Updated: Apr 6
Over the past couple of months, I’ve questioned whether there’s room for another HIV advocate in the world. I’ve wondered if I’ve had my say, had my day and should now focus only on the day job. The self-saboteur tells me that I should leave the advocacy to the professionals, the veterans, and the social-media savvy, who can do a far better job of it than me. I felt like I’d lost purpose, and with that a reason to write, a reason to speak, a reason to share. Then, a few weeks ago an aspiring pilot reached out to me, and everything changed.
They have been denied their Class 1 aviation medical, required to begin commercial training, because they are living with HIV. In the UK, we are lucky, I am lucky, that HIV is no longer a barrier to a person becoming a pilot. In the rest of Europe however, not only does that discriminatory position remain, it has recently been entrenched. On the back of our campaign to change the rules in the UK, the European regulator (EASA) commissioned study into the viability of doing the same across the continent. The results were published in autumn 2020 and in summary it was determined that despite the advancements in HIV treatment since the early 1990’s, there is not enough evidence to support a change to the rules.
I have been through the report, line by line, paragraph by paragraph, page by page to try and make sense of such a blunt conclusion. I can’t. The report references several conditions that are more prevalent in people living with HIV: diabetes, neurocognitive impairment, and cardiac issues. The evidence suggests that these conditions become more prevalent in older people, and that they will manifest themselves at roughly the same time as a HIV negative counterpart. If this is the case, then it should be possible to say with sufficient certainty, up to a defined point in a HIV positive person’s life, that the risk of their incapacitation in a 12-month period is the same as their HIV negative counterpart, especially when there both already a framework in place to monitor all pilots for such conditions and constructive recommendations to mitigate the risks, contained within the report itself.
The report goes on to talk about PrEP, a drug that can be taken daily to prevent HIV infection, much in the same way that “the pill” can prevent pregnancy. However, the report considers PrEP in a much less innocent manner: "...the problem is not related to antiretroviral drugs but to the use of other substances, which is frequent practice among PrEP users”. My jaw dropped to the floor. The report cited on this particular point a study of 361 men who have sex with men, 108 of whom reported recreational drug use during the study period. However, the entire premise, and conclusion of that study was that PrEP was a tool that could be used to safeguard the health of a population of people more likely to engage in recreational drug use in the first place. To say that a person’s motivation for taking PrEP is not to guard against contracting HIV, but to facilitate the taking of recreational drugs is dangerously harmful conjecture.
We’ve all become familiar with the phrase “follow the science”. I can’t help but think that it is that stigma and not the science that has informed both the interpretation of the evidence referenced in this report and its overall conclusion. I genuinely believe, and the questions posed by the regulator to the expert body suggests that there is an appetite for change within EASA but with expert opinion pointing in the opposite direction, their hands are still tied.
There is hope and progress in the UK. After undertaking their own review of European report, the UK CAA look set to soon allow unrestricted certification of pilots living with HIV, provided certain criteria are met and we have already implemented a system that allows those that were previously prevented from training not only due to their HIV status, but because of a number of other chronic conditions such as diabetes, to do so. This all happened whilst still under the European umbrella and it is within the gift of any other state, to do the same. Whilst barriers remain, there is still a job to do, there’s still a need for advocacy. My purpose is to do everything that I can to help break these barriers down.
Here is the full report