Aids Update: Myths and Realities

Some People have the idea that sex causes AIDS. That's not true. Ordinary sexual intercourse doesn't cause AIDS. Homosexual sex doesn't cause AIDS. Anal sex doesn't cause AIDS. Sex with prostitutes doesn't cause AIDS. If partners are free of AIDS, nothing they can do together will cause it.

What causes AIDS is a virus---a tiny, delicate shred of genetic material---called HTLV-III/LAV. As far as scientists know today, it can live in only a very limited environment. It prefers one type of cell in one type of animal---the T-helper cell in human blood. There is evidence that it also attacks brain cells. Outside these environments, the HTLV-III/LAV virus dies. In air, it dies. In water, it dies. It could not live in food. It would be dead in seconds if it landed on a toilet seat. Keeping it alive in a lab, where coaxing meas-sures are available to grow viruses, is a tedious and tricky chore.

Moreover, new evidence suggests that transmission of the AIDS virus during vaginal intercourse (especially from a woman to a man) is relatively rare. Not only is the virus difficult to transmit from one person to another but once it is in the body, evidence suggests that a normal, healthy immune system can keep it in check. Although many people believe that any contact with the AIDS virus guarantees illness and death, it is simply not so.

Aids is Hard to Catch

Fresh blood or semen infected with HTLV-III/LAV must enter the blood stream in order for the virus to be transmitted from one person to another. That is part of the reason homosexuals account for so many AIDS cases: Anal intercourse often results in a tearing of the lining of the rectum, which allows infected semen to get to the blood stream. Obviously, sharing a needle with someone who is carrying the virus is very dangerous for the same reason.

The lining of the vagina is much more resistant to tearing than is the rectal lining. That is one of the reasons that, at presstime, there were 12,935 cases of AIDS among homosexual men. compared with 43 among heterosexual men. No one knows exactly how the heterosexual men got AIDS from their female partners.

Can the virus crawl up into the penis and infect a man during intercourse with a woman carrying it? Scientists are reluctant to use the word impossible, but there are no cases on record of its happening.

The misconceptions persist. After Rock Hudson's death from AIDS, many people were alarmed to hear that researchers had found HTLV-III/LAV in saliva. As we said, the virus lives in a certain type of white blood cell. White blood cells gather at the site of an infection. A small sore in the mouth can bring forth white blood cells, as can the common cold. Nevertheless, the announcement that saliva can contain the virus led to the Screen Actors Guild's telling its members that they could refuse to do kissing scenes if they were afraid of AIDS. But there is no evidence that the scant amounts of virus in saliva would be sufficient to transmit the virus.

In studies of the families of people with AIDS, there has not been a single case of the virus' being passed by close family contact (hugging, kissing, eating together or any other kind of nonsexual contact).

The Test

A test has been developed to determine if a person has been exposed to HTLV-III/LAV. It is called ELISA (for enzyme-linked immunosorbent assay). It does not detect the virus itself but only the antibodies a person's immune system develops to fight the virus. In other words, a positive ELISA result doesn't mean that the person has AIDS. It means he has had contact with the virus. That may lead to illness; but, according to the Centers for Disease Control (CDC) in Atlanta, in 90 percent of the cases, it will not.

Heterosexual Transmission

In a University of California at Berkeley study of 22 women whose sexual partners had been exposed to HTLV-III/LAV, only one woman had a positive test result.

An AIDS expert at Johns Hopkins University has expressed his doubts that "AIDS is going to spread much into the heterosexual population, because I don't think men will acquire the infection from women sexually, except for rare occurrences." Numerous experts have said that the lining of the urethra in the penis is not readily invaded by the AIDS virus. They suggest that it may be necessary to have an injury---even a microscopic one---to allow the virus into the blood stream, or an infection that would stimulate production of the type of white blood cell the virus attacks---the T-helper cell. (Such an injury could occur during intercourse.)

Researchers have now found the virus in vaginal secretions, but according to Dr. Jay A. Levy of the University of California at San Francisco, "Only a small amount of virus was isolated, indicating the disease cannot be easily passed from women to men through vaginal intercourse."

It is important to remember that there are only about 1000 women with AIDS in the entire country. About 600 of those are IV-drug users, and 105 got the disease from transfusions. (Interestingly, there are no known cases of lesbians with AIDS.) Although the CDC has said that as many as 1,000,000 people may have been exposed to HTLV-III/LAV, those numbers are pure guesswork. Dr. Albert Sabin, who discovered a vaccine for polio, called such estimates "without foundation."

Menstruation

If a man has a cut or an open sore on his penis and has vaginal intercourse with a menstruating woman who is carrying HTLV-III/LAV, he can conceivably contract the virus. Similarly, a menstruating woman is presumed to be much more vulnerable to transmission from an infected man. A condom, however, would prevent even that unlikely occurrence. (Another AIDS myth: The virus can pass through the wall of a condom. It's not true.)

