PO Box 55045, Phoenix Az 85078-5045
Promoting Intimacy and Other-Centered Sexuality
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SPECIAL REPORT: AIDS & STD 2000 Update
About This Report
For many years, in our newsletter, we have been publishing the facts about AIDS based on The Center For Disease Control data and many other documented medical studies showing why there is no known AIDS case related to swinging and probably never will be.
However, regardless of the low risk
it is never zero. Therefore, our recommendation is and has always been: Non-monogamous
people are encouraged to get tested routinely for HIV antibodies and for other STD's, and
communicate the results to all their partners. STD's and unwanted pregnancy are much more
real issues for non iv drug using heterosexuals than HIV. If in doubt about either STD or
HIV status, condoms and other safer sex practices should be fully utilized.
Updated U.S. AIDS data for 1999 has been released by the CDC.
In 1999 for the SEVENTH STRAIGHT YEAR, AGAIN new reported cases dropped significantly down to only 46,400 (from 60,634 in 1997) and continues to be very isolated, in known high risk groups.
Here is part of the CDC Summary:
"During the 1990s the epidemic shifted steadily toward a growing proportion of AIDS cases in blacks and Hispanics and in women and toward a decreasing proportion in MSM, (men having sex with men) although this group remains the largest single exposure group... Blacks and Hispanics, among whom AIDS rates have been markedly higher than among whites, have been disproportionately affected since the early years of the epidemic." - CDC Introduction
Latest Proof of Low Non-Anal Heterosexual AIDS Risk especially for males and continued concentration in high risk groups
CDC U.S. HIV/AIDS Surveillance Report 1999 Year-End Vol 11 No.2
Full Report at http://www.cdc.gov/hiv/stats/hasr1102.htm
New Cases Continue Dramatic Decline
The year-end 1999 report shows new AIDS cases declined yet again from 105,828 in 1993 to 79,897 in 1994 to 73,767 in 1995 to 68,808 in 1996 to 60,634 in 1997, and now way down to only 46,400 in 1999. In reviewing the exposure categories, it is obvious the only significant risks are men having sex with men (still 44% of new 1999 cases), drug injecting men and women, and those having sex, especially anal sex, with a injecting drug users and bisexual men. AIDS cases continue to be highly concentrated in a few large cities such as New York and Miami as a percentage of population as well as in certain races.
Few With Heterosexual Sex As The Only Risk Factor
The total cumulative AIDS cases adult and adolescents (excluding pediatric) was 724,656. Table 5 shows of the 724,656 only 74,4770 (10%), cumulative in 19 years was from "claimed" heterosexual contact and it was mostly women (47,946 women vs. 26,530 males). This even includes those who also had secondary risk factors such as having heterosexual sex with bi men, injecting drug users, etc.
Many studies have shown bi or gay males often hide or lie about their risk factors due to our cultures discrimination against bi and gay men, not to mention they may also not admit being injecting drug users. Bi/gay sex is even a crime in many states and of course injecting drugs is illegal in all states. So not admitting to illegal acts is also not surprising. Therefore the "real" heterosexual male reported number of 26,530 cumulative in 19 years, is probably significantly lower than the admitted transmission method the CDC shows in their data. Also some women may not admit to injecting drug use. But even the admitted transmission method shows the low heterosexual risk, especially for males. Since the rate is so low for heterosexual males, female partners of such males of course have very low risk since a partner has to be infected or the risk of transmission is zero - even for anal sex!
In 1999 gene research showed a potential genetic reason why HIV AIDS is so rare in the "White" race vs Black and Hispanic. Looking at CDC Table 19 black males with AIDS were at a rate of 124.8 per 100,000 population vs. only 16.2 for white males (including those admitting sex with other men). For white females the rate is only 2.3 per 100,000 population. This isn't racist, just the statistical facts and now probable genetic explanations while there is the racial differences.
The number of women infected is growing however in the last few years. This makes sense since studies show anal sex is much more common that many might think. AIDS is very easy to transmit form a bi or injecting male to female via anal sex. We know it is extremely hard to transmit HIV from a women to a man sexually, if there are no STD sores on the penis, and difficult but more possible to transfer male to female vaginally.
We have a huge number of prostitute studies from all over the world that clearly show, while many prostitutes are infected (often from drug use), it is clear they are not passing HIV or AIDS to their male clients.
In 1999 there were 2,858 males and 10,789 females (Table 5 non-pediatric) of all races who might have (didn't admit any other risk factor) been infected with AIDS, (not died) by heterosexual sex as only risk factor. Of these many had sex with injecting drug users etc, but lets include all of these to compare to other risks.
Let's put these numbers in perspective:
2,000 people a year die from contaminated tap water in the U.S.!
22,000 per year die from Homicide
26,000 per year die from Liver Disease
30,000 per year die from Suicides
39,000 per year die from Diabetes
50,000 per year die from auto accidents
75,000 per year die from Pneumonia
488,000 per year die from Cancer
972,000 per year die from Heart Disease
Ulcers caused by such over-the-counter drugs as aspirin and NSAIDS (ibuprophen, acetominophen, etc.) kill about 16,500 people in the United States each year, as reported in the New England Journal of Medicine.
Anal Sex May Account For Most Female Cases
Studies show that anal sex is much more common than many might think. Among North American college women, 18.6% report anal intercourse (34.8% of those with 10 or more partners) per MacDonald study in 1990 and over 10% of women report engaging in anal intercourse on multiple occasions per the 1991 study by Voeller. A Danish study (Melbye and Biggar) in 1992 showed 27% to 36% of women ages 20-34 had anal intercourse. These are close to the U.S. studies of 20% found with monogamous heterosexual couples with a HIV-positive male (Peterman et. al., 1988 and Padian et al. 1991). All this easily explains why the heterosexual male to female transmission rate is so much higher than female to male.
Decline in HIV As Americans Ignore Safe Sex Message
The decline in new HIV infection comes at the same time as Americans are ignoring the "non epidemic" and all the politically correct safe sex warning: A survey published in the November 1995 issue of the American Journal Of Public Health indicates that heterosexual adults are not significantly changing their sexual behavior in response to HIV risk. In fact, the survey--which involved more than 9,000 people from 23 high-risk cities and other U.S. locations--found that the number of people reporting multiple sexual partners increased. Additionally, the majority of respondents reported using condoms either infrequently or not at all. But since heterosexual men are clearly blocking its spread we see declining numbers of new cases even when the politically correct "safe sex" messages are being ignored.
The Lying Factor In Heterosexual AIDS/HIV Claims
With the medical knowledge of how difficult HIV is to transmit heterosexually (other than anal sex) it is helpful to look at the studies showing the large lie factor. The very small heterosexual numbers, in males, are probably much lower than reported.
Lets look at some of these studies that prove that people lie claiming heterosexual status to cover up other less socially acceptable and sometimes illegal (drug) activities.
In only a few cities such as NY, heath department follow up includes home visits, interviews with friends and even snooping in the medicine chest for syringes, etc. At least two-thirds of those men claiming to have gotten HIV from a prostitute on an initial questionnaire are confirmed to have had a history of gay activity or drug use.
There was a man in the Navy claiming only heterosexual risk but when asked what percentage of time did he practice fisting, he said "fifty percent", not realizing that heterosexuals seldom do that. Further investigation confirmed he was a homosexual.
The lying factor usually puts false blame on prostitutes which many studies show are not transferring any HIV do their customers. In many states, men who claim prostitute contact are taken at their word and classified as heterosexual transmission and this is used in the official CDC data. But New York City officials are not so trusting. "Of 63 men with AIDS who reported prostitute contact was only risk, 42 were later found to have a history of contact with homosexual men or iv drug abuse.
Dr. Joyce Wallace, president of the Foundation for Research on STD's in New York had to interview an AIDS infected man four times before he admitted to homosexual anal intercourse, not prostitutes, was a factor. Another admitted to homosexual acts, but said it was "only, in an orgy setting." Says Wallace, "In my experience, many men will say they've had sex with a dog before they'll admit to sex with another man.
More published reports involve ministers who claim heterosexual only risk but later admit they are gay. The fact is now coming out that priests have the highest HIV rates of any occupational group and its all from sex with other men.
