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| pradhanum@gmail.com 2006-11-19, 4:23 pm |
| Hi we are a small group of dedicated youths... trying to prevent AIDS
from spreading in our small town Darjeeling, in north-east India. We
arrange for awareness camps... harm reduction etc... but due to our
lack of resources we are unable to ashieve as much as we want to....
can U help??? in any form.... voluntary... or in kind... or in any
way.... Plz do write back.
President
JSDS
Together for a Better Tomorrow
| |
|
| Best advice to prevent AIDS: XXXX yourself.
<pradhanum@gmail.com> wrote in message
news:1163974007.863307.17030@m7g2000cwm.googlegroups.com...
> Hi we are a small group of dedicated youths... trying to prevent AIDS
> from spreading in our small town Darjeeling, in north-east India. We
> arrange for awareness camps... harm reduction etc... but due to our
> lack of resources we are unable to ashieve as much as we want to....
> can U help??? in any form.... voluntary... or in kind... or in any
> way.... Plz do write back.
>
> President
> JSDS
> Together for a Better Tomorrow
>
| |
|
|
<pradhanum@gmail.com> wrote in message
> Hi we are a small group of dedicated youths... trying to prevent AIDS
> from spreading in our small town Darjeeling, in north-east India. We
> arrange for awareness camps... harm reduction etc... but due to our
> lack of resources we are unable to ashieve as much as we want to....
> can U help??? in any form....
" Death" <Death@yourdoor.net> wrote in message >
> Something for you to read when time allows
>
> AN ACTUARIAL ANALYSIS OF THE AIDS EPIDEMIC IN THE U.S.
> By Peter Plumley
>
> Since the AIDS epidemic first appeared in the early 1980s, hundreds of thousands of people
have
> been diagnosed with the disease. It has captured the attention of medical authorities, the
> press, the public, and many special interest groups. Billions of dollars have been spent on
> AIDS treatment, research, and attempts at prevention. In the process, AIDS has replaced
smoking
> as the greatest single cause of statistics.
>
> Unfortunately, AIDS is a complicated disease, poorly understood by the public. Furthermore,
it
> affects different groups to vastly different degrees. Because of this, and because one of the
> means of transmission of HIV is by sexual intercourse, it has proven to be a fertile ground
for
> special interest groups to pursue their various agendas. As a result, many of the statistics
> have been distorted, and many of the prevention efforts have been misguided and even
> counterproductive.
>
> The professional training of the actuary includes the development of skills useful for
analysis
> of data, modeling, and determination of risk levels. This paper examines the AIDS epidemic
from
> the viewpoint of the actuary, with particular emphasis on the relationship of risk of HIV
> infection and AIDS to lifestyles and health.
>
> It is well-known that most AIDS victims are either homosexual men or IV drug users, or both.
> For them, the risk levels are high. As will be shown in this paper, nearly all of these AIDS
> victims have a lifestyle that creates immune system disorders and is generally not conducive
to
> good health.
>
> At the same time, the vast majority of Americans are healthy heterosexuals. ("Healthy" within
> the context of this paper means free of street drugs, other sexually transmitted diseases,
and
> immune system disorders which might make one susceptible to HIV and AIDS.) For them, the
> conclusions as to risk levels and best techniques for the prevention of HIV transmission can
be
> summarized as follows:
>
>
> 1. Unless one has a regular sexual relationship with someone who is HIV-positive, it is
> virtually impossible to become infected with HIV by heterosexual intercourse.
>
> 2. Mutual monogamy provides little protection from AIDS, because most HIV transmissions from
> heterosexual contact are from someone infected by non-sexual means such as IV drug use or
blood
> transfusions, to his or her regular (and quite possibly monogamous) sexual partner.
>
> 3. Multiple sexual partners involve little or no increase in risk of HIV infection, as
compared
> with monogamous relationships.
>
> 4. Because the risk of HIV transmission is so extremely remote for this group. urging the use
> of condoms will do virtually nothing to prevent transmission of HIV. Therefore, because
condoms
> intrude so much on the lovemaking process, there usually is little point in using one, unless
> it is felt necessary for the prevention of pregnancy or the transmission of other, more
easily
> transmitted, sexually transmitted diseases ("STDs").
>
> 5. AIDS education and prevention efforts for heterosexuals, as presently structured, can be
> counterproductive, because it may create fear and paranoia which in turn may cause more of an
> increase in mortality than that from the rare case of HIV transmission that might be
prevented.
> Instead, the focus of AIDS education and prevention for this group should concentrate on
three
> points:
>
>
> By far the most important way to prevent HIV infection is to maintain a healthy body, free of
> street drugs, other STDs, and immune system disorders, so that one's body will not be
> susceptible to HIV infection, if by chance one is exposed.
>
> While the healthy person has little to fear from the "one-night" stand, a regular sexual
> relationship with an HIV positive person can involve significant risk because of the repeated
> exposure to HIV. Therefore, greater care should be used in choosing one's regular sexual
> partner.
>
> Receptive anal sex presents a higher risk than vaginal sex, for several reasons. Therefore,
if
> done at all, it should be done carefully and sparingly, and only with a reliable partner who
is
> HIV-negative and free of any STDs.
>
> Some of the actuarial analysis in this paper makes the implicit assumption that HIV causes
> AIDS. However, it should be noted that there is a growing body of scientific opinion that
> questions the role of HIV in AIDS. A full analysis of that issue is beyond the scope of this
> paper. What is clear, however, is that nearly all cases of AIDS are associated with other
> significant health problems which impair the immune system, and which are unrelated to HIV.
In
> view of this fact, from the viewpoint of the actuary, mortality rates would be improved far
> more if the focus were more on the underlying causes (street drugs, anal sex, other STDs,
etc.)
> of the immune system disorders affecting nearly all of those with AIDS, rather than merely
> trying to find a cure for HIV.
>
> Distribution of AIDS cases in the United States
>
> As of the end of 1992 (publication of the 1993 report having been delayed by the CDC), the
> cumulative distribution of adult cases since 1981 by exposure category was as follows:
>
> Male homosexual/bisexual contact 142,626 (57%)
>
> IV drug use (female and heterosexual male) 57,412 (23%)
>
> Male homosexual/bisexual contact and IV drug use 15,899 ( 6%)
>
> Hemophilia/coagulation disorder 2,026 ( 1%)
>
> Heterosexual contact with a person with, or at increased risk for, HIV infection 13,292 (5%)
>
> Born in Pattern II country 2,962 ( 1%)
>
> Receipt of blood transfusion, blood components or tissue 4,980 ( 2%)
>
> Other/undetermined 10,002 ( 4%)
>
> Total 249,199 (100%)
>
>
> The heterosexual contact cases are subdivided into the following categories, shown with cases
> reported through December 31, 1992:
>
> Sex with IV drug user 8,481 (64%)
>
> Sex with bisexual male 823 ( 6%)
>
> Sex with person with hemophilia 131 ( 1%)
>
> Sex with person born in Pattern II country 205 ( 2%)
>
> Sex with transfusion recipient with HIV infection 311 (2%)
>
> Sex with HIV-infected person, risk not specified 3,341 (25%)
>
> Total 13,292 (100%)
>
>
> As mentioned in the introduction, it is clear that, unlike many infectious or contagious
> diseases, AIDS strikes different groups very unevenly, and therefore the risk of contracting
> the disease varies significantly. This paper examines the epidemic from the point of view of
> the level of risk for each group, and the relationship of poor health and immune system
> disorders to these risk levels.
>
> Reliability of the CDC's classification system
>
> The CDC does not itself report AIDS cases; that is the responsibility of state and local
health
> departments. The CDC states as follows in the information provided with its public data set
> with respect to the surveillance process:
>
> "Although state and local health departments share AIDS surveillance data with CDC, the
> responsibility and authority for AIDS surveillance rests with the individual health
> departments. Like any reportable disease, the completeness of AIDS reporting reflects the
> aggressiveness with which these health departments solicit case reports. Health departments
may
> depend on health-care providers to know and comply with reporting requirements.
Alternatively,
> health departments may regularly contact and interact with health-care facilities or
individual
> providers to stimulate disease reporting."