Aids and Prostitution

Early reports that AIDS was being spread by the prostitutes of our major cities have turned out to be unfounded.

The assistant health commissioner of New York City, among others, has noted that no one has produced convincing evidence that prostitutes are giving the AIDS virus to their customers. There are no proven cases of AIDS transmission to men from prostitutes in all of New York City, where AIDS and prostitution are common.

In fact, in the entire U.S., only 240 heterosexuals (outside the known groups at risk for AIDS, such as IV-drug users) have contracted the disease. Only 43 are men. Given the number of men patronizing prostitutes in large cities, one would expect far more cases, but they simply aren't there (though some studies in Africa have linked prostitution and AIDS cases).

Dr. Parkash Gill of the University of Southern California said, "It is true that a small minority of prostitutes do have the virus, but that may be related to the fact that they abuse IV drugs." In a study often cited to link prostitution with AIDS, ten Miami prostitutes were found to be carrying HTLV-III/LAV. What is not so often cited is the fact that eight of the ten reported using IV drugs.

The Vanishing Aids Epidemic

You may now begin to understand why, in spite of dire predictions, AIDS has failed to become a wildfire epidemic. It has not happened and is not likely to happen.

Although the number of AIDS cases has gone up and continues to go up, the rate of increase has slowed markedly, and the distribution of those cases has remained the same, both within the risk groups and within the general population.

"The numbers [ratios] have stayed quite constant over the past few years," says Dr. Harold Jaffe, chief epidemiologist for the CDC. "Only about one percent of the cases are in the heterosexual-contact group." One reason is that not only is it difficult for the virus to enter your body but once it gets there, it needs even more help to stay active.

Contributing Factors

HTLV-III/LAV is a virus. Having AIDS means succumbing to that virus. Being exposed to the virus and having AIDS are not necessarily the same thing.

AIDS is the result of a barrage of attacks on the body---physical, biological, perhaps even chemical. Numerous factors may be necessary for a case of AIDS, e.g.:

• A history of multiple infections, especially with certain viruses: Epstein-Barrvirus and cytomegalovirus, among others.

• General poor health. When the body's immune system is under stress, further infection becomes more likely. Many researchers believe a person in good health runs a significantly smaller risk from contact with carriers of the AIDS virus.

• The abuse of recreational drugs, especially butyl nitrite (poppers), has been linked with immune-system impairment.

• Genetic predisposition. Some researchers believe only certain people are born with a susceptibility to the virus.

• Malnutrition, particularly in certain areas, such as Africa.

In the absence of one or more of those factors, AIDS begins to look like a very rare condition. For a variety of reasons, promiscuous homosexual men are susceptible to a wide range of sexually transmitted infections. Some gay men are persistently ill with Epstein-Barr virus, cytomegalovirus, rectal gonorrhea and other diseases. IV-drug users also suffer from repeated infections and compromised immune systems. It is not surprising, then, that those two groups account for 90 percent of all AIDS cases in the U.S.

If you are not in one of those groups, you are extremely unlikely to get AIDS.

Distinguishing Cause and Effect

Sexual preference, per se, has nothing to do with AIDS. A case study will illustrate the different effects the virus has on different people. A white, heterosexual English couple lived in Africa for more than six years. They returned to England and both tested positive for HTLV-III/LAV. The woman got AIDS and died. The man remained well. What was the difference?

The Lancet, a British medical journal, reported, "Apparently, she had been unwell for two to three years." In fact, she was under constant attack from one illness or another, including two major viral infections, during that period. Lancet suggested that the woman's body had been compromised for years by viral infections. When the AIDS virus came along, her defenses were down and her husband's were not. Contributing factors, again, seem crucial in the development of the disease.

But the story took an interesting turn: Once the couple had returned to England, the woman was put into the hospital, where a nurse drew blood for examination. As she was putting the cover back onto the needle, she stabbed herself, injecting some of the patient's blood into her finger. She had infected herself with HTLV-III/LAV, and tests of her blood confirmed that fact. About two weeks after the accident, she came down with something like the flu---sore throat, headache, muscle pains and fever. She was sick for about a week, with a fever up to 102 degrees. As Lance put it, "Recovery thereafter was uneventful."

Here we have the entire range of effects we might expect from HTLV-III/LAV: (1) A carrier experiences no ill effects, though he clearly has the virus in his blood stream; (2) a nurse comes down with a transitory illness and then recovers, much like a patient with flu or mononucleosis; and (3) the weakest member of the group, the one who had been subjected to a number of viral infections over a long period of time, succumbs to HTLV-III/LAV, develops true AIDS and dies.

Immunity and Recovery

The case of the English couple and the nurse, along with other research, indicates that although AIDS appears to have an extremely high mortality rate (around 90 percent), infection with HTLV-III/LAV does not equal AIDS and AIDS will not make mankind an endangered species.