In such a homophobic society with a religious agenda it is natural people will lie about their risk category or admit to illegal iv drug use.
Early in the AIDS scare there was the front page headlines about the high rate of HIV when testing began in the military. One study (Potterat et al., 1987) sampled 20 soldiers that tested HIV-positive. Three quarters (15) claimed heterosexual contact only. Later upon more detailed questioning and assuring confidentiality, 12 of these 15 admitted homosexual contacts or iv drug activity. It is also possible the other three were better and more consistent at lying than the 12 that admitted other risk factors.
The Los Angeles Times, August 14, 1987 showed the result of another follow-up of military recruits testing HIV-positive. In this study of 23 infected who were classified as heterosexual, most claimed to have contracted it from prostitutes. But after 20 agreed to participate in more questioning and with confidentiality assured, ten were iv drug users, eight had homosexual relations. One was a women who eventually admitted to having sex with a iv drug user and one man alone could have contracted HIV from heterosexual activity, but subsequent testing showed he was not HIV-positive. The initial test probably had given false positive result.
A very well documented study of the lying factor, "Lack of Evidence for Transmission of HIV Through Vaginal Intercourse", was published in the Archives of Sexual Behavior, Vol 24, No. 4, November 1995. The study by Stuart Brody, Ph.d., a specialist in medical PSYCHOLOGY traces the invalid reports of heterosexual contact in detail including data on broader sexual lies told and the various psychological tests to measure the lie factor in other activities. The strong conclusion is lying by respondents (including socially desirable response bias), is one of a number of factors resulting in HIV-positive reports that fail to show the true risk factor of anal intercourse or iv drug activity. Mr. Brody says: "Scientifically proving that something does not exist or occur is always very difficult and usually impossible. The primary point this paper attempts to convey is that there has been the assumption in both scientific and lay communities that vaginal HIV transmission does commonly exist, and that the basis for this assumption rests on data that are unacceptably weak or flawed. The need for sexual behavior change that has been claimed by public health and other authorities is not supported by the scientific data. The potent vectors remain anal intercourse and iv activity, especially in the presence of relatively suppressed immune functioning. However pervasive the lack of evidence for vaginal transmission of HIV may be, it may also be prudent to view the risk as nonzero. Such nonzero risk assignment might also pertain to other vectors (such as nongenital body contact) which have been dismissed by the public health community."
"A tighter research design on risk factors for HIV transmission would include specific, detailed, clear, simply and colloquially phrased questions on sexual, drug, and medical histories posed by clinically sophisticated interviewers; assessment of a social-desirability response set with lie scales and at least one other detector or response bias (perhaps using forensic interview techniques), serology to look for unreported hepatitis or drug use (the latter not unlike approaches used in substance abuse treatment, employment or insurance screening), and physiological markers such as needle tracks or evidence in or on the rectal mucosa."
Insurance Companies See No Risk To The General Population
Insurance companies are now dropping mortality costs since they see no epidemic. They are betting their future profits on the hard evidence there never will be an AIDS epidemic, since in the U.S. it is virtually entirely limited to known high risk groups and not spreading to others. Peter W. Plumley, an independent consulting actuary, is a Fellow of the Society of Actuaries and a member of the American Academy of Actuaries, has published a number of articles on the very low risk of heterosexual AIDS such as CONDOMANIA - COMMON SENSE OR NONSENSE? Mr. Plumley is also Chairperson of the Society of Actuaries Non-Insurance HIV/AIDS Task Force and is a member of the Society of Actuaries Committee on HIV/AIDS (which deals with insurance-related AIDS issues). He served on the Board of Governors of the Society of Actuaries from 1981-1984.
Women have more heterosexual risk than men and need to be careful of that their partners are not bisexual or drug users. Healthy heterosexual men and their female partners, have virtually no risk. The problem for women is knowing their partner well enough to know for sure they are not an anal sexually active bisexual or drug user.
More and more scientific evidence is mounting that the scare everyone tactics to get funding etc. is based on a myth more than fact. Instead of scaring the wrong people with false information about the heterosexual risk, why not devote such effort and resources to reach drug users and tell heterosexual women simply to avoid anal sex if they are not sure their partner is not using drugs or bisexual. Actually, being gay or bisexual is not the risk but anal intercourse. Not all bisexuals or gay men have anal sex. One of the best answers which was so successful in Thailand is a major condom education campaign in schools. But of course religious groups are opposed to such honest education and instead teach totally unnatural sexual repression. Even more sad is their is no biblical basis for the sexual repressive teachings, only Church traditions.
I do support funding and doing everything possible to find a solution. Just because someone got a terrible disease due to iv drugs or anal sex, in no way should make a cure any less important. Finding affordable treatment and eventual cure is also very important due to the high number of cases in third world countries, especially Africa which has very different reasons for the AIDS crisis.
But in the U.S. the UK and most all of the Western world, other than known high risk activities, the normal healthy heterosexual has a very low risk compared to much higher risks everyone takes by just being alive. Yet just because AIDS is a sexual risk it seems to be blown out of proportion, especially now since the only real risk transmission vectors seem to have been clearly identified.
Still, as a precaution, non-monogamous people are encouraged to get tested routinely for HIV antibodies *and for other STD's*, and communicate the results to all their partners. STD's and unwanted pregnancies are much more real issues than HIV.
Dave's concluding comments: Everyone needs to be responsible for their actions based on knowledge and facts as to the relative risk of different activities. We drive a car every day. The risk of death from being killed in an auto accident, even if wearing a seat belt is far greater than the risk of getting AIDS from someone not in a high risk group. Some people may decide to walk everywhere instead of drive a car. Some people may decide to even further reduce the low risk of AIDS by using condoms, dental dams etc. I encourage everyone to learn the facts to make informed decisions and if you are not comfortable with the risk it's your responsibility to practice safer sex and its your partners responsibility to respect your decision.
Although this is a study is a few years old, the low heterosexual rates that we see confirm the numbers published in JAMA (Journal of American Medical Assn).
The risk of one sexual encounter is:
With no condom and unknown HIV status of partner but not in known high risk group (gay or IV drugs): 1 in 5 million. If partner is HIV negative of course the risk is ZERO.
The risk is higher for females getting from males and lower for males getting from females but exact difference not quantified.
The risk leaps to 1 in 500 if the partner is known to be HIV+ and no condoms are used. Again more for a women and much less for a man but exact difference not quantified.
Other studies show these risks if no condoms used:
Female risk via vaginal intercourse is 1 in 1000 IF the partner is HIV+.
Much less if status not known. No risk if HIV-
With the risk of death in an auto accident 1 in 5000 EVERY YEAR, it is so much more risky for you to drive than to have 500 acts of unprotected sex.
Prostitutes are not a high-risk group and have HIV rates similar to the overall population and when they have HIV it's almost always associated with drug use not sex.
Prostitute studies all over the world show while the provider may be HIV+ she isn't passing to male clients..even when condoms not used. A good example is all the Japanese man that go all over Asia for sex, yet there is virtually no HIV in Japan.
And consider South Korea. Anyone who has been there for any period of time knows that prostitution is widespread and often without condoms. But, South Korea with a population of 40million+ has but has less than 1000 HIV cases.
Overview Of AIDS Risk An Emotion-Packed Issue For Many
Before going into great depth of data, I will summarize the conclusions more briefly. For some the AIDS issue is so emotionally charged that they don't want to be bothered with any facts, if the facts are not in agreement with preconceived notions about the risk of AIDS. For example, whenever I got into any attempt at serious discussion with the Society for Human Sexuality mailing list, they had an emotional fit. The CDC data and reports are nothing but a bunch of lies to them and they get very upset with any idea that HIV is not a serious risk to everyone. The CDC data shows how rare heterosexual transmission is, especially female to male. Likewise, on the polyamory newsgroup we are accused of spreading dangerous lies about AIDs, but they never have any hard data to back up their beliefs. I can understand their emotions since they know wonderful people (usually in a high risk group) that have died from AIDS.
Every life is precious and the risk is not zero. But people need to make informed choices in their safe sex decisions based on the actual facts regarding the relative risks. The Wall Street Journal did a very in-depth article which we share showing the political pressure even within the CDC to promote the everyone-is-at-high-risk lie even when they knew it was not true. If people want to call us names and attack our reports, we would hope they would do so with facts, not groundless emotion.