>
> In examining the accuracy of the classification of cases by the CDC, it must be recognized
> that, except in perinatal cases, it is virtually impossible to know with absolute certainty
how
> a particular individual became infected with HIV. Originally, AIDS was referred to as "GRIDS"
> ("gay related immunodeficiency syndrome"), because it appeared to be a disease which affected
> only homosexual men. Later, it became clear by statistical analysis that it primarily
affected
> homosexual men and IV drug users, but that HIV could also be transmitted by penile-vaginal
> intercourse and blood transfusions, and from an infected mother to her child. All of these
> transmission methods are consistent with the fact that AIDS is a blood disease. However, even
> though the high risk categories are known, there is no way of knowing for certain whether a
> particular person became infected in a particular manner, because the precise details of
one's
> life cannot be known with absolute certainty by others.
>
> This is particularly important with respect to AIDS cases attributed to heterosexual contact,
> because so many homosexuals and IV drug users try to conceal their lifestyles. These are
> lifestyles which are condemned by a large part of our society, and which many times cause
loss
> of jobs, ostracism, and criminal action. Studies have shown that AIDS cases which at first
> appeared to be attributable to heterosexual contact were actually linked to other risk
> classifications., The overall level of concealment which has occurred is difficult to
> determine, because it varies with the effectiveness of local health departments in
determining
> the full facts. However, it may well be a significant part of the cases categorized as
> heterosexual contact, particularly for males. We sometimes read about how someone is supposed
> to have become infected with HIV under some unusual circumstance. This incident is then used
to
> justify precautions against the spread of HIV, where none were felt needed previously. Yet in
> most cases, such precautions are not productive, because either (1) the cause of the HIV
> infection may have been misclassified, or (2) the risk is so remote that it is not worth the
> precautions that are being considered.
>
> Risk of AIDS - risks of life
>
> We are all "at risk" for AIDS - and for that matter, for death from many other causes, each
day
> of our lives. Merely walking down the street could result in HIV infection from being stabbed
> with an HIV-infected needle. It also could result in death from falling objects, or from an
> out-of-control car, or a stray bullet. People have been killed in plane crashes while
sleeping
> in their beds. "Freak" accidents occur nearly every day. And death from natural causes can
> strike, suddenly or slowly, at any age. Therefore it is pointless to try to lead a risk-free
> life. It just simply cannot be done, and those who try will be termed "paranoid" by their
> peers, and will do little to extend their life expectancy, while diminishing their enjoyment
of
> life.
>
> So the first challenge is to sort out the "significant" risks from the "insignificant" ones.
> But even here, it is not so easy. A 20 year old healthy man might well feel that unprotected
> sexual intercourse with an HIV-infected partner presented an unacceptably high risk. However,
> if he was 90 years old and the woman was young and beautiful, he might decide that the risk
was
> well worth the reward.
>
> Nevertheless, in order to discuss HIV and AIDS in terms of significant risk levels, we must
> have some type of benchmark. So let us start by considering how often we incur a
> "one-in-a-million" risk in our daily lives. The average risk of death from all causes for a
> 25-year old (both sexes and all races combined) is 1.18 per 1000 per year. This means that
the
> average 25-year old has a "one-in-a-million" risk of death from all causes every 7 hours. Yet
> people at that age generally are not concerned about the risk of death in the near future, in
> the absence of a specific situation which is perceived to involve a higher risk.
>
> Another instructive comparison can be made with automobile fatality rates. In 1988, there
were
> 2.4 deaths from automobile accidents per 100 million vehicle miles. Assuming an average of 2
> people per vehicle, this means that the risk of being killed in an automobile accident is
> "one-in-a-million" for every 83 miles traveled - less than two hours time at normal highway
> speeds. (Considering the higher automobile fatality rates for younger drivers, the number of
> miles presumably is significantly lower for the 25-year old.)
>
> A 1991 television special also referred to "one-in-a-million" risks. It stated that one
> increased his risk of dying by one-in-a-million by:
>
> Traveling six miles in a canoe
>
> Traveling 10 miles
>
> on a bicycle
>
> Spending one hour in a coal mine
>
> Smoking 1.4 cigarettes
>
>
> This author has made no attempt to verify the accuracy of these figures; however, they are
> further demonstration that most of us take "one-in-a-million" risks routinely in our lives,
> without undue fear of the consequences, simply because we believe that the risk is too
> insignificant to worry about. In examining the AIDS epidemic in terms of how it should affect
> our daily behavior, it is important that we realize that our lives are full of
> "one-in-a-million" risks, many of which we cannot avoid no matter how hard we try. We of
course
> should be aware of the dangers of "high-risk" activities of any type so that we can avoid
them
> if we do not want to take the risk. At the same time, we should recognize that some
activities
> which are described as putting people "at risk" for HIV infection in fact involve
> "one-in-a-million" risks such as those described above, and therefore might reasonably be
> ignored in going about our everyday lives.
>
> The difficulty of transmission of HIV by heterosexual contact
>
> Most STDs have a fairly high efficiency of transmission - perhaps a 10% to as high as a 50%
> probability of transmission during a single sexual act with an infected partner. As a result,
> the typical route for such diseases is from male-to-female-to-male-to-female..., by
> heterosexual intercourse. Obviously, therefore, the best defenses against the spread of such
> diseases are (1) monogamy, (2) condoms, and (3) medical treatment when symptoms occur.
>
> HIV, however, is very different in one fundamental respect. Although it has been demonstrated
> that the transmission of HIV by heterosexual intercourse is possible, both male-to-female and
> female-to-male, unlike most other sexually transmitted diseases, the transmission is
extremely
> inefficient, particularly female-to-male.
>
> In addition, transmission usually is associated with some type of abnormality, such as some
> other STD. This was dramatically illustrated in a paper titled "Female-to-Male Transmission
of
> Human Immunodeficiency Virus", by Padian et al, published in the September 25, 1991 issue of
> the Journal of the American Medical Association. In this paper, 72 male, non-drug using
> partners of HIV-positive women were studied, beginning in 1985. Of the 72 males, only a
single
> one became infected through sexual contact. It is instructive to quote excerpts from the
> description of this couple's sexual practices and physical condition, to show the conditions
> which caused the man to become infected.
>
> "Over the five years prior to the study, [the woman] had over 600 male partners, including
over
> 2000 contacts with a bisexual man, an unidentified number of contacts with an intravenous
drug
> user, and over 1000 contacts with a person she knew to be HIV-infected.
>
> "The couple reported an average of 15 sexual contacts a month for the last 7 years. Almost
all
> of these contacts consisted of unprotected vaginal-penile and oral intercourse. The couple
> practiced anal intercourse twice. The couple never used condoms. ... The woman would
frequently
> have sexual intercourse with another partner while her husband first observed and then had
> intercourse with her immediately after the other partner.
>
> "This couple reported ... over 100 episodes of both vaginal and penile bleeding. The cause of
> this bleeding could not be established. Medical data were available only by history, and over
> the last 5 years, the woman reported four cases of vaginal yeast infections, both reported
one
> case of trichomoniasis, and the man reported one case of urethral gonorrhea. In addition, the
> woman reported a history of endometriosis and had a hysterectomy during the year prior to
entry
> into the study."
>
> The report goes on to suggest that the man's HIV infection may have come from one of the
other
> men who had sexual relations with his wife immediately prior to his sexual activity, rather
> than from his wife.
>
> The report also states that six other of the 72 men reported penile bleeding during sexual
> intercourse, but did not become infected.