The CDC has said that a lot of people who have been exposed to HTLV-III/LAV are going to get AIDS---though not enough time has passed to indicate how many. But Science reported in November 1985 that "five (concluded on page 179) Aids Update (continued from page 53) years after being infected" with HTLV-III/LAV, one third of a group of homosexuals and bisexuals in a study in San Francisco "were showing symptoms of infection and two thirds remained healthy." Only two men in the affected group actually got AIDS---as distinguished from simply being infected with the virus, which, as we have seen, may result in no illness at all. The others had what amounts to the same thing as the British nurse: flulike illness.

The CDC states, "The fact that two thirds of men infected for over five years have not developed AIDS or AIDS-related illness is an encouraging indication that infection with this virus is not necessarily followed by rapid development of symptoms and death."

How Aids Spreads

As speculation about AIDS turned into an epidemic of misinformation, we were left with the impression that the disease itself was spreading in epidemic fashion as well. It is now clear that it was not.

An epidemic spreads in rings, like ripples on the surface of a pond. AIDS is spreading like fire in a vein of coal. The earth, the rocks don't catch fire---only the coal along a narrow line. AIDS cases have increased among people in the high-risk groups, while those around them, those in contact with them, do not get the disease.

Since the late Seventies, when AIDS was first reported in the United States, there have been almost 18,000 cases in the U.S. That's approximately the number of new cancer cases that developed in just one state (Maryland) in a single year (1985). (The comparison is not a frivolous one: One form of cancer, Kaposi's sarcoma, is specifically associated with AIDS. There is much to suggest a more than casual link between cancer and AIDS. Both of them hit you while you're down. Cancer cells, like viruses, may develop without your ever knowing it and without causing the disease. A healthy immune system can protect you.)

The Missing Aids Case

The generalized fear of AIDS is simply not supported by the number of cases. The most recent numbers are these:

Homosexual men 12,935

IV-drug users 3007

Unknown 1015

Transfusion recipients 277

Heterosexuals in contact with HTLV-III/LAV 240

Hemophiliacs 143

There are some nonhomosexual men who have gotten AIDS through transfusion with contaminated blood or through the use of IV drugs (by sharing contaminated needles). But outside of those cases, only 43 heterosexual men in the U.S. have gotten AIDS, and most of them have had sex with IV-drug users. That number is so small that it is listed by the CDC as zero percent of the total. Furthermore, according to statistics, there should be thousands of women who have contracted AIDS from bisexual men; yet only 197 (excluding IV-drug users) have contracted AIDS. The numbers don't support an epidemic spread of AIDS through the heterosexual community---not through one-night stands, not through prostitution, not through the "swinger" community.

In addition, the rate at which the people in known high-risk groups are getting AIDS is on the decline, from 184 percent between 1982 and 1983 to 115 percent between 1983 and 1984 and down to 84 percent between 1984 and 1985. In other words, it's taking longer and longer for the number of AIDS cases to double.

Aids and Geography

Location is important. That is why the CDC publishes its list of AIDS cases in state-by-state form. The scientific textbook AIDS: Etiology, Diagnosis, Treatment and Prevention says that the incidence of the virus ".is most closely related not to the number of partners or to specific sexual practices but rather to geographical parameters, so that sexual contact with a person from an area where the infection is widespread is the most important risk factor." In other words, if you are in an area where there is no AIDS, your risk of coming in contact with it is reduced to a very low order of probability. AIDS is not spreading across the country; it is merely increasing in the areas where it already exists. Obviously, someone from San Francisco could fly into Montana and carry HTLV-III/LAV. But if repeated exposure to the virus and contributing factors are necessary to develop a case of AIDS, that may help explain why the disease has not spread laterally across the nation. Seventy percent of all U.S. AIDS cases remain in New York, California, Florida and New Jersey.

Precautions

We've said it before, and we'll say it again: Sex doesn't cause AIDS. If you do come in contact with someone who is carrying HTLV-III/LAV, all you have to do to prevent infection is to avoid getting that person's blood or semen into your blood stream. There are two easy ways to do that. One is to avoid being the receptive partner in anal intercourse with that person. The other obvious preventive measure is to refuse to share needles with others---a wise choice in any case.

Even if you are unlucky enough to come in contact with the virus and get it, that doesn't mean you are doomed. Fully 90 percent of people who test positive for the antibodies to the virus do not get AIDS. It seems likely that in most healthy people, properly functioning immune systems can respond to HTLV-III/LAV in the same way they respond to any other virus: by killing or containing it. The best advice today: Take measures to prevent exposure to the AIDS virus and other viruses. Use condoms when in doubt.

"The rate at which the people in known high-risk groups are getting AIDS is on the decline."