Sexual Trauma Of SEX=AIDS=DEATH
Message of Abstinence Programs
I recently tried to help a 28 yr old man on the phone for 2 hours. Until he started reading our stuff he believed all the evils of sex being so wrong before marriage and the message that sex=death that had had been yelled at him almost every Sunday. He had never had sex until recently. But he is so screwed up emotionally, especially about sex=AIDS=death, that he can't maintain an erection with his new very nice girlfriend. He has been to a urologist who finds no physical problem.
I also attended a singles group in Phoenix with a guest speaker who was a sex education worker in high schools employed by the AZ Health Dept. She had us do this silly game of how you pass on AIDS to every partner, who spreads it on further, until the whole room is infected. She teaches that everyone is at high risk and scares kids to be unnaturally abstinent when their bodies and emotions are designed to be sexual.
The message for youth should be the same as for adults: good sex education with an emphasis on learning about loving intimacy and responsible behavior, including contraceptive use.
AIDS in Swinging
Having been around the swing scene for 10 years a couple things seem universally clear. The vast majority of swingers (the most sexually active of the polyamory category) don't use safe sex practices. At first I was disturbed and surprised by this. However, with all the "unsafe" sex going on, there has never been a documented case of AIDS ever directly linked to the swing community. Believe me, word would spread VERY fast if others were getting AIDS.
Their was one case was in
Minneapolis in the very early days of the AIDS hysteria (1980s) where a very active
bisexual HIV+ male passed HIV to two women who belonged to a swing club with whom he had
anal sex. The man was from another city and was not a club member. The sex took place
outside the club so it wasn't directly swing related. However, everyone in the club
was understandably terrified and the Dept of Health came into the club and offered HIV
testing and almost everyone was tested. No one else tested positive but the club closed
since everyone was so scared. Now we know that anal sex is a very dangerous activity and
almost the only way it spreads sexually. Now we know why from the huge number of
documented studies and CDC data that show the very low risk to healthy heterosexuals that
are not in any high risk group. This would include 99% of swingers.
Other STD's are a more real concern, but again, rare in the swing community. Most, but not all, STD's can be seen so we encourage playing with the genitals and examining them before having sex. Any sore that looks unusual should be a warning to use a condom. Some people will bring up the possibility of herpes transmission without the sores. But medically this is very rare and for a very brief period...something like 2 days a year when pre-shedding occurs without you having any symptoms, if you even have repeated outbreaks at all. But other than an initial infection (which I understand is usually the worst), people usually know if they have herpes and can be aware of the tingling and sensations that I'm told come on just before an outbreak. Other than the rare pre-shedding situation, with herpes it's the big sore that is dangerous and its pus can easily spread herpes to a partner. Fortunately, I've never had any STD (been tested for all just to be sure) but I've done quite a bit of research on this important topic.
Swingers Usually More Responsible
Another reason perhaps why STD's are so rare in swinging is that most swingers are responsible, sexually knowledgeable adults. If they had an STD, they would be sure they were treated or wouldn't participate if they were contagious. This is far different from the bar scene where many folks aren't as responsible.
Liberated Christian Parties
At Liberated Christian parties in Phoenix, we always make condoms available and encourage their use. But we also believe in personal responsibility. We can share the best known medical facts and its your responsibility to make your own decisions. If any partner feels they want to use a condom, of course, his/her wishes should be respected. The downside is that it does greatly reduce the physical pleasure for most men and women.
In summary our position is: Non-monogamous people are encouraged to get tested routinely for HIV antibodies *and for other STD's*, and communicate the results to all their partners. STD's and unwanted pregnancy are much more real issues for non iv drug using heterosexuals than HIV. If in doubt about either STD or HIV status, condoms and other safer sex practices should be fully utilized.
Still, as a precaution, non-monogamous people are
encouraged to get tested routinely for HIV antibodies *and for other STD's*, and
communicate the results to all their partners. STD's and unwanted pregnancies are much
more real issues than HIV.
KISSING PASSED HIV SUMMER 97 SCARE
A women apparently became infected with the AIDS virus from deep kissing a man who had bleeding gums and canker sores in the first ever reported case of HIV transmission though a kiss. The man also had hairlike growths on his tongue, which is common in AIDS sufferers. The recipient likewise had very poor oral hygiene and bleeding gums.
The CDC emphasized that blood not saliva was the cause of transmission and pointed out that there has never been a case from saliva transmission. Further it pointed out researchers have found a protein in saliva that keeps the virus from infecting white blood cells as well as possibly other "things" in saliva that prevents infection.
You have to remember how terribly fragile HIV is. It dies immediately outside semen or blood. you have to have a very efficient route to other persons blood. That is why anal sex and drug needles are the prime method of infection.
Arizona State University Drops AIDS Testing Since Waste Of Money
In three years more than 1500 worried students came for a free, anonymous AIDS test. But with hardly any positive results, officials say the service is needed where more people are at risk for AIDS and therefore is being discontinued at ASU.
Condom Protection The Myth That HIV is Too Small
The is lots of false information regarding condom protection. The biggest myth is that because HIV is much smaller than the pores of a condom designed to stop seamen. BUT the HIV needs a carrier it can not transfer by itself. This myth has absolutely no medical basis but the lie is being spread by the religious right bend on sexual repression rather than meaningful education..
HIV lives INSIDE cells, specifically the T4 cells of the immune system which are found in large volumes in semen and pre-ejac. fluids. These cells do not leak from high quality latex condoms. However, lambskin condoms should be avoided since they are much more porous. Tests have put latex condoms through much more stress than a man can without breaking. Armed with lots of scientific proof of effectiveness, the Centers for Disease Control says "The biggest problem...is failure to take the condom out of the wrapper and use it. We need to shift our focus from the product, which is reliable, to the user."
Condom critics are spreading myths, the CDC says. It says two new studies, the largest ever, show that latex condoms are HIGHLY EFFECTIVE in stopping HIV. "Condoms aren't 100 percent (effective), but they can be very, very close if used consistently," Dr. Kay Stone of the CDC states. When they fail, its usually because people do dumb things, like lubricate them with baby oil or petroleum jelly, or just plain don't use them.
In one study, NONE of 124 healthy Europeans who used condoms every time they had sex with an AIDS infected partner became infected over a two year period. 12 of another 121 Europeans (10%) who didn't use condoms consistently became HIV infected. The highest risk was when one partner had full-blown AIDS, rather than just HIV positive. This led researchers to put the risk of infection at 5% with unprotected sex with an AIDS infected partner. Over 300 other studies consistently show clearly the effectiveness of condom use. Another Italian study also confirms the lack of HIV transmission in the highest possible risk group (HIV infected having sex with spouse). The infection rate was only 9.7 per 100 YEARS in the group that DID NOT use condoms, and 1.1 per 100 YEARS in group that used condoms. Most of the transmission was when the male was the infected partner to the female spouse. Withdrawing before ejaculation reduced to risk of spreading HIV from an infected male to his female partner (as would be expected).
Long-Term Monogamous Relationships
More Dangerous Than "One-Night Stands"
It is interesting that the risk of HIV from a one night stand or from a prostitute is much lower than in a long term relationship since repeated exposure is usually needed and it is so difficult to transmit vaginally. This is because the vagina acids usually kill the HIV. Of course, it is almost impossible to transmit female to male unless other factors are involved such as open lesions from STD's etc. But a women is at more risk than a man. Homosexually it is very easy to pass, but the gay community has been on the forefront of teaching and mostly using condoms and seeking more monogamous relationships, than in the pre AIDS days. The big question is do we teach safer sex knowing it is natural and not going to go away, or do we insist on abstinence and be laughed at or ignored by most.
Condoms In Brothels
(RENO)- Two of Nevada's legal brothels are making national headlines in a study of condom use conducted jointly by Princeton and Emory Universities. The results of the study were made public in the American Journal of Public Health. 41 Nevada prostitutes averaging six clients per day showed that when put on correctly, few condoms break and they work well in preventing disease when used properly and consistently.