>
> It is not at all surprising that this one man became infected, given his history of penile
> bleeding and other STD's. In fact, it illustrates that the risk of transmission of HIV
> infection may depend on a variety of factors relating both to the degree of infectiousness of
> the infected partner and to the susceptibility to infection of the uninfected partner. Of
> particular interest in this regard is the paper "Biologic Factors in the Sexual Transmission
of
> Human Immunodeficiency Virus", by Holmberg et al. This paper discusses a number of possible
> cofactors, and concludes with the following summary:
>
> "The probability that any single episode of genital-genital or anogenital sexual intercourse
> will result in transmission of HIV may be determined by multiple biologic factors of the
> infectious person, the virus itself, and the exposed susceptible person. Some of these
factors
> are known or suspected (figure 1), and they may explain observed differences in the sexual
> transmission of HIV in different parts of the world, notably in Africa, where genital
> ulcerative disease is probably influencing the epidemiology of HIV. Several studies have
shown
> that infection in partners of HIV-infected persons is not determined solely by numbers of
> sexual encounters; on the contrary, HIV-infected partners have usually had fewer sexual
> encounters with infectious mates than have noninfected partners.,, Thus, sexually active
> persons should be cautioned that, to our knowledge, there are no nonsusceptible persons and
> that any single sexual encounter may lead to HIV transmission. Research into biologic factors
> that modulate HIV transmission continues to be hampered by difficulties in identifying HIV
> transmitters and nontransmitters, infective and noninfective variants of HIV (if the latter
> exist in vivo), and persons relatively more or less susceptible to HIV infection. However, as
> the number of partner studies and the number enrolled in them increase, a progressively
clearer
> idea of the biologic determinants of sexual transmission should emerge."
>
> The "figure 1" referred to above shows the following biologic factors considered possible
risk
> factors in the sexual transmission of HIV. Question marks indicate factors whose effect in
> enhancing transmission are debatable, in the opinion of the authors of the paper.
>
> Host Infectiousness:
>
> Late HIV infection: marked by low T-helper cell levels. p24 antigenemia, clinical symptoms
(?)
> Early HIV infection: marked by increased T-suppressor cells, and (?) p24 antigenemia and (?)
> elevated antibody titers to cytomegalovirus (CMV)
>
> (?) Menstruation (female-to-male transmission)
>
> (?) Lack of integrity of vaginal sucosa from genital ulcer disease (female-to-male
> transmission)
>
> Viral Virulence/Infectivity:
>
> (?) Variation in the viral genome, resulting in increased or decreased infectivity
>
> Host Susceptibility:
>
> Genital ulcerative disease from herpes simplex virus type 2 and syphilis (Western
> industrialized societies) and by chancroid and syphilis (Africa)
>
> (?) lack of circumcision in men: intact foreskin
>
> (?) Trauma during sex, especially in post-menopausal women
>
> (?) Estrogen (birth control pill) use in African prostitutes
>
> (?) Variants of CD4 receptor molecule of T-lymphocytes
>
> (?) HLA haplotype or other cell surface antigens
>
> Is it theoretically possible for a fully healthy heterosexual to become infected with HIV
from
> a single act of heterosexual intercourse with an HIV-positive partner? Holmberg et al believe
> that it is. On the other hand, as stated earlier, it is never possible to be absolutely
certain
> how a person became HIV-positive, simply because we can never know of all of the details of
> anyone's life. Thus the supposedly otherwise totally "clean living" victim of the "one night
> stand" may have had a secret drug habit, or other venereal disease, which placed him or her
at
> risk. It is only when a significant number of such instances occur that we can be reasonably
> certain that that means of transmission really does occur, rather than simply indicating some
> kind of aberration or misclassification.
>
> In any event, it is clear that the average efficiency of HIV transmission among people of
> average health is extremely low. Moreover, for the "one night stand", it appears to be
> virtually zero in the absence of some cofactor such as other STD or penile bleeding. Robert
> Root-Bernstein sums it up in his book "Rethinking AIDS" as follows:
>
> "In short, although HIV certainly can be transmitted through semen from one person to
another,
> it is in fact transmitted so rarely to healthy sexual partners and is present at such low
> amounts in so few sperm samples from HIV-infected men that it is probable that those who
become
> infected must be exposed repeatedly to many HIV carriers or have some unusual susceptibility
to
> the virus."
>
> Root-Bernstein further states (p. 313), that "The chances that a healthy, drug-free
> heterosexual will contract AIDS from another heterosexual are so small they are hardly worth
> worrying about. One statistician has compared them to the probability of winning a state
> lottery game or being struck by lightning." Root-Bernstein goes on to quote a report in the
> journal Science which states that the chance of becoming infected with HIV after one sexual
> fencounter, without using a condom, with someone whose HIV status is unknown, but who does
not
> belong to any high-risk group, yields a calculated risk of 1 in 5 million.
>
> Some important implications of the low efficiency of HIV transmission by heterosexual contact
>
> The low efficiency of transmission of HIV by sexual intercourse results in some fundamental
> differences between HIV and other STDs. These include the following:
>
> It can be mathematically demonstrated (see Appendix A) that the lower the efficiency of
> transmission of a sexually transmitted disease, the greater the proportion of transmissions
> will occur between regular partners, rather than secondary partners (e.g., "one night
stands").
> Most heterosexuals who get HIV do so by sharing IV drug needles, not from sex. Some of them
in
> turn infect their sexual partners - generally their regular partner. Therefore, mutual
monogamy
> does little to reduce the transmission of HIV - even if both partners have tested negative
for
> HIV at the time the monogamous relationship began.
>
> The number of heterosexual partners makes little difference in the risk of HIV infection
> (although the type of partner may make a difference). This also can be demonstrated
> mathematically (see Appendix B). It even is theoretically possible, in fact, that for a given
> amount of sexual activity, multiple partners might reduce risk because of greater sexual
> arousal, and therefore better vaginal lubrication and consequent lower efficiency of HIV
> transmission. (Obviously, those who became infected from their regular partner might have
been
> better off if less of their sexual activity had been with that person!)
>
> Only very rarely does someone become infected with HIV from engaging in penile-vaginal sex
with
> someone who in turn became infected in the same manner (rather than from IV drugs, homosexual
> activity, or some other means such as a blood transfusion). Therefore it usually makes little
> or no difference whom your sexual partner has had heterosexual relations with previously
> (though it would matter if a man's previous partners were male).
>
> HIV risks for those with multiple sexual partners
>
> In Appendix B, it is demonstrated that, for a disease with as low an efficiency of
transmission
> as HIV, the number of sexual partners makes little difference. This theoretical result
appears
> to be validated by an examination of the experience of those who are known to have many
> partners. Let us look at three groups: (1) professional athletes, (2) "swingers", and (3)
> prostitutes.
>
> HIV and professional athletes
>
> Several years ago, Magic Johnson was forced to retire from basketball when he was discovered
to
> be HIV-positive. He claimed to have become infected from unprotected sexual activity, and
> admitted to having had a large number of sexual partners, without using condoms. Much was
made
> of this by the media and health care officials, and his experience was used to demonstrate
the
> "high risk" involved with unprotected sex with multiple partners.
>
> However, a further analysis suggests that the risk wasn't so high after all. Since the AIDS
> epidemic began, there have been hundreds, if not thousands, of professional sports figures
who
> would have made the headlines if they had been found to be HIV-positive. Sports figures are
> noted for their sexual activity - a reputation deserved by some, and not by others. Yet to
the
> best of this author's knowledge, Magic Johnson is the only one to have fmade any such
headlines
> (except for Arthur Ashe, who was known to have become infected from a blood transfusion). To
> this day, it is not certain exactly why Magic Johnson became infected while others have not.
> Therefore, although it is not possible to develop a reliable risk factor for professional
> athletes, his experience appears to be more of an faberration or misclassification than
> something which is likely to befall other athletes.
>
> HIV and social/sexual clubs
>
> Another group with multiple sexual partners are the members of social/sexual clubs, commonly
> known as "swingers". Swingers engage in recreational sexual activity with multiple partners.
In
> many cases, these sexual partners were strangers when the evening began. There are more than
> 200 swingers clubs in the U.S. and Canada, with a membership totalling perhaps 100,000,
> according to one magazine report. Swingers generally do not use condoms. Therefore they
provide
> in effect a made-to-order laboratory for the study of transmission of HIV through multiple
> sexual partnerships and unprotected sex. If in fact the swinging lifestyle did present an
> "increased risk" of HIV infection, by now there would have been many cases of HIV and AIDS
> among the various swing clubs (or, more likely, the clubs would have closed up because of the
> unacceptability of the high risk).
