A.I.D.S.—the avoidable plague

Press, 12 November 1985, Page 16

A.I.D.S.—the avoidable plague

From ‘The Economist’ London

“Well, .first I’d shoot the queers,” said Mr Louie Welch, Houston’s once and possibly future mayor, into what he thought, mistakenly, to be a dead microphone. He was about to present his proposals to control A.I.D.S. to the voters.

Americans peer at the epidemic through so thick a cloud of unknowing that it was not even clear whether Mr Welch’s “joke” would lose or win him Houston’s votes.

There is much that is genuinely mysterious. It is known that the A.I.D.S. virus suppresses a body’s immunity to a number of killing diseases; it is now thought that it may also, more slowly, attack the brain. If this were so, the estimate that only one-fifth or one-tenth of the people who carry the A.I.D.S. virus are likely actually to get the disease would have to be revised alarmingly upwards. By contrast, the disease’s progress through the United States has been unusually precisely documented. Among the 14,300 recorded cases (most of them either homosexuals or intravenous drug users) there is no evidence that the infection was transmitted in any way other than by the mixing of blood (mainly through dirty needles) or the mixing of semen and blood (mainly through anal intercourse).

Yet the American public, knowing the disease to be death, wants a rock-solid guarantee that there is no chance of infection by less easily avoidable means. Doctors, a cautious lot, will not provide such a guarantee. So Americans cast about for ways to protect themselves. Parents keep their children away from a New Jersey elementary school because the young sister of a nine-year-old pupil is found to have A.1.D.5., people stop donating their blood, communicants at Washington’s Episcopal cathedral are encouraged to dunk their wafer in the wine if they fear to drink from the chalice.

Some public authorities are beginning to speak of quarantine, but this, with its assumption that ordinary close contact is dangerous, is both inappropriate and impracticable; the million or so suspected American carriers, who bear no mark of the virus until their blood is tested, are no less contagious than people struck down by the disease itself. The Texas health authorities, more sensibly, suggest a much more limited form of quarantine, really a kind of imprisonment, of A.I.D.S. victims who refuse to stop having multiple sex; the city of San Antonio has said that such people would be charged with

committing a felony. Colorado has become the first state to require that the names of people whose blood shows traces of the virus should be reported to the state health department And Transamerica Occidental is the first of the insurance companies to require an A.I.D.S. blood test from any new life-insurance applicant who is fairly young and lives in one of the big cities. The Defence Department, which already requires new recruits to take the blood test, has now said that all its 2.1 million military personnel must also be screened. This has raised an interesting question about homosexuality in the armed services. This is not countenanced, but the department has got- itself into a tangle. Its first statement was that if, after a positive blood test, an otherwise healthy member of the armed services admitted to homosexual activity, he would not be automatically discharged, although he might be given a different job. A few days later, the department reversed itself: anybody admitting either to homosexuality or to drug use after screening could be immediately, albeit honourably, discharged. He would still qualify for medical benefits but, and this has alarmed civil libertarians, the result of his test and his own confidential disclosure could be revealed during the discharge proceedings.

One result of this will be funny statistics. People charting the disease allow for a certain amount of lying, particularly, they say, from prostitutes. But there will now be a rather strong inducement for members of the armed services to claim heterosexual activity only. This has already started. Out of 41 AI.D.S. sufferers in a military hospital, 15 (ten men and five women) claimed to have become infected after intercourse with the opposite sex. Some of them must have been fibbing; only 1 per cent of all A.I.D.S. cases in the country have been attributed to heterosexual contact.

Attention in the last month has focused on a particularly sleazy subject bathhouses. Governor Mario Cuomo has said that he will close the bathhouses in New York state unless they obey new regulations prohibiting anal or oral sex. The term “bathhouses” is a euphemism; they are places, probably with some sort of steam bath or jacuzzi, where a homosexual can, if he wants, have anonymous or multiple sex. since the advent of A.I.D.S. they are a mortal hazard, although they are used by only a tiny proportion of the homosexual community. San Francisco’s experience is illuminating. The city is a couple of years ahead of New York, both in its efforts to control the spread of A.I.D.S. and in its care for the

people who have already caught it With the bathhouses, however, San Francisco had no success. Putting a poster about unsafe sex in a bathhouse, says the city’s former public health director, is like putting a sign that sweets are bad for you in a sweetshop. In the end, just before the Democratic convention in 1984, the bathhouses were closed temporarily. This order did not stand up in court, but San Franciscan homosexuals had been prepared; fewer of them went on patronising these Russian roulette parlours and by now only one or two are still open. The lesson for New York, where nearly a third of the A.I.D.S. cases live, may be that an offensive against the bathhouses has a better chance of success if it is carried out in the context of a comprehensive attempt to halt the spread of the disease and to care for its victims. Education is the key, both for the general public and, in particulr, for the people most at risk. There is no known cure for a person who has caught A.1.D.5.; American doctors are unhappy at the precipitateness of the recent announcement by three French physicians that they have a treatment that seems to be working. But unlike most plagues, the act of catching A.I.D.S. is rather easy to avoid. ■! Copyright—The Economist.