HIV infects 1 in 92 Scare Hoax
The latest news in the AIDS Terror Campaign is the reporting that some "scientist" at the National Cancer Institute pointed out, as if it was a big surprise, that HIV may be present in 1 of every 92 young man in the U.S. Minorities it points out have a much higher risk and Anglo men much less.
Since the best estimate of homosexuality is probably 10% and bisexuality another 20%-30% and drug use another 5-10%. This 1 in 92 or about 1% of all young men, sounds just about what would be expected. But what is more important is to look at the risk of specific behaviors which would be much more good information.
If you eliminate anal sex by gays and bisexuals, iv drug users, and hemophiliacs your risk is not 1 in 92 but assuming unknown HIV status for your partner the consensus estimate of many is the risk of vaginal-penile intercourse in the U.S. is
For males: 1 in 80 million
Females: 1 in 5 million.
That would be more useful and accurate information to make informed decisions about your sexual practices.
Immunosuppression May Be Required
Many believe that to become HIV infected you need both the HIV from your partner and immunosuppression of your own system to allow the HIV to take hold, or infect the cell. This seems to be another reason why healthy heterosexuals (especially male) are not getting HIV and why anal insemination is a much higher risk than vaginal.
The anal route provides easy exposure in the recipient to HLA anitgens via sperm and blood of the active assumed infected partner. It is well-documented that such exposure can result in transient suppression of the cell-mediated arm of the immune system in the recipient. The degree of immunosuppression depends on the immunogenic makeup of the recipient, HLA allogenicity, and the frequency of exposure to the same HLA anitgens. Similar immunosuppression of the cell-mediated arm is observed in transfused patients who are, as a result, exposed to HLA alloantigens.
The immune response to these alloantigens has a purpose -- to protect the embryofetus from being rejected by a women when pregnancy is desired. The difference between pregnancy and the exposure to HLA antigens via transmission, needle sharing, and anal insemination is as follows: The pregnancy immune response is local - occurring in the lymph nodes that drain the uterus - and there is only a small effect on overall immune capability of the mother, whereas the other exposures result in a system-wide (all lymph nodes) response which leads to transient systemic immune suppression which is a perfect environment for HIV transmission. The risk is further enhanced if there is co-infection with STD organisms, mycoplasma, herpersviruses, and other orgasms that have a deleterious effect on the immune system.
AIDS Risk From Various Body Fluids
In a person infected with HIV, the virus is most present in male semen, pre-ejaculate fluid and, of course, blood. Other body fluids present much less risk. For example, a woman's cervical mucous will not carry HIV unless blood cells are present, such as if the woman has a STD infection. The blood from menstruation has very low risk.
Even less risk is fluids that may contain a trace of HIV but not enough to transmit HIV. Breast milk, saliva and tears are examples. In infected people rarely is HIV even detectable in these fluids, but even if it is Dr. Sabin, the developer of the polio vaccine, and a consultant to the National Institute of Health, says: "Surely a trace of the virus somewhere, in tears, saliva, the vaginal mucous, doesn't mean the disease is transmitted that way." Langone: "AIDS: The Facts," p. 54.
In one study, out of 83 infected AIDS patients, HIV could be detected in the saliva of only one. The Journal of the ADA (May, 1988, p. 636) reported that saliva actually inhibits the ability of HIV to infect cells. Therefore even when it is detectable in saliva, it first needs an open blood path to transfer and even if this was present, actually infecting the blood is highly unlikely.
A study of 2,500 gay men indicated that those who engaged only in oral sex did not acquire HIV. (AIDS: Where Is It Taking Us?, Harvard Medical School Health Letter, 4-87 pg 5.)
A study of nearly 7500 gay men who only engaged in oral sex with ejaculation reported the two men who became HIV infected also had gingivitis, a condition that can result in bleeding gums. (American Journal Public Health, 80(12) page 1509.
Performing Oral Sex On A Woman:
Highly unlikely to transmit HIV. The MUCH more easily transmitted Hepatitis B has not been shown to be transmissible this way, suggesting the HIV would be even less transmissible. Dr. Mark Kane, of the CDC hepatitis branch, has stated that "We've never had any clear evidence that hepatitis B is transmitted that way (oral-vaginal)." With billions of acts of cunnilingus occurring, where is the transmission?
If a woman has an STD, however, the risk is greater since she has lots of white blood cells from the STD sore fighting the infection. These white cells certainly carry HIV if she is HIV infected. Its possible the man could be infected if he had open sores on his mouth or STD open sores on his penis. But otherwise it would be virtually impossible.
The AIDS virus can be transmitted technically by most body fluids, but only semen and blood are likely to be involved. Anal sex is the most efficient and easiest method of transfer to the receptive partner from an infected man. The receptive partner could be either male or female and this accounts for most of the hetero AIDS transmission male to female.
Vaginal Sex Male To Female
Vaginal transfer male to female does occur. But on average it my take a woman about 10 years of sex with the same infected man to do so. In a study of women who were long-term sex partners of HIV infected men three (2%) out of 171 consistent condom users became infected vs. eight (15%) of 55 inconsistent condom users. When person-years at risk were considered, the rate of HIV transmission among couples reporting inconsistent use (the highest risk) was 9.7 per 100 person years to become infected. (Source: "Man-to-woman sexual transmission of HIV: longitudinal study of 343 steady partners of infected men." in J Acquir Immune Defic Syndr 1993;6:497-502.) Remember this was with men who actually were HIV+. There are of course no studies of couples never using condoms since this would never be recommended with a known HIV+ partner.
Female To Male Transmission
There are virtually no documented cases of female to male transmission without other risk factors such as needle sharing or open STD sores on the male. It appears the only "cases" are instances that have not been diligently followed up by health authorities to find the real cause. Many men who become infected from bisexual activities or drug activities will lie to protect themselves and their family. In cities such as NY, heath department follow up includes home visits, interviews with friends and even snooping in the medicine chest for syringes, etc. At least two-thirds of those men claiming to have gotten HIV from a prostitute on an initial questionnaire are confirmed to have had a history of gay activity or IV drug use. Other studies such as the U.S. Army study where every single case that claimed to be hetero transmission was actually hiding other risk factors. Most jurisdictions do not have the level of investigation as NY or the military so the patient gets to "choose" the cause, and corrupt the national statistics. What is interesting is the fact that even with this problem the CDC shows almost no male heterosexual transmission. The transmission female to male is so small that its only theoretical, unlike the measurable male to female long term risk of repeated expose to the same man discussed above.
Prostitutes Not Spreading To Clients
"Rethinking AIDS" Wall Street Journal 3/17/93 Highlights by Mr. Root-Bernstein: There is absolutely no doubt that some people are much more susceptible to AIDS than others. Perhaps the most striking data concern female prostitutes in Western nations. Early in the epidemic, it was assumed that female prostitutes would spread AIDS to the heterosexual community but that clearly is not true.
HIV infected prostitutes, with only a few exceptions, are intravenous drug abusers. Cases of sexually acquired HIV among drug-free prostitutes are almost unknown. In literally only a handful of cases have female prostitutes transmitted HIV to a client, and drug abuse by both the prostitute and the client has been documented in almost all those cases.
Every major review of female prostitution by medical authorities of Western nations has concluded that drug-free female prostitutes are not susceptible to HIV and are not, and will not be, the means of infecting the general population.
An even more striking fact is that, like female prostitutes, hemophiliacs have not become vectors for spreading AIDS into the heterosexual population. Secondary cases of AIDS, in which a person not in a primary risk group acquires AIDS from someone in such a group, constitute only 3% of all AIDS cases ever reported in the U.S. Most all cases of AIDS transmitted by hemophiliacs have documented assaults on their immune systems by other factors in addition to the HIV exposure. Immunologically healthy individuals seem to be almost immune - but it's the few exceptional cases that get all the media attention.
Tertiary cases of AIDS are completely unknown. No documented case of AIDS exists anywhere in the Western world of a drug-free heterosexual who contracted AIDS from a primary carrier (like a hemophiliac) and then transmitted the disease to a healthy, drug-free third party. (Dave's comment: So the scare that a man who has sex with an infected woman, such as a prostitute, is likely to then infect his wife is a myth, not a fact.)