>
> However, there has been only one reported episode of HIV infection among members of a
swingers
> club. It involved anal rather than vaginal sex, and was reported by the CDC. In this
instance,
> which occurred in 1986, all of the members of a swingers club were tested, and two female
> members were found to be HIV-positive. Both had engaged in repeated anal intercourse with two
> bisexual men whose HIV status could not be determined. As will be seen later in this paper,
> receptive anal intercourse appears to involve much higher risk levels than penile-vaginal
sex.
> Presumably they became infected from the anal sex, rather than from vaginal sexual activity.
> They did not infect any of their male sexual partners, even though their HIV status was not
> detected until some time after their infection occurred, during which time they continued
their
> sexual activity with various other partners.
>
> A recent article in Penthouse magazine titled "Swinging Swings Back" described the resurgence
> of swinging. As might be expected, the article included some "hand wringing" about the risks
of
> AIDS being taken by these people, including a quote from a representative of the CDC that
> swingers were "just whistling past the graveyard".
>
> Yet the facts are to the contrary. Robert McGinley, President of the North American Swing
Club
> Association, is quoted in the Penthouse article as stating categorically that "as far as we
can
> tell, no person has ever contracted AIDS through heterosexual [i.e., penile-vaginal] swinging
> in North America". His statement appears to be correct. This author has been unable to find
any
> data which contradicts his statement or suggests anything to the contrary.
>
> How can this be, in the face of all of the warnings about the high risk of unprotected sex,
> particularly with multiple partners who frequently are relative strangers?
>
> The answer appears to lie in the ethics of the swinging lifestyle, and in the type of people
> who are involved in swinging.
>
> For obvious reasons, swingers clubs will not allow any members under age 18, and usually not
> under age 21. In addition, swingers generally are "middle class" types who have a primary
> sexual partner, with whom they are involved in a regular, frequently long-term relationship.
> Therefore, they tend to be a generally healthier group than those most susceptible to HIV and
> AIDS.
>
> Because swingers are potentially vulnerable to the spread of the more contagious STDs, they
are
> careful to watch for the symptoms of any STDs, and to take appropriate steps to correct any
> problems as quickly as possible, on those rare occasions when they occur.
>
> Swingers realize that, while authorities cannot legally prevent adults from engaging in
> consensual heterosexual activities, many disapprove of their lifestyle and would shut them
down
> if they had an excuse to do so. Therefore, swingers clubs are very strict about forbidding
> illegal drugs, and generally will throw out anyone who disobeys this prohibition. By doing
> this, the clubs keep out the primary source of heterosexual HIV infections.
>
> What is the lesson to be learned from the swingers about the risk of HIV infection from
> heterosexual (vaginal) intercourse? It is this: keep your body in good health, and free of
> other STDs, avoid any regular sexual relationships with high risk people such as drug users,
> and you don't need to worry about AIDS.
>
> HIV and female prostitutes
>
> Prostitutes are another group which engages in sexual activity with multiple partners.
> Root-Bernstein discusses their experience as follows:
>
> "M. Seidlin and his colleagues examined the prevalence of HIV infections in New York City
call
> girls during 1987, They studied seventy-eight women who had been prostitutes for an average
of
> five years each. Each woman had had an average of over 200 clients during the past year, or
> approximately 1,000 lifetime partners. Use of condoms was sporadic at best. Vaginal
intercourse
> was common; anal, rare. Since it is estimated that nearly 5% of men in New York City are
> thought to be intravenous drug users and half of these are HIV seropositive, it is probable
> that each of these prostitutes had sexual relations with an average of twenty-five
> HIV-seropositive individuals. Despite this unusual promiscuity and despite living in one of
the
> AIDS capitals of the world, only one of the women was HIV seropositive. She admitted being an
> intravenous drug abuser. Her seventy-two non-drug abusing co-workers were all HIV negative.
>
> "Another study carried out in New York City by Dr. Joyce Wallace and her co-workers between
> 1982 and 1988 found similar results. They surveyed several hundred streetwalkers (a lower
class
> of prostitute than call girls) for a variety of measures of immunodeficiency. Excluding
> admitted intravenous drug users from their study, they found that only 4.5 percent of the
> prostitutes were HIV infected. The only statistical difference between those who were
infected
> and those who were not was that the HIV-positive women had had a mean of 3,062 sexual
partners
> during their lifetime, whereas the HIV-seronegatives had had 1,047. On the other hand,
Wallace
> found an HIV seropositivity rate approaching 50% among drug-abusing prostitutes."
>
> Similarly, a 1988 study concluded that "HIV infection in non-drug using prostitutes tends to
be
> low or absent, implying that sexual activity alone does not place them at high risk, while
> prostitutes who use intravenous drugs are far more likely to be infected with HIV".
>
> Given the level of STDs among streetwalker prostitutes, and the desire by some to try to
> conceal their drug habit, it is not surprising that a small percentage of those who did not
> admit to drug use nevertheless were HIV-positive. All things considered, it is significant
that
> the percentage was so low, and is another indication of the extreme difficulty of HIV
> transmission by heterosexual intercourse.
>
> Condoms - common sense or nonsense?
>
> The low average efficiency of transmission of HIV raises serious doubts as to the value of
the
> emphasis being placed on the use of condoms for the prevention of transmission of HIV
infection
> during heterosexual intercourse, for several reasons:
>
> The vast majority of people are (1) in good health and free of STDs, and (2) not sexually
> involved on a regular basis with anyone who is in a "high risk" group (i.e., an IV drug user
or
> a homosexual/bisexual). For them, the risk of HIV infection from sexual intercourse is so
> remote (generally considerably less than one chance in a million per episode) that using a
> condom is comparable to wearing a hard hat for a walk down Main Street - it may be
> theoretically possible that it could save your life, but it really isn't worth the bother and
> inconvenience, considering the remoteness of the risk.
>
> Condoms are more likely to be used for casual sex, and by those who are "safety-conscious"
and
> unlikely to be involved with IV drug users or other "high-risk" sexual partners. However, the
> majority of transmissions of HIV from sexual intercourse occur between regular partners,
where
> one partner became infected from some non-sexual means such as IV drug use or blood
> transfusion.
>
> Condoms may create a false sense of security (they are not foolproof, and have shown a
failure
> rate of from 10% to 20%), and may cause an increase in sexual activity or a less careful
choice
> of sexual partners.
>
> Finally, who is supposed to use condoms, anyhow? If they are to be used only for casual sex,
> very few cases of HIV transmission will be prevented. If they are to be used for all sexual
> activity, are we proposing reducing the birth rate to zero to prevent HIV transmission? (It
is
> to be noted in this respect that in Africa, where life expectancy is low and the need to
> reproduce is more keenly felt than in the United States, some are concerned that the emphasis
> on condoms will have an adverse effect on the population demographics because of the impact
on
> birth rates.)
>
> Condoms make good sense in some situations, particularly for young people for whom the risk
of
> unwanted pregnancy and STDs is high. Condoms are one method of birth control (though usually
> not the best one). They also can reduce the spread of the more easily transmitted STDs.
> However, the blunt truth is that, in spite of all of the public health campaigns urging their
> use, they will have virtually no effect on the spread of HIV and AIDS among heterosexuals.
>
> AIDS and homosexual men
>
> In contrast to the low risk for heterosexuals, homosexual men incur a significant risk
because
> of their lifestyle. Root-Bernstein details the many immunosuppressive risk factors that
affect
> homosexual men. Many of these, such as syphilis and a variety of other infections, are
> associated with anal sexual practices engaged in by a significant percentage of homosexual
men.
> However, other risk factors were related to the widespread use of various drugs by
homosexuals.
> In this respect, Root-Bernstein quotes the following studies:
>
> "A CDC survey conducted in 1983 found that a 'typical' gay man in New York, Los Angeles, and
> San Francisco used four street drugs regularly. Those who had developed AIDS by 1983 had a
> history of increased drug use both in therm of frequency of use and number of different drugs
> used regularly. Ninety-five percent of the gay men surveyed regularly used inhalant nitrites;
> over 90 percent smoked marijuana; 60 percent used cocaine; about 8 percent used heroin; over
50
> percent used amphetamines; over 30 percent, barbiturates; almost 50 percent, LSD and
> methaqualone; and about 40 percent had used phencyclidine. Linda Pifer's 1987 survey of gay
men
> in Memphis found slightly lower rates of drug use. Over 80 percent of this group admitted to
> using nitrites at least occasionally and 30 percent more than once a week. Seventy-four
percent
> admitted to use of other illicit drugs, including marijuana, cocaine, phencyclidine, and LSD,
> with an average of nearly seven years of 'routine use.' Eleven percent described themselves
as
> being 'heavy drinkers' and another 37 percent as 'moderate drinkers.' Multiple drug use was
the
> norm among the heavy abusers."
