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Is nobody safe from A.I.D.S.?
So far, at least in America and Europe, most victims of A.1.D.5., or the acquired immune deficiency syndrome, are homosexuals, drug addicts, haemophiliacs, or recipients of blood transfusions. Will A.I.D.S. spread through the rest of the population? The first of two articles from “The Economist,” London.
Imagine a disease X, new to the human species, which kills 10 per cent of the people it infects and renders the rest immune after 10 days of illness and infectiousness. Imagine that the average sufferer meets 50 people in the 10 days and, if none is immune, infects five of them, that disease will spread until more than four fifths of those a diseased person meets have recovered and are immune. At that point, the disease begins to die down, because each carrier infects fewer than one other person. X will by then have killed 9 per cent of the population. X is not A.I.D.S. It is a caricature of a nasty but otherwise typical disease — quite easy to spread, yet quickly defeated by the immune system. A.I.D.S. is neither. Carriers are infectious not for 10 days, but for a lifetime. And they can give the disease to others only with difficulty or deliberateness. It is these two facts that make the spread of the disease so hard to predict. Medical researchers are now certain that casual contact — communion chalices, shared school playgrounds, nursing of A.I.D.S. patients — carries a risk so infinitesimal that it is much too small to sustain an epidemic. Three “easy” ways exist of getting the A.I.D.S. virus: having anal sex with a carrier, sharing a hypodermic needle with a carrier, or receiving a blood transfusion from a carrier. These means of transmission could not spread an epidemic to the population as a whole; the screening of donations has made blood supplies safer, and most people do not indulge in anal sex or share hypodermic needles. That leaves ordinary sexual intercourse.
So the spread of A.I.D.S. depends on one question: how many sexual partners of an A.I.D.S. carrier will get the virus? If the average is less than one, the disease will die. Simple question, complex answer. How many sexual partners do people have? How easily does the virus pass from one body to another during each sexual act? The evidence is patchy. That A.I.D.S. can be transmitted from nan to woman is not in doubt. Several Australian women got the virus after being artificially inseminated with the semen of an infected man; a chimpanzee in Atlanta, Georgia, became infected from a single infected vaginal swab. In America, the evidence suggest that about 180 A.I.D.S. victims got infected by having ordinary sex with a carrier. Some take comfort from the proportion of such cases remain-
ing static, at about 1 per cent, for the last five years. But the heterosexually-infected victims are most "second-generation”: they got A.I.D.S. from sex with people infected by other means, notably drug abuse. Given the disease’s long latency, a lag before many heterosexuals catch the disease is inevitable. How easily is the virus transmitted heterosexually? One in 10 wives of haemophiliacs has caught the virus, but Dr Nancy Padian of the University of California at Berkeley found that only one of 22 female sexual partners of other infected men had done so. A recent estimate from a sample of blood donors (which excluded high-risk groups) suggests that 100,000 Americans have been infected via hetero? sexual intercourse.
Nonetheless, the experience of doctors in New York, where the disease first appeared in America in 1978, indicates that heterosexual transmission is difficult. It has spread beyond the homosexual population there largely because of intravenous drug use: 80 per cent of A.I.D.S. cases among drug addicts are from New York and more than half of New York’s intravenous addicts are infected. Dr Don Des Jarlais, of the New York State Division of Substance Abuse, says that a woman in New York is 10 times more likely to catch the virus if she becomes a drug addict than if she becomes the regular sexual partner of a carrier. In New York, no case of A.I.D.S. is unambiguously attributed to infection from a prostitute. Yet a study in Sweden found that three out of 50 clients of an infected prostitute caught the virus. The explanation may be the insistence of New York prostitutes on the use of condoms.
“Sleeping around” may, in itself, be risky. Dr Michael Koch, a Swedish researcher, has found an A.I.D.S. hot spot where the blame lies not with homosexuality or drug abuse but with promiscuity: Belle Glade in Florida, which has the highest concentration of A.I.D.S. victims in North America.
The town has a large population of young, unmarried, and relatively affluent migrant workers from the Caribbean (including Haiti, where A.I.D.S. is reported to be common in some districts). They bring with them many prostitutes. Dr Koch reckons they also bring A.I.D.S. and that it has spread by heterosexual intercourse.
How does the virus move from body to body? That the virus can be found in semen proves nothing in itself. The virus must
not only get out of a carrier’s body alive, but also into somebody else’s cells. In the case of A.1.D.5., this means the T 4 cells of the blood.
This points to anal sex being more dangerous than vaginal. The rectum has thinner walls than the vagina, it is frequently damaged during anal intercourse, and the colon (at the rectum’s upper end) is actually sheathed in T 4 cells — the very cells A.I.D.S. infects. They are probably there as a defence against invasion of the body by bacteria from the gut. Passing the disease from man to woman by vaginal intercourse is more difficult And some scientists think that passing it the other way — from woman to man — is harder still.