The prostitute and hemophiliac data argue strongly for the conclusion that healthy, drug-free heterosexuals do not get AIDS. The people who get both HIV and AIDS have additional immunosuppressive factors at work on them that predispose them to AIDS. These additional factors include:
Semen-induced autoimmunity following unprotected anal intercourse.
Blood transfusions or infusions or blood-clotting factors.
Multiple, concurrent infections.
Chronic use of recreational and addictive drugs.
Prolonged or high doses of many antibiotics, antivirals and antiparastics, anesthetics, opiate analgesics or steroids.
Malnutrition and anemia.
A particular type of autoimmunity, in which one part of the immune system is triggered to attack the same T cells that are the target of HIV in AIDS.
Every person with AIDS for whom there is sufficient documentation has some subset of these risk factors."
For Safe Sex Brothels Are Best
The safest places for sex are the brothels of Nevada and among those practicing responsible non-monogamy or polyfidelity with careful, knowledgeable, sexually mature people. An article "No gambling in the brothels" said "In the last year and a half of testing approximately 4.700 prostitutes, Nevada has not found one to be positive for AIDS. You are more likely to be killed in an auto accident than enjoying sexual pleasure sharing. A man who sees prostitutes takes much less of a risk for AIDS than you on your drive to work. This may not fit many moralists' agendas but it is the fact.
The Difference Between The U.S. And Africa's Heterosexual Spread
The reason men act as a block is that you need an open entry to the male blood supply. Unlike in Africa where men stick ornaments in their genitals like women in their ears, it is very difficult for a healthy male organ to provide the route. The risk from a non-infected person is ZERO. The African heterosexual spread also has more to do with STDs, bad hygiene, open sores from diseases of malnutrition and inadequate protein synthesis, and the popularity of anal sex as a method of birth control. The CDC went to Africa in 1987 and concluded the risk to heterosexuals was far different vs. the U.S. African heterosexuals had syphilis and gonorrhea, at thousands of times the rate in the U.S. Worms infect 40%-50% of the population. These infections are known to be immune-suppressive.
The Statistical Real Risk
The risk of AIDS transmission from an infected person has been estimated to be about: 1 in 4 for anal (very high), 1 in 200 for female getting from vaginal intercourse with an infected male (high enough to take precautions if not sure if your partner is in a risk group). 1 in 16,000 for a male having 500 sexual encounters with females not using a condom and 1 in 110,000 from 500 female encounters if using a condom. With the risk of death in an auto accident 1 in 5000 EVERY YEAR, it is so much more risky for you to drive than to have 500 acts of unprotected sex. The one in 500 risk would be worse for a women and much less than one in 500 for a man to have sex with an HIV infected women. If your partner is not HIV infected the risk is ZERO.
These relative risks are from Norman Herast, M.D. and Stephen B. Hulley, M.D., researchers at the Center for AIDS Prevention. Dr Herast also in Dept Epidemiology of San Fran General Hospital. The info was originally published in JAMA (Journal of American Medical Assn). Vol 259, No.16, page 2428. While the estimates were made a few years ago, the current continuing low incidence of heterosexual spread, especially almost none female to male,tend to confirm the original estimates.
Well, from the time "Magic" entered the NBA in 1979, he's been dogged by rumors that he was gay. When he started kissing his pal Isaiah Thompson in the playoffs a few years back, that didn't help quell the rumors. Later, Magic Johnson admits to 20-30 women/day. I wonder if he didn't try a bi experience or had STDs that would easily transmit the infection. He reached his 1 in 16,000 odds far faster than us not training for the sexual Olympics. By day's end his organ may be bruised-maybe even bleeding! Its designed well, but he was beyond its manufacturers specifications!
Women - Low Risk But Greater Risk Than Men
Concerning the Low Risk of Heterosexual AIDS, while almost nonexistent in heterosexual males, women are at higher risk, especially from anal intercourse. A number of AIDS studies have confirmed that HIV transmission is occurring through heterosexual anal intercourse, which has a much higher risk for women than vaginal intercourse. This is since the intestinal tract is "designed" to absorb. It does so efficiently even "eagerly" - and it cannot distinguish between a virus and a protein molecule that started out as a sirloin steak. To fool around with anal intercourse is dangerous unless you are absolutely sure your partner is not HIV infected.
Researchers at the University of Washington have been studying the factors in women's vaginas that affect the survival of the HIV virus to understand why some women become infected after a few exposures and others don't have even with long-term exposures to an infected partner. Drs. Kiebanoff and Coombs focused on a powerful innate antimicrobial system including peroxidase and halides, as well as hydrogen peroxide generated by Lactobacillus acidophilus, the predominant bacterial species present in the vagina of most normal women.
In plain English this means that when a woman's vaginal ecology is intact, the HIV virus cannot survive there because substances known to be toxic to HIV are naturally produced. Antibiotic drugs and other commonly used medications are known to kill off vaginal lactobacillus, frequently causing candida (yeast) and other common vaginal infections. Lactobacillus may also be absent due to imbalances in vaginal flora due to poor nutrition, other infections, or hormonal imbalances.
Other studies show vaginal secretions too acidic for the virus to survive. It is also known that repeated exposure is usually required to be infected, which is why a "one night stand" is rarely a risk to heterosexual women, and of course virtually no risk to heterosexual men. Another myth is that multiple partners increase the risk. The fact is most HIV infected women become so in a monogamous relationship (often with a drug user). It is very difficult to get HIV heterosexually. Even using terms like "safer sex" is misleading since it implies sex is dangerous.
By avoiding the real facts of AIDS and sexuality, we fail to promote healthy and responsible attitudes about sexuality. Unfortunately, the politics of abstinence and monogamy are getting in the way of really preventing the spread of AIDS by focusing the attention on those with the least risk - non drug using heterosexuals enjoying vaginal intercourse and of course much more full body sexuality which can be much more loving and meaningful than just intercourse.
Note: The following article is reprinted, unedited, for educational use, under the fair use doctrine of U.S. copyright law with proper attribution and with no commercial benefit
May 1, 1996 Wall Street Journal
"AIDS FIGHT IS SKEWED BY FEDERAL CAMPAIGN EXAGGERATING RISKS
Most Heterosexuals Face Scant Peril but Receive Large Portion of Funds"
By AMANDA BENNETT and ANITA SHARPE Staff Reporters of THE WALL STREET JOURNAL
In the summer of 1987, federal health officials made the fateful decision to bombard the public with a terrifying message: Anyone could get AIDS.
While the message was technically true, it was also highly misleading. Everyone certainly faced some danger, but for most heterosexuals, the risk from a single act of sex was smaller than the risk of ever getting hit by lightning.
In the U.S., the disease was, and remains, largely the scourge of gay men, intravenous drug users, their sex partners and their newborn children.
Nonetheless, a bold public-relations campaign promised to sound a general alarm about AIDS, lifting it from a homosexual concern to a national obsession and accelerating efforts to eradicate the disease. For people devoted to public health, it seemed the best course to take.
But nine years after the America Responds to AIDS campaign first hit the airwaves, many scientists and doctors are raising new questions. Increasingly, they worry that the everyone-gets-AIDS message -- still trumpeted not only by government agencies but by celebrities and the media -- is more than just dishonest: It is also having a perverse, potentially deadly effect on funding for AIDS prevention.
No Allocation for Gays
The emphasis on the broad reach of the disease has virtually ensured that precious funds won't go where they are most needed. For instance, though homosexuals and intravenous drug users now account for 83% of all AIDS cases reported in the U.S., the federal AIDS-prevention budget includes no specific allocation for programs for homosexual and bisexual men. And needle-exchange programs, widely seen as among the most effective methods available in fighting infection among drug users, are denied any federal funding.
Much of the Centers for Disease Control's $584 million AIDS-prevention budget goes instead to programs to combat the disease among heterosexual women, college students and others who face a relatively low risk of becoming infected. Federally funded testing programs alone, which primarily serve low-risk groups, account for roughly 20% of the entire budget.
Some scientists charge that tens of thousands of infections a year could be averted if only practical assistance were directed to the right people. Instead of aiming general warnings at non-drug-using heterosexuals, these critics say, the government should use the bulk of its anti-AIDS money to teach homosexual men to avoid unprotected anal sex and to dissuade addicts from sharing infected needles.