>
> The increased risk of HIV infection for those homosexuals (and heterosexuals) who engage in
> anal sex is described by Root-Bernstein as follows:
>
> "Immunological contact with sperm, or material carried in sperm, is increased in anal, as
> contrasted with vaginal or oral, intercourse. On reason has to do with the physiological
> differences of the rectum, vagina, and upper gastrointestinal tract. Vaginal tissue differs
> markedly from rectal tissue. The vagina has thick, muscular walls covered by a fdeep layer of
> epithelial (skin-like) cells that are easily sloughed off and secrete a lubricating mucus to
> decrease the possibility of abrasion. Even if abrasion does occur, the capillaries that
> embedded in the vaginal tissue are far from the surface and difficult to reach. There are
also
> very few lymphocytes directly in the vagina, most of them being located higher up, near the
> cervix. The rectal tissue presents an entirely different picture. The rectum is comprised of
an
> extremely thin layer of tissue, densely entwined with capillaries. It lacks the thick layers
of
> epithelium that protect the vagina and its ability to produce a protective mucus. Moreover,
the
> intestines are studded with Peyer's patches. Located along with the Peyer's patches are
> concentrations of M cells, which apparently function as portals through which the resident
> lymphocytes constantly sample the contents of the rectum for foreign material. These M cells
> have been shown to permit viruses such as HIV to gain access to the immune system from the
> rectum. Thus, unlike the vagina, the rectum represents a place in the body through which the
> immune system can easily be reached, even under normal conditions. Since microscopic tears
and
> bleeding can accompany anal intercourse and infections but are rare in vaginal intercourse,
> anal exposure confers another means for semen components (and viruses) to enter the
> bloodstream, there to be immunologically processed."
>
> Root-Bernstein then goes on to list a number of diseases that may develop in the rectum as a
> result of the various anal sexual practices engaged in by homosexual men. It is no wonder
that,
> even apart from AIDS, homosexual men who engage in anal sexual activity have a higher
incidence
> of immunosuppressive disease than heterosexuals.
>
> AIDS and drug use
>
> It is well known that IV drug users are at high risk of AIDS. The reason for this is believed
> to be the sharing of needles. To reduce this risk, there are "clean needle" programs in some
> areas, through which IV drug users are provided with clean needles so that there will not be
> HIV transmission during the injection of IV drugs.
>
> There is no doubt that IV drug users are at high risk for a variety of conditions relating to
> damage to the immune system, and there is little to be gained by elaborating on this point
> here. However, what is not usually emphasized is that those who use non-intravenous drugs
also
> are damaging their immune system, and in the process leave themselves open to various
> immunosuppressive agents. Root-Bernstein sums it up as follows:
>
> "The various immunosuppressive effects [of drug use] occur independent of the route by which
> the drugs are administered. It does not matter to the immune system whether the drugs are
> smoked, injected intravenously, injected by 'skin popping' (the technique used in tuberculin
> testing), or taken by oral or nasal routes. As long as the drug appears in sufficient
> concentrations in the blood for a long enough period of time, it will lead to both short term
> and long term immune suppression, with specific effects on T cells. A common result,
> particularly of heroin addiction and high dose cocaine use is an inversion of the T helper/
> T-suppressor ratio, such as that seen in AIDS. Thus, one important feature of drug abuse that
> has not been taken into account in defining who is at risk for AIDS is the possibility that
> nonintravenous drug abusers who are exposed to HIV or other immunosuppressive agents by
sexual
> routes will be at as great a risk of AIDS as are intravenous drug abusers. This fact may help
> to explain why so many sexual partners of intravenous drug abusers - people who are almost
all
> drug users themselves - are developing AIDS despite the fact that they do not share needles."
>
> The misinforming of the public
>
> For better or for worse, we live in an age of the "thirty-second sound bite". Most of the
> public gets its knowledge about matters such as AIDS from the evening news, newspaper
> headlines, and other easy to absorb sources such as talk shows and advice columnists.
> Relatively few people acquire much knowledge from more reasoned sources such as scientific
> studies or in-depth analyses such as might be presented in serious books or articles in
> scientific publications.
>
> The AIDS epidemic has provided the popular media with ample material. There have been many
> warnings given to the public about the dangers of contracting HIV by sexual intercourse. In
> addition, there have been stories of people who have supposedly contracted HIV from what
> normally would be considered to be casual contact. A number of groups have had a self
interest
> in making the epidemic appear worse than it really is. Only rarely is the low risk level for
> heterosexuals mentioned. The result is that the public has been badly misinformed, and in the
> process has been terrorized far more than justified by the facts.
>
> The misleading of the public has appeared in many forms, but in general has fallen into
several
> broad categories:
>
> Gross exaggerations of the extent to which the epidemic would spread among heterosexuals.
> Example: The statement heard by millions of television viewers in February, 1987, that
> "Research studies now project that one in five - listen to me, hard to believe - one in five
> heterosexuals could be dead from AIDS at the end of the next three years. That's by 1990."
>
> Failure to recognize the low efficiency of transmission of HIV by making the implicit
> assumption that sexual activity with an infected partner will cause the virus to transmit
100%
> or nearly 100% of the time. Example: The letter published by a nationally syndicated
columnist
> from a woman who said "Last night I had sex with 4,096 people... I had sex with a man (who)
> admitted to having sex with eight...female partners during the past year... I took those
eight
> women and assumed that they also had slept with eight men, and each of those eight men had
had
> sex with eight women, etc. By using simple arithmetic progression, after only three series I
> realized that I had been exposed somewhere along the line to 4,096 persons, plus one. How can
I
> assume that there was no one in that family tree who was not an AIDS carrier...?" The
columnist
> had no quarrel with the analysis, and replied, "You have focused on the aspect of AIDS that
> makes it such a terrifying disease."
>
> Overemphasis by the media on isolated cases because of their human interest and dramatic
> appeal, even though they represent situations in which the risk is so remote, and many times
so
> unproven, as to be unworthy of serious concern. Those familiar with the news business know
that
> the unusual will make the evening news, particularly if sex is involved. Thus the thousands
of
> homosexual men and IV drug users who are HIV-positive no longer are newsworthy; however, the
> person who claims, rightly or wrongly, to have contracted HIV from some act not generally
> thought to be capable of transmission of HIV will be given prime air time. Example: Kimberly
> Bergalis, who claimed, perhaps incorrectly, to have contracted AIDS during the course of
dental
> treatment.
>
> In the case of most news stories of unusual incidents (e.g., an airplane killing people
asleep
> in their beds), the public generally will understand that it is not something likely to
happen
> very often, if ever again, and will not be concerned. However, the public has so little
> understanding of the risk levels for AIDS that each report of a freak occurrence is
interpreted
> by many as a new method of transmission, and a new and significant risk to be avoided at all
> costs.
>
> Allegations that HIV can be transmitted in ways not possible. Example: A recent letter to an
> advice columnist from a mother who complained that she would have to have her child tested
> repeatedly for HIV because she had picked up a used condom in a hotel room and put it to her
> mouth. The columnist published the letter, and made no effort to tell the mother that her
child
> could not possibly get AIDS in that manner.
>
> Misuse of statistics. Example: The 1991 headline stating "Illinois AIDS Cases Doubled Since
> '89". The impression given is that the rate of AIDS cases had doubled. In fact, the story
> merely stated that the number of cases reported during the most recent two years was
> approximately the same as the total number reported previous to the most recent two years, so
> that the cumulative number of cases was double what it had been two years earlier. (By the
> headline's logic, deaths from any cause could be said to be on the increase!)
>
> Mistakes of fact, even in publications which generally are relied on as being accurate.