They may be too sanguine. In a recent study of nine couples in which the man was infected, only two of the women caught the virus. In a parallel study of nine couples in which the woman was infected, all nine men caught it. That could suggest that female-to-male transmission is easier than male-to-female, though another explanation is possible. Since many infected women do not produce the telltale antibodies on which the A.I.D.S. tests rely, the seven women who appeared to have escaped infection may have the virus after all.
A new explanation of why many infected women do not produce antibodies has emerged. A study in a Berlin hospital has found that rings of T 4 cells exist in the mouth and in the cervix as well as the rectum. Two things follow from this.
First, it might be much easier for a man > to infect a woman than was thought. Second, that infection might take a long time to work its way into the woman’s blood. While it remains in the cervical cells, that woman is infectious. But this would not be detected by blood tests. Epidemiologists often work from analogy. Find a similar epidemic to A.I.D.S. and see how it spreads. A.I.D.S. is not like the Black Death or influenza or tuberculosis or any othet disease spread by breath. It is much less contagious. Nor is it like genital herpes or syphilis or gonorrhea, because it can be spread by other means than sex and is much more dangerous.
The only model that suits A.I.D.S. well is hepatitis B, a disease that affects 200 million people a year, mostly in the third world. It is much less dangerous, slightly more infectious and much less persistent than A.1.D.5., but it also has significant similarities. It must get into the blood if it is to infect, and it is spread effectively by hypodermic needles and anal intercourse.
A few years ago, Dr Woif Szmuness of the New York Blood Centre discovered that New York homosexuals had a high risk of catching hepatitis B. Each year, the average New York homosexual stood a 12 per cent
chance of getting the virus. The risk for the population as a whole was 1 per cent during a whole lifetime.
This was one of the first signs that promiscuous homosexual intercourse was especially good at spreading certain diseases. In 1978, the San Francisco health department selected 6875 volunteers from a group of homosexuals visiting the city clinic for treatment for venereal disease in order to study the spread of hepatitis B among them. The regular blood samples they gave have now helped in the study of A.I.D.S. By analysing early samples from 500 of those 6875, scientists have documented the growth of A.I.D.S. infection from 4.5 per cent in 1978 to 73 per cent in mid-1985. It is from these data that the rate at which infected people go down with the disease has been estimated.
The study also allows a close inspection of the parallels between A.I.D.S. and hepatitis B. Dr Donald Francis of the Centres for Disease Control has extracted these lessons: ® A.I.D.S. is harder to catch. When 8 per cent of the group had the A.I.D.S. virus it was spreading at 7 per cent a year; when 8 per cent had hepatitis B, it was spreading at 25 per cent a year. So A.I.D.S. is three to four times less easy to transmit by
homosexual contact than is hepatitis B. . ® A.I.D.S. makes up for lack of infectiousness by being per-; sistent. An A.I.D.S. carrier is infectious for life. A hepatitis B carrier gets over his infection and is safe. These two factors approximately cancel out among the homosexuals studied, with the result that A.I.D.S. and hepatitis B spread at about the same rate. But what about heterosexuals? Hepatitis B probably can spread by heterosexual intercourse. Between a quarter and a half of women who are regular sexual partners of hepatitis B carriers do get it. And a Japanese study found that 44 per cent of husbands of hepatitis B carriers caught the infection. Does this mean that A.I.D.S. can spread this way as well? Not necessarily. After all, hepatitis B can be passed on by casual contact between family members, though not easily. It is now almost certain that A.I.D.S. cannot. The best guess must be that the same pattern obtains in heterosexual as in homosexual spread: that A.I.D.S. is about onethird to one-quarter as easy to pass on as hepatitis B. Tomorrow: The African connection and A.I.D.S. as an heterosexual disease, ’h
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Press, 10 February 1986, Page 12
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1,737Is nobody safe from A.I.D.S.? Press, 10 February 1986, Page 12
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Is nobody safe from A.I.D.S.? Press, 10 February 1986, Page 12
Using This Item
Stuff Ltd is the copyright owner for the Press. You can reproduce in-copyright material from this newspaper for non-commercial use under a Creative Commons BY-NC-SA 3.0 New Zealand licence. This newspaper is not available for commercial use without the consent of Stuff Ltd. For advice on reproduction of out-of-copyright material from this newspaper, please refer to the Copyright guide.
Copyright in all Footrot Flats cartoons is owned by Diogenes Designs Ltd. The National Library has been granted permission to digitise these cartoons and make them available online as part of this digitised version of the Press. You can search, browse, and print Footrot Flats cartoons for research and personal study only. Permission must be obtained from Diogenes Designs Ltd for any other use.
Acknowledgements
This newspaper was digitised in partnership with Christchurch City Libraries.