"You can't stop this epidemic if you spend the money where the epidemic hasn't happened," says Ron Stall, associate professor of epidemiology at the University of California in San Francisco.
Helene Gayle, who is in charge of AIDS prevention at the CDC, agrees that "increasingly, it is important to shift strategies to meet the epidemic." She says that the CDC, by giving communities more freedom to decide how to spend federal AIDS money, is now seeking to direct more help to those who need it most.
But she defends the CDC's pivotal decision in 1987 to emphasize the universality of AIDS: "One should not underestimate the fear and confusion this disease caused early on," Dr. Gayle says. "We needed to build a base of understanding before we could go for the jugular."
Certainly, powerful political and social forces at work nine years ago made it nearly impossible for health officials to focus attention on those most at risk, a reconstruction of events of that year shows. And though, as Dr. Gayle says, the CDC is now trying to revamp its AIDS-prevention efforts, the same forces that shaped public policy in 1987 are making it difficult for the government to change directions, even now.
Clear Picture of Risks
By 1987, CDC officials already had a fairly clear picture of where and how AIDS was spreading -- and how much risk different groups faced. The disease was proving less likely to be transmitted through vaginal intercourse than many had feared. A major study that was just being completed put the average risk from a one-time heterosexual encounter with someone not in a high-risk group at one in five million without use of a condom, and one in 50 million for condom users.
Homosexuals, needle-sharing drug users and their sex partners, however, were in grave danger. A single act of anal sex with an infected partner, or a single injection with an AIDS-tainted needle, carried as much as a one in 50 chance of infection. For people facing these risks, it was fair to say AIDS was truly a modern-day plague.
A key player in the CDC's earliest AIDS-prevention efforts was Walter Dowdle, a virologist who was a veteran of the war on herpes and had helped create the CDC's anti-AIDS office in the early 1980s. Like most people in his operation, he understood that AIDS had to be fought hardest in the places it was most prevalent.
But by the spring of 1987, Dr. Dowdle had already been rebuffed repeatedly in efforts to prep are AIDS warnings aimed directly at high-risk groups. TV networks were refusing to air announcements advocating the use of condoms. And Dr. Dowdle had failed in his attempt to disseminate a brochure that mentioned condoms as effective in slowing the spread of AIDS. At the time, all AIDS material had to be cleared by the president's Domestic Policy Council, and the Reagan White House objected to pro-condom messages on moral grounds. The 1986 brochure went into the White House for review and never came out.
Help on Marketing
Searching for clues about how to proceed, CDC officials began a series of internal meetings at their red-brick headquarters on Clifton Road in Atlanta. They also reached outside for high-powered marketing help, retaining Steve Rabin, then a senior vice president of the advertising giant Ogilvy & Mather. In August, Mr. Rabin, openly gay and deeply committed to the effort, ran focus groups in a half-dozen cities to gauge attitudes toward the disease.
The results were discouraging: In city after city, the focus groups made clear that concern about AIDS hadn't taken hold in much of the country, despite the widely publicized announcement two years earlier that Rock Hudson had the disease. With some exceptions in big cities like New York and San Francisco, homosexuals continued to engage casually in unprotected sex, as did heterosexuals everywhere. The prevailing attitude: It was somebody else's problem.
For gays and drug users, this view was flatly wrong and potentially fatal. Moreover, the focus-group results highlighted a huge policy issue: Would the public support funding for AIDS prevention and research if the majority of heterosexuals believed they and their families were only minimally at risk? Would they be compassionate toward the victims of the disease?
Poll data suggested otherwise. A 1987 Gallup Poll showed that 25% of Americans thought that employers should have the right to fire AIDS victims. In that same poll, 43% felt that AIDS was a punishment for moral decline. In meetings within the CDC, many people, including Messrs. Dowdle and Rabin, expressed particular concern about the growth of housing and job discrimination against people with AIDS.
It was in this environment that the idea of presenting AIDS as an equal-opportunity scourge began to form. Politicians, including Republican Sen. Jesse Helms of North Carolina, were blocking campaigns aimed at gays anyway. And homosexual and minority groups were concerned about being linked too closely with the disease. Some CDC scientists, watching the spread of the disease among heterosexuals in Africa, worried that AIDS might yet make inroads among non-drug-using heterosexuals in the U.S. In any event, CDC officials believed that fighting AIDS was everyone's responsibility, even if everyone wasn't equally at risk of getting it.
"We were drawing on gut instinct," recalls Paula Van Ness, who had come to the CDC after serving as chief executive of the AIDS Project, a community program in Los Angeles. "The aim was, we thought we should get people talking about AIDS and we wanted to reduce the stigma." Earlier, in Los Angeles, she had reached out directly to high-risk groups: "Don't go out without your rubbers!" warned a motherly woman in one announcement the AIDS Project had sponsored. But now, on the national scene, she too felt that such a direct approach was impossible.
Dr. Dowdle, burned by the response to his earlier, more targeted efforts, agreed with his colleagues that the CDC's best bet was to present AIDS as everyone's problem: "As long as this was seen as a gay disease or, even worse, a disease of drug abusers, that pushed the disease way down the ladder" of people's priorities, he says.
After considerable soul-searching and debate, officials fixed on a dramatic approach they believed would do the most good in the long run: a high-powered PR and advertising campaign to spread a sobering yet politically palatable message nationwide.
Touching Their Hearts
In subsequent meetings in the summer and fall of 1987, the CDC team developed the idea of filming people with AIDS and building a series of public-service announcements around what they had to say. Subjects wouldn't be identified as gay, and the dangers of intravenous drug use would get little attention.
Early on, the staffers stumbled on their defining slogan when they interviewed the son of a rural Baptist minister. As Ms. Van Ness recalls it, the man said, "If I can get AIDS, anyone can." His remark "wasn't scripted. That's what he actually said." Other similar public-service announcements were prepared, all with the same personal approach. "If you want your audience to be more receptive about this, you had to touch their hearts," Ms. Van Ness says.
The CDC's award-winning campaign, deftly pitched to a general audience, was launched in October 1987 and featured 38 TV spots, eight radio announcements and six print ads. The initial ads steered clear of specific advice on how to avoid AIDS, instead focusing on the universality of the disease and counseling Americans to discuss it with their families.
It wasn't until the spring of 1988, when the government mailed its "Understanding AIDS" brochure to 117 million U.S. households, that the risks of anal sex and drug abuse were underlined. But even this brochure accentuated the broader risk; it featured a prominent photo of a female AIDS victim saying that "AIDS is not a 'we-they' disease, it's an 'us' disease."
As public relations, the CDC campaign and parallel warnings from other groups proved to be remarkably effective, particularly because these messages were reinforced by various public agencies and the media. According to one poll, during the last three months of 1989, 80% of U.S. adults said they saw an AIDS-related public-service announcement on television.
Everyone at Risk
Millions of people were thus sold and resold on the message: Though AIDS started in the homosexual population it was inexorably spreading, stalking high-school students, middle-class husbands, suburban housewives, doctors, dentists and even their unwitting patients.
In late 1991, Magic Johnson dramatically boosted the perception that everyone was at risk when he announced that his infection was due to promiscuous heterosexual behavior. Talk shows and magazines pursued the theme relentlessly. Even late last year, Redbook magazine -- written for a largely middle-class female audience -- carried a major story about married women called, "Could I have AIDS?" In it, the author wrote: "My mind automatically telescopes to AIDS every time I get sick."
Meanwhile, the CDC itself was producing research that made clear that heterosexual fears were exaggerated. And some CDC scientists, including then-epidemiology chief Harold W. Jaffe, publicly railed against the everyone-gets-AIDS message and urged that assistance be targeted to those who most needed it. But his opinion, along with the internal research on which it was based, was typically drowned out by the countervailing mass-media campaign.
Fear of AIDS spread -- and remains. Gallup surveys show that by 1988, 69% of Americans thought AIDS "was likely" to become an epidemic, compared with 51% a year earlier, before the PR campaign got in full swing. By 1991, most thought that married people who had an occasional affair would eventually face substantial risk.