> Example: The table heading in the 1991 Edition of The World Almanac and Book of Facts listing
> "U.S. Metropolitan Areas with AIDS rates of 25% or More, 1989-1990, and Cumulative Totals".
> Examination of the table reveals that it lists cities in which the AIDS rates were more than
25
> per 100,000, not 25 per 100.
>
> Because AIDS is almost uniformly fatal, and because one of the ways that HIV can be
transmitted
> is by sexual intercourse, the epidemic has gotten the attention of the public in a big way.
> Unfortunately, there are many misunderstandings about AIDS and the risk of contracting HIV,
as
> evidenced by a survey conducted in August, 1987 by the National Center for Health Statistics.
> Respondents were asked the question "How likely do you think it is that a person will get the
> AIDS virus from the following". Answer choices offered were "very likely", "somewhat likely",
> "somewhat unlikely", "very unlikely", "definitely not possible", and "don't know". The
replies
> clearly showed the extent to which the public misunderstood the risk of contracting HIV.
>
> 69% believed that it was "very likely" or "somewhat likely" that one would get the AIDS virus
> from receiving a blood transfusion. (Even though there have been a number of unfortunate
cases
> of HIV infection from blood transfusions before screening procedures were improved, the
correct
> answer always was "very unlikely".)
>
> 25% believed it "very likely" or "somewhat likely" from donating blood. Only 18% correctly
> believed it to be definitely not possible.
>
> 21% believed it "very likely" or "somewhat likely" from working near someone with AIDS. Only
> 18% correctly believed it to be definitely not possible.
>
> 35% believed it "very likely" or "somewhat likely" from eating in a restaurant where the cook
> has AIDS. Only 11% correctly believed it to be definitely not possible.
>
> 47% believed it "very likely" or "somewhat likely" from sharing plates, forks, or glasses
with
> someone who has AIDS. Only 8% correctly believed it to be definitely not possible.
>
> 31% believed it "very likely" or "somewhat likely" from using public toilets. Only 13%
> correctly believed it to be definitely not possible.
>
> 41% believed it to be "very likely" or "somewhat likely" from being coughed on or sneezed on
by
> someone who has AIDS. Only 9% correctly believed it to be definitely not possible.
>
> 38% believed it to be "very likely" or "somewhat likely" that a person could get AIDS from
> mosquitoes or other insects.
>
> Finally, 92% said that it was "very likely", and another 5% said that it was "somewhat
likely",
> that a person would get the AIDS virus from having sex with someone who has AIDS. Less than
3%
> understood that the low efficiency of transmission made it unlikely.
>
> Subsequent surveys have shown some improvement in the public's knowledge about the risk of
> transmission of HIV. Nevertheless, most people are still unaware of how difficult it is to
> transmit HIV by penile-vaginal sexual activity, and significant proportions of the population
> still believe that HIV can be transmitted by various types of casual contact, even though
there
> are no known cases of the types of transmission referred to in the survey.
>
> The risks of the fear of AIDS
>
> In recent years, a great effort has been made to educate the population on the danger of
> contracting HIV, and what to do to reduce or avoid the risks. These efforts have been
warranted
> with respect to male homosexuals and IV drug users, for whom the risks have been high. They
> also are warranted for those heterosexuals whose regular sexual partners are likely to be
drawn
> from within the IV drug community.
>
> However, the fear of AIDS has done great harm to the personal rights of those known or even
> suspected of having the disease, or being part of a high-risk group. The cases of unfair and
> unnecessary discrimination against such persons which have taken place because of these
> exaggerated fears number in the thousands. In 1990, the American Civil Liberties Union
("ACLU")
> published a report titled "Epidemic of Fear". To produce the report, the ACLU sent
> questionnaires to more than 600 legal and advocacy organizations in the United States. The
260
> that responded reported receiving or referring approximately 13,000 complaints of HIV-related
> discrimination from 1983 to 1988. Since then, many thousands more have surfaced. Indeed, the
> problem of AIDS discrimination was recently highlighted by the Academy Award winning movie
> "Philadelphia", which dealt with employment discrimination against an HIV-positive person.
>
> Considering that the risk of heterosexually transmitted HIV is so small, is it also possible
> that, apart from the discrimination problems, the fear of AIDS can do more harm than the
> disease itself to the average middle class heterosexual not involved with IV drug users?
>
> There is of course no one correct answer to this question. For some, the perceived dangers of
> AIDS merely provides an excuse to avoid relationships which they would prefer not to have
> anyhow. But for others, they may cause a number of undesirable results:
>
> Fear and paranoia about AIDS may impair the healthy sexual activity necessary for the
enjoyment
> of one's adult life.
>
> Unnecessary or exaggerated alarm sounded by public health officials could adversely affect
> their credibility. This would make it more difficult to convince people that there was a real
> danger to public health in some future situation.
>
> People may avoid medical treatment that they need, because of a fear of becoming infected
with
> HIV while under treatment. One must wonder how many already have not agreed to necessary
> surgery, or skipped a visit to the dentist, because of headlines about persons getting HIV
> infections from surgeons and dentists. The risk of avoiding or delaying necessary medical
> attention almost surely is greater than the risk of HIV infection.
>
> There may be added stress, with resulting health and other problems - for example, sexual
> dysfunction caused by fears about AIDS among those who actually had no reason ever to be
> concerned. Many prisons permit conjugal visits, in order to relieve stress and reduce the
risk
> of riots and other violence. Is it possible that "AIDS education" is in fact a contributing
> factor in the violence we are experiencing today throughout the country?
>
> Finally, people may delay or avoid the development of relationships which lead to marriage
and
> the raising of families.
>
> There does not appear to be any precise way to measure the effect of AIDS-related stress on
> mortality and morbidity levels. However, the following comparison is instructive. If a
25-year
> old man has one evening of sexual activity each week for the rest of his life with someone
not
> in a high-risk group, the risk of AIDS will reduce his life expectancy by less than a single
> day, assuming that risk levels remain as they are today, and that HIV infection means certain
> death. On the other hand, a 1% increase in mortality from heart disease caused by added
stress
> levels would reduce his life expectancy by 18 days.
>
> Does HIV cause AIDS?
>
> After more than a decade of hearing that "HIV is the cause of AIDS", there now is a growing
> body of opinion that this is not necessarily true after all. Today, we can hear knowledgeable
> people take a position all the way from "HIV is the sole cause of AIDS, and if you are
> HIV-positive you will eventually get, and die from, AIDS (if, of course something else
doesn't
> kill you first)", to "HIV is unrelated to AIDS".
>
> Clearly, there is a correlation between HIV and AIDS.
>
> This is not surprising, since the definitions of "AIDS" have been closely associated with the
> finding of antibodies to HIV in blood tests. However, this does not necessarily mean that HIV
> causes AIDS, any more than the correlation between the increase in the cost of baseball
tickets
> and football tickets means that one caused the other. In fact, of course, both are caused by
> other, external factors, some of which may be common to both increases.
>
> Similarly, nearly all of those with the disease defined as "AIDS" (which has been changed
> several times) have one or more immune system problems, as do those who have been diagnosed
as
> "HIV-positive."
>
> 1. Male homosexuals with AIDS nearly always have a history of drug use (which is damaging to
> the immune system, regardless of the nature of the drugs), and frequently have one or more
> sexually transmitted diseases associated with anal sex.
>
> 2. IV drug users obviously seriously abuse their bodies and always have immune system
> disorders.
>
> 3. Hemophiliacs also always have obvious immune system disorders.
>
> 4. People who receive blood transfusions also have had some type of illness or injury, in
many
> cases involving immune system disorders of some type.
>
> 5. Heterosexuals who are categorized as having gotten AIDS from heterosexual contact are
> usually involved sexually with drug users, and likely have done drugs themselves (though not
> necessarily IV drugs). Only rarely does someone become HIV-positive from penile-vaginal
sexual
> contact unless he or she has some type of health problem which sharply increases
susceptibility
> to HIV and AIDS.
>
>
> Thus, while one theory is that HIV "causes" AIDS, is it not also possible instead that the
> underlying immune problems affecting those who constitute virtually all of those who are
> diagnosed with AIDS also are causing these people to develop AIDS, or at least to be far more
> susceptible to it if they have HIV? As a minimum, there appears to be much to be learned
about
> the relationship between HIV, other immune system disorders, and AIDS.
