WE'RE INTO the long haul. AIDS and HIV have become two of the most instantly recognisable acronyms in any language. We may not know everything about the disease (far from it). but we know a lot. We certainly know what it does to people. And, most importantly, we know several ways to avoid contracting it.

Most scientists agree that discovery of a cure is unlikely in the short or even the medium term. Indeed, apart altogether form the medical and genetic challenges posed by this search, the process is being further frustrated and delayed by the multi-national pharmaceutical companies themselves, who surround their research with extreme secrecy and refuse to pool any new data or development for fear of helping their competitors. The quest for an AIDS cure is not only a race to save lives, it's a fevered sprint to a potential cash jackpot.

So, in a very real sense, society has had to start living with AIDS. We are now in a period of consolidation. The level of awareness that has been raised must be maintained. The flow of information must continue and intensify. Pressure on governments for resources must be sustained - and if possible re-doubled.

However, it is also a period of re-evaluation. Conventional wisdom about the disease is being questioned and a diversity of opinion has emerged over just what is the nature of this human immunodeficiency virus. A lot of people have decided to go back to the drawing board. And the most controversial of the alternative ideas to be put forward is one that strikes at the very heart of everything we think we know about this problem - it has been suggested that HIV is not the sole cause of AIDS.

MAJOR SOURCE

Although only a small minority of scientists hold the view that AIDS is not caused by HIV alone, the hypothesis is being given serious attention, and it is winning some quite eminent converts. Not long ago, Dr Luc Montagnier, the French virologist who first isolated HIV in 1983, stunned his colleagues by announcing at an International Conference on AIDS in San Francisco that he had now come round to this viewpoint. Montagnier said he had two AIDS patients who had no HIV detectable in their blood. Throughout the world, a number of other HIV-negative AIDS cases have also been reported.

At the core of the HIV-May-Not-Be-The-Cause-Of-AIDS movement is the assertion that the disease is not transmitted sexually but rather is acquired gradually over a period of years (some say) by excessive use of certain recreational and pharmaceutical drugs. They argue that AIDS is not infectious but toxic. None of this, of course, has been proven and some of the science involved in the theory has been categorised by more orthodox doctors as less than rigorous.

However, the very fact that debates like this one are taking place at all is a positive development. After a decade of public familiarity with AIDS, there is a real danger that the disease could become the sole preserve of an "AIDS establishment", a monolithic medical élite whose every pronouncement would go unquestioned. Obviously, science is science and facts are facts but nobody should have a monopoly on interpretation or response.

The dangers of an uncritical belief in the official line as peddled by self-appointed AIDS authorities are manifest. For one thing, the information on their tablets of stone is often downright false. For example, as the AIDS crisis took root in the early eighties, a number of medical publications fostered the myth that Haiti was a major source of AIDS and that Haitians were AIDS "carriers", and the mass media dutifully soaked this up.

This singling out of Haitians had, and has, no basis in reality. World Health Organisation statistics for the Caribbean region document that at least five other countries have higher rates of AIDS per capita than Haiti. In 1990 alone, sixteen of the forty-five countries or areas in the Americas polled by WHO reported higher rates of AIDS than Haiti - among them the United States.

TESTING POSITIVE

It is now also widely accepted that the scale of the AIDS epidemic in Africa was grossly exaggerated. In fact, that very exaggeration has allowed cynical governments in several African countries to plead helplessness in the face of a marauding plague of such apocalyptic magnitude. It has also emerged that for some time now, a variety of illnesses and afflications, many stemming from malnutrition, have been "diagnosed" by these same governments as further manifestations of AIDS.

If the problem was identified as malnutrition, something might have to be done but AIDS, you see, is an insurmountable mass tragedy and all you can do is throw up your hands in despair.

Then, there's the whole area of treatment and drugs. The AZT saga alone provides a disturbing and cautionary tale which is unlikely to be forgotten. The drug was launched some years ago by the Burroughs Wellcome Corporation as, if not quite a miracle cure, then something pretty close. It came trailing a blaze of endorsements from a litany of clinicians and biologists.

Gradually, however, the hype about AZT started to die down. It was found to be an extremely toxic product which itself could, in certain circumstances, actually accelerate the collapse of the immune system. Recent US studies have also shown that AZT does not delay the onset of full-blown AIDS in asymptomatic HIV-positive patients. And its pricing is also controversial, with allegations that its cost has been greatly inflated by its manufacturers.

Ultimately, however, the most sinister dangers of a blanket corporate wisdom about AIDS are political. Absolutes provide political absolutists with easy propaganda and encourage black and white responses to a situation which, in reality, is far form black or white. In America in 1987, for instance, Senator Jesse Helms proposed that HIV infection be added to the list of "excludable diseases" (leprosy, TB, gonorrhea, syphilis) which would disqualify immigrants from entrance to the US.

Such was the climate at the time that there was virtually no mainstream opposition to this move and, readily supported by President Ronald Reagan, Senator Helm's proposal was endorsed by congress. Now, everyone applying for a US visa must undergo HIV screening and those testing positive will automatically have their requests rejected.