Yet, as CDC officials well knew, many of the images presented by the anti-AIDS campaign created a misleading impression about who was likely to get the disease. The blonde, middle-aged woman in the CDC's brochure was an intravenous drug user who had shared AIDS-tainted needles, although she wasn't identified as such in the brochure. The Baptist minister's son who said, "If I can get AIDS, anyone can," was gay, although the public-service announcement featuring him didn't say so.
Ryan White, perhaps the epidemic's most compelling symbol, had been diagnosed in 1984, at the age of 13, after receiving a transfusion from an AIDS-tainted blood-clotting agent used in the treatment of hemophilia. Barred by his school, shunned by neighbors, he emerged with his family as a forceful opponent of discrimination against AIDS patients. But five years before he died in 1990, the availability of a blood test for the human immunodeficiency virus, which causes AIDS, had nearly eliminated the infection from America's blood-products supply. (Similarly, activist Elizabeth Glaser, who spoke at the 1992 Democratic Convention, was infected through a blood transfusion well before AIDS testing began.)
Meanwhile, Kimberly Bergalis became famous for a particularly rare case: She and five other Florida patients apparently acquired their infections from their dentist, who later died of AIDS. But although the CDC has tracked down and tested thousands of patients of hundreds of HIV-positive doctors and dentists, that single Florida dentist remains the only documented case in the U.S. of a health professional's passing the virus on to patients.
Research continued to show that AIDS among heterosexuals had largely settled into an inner-city nexus, a world bounded by poverty and poor health care and beset by rampant drug use. AIDS was also on the rise in some poor rural communities. Yet government ads typically didn't address the heterosexual group at greatest risk, a group that a CDC researcher would later define as "generally young, minority, indigent women who use 'crack' cocaine, have multiple sex partners, trade sex for 'crack' or other drugs or money, and have [other sexually transmitted diseases] such as syphilis and herpes."
'Less Likely to Fool Around'
Though scientists and anti-AIDS activists knew that the government-nurtured fear of AIDS among upscale, non-drug-using heterosexuals was exaggerated, not everyone thought this was a bad thing. Indeed, many credited rampant fear with achieving pro-family goals that no amount of moralizing alone could have accomplished. In a 1991 Gallup Poll, 57% of respondents said they believed that AIDS had already made their married friends "less likely to fool around." Singles reported being less apt to have one-night stands and more reluctant to date more than one person.
Moreover, there was no question that even mainstream heterosexuals bore some risk of AIDS and that greater caution would reduce their already-low rate of infection. "I don't see that much downside in slightly exaggerating [AIDS risk]" says John Ward, chief of the CDC branch that keeps track of AIDS cases. "Maybe they'll wear a condom. Maybe they won't sleep with someone they don't know."
The marketing campaign also appeared to be having another key desired effect: to mobilize support for public funding of AIDS research and prevention. Federal funding for AIDS-related medical research soared from $341 million in 1987 to $655 million in 1988, the year after the CDC's campaign began. (This year, the figure stands at $1.65 billion.) Meanwhile, the CDC's prevention dollars leapt from $136 million in 1987 to $304 million in 1988; $584 million was allocated for 1996.
Even the gay community, though not specifically targeted for assistance, began to see the wisdom of the everyone-gets-AIDS campaign. "This was a time of decreases in government funding," according to Jeff Amory, who headed the San Francisco AIDS Office in the 1980s. "Meanwhile, AIDS money was increasing."
Rush to Testing
It took a while before people realized that much of the money pouring in wasn't reaching the groups most at risk. In 1990, Mr. Amory took part in a telephone survey of about 50 HIV/AIDS groups funded by the CDC. Fewer than 10% even mentioned gay men as among their constituencies. (Mr. Amory died in November, after his interview with this newspaper.)
Meanwhile, the rush to testing meant that people at low risk were using up more and more of the available AIDS-prevention money just to discover they weren't infected. In 1994, 2.4 million tests were administered at government-funded locations, more than 10 times the number in 1985. Only 13% of those tests were given to homosexual or bisexual men or intravenous drug users.
As the CDC's biggest single prevention program, AIDS testing in 1995 accounted for about $136 million of the agency's total $589 million AIDS-prevention budget for that year. "It was not efficient or effective in picking up HIV-positive people," says Eric Goosby, director of the HIV/AIDS Policy Office of the U.S. Public Health Service, which oversees the CDC and other health agencies.
Moreover, because treating drug-addiction wasn't directly part of the CDC's mandate, stopping the spread of AIDS among needle-sharing addicts fell "between the cracks," says Dr. James W. Curran, who was director of the anti-AIDS office at the CDC until late last year and is now dean of the School of Public Health at Emory University in Atlanta.
Funding for Prevention
State funding for AIDS prevention -- tracking public attitudes toward the disease -- was also being directed largely toward low-risk groups, says Patricia E. Franks, a senior researcher at UCSF, who spearheaded a study of California AIDS spending between 1989 and 1992. The study found that while 85% of AIDS cases were concentrated among men who had sex with men, programs targeting this group received only 9% of all state AIDS prevention dollars.
Spending for women, in contrast, grew to 29% of the state money in 1992 from 13% in 1989, even though HIV rates among women of childbearing age held steady at less than one-tenth of 1% from 1988 through 1992.
California health officials say they believe spending on high-risk groups has improved in the past few years. But Wayne Sauseda, director of the California Office of AIDS, concedes that "it's hard to take money away from groups already receiving grants." In California's last three-year state funding cycle, "we were being deluged by proposals from low- and no-risk population groups," Mr. Sauseda says. "We got two proposals for every one from a high-risk group."
Typical of the requests from low-risk groups, he says, were proposals to offer education on college campuses. "No one would say coeds are not at any risk," says Mr. Sauseda. "But in California, that's not our first priority."
Tough to Redirect Funds
AIDS officials in other states report similar frustrations. In 1994, the CDC turned to a community- planning process for dispensing AIDS funds, a system that theoretically allows local people to allocate dollars to groups most in need. But various community planners say it has been tough to redirect the funds, in large part because public attitudes have become so entrenched.
In Oregon, for example, many community AIDS workers "are unwilling to acknowledge that youth who are truly at risk [are] young gay men," says Robert McAlister, the state's HIV program manager. Thus, most of Oregon's AIDS-prevention money is still spent on counseling and testing that primarily serves low-risk individuals. "When Magic Johnson made his statement, we got overwhelmed with clients demanding service," Dr. McAlister says. "You start to cut corners. If we try to serve everybody, we wind up serving everybody poorly."
Having helped shape current attitudes and set AIDS-prevention policies in motion, the Centers for Disease Control finds itself in a serious bind. So far, AIDS has killed 320,000 Americans, according to the CDC. Between 650,000 and 900,000 others are currently infected with the virus that causes the illness.
Overall, rates of new HIV infections appear to be declining from their peak in the mid-1980s. Nonetheless, as many as 40,000 people, mostly gay men, drug users and their sex partners, will contract the virus this year alone. Despite this, the CDC aims its current education campaign, called "Respect Yourself, Protect Yourself," at a broad spectrum of young adults, rather than targeting the high-risk groups. A current focus of the campaign is to discourage premarital sex among heterosexuals.
Women at Risk
The CDC also has been emphasizing that women constitute a growing proportion of AIDS cases. But close analyses of the data indicate that the vast majority of these victims are drug users or sex partners of drug users. Also, the data partly reflect a statistical quirk: Because the number of infections among gay men has declined, other groups -- such as women -- now represent a larger percentage of victims. Yet the infection rate among women not in high-risk groups appears to be holding roughly steady.
Meanwhile, unpublished research by the CDC itself concludes that "the most effective efforts to reduce HIV infection will target injecting drug users on the Eastern seaboard, young and minority homosexual and bisexual men, and young and minority heterosexual women and men who smoke crack cocaine and have many sexual partners."
Numerous studies have shown significant behavior changes in gay men who have been counseled by gay-outreach programs. Susan M. Kegeles, a behavioral scientist at UCSF's Center for AIDS Prevention Studies, reports that an eight-month program in Eugene, Ore., reduced one of the highest-risk acts, unprotected anal intercourse, by 27% in young gay men. The program used leaders in the gay community to demonstrate and consistently reinforce safe-sex practices.