>
> Does any otherwise fully healthy person get AIDS solely because of being HIV-positive? Some
> appear to do so. However, nearly all cases of AIDS can be proven to be associated with other
> significant health problems affecting the immune system. Many of the cases that cannot be
> proven to be so associated probably in fact were, if the full facts were known. So while HIV
> infection may be a factor in the development of clinical AIDS, health problems and immune
> system disorders appear to be at least as closely associated with the disease as is HIV. In
> view of this fact, from the view point of the actuary mortality rates would be improved far
> more if the focus were more on the underlying causes (street drugs, anal sex, other STDs,
etc.)
> of the immune system disorders affecting nearly all of those with AIDS, rather than merely
> trying to find a cure for HIV.
>
> In other words, without HIV, people still would be dying from the many immune system
disorders
> associated with drugs and sexually transmitted diseases. However, if people did not destroy
> their bodies in those ways, there probably would be few cases of HIV, and little in the way
of
> an AIDS epidemic.
>
> Conclusion
>
> The latest available data shows that deaths from AIDS are running at about 45,000 per year.
> This is about 2% of the total deaths in the United States. Most experts agree that the number
> of AIDS cases is leveling off, so that it is unlikely that the number of deaths from AIDS
will
> ever be much in excess of 50,000 per year.
>
> Viewed from this perspective, the money being spent on AIDS research is far in excess of that
> which can be justified on the basis of the number of deaths, as compared with such diseases
as
> cancer and heart disease, each of which is responsible for far more deaths. At the same time,
> the AIDS epidemic represents an opportunity for important research regarding the body's
immune
> system - research which can eventually benefit all of us, including the millions who will
never
> have any contact with AIDS as a disease.
>
> However, while it may be argued that research into the cause and cure for AIDS is worthwhile,
> current efforts at AIDS education and prevention are badly misdirected. As we have seen, the
> public is terrorized about AIDS, and in many cases sees risk where little or none exists.
>
> The tragedy about our current efforts of AIDS education and prevention is that we are missing
a
> unique opportunity to use the AIDS epidemic to scare people into better health by emphasizing
> that healthy people rarely ever get AIDS. Instead, we are using AIDS to sell condoms and to
try
> to change the sexual desires of the public. In the process we have created a climate of fear
> and paranoia which has done great harm, while contributing little to controlling the AIDS
> epidemic.
>
> As we have seen, nearly all AIDS victims have one or more health problems, generally
involving
> the immune system, which has left them unusually susceptible to HIV and AIDS. With health
care
> costs increasing rapidly, and with strong public pressure for health care cost containment
and
> universal health care, the opportunity exists to improve the health of the nation by
> emphasizing one simple message: "Good health prevents AIDS." This is a message all could live
> with, and might go a long way to help reduce the incidence of STDs, drug use, and anal sexual
> practices which are the main causes of HIV transmission.
>
> Instead, we have allowed a combination of ignorance and the influence of a variety of special
> interest groups to create a vast public paranoia among the healthy heterosexuals who
represent
> most of the population and who have little or no risk of HIV infection.
>
> We have permitted the gay rights activists to convince the public that "we are all at risk
for
> AIDS" (even though the risk for most is too low to be of rational concern, if it exists at
> all).
>
> We have allowed ourselves to become convinced that multiple sexual partners and the "one
night
> stand" puts us at increased risk of HIV infection (even though it now is clear that this
> generally is not true).
>
> As a justification for AIDS education in the schools, we have claimed that there is an
> "explosion" of AIDS cases among young people (there is not - in fact the number of AIDS cases
> reported by the CDC actually declined from 1990 to 1992 for the age group 13-24, at a time
when
> other age groups were showing an increase!).
>
> We have engaged in endless debates as to whether we should preach condoms or abstinence to
our
> young people (even though neither will have a significant impact on the spread of HIV).
>
> In order to bring a more balanced view of the AIDS epidemic to the heterosexual population,
the
> following should be done instead:
>
> 1. Try to educate the public that there is a vast difference between what is theoretically
> possible and what is probable enough to be of concern. More than ever before, we need a
> concerted effort to educate the public about risk levels, in order to bring some rational
> thinking in public attitudes about AIDS.
>
> 2. Emphasize the generally low efficiency of heterosexual transmission in most cases, and the
> fact that few heterosexuals not involved with IV drugs ever become infected. The statement
that
> "everyone is at risk" may be literally true, in the same sense that men are at risk of
> developing breast cancer, or people on the ground are at risk of being killed in a plane
crash.
> But the statement implies an equal risk for all, which is far from the truth.
>
> 3. Focus heterosexual AIDS education for school children more sharply. There are those who
want
> to use the AIDS epidemic to try to scare all young people into abstinence, in order to reduce
> unwanted pregnancies and the transmission of other STDs. The objective is commendable;
however,
> falsifying the facts doesn't work in a free society. Ultimately, it destroys the credibility
of
> those on whom the young people should be able to rely for help. Instead, the need to avoid
> sexual activity with those who use IV drugs (and of course anyone else known or suspected to
be
> HIV-positive) should be emphasized. By making the drug users the pariahs of the teenage
> community, not only would AIDS education be correctly focused, but gains probably could be
made
> in the war against drugs as well.
>
> 4. Emphasize the importance of prompt treatment of other STDs. The paper by Holmberg et al.,
> referred to earlier, lists genital ulcerative diseases, including herpes and syphilis, as the
> only unquestioned cofactors in host susceptibility to HIV infection. In 1988, black women,
who
> have a much higher rate of heterosexually transmitted AIDS than white women, had a rate of
> gonorrhea 21 times as great as white women. Similarly, black males, who also have a much
higher
> rate of heterosexually transmitted AIDS than white males, had rates of early syphilis 25
times
> as high as white males. For black women, the rate of early syphilis was 31 times as great as
> for white women. Finally, rates of STDs in Africa, where heterosexual contact is considered
to
> be the primary means of transmission of HIV, are believed to be far higher than in the U.S.
So
> the key to reducing the heterosexual transmission of HIV in the U.S. may well involve control
> of the spread of other STDs, so as to reduce host susceptibility.
>
> 5. Stop emphasizing reducing the number of sexual partners as a means of reducing
> heterosexually transmitted AIDS. Most heterosexuals that get HIV from sexual intercourse do
so
> from their primary sexual partner. Monogamy has little value in reducing HIV infections, and
> emphasizing it takes the focus away from the real ways in which transmission of HIV can be
> significantly reduced.
>
> 6. Better focus the need for using condoms. As was the case before the AIDS epidemic, for
some
> they are useful in reducing the risk of pregnancy and STDs. However, for those who can avoid
> the risks of pregnancy in other ways, and for whom other STDs are rare, condoms provide
little
> benefit, and detract from the love making process.
>
> 7. Better educate health care and government officials, who still have many misunderstandings
> about the epidemic and what needs (and doesn't need) to be done to control it's spread.
>
> 8. Most important of all, emphasize the message that "Good Health Prevents AIDS". As more
facts
> become available about the nature of AIDS and other immune system disorders, it is becoming
> increasingly apparent that those who are in good health and who are not engaging in
activities
> which are damaging their immune systems have little to worry about with regard to AIDS.
>
>
> APPENDIX A
>
> Effect of Transmission Efficiency on Proportion of Transmissions from Primary Partner
>
> Let us assume that there are three types of heterosexuals: "monogamous", "semi-monogamous",
and
> "multiple partners". "Monogamous" persons are those who have a sexual relationship with only
> one partner. "Semi-monogamous" persons are those who have a primary sexual partner, but who
> also have some sexual activity with others. Those who are identified as having "multiple
> partners" have sexual activity with a number of people, no one of whom can be called a
primary
> partner.
>
> The number of monogamous people to become infected with HIV in a given period of time can be
> expressed by the following formula:
>
> Vm = Nm x im x [1 - (1 - p)n]
>
> where:
>
> Vm = the number of monogamous people to become infected during the period.
>
> Nm = the total number of monogamous people in the population.