BOTTOM LINE

The logical manifestation of this exclusion policy can be found today in Camp Bulkeley, a US military compound in Guantanamo Bay, Cuba. There, almost three hundred HIV-positive Haitian refugees are held under armed guard and twenty-four surveillance. In late 1991, after the bloody military coup that ousted democratically elected Haitian president, Jean-Bertrand Aristide, some 11,000 civilians fled northward to the US as political refugees. All were screened for excludable illnesses and all were permitted entry except for two hundred and thirty who tested HIV positive and fifty-nine of their family members.

These people were then interned at Camp Bulkeley and will remain there until they "voluntarily" return to their homes. On the few occasions when the detainees have staged protests, they have been suppressed by armed troops in full combat riot gear, sometimes backed up by tanks and helicopters.

Apart altogether from the inherent injustice of this kind of measure (if you only allow healthy people into your country today why not white people, rich people, thin people tomorrow?), it ignores basic realities about HIV infection. This equally applies to all of the other attempts to turn HIV into an "excludable disease", whether it be for insurance, mortgages or even employment prospects.

We are entering a time where we're beginning to realise that there is no such thing as a typical HIV positive case. People are living longer. People aren't getting sick quite as early as predicted, or at least they are not getting quite as sick. Some people aren't getting sick at all.

Obviously, deaths are occurring and the disease is still wreaking a great deal of emotional and physical havoc (in Ireland, there have been twenty-five AIDS-related deaths so far this year), but the bottom line is that the resistance movement, in all its shapes and forms, is having an impact.

We're into the long haul. Like the slogan says, AIDS is everybody's problem.

ALTHOUGH SOMEWHAT preoccupied with his own problems at the moment, George Michael is taking time out to mark World AIDS Day by headlining a special show at the Wembley Arena on December 1st, which will go under the banner of 'Her Royal Highness The Princess of Wales' Concert of Hope'.

With Princess Diana in attendance and both Mick Hucknall and k.d. lang already confirmed as guests, the gig is guaranteed to receive widespread media coverage and, as a result, help to get the AIDS awareness message across to the ordinary man and woman in the street.

"Our hope," comments Ian Poitier of the UK-based National AIDS Trust, "is that World AIDS Day - and this concert, as part of it - will remind everybody that they must not be complacent and they need to protect themselves and their family."

Explaining why he decided to get involved with the project, George Michael adds that, "I was invited to put together a bill that I thought would work well at Wembley Arena to benefit the National AIDS Trust and Crusaid and, rather than conforming to the normal benefit format, I thought it would make a nice change to do something slightly different. Mick Hucknall and k.d. lang have kindly offered their time and effort and we are looking forward to a great show, for a great cause."

Tickets priced at £35 are available now from the Wembley Box Office at (081) 900 1234 or from the Virgin Megastore in Oxford Street.

OVER THE last year the Eastern Health Board has increased its HIV prevention and care services around Dublin. The services are provided free of charge by Outreach workers/counsellors, HIV counsellors, nurses and doctors, operating from clinics at three local community bases in Ballyfermot, Haddington Road and Amiens Street.

These clinics handle a very wide range of HIV-related activities and concerns. Individuals are often worried about previous sexual experiences or are not sure of what's safe or unsafe. Some might want to discuss taking a HIV test, or they might need condoms or clean works. A group or organisation might similarly request a talk on HIV transmission, and so on.

Against that background the clinics function as drop-in centres for members of the public where they can get information, advice on HIV, AIDS or safer sex, and condoms. HIV testing is also available, and everyone going for the test receives pre-test counselling, which is provided by the HIV and Outreach Counsellors.

For people with HIV or with AIDS there is a care and support programme provided by the HIV counsellors and community welfare officers based in the three clinics. Primary care is also provided by GPs from some of the clinics.

In terms of the wider issue of community education and prevention, Outreach workers dovetail closely with local community groups, networking and providing talks or workshops around HIV transmission, safer sex etc. A major proportion of the work is with IV drug users, where contact is made on a local level with the individual.

To encourage safer drug use and to prevent the spread of HIV, clean works are provided from the needle exchanges in relation to which there are twelve 'sessions' around Dublin. Apart from clean works and condoms, advice and counselling is available around the issues of safer sex and safe injecting. Needle exchanges are based in Ballyfermot, Inchicore, Finglas, Baggot Street, Summerhill and North Strand.

The Gay Men's Health Project meanwhile provides an outreach and drop-in information and clinical service for gay or bisexual men, and men who have sex with men. The Drop-in service takes place on Tuesdays and Wednesdays between 8 and 9.30pm (no appointment is necessary) at 19 Haddington Road, Dublin 4. Counselling, advice, HIV testing, Hepatitis B vaccination, STD screening and condoms are provided.

Outreach takes place in the gay venues and public sites where gay men frequent, where safer sex packs containing condoms and lubrication and leaflets are distributed. Safer sex workshops for gay or bisexual men also take place regularly. Workshops on homophobia and lesbian and gay issues are also provided to agencies or groups.

The Women's Health Project is primarily aimed at women in the sex trade and a full service is also on offer to them. Outreach workers also frequent the venues and sites where the women work from, to provide information, advice etc. Further information may be had from the telephone numbers below.

• Mick Quinlan

•Eastern Health Board services are available at the following locations:

Aisling Clinic, Ballyfermot Road, Dublin 10. Tel. 01-6232200

Baggot Street Clinic,

19 Haddington Road, Dublin 4. Tel. 01-6602149, and

City Clinic, Amiens Street,

Dublin 3. Tel. 01-8749365.