Other studies have shown that drug users need even more intense behavioral counseling to break their addiction. But "only 15% of active drug users are in treatment on any given day, and there are not enough treatment slots to meet the demand from drug users, according to, a report by the Federal Office of Technology Assessment. Further, the ban of federal funding for needle exchanges continues, even though most reports conclude that locally funded efforts to distribute sterile needles or needle-cleaning supplies have been effective in reducing the spread of the infection.
An epidemiologist at UCSF, James G. Kahn, recently created an academic model which, he says, shows that over five years, $1 million spent in a high-risk population averts 154 infections, compared with two or three infections if the money is spent in a low-risk population. Moreover, he argues that reducing infections in high-risk groups will "almost certainly" benefit low-risk groups by reducing the pool of people who could potentially infect others.
Then there is the separate issue of honesty in government: Shouldn't the public hear the truth, even if there might be adverse consequences? "When the public starts mistrusting its public health officials, it takes a long time before they believe them again," says George Annas, a medical ethicist at Boston University.
Yet many both inside and outside the government fear that speaking more directly about AIDS transmission, and seeking federal programs to match, poses the same dangers it did nine years ago. Congress controls the purse strings, and Sen. Helms, in particular, still monitors every AlDS-related bill. Says a Helms staff member, "We would certainly have a problem" with money going to gay-activist groups or to produce materials that illustrate gay sex acts.
"There is a real concern that funding won't be shifted, it will be cut, that if most people in the U.S. feel they are at very low risk, there will be little support for any AlDS-prevention efforts," says Don Des Jarlais, director of research at the Chemical Dependency Institute of Beth Israel Medical Center in New York. Still, he and many others believe that prevention experts have no choice-and that it is time to fight for programs based on candor. "You can't build a good prevention program on bad epidemiology," he says.
Even back in the 1980s, Stephen C. Joseph, who was commissioner of public health for New York City from 1986 to 1990, blasted the notion that AIDS was making major inroads into the general population.
Today Dr. Joseph, who is assistant secretary of defense for health affairs at the Pentagon, says: "Political correctness has prevented us from looking at the issue squarely in the eye and dealing with it. It is the responsibility of the public-health department to tell the truth.''
SCIENTISTS HONE KNOWLEDGE OF HOW VIRUS SPREADS
Scientists once feared that the AIDS would become an epidemic among non-drug-using heterosexuals. Today, there is a broad consensus among experts that it probably won't.
"Over 90% of the population is heterosexual. and most people are at zilcho or very low risk." says Lyle Petersen, until recently chief of the CDC branch that estimates the prevalence of HIV, the virus that causes AIDS.
This doesn't mean heterosexuals shouldn't take precautions, including condom use. Cases have been documented of people contracting AIDS after a single heterosexual encounter. Any individual's risk of contracting a disease is very different, and much more specific, than the overall risk to a large group of people.
For a person to become infected with HIV, scientists believe the virus must pass from the blood, semen or vaginal secretions of an infected person into the cells or bloodstream of another.
People who share infected needles accomplish that quite readily: in one Connecticut study. as many as 70% of drug-users needles contained HIV, which could be injected directly into the blood of the next user. Between 1% and 2% of infections with. HIV-tainted needles appear to result in infection, according Don Des Jariais. director of research at the Chemical Dependency Institute of Beth Israel medical Center in New York.
HIV is also transmitted fairly readily to the receptive partner in anal intercourse, whether that partner is male or female. Scientists believe such transmission occurs largely because the sex practice frequently leads to anal tears and abrasions. Scientists estimate that O.5% to 3% of such acts with an infected person will lead to infection.
HIV apparently can also infect vaginal cells but, at least in the U.S. and Western Europe. it doesn't appear to do so easily. Studies of couples in which only one partner is infected show that about one in every 1,000 sexual acts results in infection. Women appear to be infected during vaginal sex several times as often as men, although still not, on average, very frequently.
For both men and women, it is much harder to transmit AIDS than to pass on other, less serious sexually transmitted diseases. Some studies suggest that gonorrhea. for example, passes from men to women in as many as 9O% of ail encounters with an infected person, and from women to men about one-quarter of the time.
There is an insidious link, though. between venereal diseases and AIDS: people with diseases such as syphilis and herpes, which may produce open sores, are much more likely to become infected with AIDS or to transmit the disease to a partner.
Scientists also now believe that most people with HIV are most infectious during two periods: before any symptoms appear and later in the disease when the person maybe very ill. Therefore, many scientists believe for widespread transmission to take place, infected people have to have sexual contact with a large number of partners in a fairly short period of time.
This is one of the reasons that AIDS spread rapidly among homosexuals in the early days of the epidemic, as gay bath houses provided the venue for large numbers of sexual contacts. In one San Francisco study published in 1987, for example. nearly 40% of the gay men studied had had 10 or more sexual partners in the previous two years; an additional 25% had had more than 5O partners. Of those reporting more than 5O partners, more than 70% had been infected.
All this also helps explain why AIDS hasn't spread rapidly among non drug-using heterosexuals in the U.S. but has made bigger inroads in parts of Africa and Asia.
For one thing, prostitution is more widely practiced in the developing world. This means that random heterosexual encounters in which partners may be infected with a venereal disease are more widespread. "Good studies in Thailand show that roughly one in five men reported visiting a prostitute in the last 12 months,' says Bruce G. Weniger, a medical epidemiologist at the CDC who has studied the Asian epidemic.
Even when prostitutes aren't involved, the developing world has a higher incidence of venereal disease: in addition, in some areas, local sexual practices lead to tearing of the skin, which contributes to the more-rapid spread of AIDS, many scientists believe.
In the U.S., the use of prostitutes is low by comparison. In a major survey of sexual practices, centered at the University of Chicago, fewer than 1% of the 3,432 people surveyed said they had paid for sex in the previous year. Even those who think the true rate is much higher don't believe it approaches the level found in developing countries. Moreover, in the U.S., outside of drug using communities, HIV prevalence among prostitutes isn't as high as in developing countries.
The situation, however, is far different in inner-city neighborhoods where drug use is high, access to good medical care is insufficient and trading sex for drugs is relatively common. A recent study of crack users in New York. .Miami and San Francisco, for example, found that more than one-third of the women and 15% of the men had a history of syphilis; more than two-thirds of the women had traded sex for money or drugs. More than 40% of the women who recently had engaged in unprotected sex for pay were HlV positive.
But large surveys that systematically exclude drug users and gay men indicate that the spread of HIV infections in the U.S. has either been leveling off or dropping. In a 1992 CDC study at blood banks, which seek to block high-risk individuals from donating, 0.0067% of blood donors were HIV-infected, down from 0.0223% in 1985. Moreover, subsequent research shows that the rate has continued to drop.
Further, says the CDC's Dr. Petersen. who studied the bloodbank results, most of the HIV-positive donors turn out, on investigation, to have engaged in some high-risk behavior.
Meanwhile, blood tests of newborns, which indicate the HIV status of the mother, show that the overall percentage of infected women has remained stable nationally for several years, and has actually begun dropping in New York, New Jersey and Florida, three states with very high HIV/AIDS rates. Nationally, the HIV-infection rate for women is 1.6 per 100.000 women.
Other surveys support the suggestion that most heterosexuals aren't seriously at risk. The University of Chicago's sexual- practices survey turned up six people out of the 3.432 surveyed who credibly reported themselves HIV positive. Of those six. three were bisexual men, one a woman who injected drugs and one a woman who had had more than 100 lifetime sex partners.
Some scientists argue that the U.S. still faces a big threat from strains of HIV that are much more readily transmitted heterosexually than the strains that exist here today. Max Essex, a professor of virology at Harvard University and chairman of the Harvard AIDS Institute, says his research suggests that such strains are contributing to the extensive heterosexual threat in Africa and Asia
But after attending a European conference on the topic, Roy Anderson, professor of epidemiology at Oxford University, is unconcerned. "I find it plausible but, as yet, scientifically unsubstantiated' that such strains exist, he says. Even if they do, he adds, they probably won't lead to a heterosexual epidemic in the U.S. or Western Europe.
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