>
> im = the probability for monogamous people that one's sexual partner is infected with HIV.
>
> p = the probability of becoming infected from a single act of sex with an infected partner.
>
> n = the number of sexual acts during the period.
>
> The number of people with multiple partners to become infected with HIV in a given period of
> time can be expressed by the following formula:
>
> Vp = Np x {1 - [1 - (ip x p)]n}
>
> where:
>
> Vp = the number of people with multiple partners to become infected with HIV during the
period.
>
> Np = the total number of people with multiple partners in the population.
>
> ip = the probability for people with multiple partners that one's sexual partner is infected
> with HIV.
>
> The remaining symbols are as previously defined.
>
> The number of semi-monogamous people to become infected with HIV in a given period of time
can
> be expressed by the following formula:
>
> Vs = Ns x {1 - [1 - is x (1 - (1 - p)nm)] x [1 - (is xp)]np}
>
> where:
>
> Vs = the number of semi-monogamous people to become infected with HIV during the period.
>
> Ns = the total number of semi-monogamous people in the population.
>
> is = the probability for semi-monogamous people that one's sexual partner is infected with
HIV.
>
> nm = the number of sexual acts engaged in with one's primary sexual partner during the
period.
>
> np = the number of sexual acts engaged in with people other than one's primary sexual partner
> during the period.
>
> Finally, the proportion of total HIV infections caused by sexual relations with one's primary
> partner is as follows:
>
> Ns x {1 - [1 - is x (1 - (1 - p)nm)]} + Vm
>
> Vm + Vs + Vp
>
> To examine the effect of the efficiency of the transmission of HIV on the proportion of
> heterosexual infections coming from primary partners, it is necessary to make certain
> assumptions. For the purpose of this analysis, we initially will assume the following:
>
> 1. The total number of sexual acts (n) for each person in the period is 200.
>
> 2. The probabilities that one's sexual partner is HIV+ (im, is, and ip) are all assumed to be
> 0.1%.
>
> 3. The distribution of people among the three categories is: monogamous, 60%;
semi-monogamous,
> 36%; and multiple partners, 4%.
>
> 4. For those in the semi-monogamous category, the proportion of sexual acts with persons
other
> than their primary partner was 10%.
>
>
> The number of people in the total population does not actually affect the distribution of HIV
> infections between the three groups, although it does of course affect the number of
> infections.
>
> The following table shows the effect of various levels of efficiency of transmission on the
> proportion of infections arising from sexual activity with one's primary partner, based on
the
> above formulae and assumptions.
>
> Percent of Infections from Primary Partner
>
> Prob. of Transmission per Act
>
> Percent of Total Infections Percent of Infect. from Primary Part.
>
> Monogamous Semi-monog. Mult. Part.
>
> 0.5 9.1% 32.8% 58.0% 14.6%
>
> 0.2 18.5 33.2 48.3 29.6
>
> 0.05 39.0 35.1 25.9 62.4
>
> 0.02 50.2 36.2 13.6 80.3
>
> 0.005 57.6 36.3 6.1 91.2
>
> 0.002 59.1 36.1 4.8 93.1
>
> 0.00125 59.4 36.1 4.5 93.5
>
> 0.000625 59.7 36.0 4.2 93.9
>
> 0.0001 60.0 36.0 4.0 94.1
>
>
> The table shows that for a disease that is easily transmitted by sexual activity, a high
> proportion of transmissions will occur from sexual activity with someone other than the
primary
> partner. However, as the efficiency decreases, the proportion of transmissions that occur
from
> sexual activity with the primary partner increases. For the efficiencies typical of
> heterosexual transmission of HIV, about 94% of the transmissions would be from the primary
> sexual partner.
>
> The figures are somewhat dependent on the assumptions.
>
> Of particular importance is the assumed distribution of people among the three categories.
> There is no way of knowing precisely what portion of heterosexuals are monogamous, what
portion
> are semi-monogamous, and what portion should be considered to have multiple partners, without
> any one primary partner. Even if the distribution were known for the population as a whole,
it
> could well differ for those persons who are more likely to have sexual contact with HIV+
> partners.
>
> However, there are two references which are somewhat helpful. In the article titled "The
Study
> of Sexual Behavior in Relation to the Transmission of Human Immunodeficiency Virus", by
> researchers at the Kinsey Institute for Research in Sex, Gender, and Reproduction, published
in
> the November, 1988 issue of American Psychologist, the following estimate is made of the
degree
> of extramarital sexual relations:
>
> "Based on six data sets, we estimate that 37% (range = 26-50%) of husbands have had at least
> one additional sexual partner during marriage. In a study of men over 50 years old, 23% of
the
> respondents said that they had had extramarital sexual interaction since the age of 50
> (Brecher, 1984). The estimate for wives' extramarital sexual relations, based on nine
studies,
> is 29% (range = 20-54%)."
>
> Another study, done by the Center for Health Affairs in Chevy Chase, Maryland, showed the
> following percentages of respondents admitting to four or more heterosexual partners:
>
> Age 16-24 10.7%
> Age 25-34 4.2%
> Age 35+ 2.4%
> These studies suggest to this author that the assumption of 60% monogamous, 36%
semi-monogamous
> (with 10% of their sex with other than primary partners), and 4% multiple partners is a
fairly
> reasonable depiction of the distribution of sexual habits of heterosexuals, particularly if
the
> effect of the greater use of condoms by those engaging in sexual activity with other than
their
> primary partner is considered.
>
>
> APPENDIX B
>
> Comparison of Risk Levels for Multiple vs. Single Partners
>
> For homosexuals sexual activity with multiple partners significantly increases an already
> relatively high risk. However, for heterosexuals the risk remains about the same for any
> reasonable number of partners. The following table summarizes the risk levels for these two
> groups:
>
> Risk Ratio: Multiple Partner vs. Single Partner
>
> Heterosexual Men Heterosexual Women
>
> Number of Homosexual Partners Partners Sexual Acts
>
> Men Not HiRisk IVDU Not HiRisk IVDU
>
>
> 20 1.08 1.01 1.01 1.01 1.01
>
> 50 1.21 1.03 1.02 1.03 1.02
>
> 100 1.45 1.06 1.03 1.06 1.03
>
> 200 1.95 1.13 1.06 1.13 1.06
>
> 500 3.37 1.34 1.16 1.34 1.16
>
>
> For monogamous relationships, the probability of HIV infection from a given number of sexual
> acts was determined by the formula:
>
> i x [1 - (1 - p)n]
>
> where:
>
> i = the probability that one's sexual partner is infected.
>
> p = the probability of infection from a single act of sex with an infected partner.
>
> n = the number of sexual acts during the period.
>
>
> For the person with multiple partners, the probability of getting an HIV infection from a
given
> number of sexual acts is as follows, assuming that one's partners are chosen at random from
> among the pool of persons in the risk group (i.e., that there is not some element of monogamy
> involved):
>
> 1 - [1 - (i x p)]n
>
> The table demonstrates that, even for as many as 100 different sexual partners, there is only
a
> 6% increase in risk for heterosexuals, as compared with the same amount of sexual activity
with
> one partner. By comparison, there is a 45% increase for homosexual men. The additional risk
for
> homosexuals is further increased by four other factors:
>
> 1. The average risk of infection even from a single homosexual act is much greater than that
> from a single act of vaginal intercourse if the heterosexual's partner is not an IV drug
user,
> and is several times greater even if the heterosexual's partner is an IV drug user.
Therefore,
> a 45% increase is very large in absolute terms, as compared with the risk for heterosexuals.
>
> 2. The number of sexual partners that some of the more promiscuous homosexual men have had is
> generally believed to be much greater than that for heterosexuals (except for prostitutes).
>
> 3. Because of the greater risks of promiscuity, the sexual partners of the homosexual man who
> is promiscuous are more likely to be infected than those of the less promiscuous homosexual.
>
> 4. Finally, the majority of infected homosexuals became HIV-positive through sexual activity.
> By contrast, the majority of infected heterosexuals became HIV-positive through IV drug use
or
> blood transfusions. The result is that restricting one's sexual activity is far more
important
> for homosexuals than for heterosexuals. *
>
>
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>
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>
>
>
>
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