIV all conspire to create a situation where far too many people still test far too late. A critical issue not only for their own health but, because they have spent all that time with detectable viral loads, for the health of partners too.

Finances for the over-50s had rather the opposite effect. There are certainly a lot of people around, like ‘Michael’ in the article, who face poverty in old age because they never assumed they would be old, and because they were out of the job market for years. The piece, however, reminds us that this is an issue shared with a lot of people who don’t have HIV (many HIV-negative people also leave it very late to prepare for their older age), and that there are possible remedies we may not have thought of.

One interesting aspect of the late-diagnosis and PrEP articles is that they don’t directly concern the health of HTU’s core readership – people with HIV. By definition, PrEP is for HIV-negative people, and we’ve already been diagnosed, late or otherwise. And yet people living with HIV are deeply involved in activism around both these questions.

This is partly because many of us are only too well acquainted with the harm that HIV can do, and we want to spare others the same experience. But it’s also because HIV activists tend not only to care passionately about their cause but are also an unusually scientifically literate bunch. We know what is likely to work and what’s likely to be a dud. Precisely because we are now living longer lives, it gives us the chance to give something back and to contribute as positive citizens.