Subject: AIDS: Spreading The Word About the Dangers Date: Published: 1/22/87 125 lines Source: Wall Street Journal. Copyright Dow Jones & Co. Inc. AIDS: Spreading The Word About the Dangers --- By J. D. Robinson In the U. S., acquired immune deficiency syndrome is spreading -- slowly, imperceptibly and inexorably. The calming of fears by public-health and government officials, as well as journalistic restraint, have been admirable in preventing panic, particularly regarding the risks of casual contact. However, it is extremely difficult to modulate public concern while simultaneously making it clear that many people -- heterosexuals as well as homosexuals, physical-fitness fanatics as well as intravenous drug users -- will have to voluntarily change their sexual habits. While there is energetic and ingenious research in progress with promising results, it cannot be assumed that a cure or vaccine will emerge within the next several years. For practical purposes, at this time the disease must be considered uniformly fatal. While avoiding alarmism, one must realize the profound consequences of erroneous judgment in this matter. Most carriers of the virus bear no distinguishing marks. While those who have overt signs of illness are not easily mistaken, it is the behavior of the apparently well that is responsible for most of the current transmission. New relationships are constantly being formed and consummated; but the semi-carefree days of easy intimacy are gone. Caution in sexual matters is now a matter of necessity. --- Though the spread of AIDS must be checked, mandatory testing, strict laws and quarantines are likely to be, at best, impractical and ineffective. Could we physically isolate those who test positive? Threaten them with arrest if they are sexually active? Mandated testing is a diversionary issue that would embroil the society in a series of civil-rights issues, be unlikely to have any major immediate impact on behavior, and be so cumbersome to execute as to be mostly ineffective. Quarantine would be largely useless, as there is no evidence for casual transmission, and would be divisive and impractical with close to 1.5 million people testing positive for the antibody already in the U. S. The means of control lie only at the individual level, for legislation of morality, sexual behavior and self-inflicted suffering have an undeniable history of failure. Risk of acquiring this disease depends largely on what you do and with whom. To break this chain of transmission, there must be a moratorium on new casual sexual relations as well as non-monogamous ones. Unfortunately, sex with a new person joins one's fate to that of an unknown number of prior partners, extending back over an indefinite period. Once sexual relations are much beyond the bounds of traditional cultural norms, it is very difficult for either partner to make a reliable judgment as to the complex matrix of prior sexual experience; taking a personal sexual history of a potential partner is an exercise in self-delusion. --- There remains considerable uncertainty as to what constitutes intimate contact. The virus is found in virtually all body fluids, albeit in smaller concentrations in some than in others; sexual contact inevitably involves the exchange of body fluids. Though condoms are a major preventive measure, it is impossible to evaluate the contagion from amorous and prolonged kissing. The majority of sexually active people are youthful and vigorous. As such, they normally have little sense of their own vulnerability. Taking seriously an invisible and imperceptible threat is particularly difficult; but as with life in general, the underlying reality continues to determine the course of events -- whether or not people acknowledge it. A major variable in predicting the magnitude of the problem is the percentage of those testing positive for the virus who will eventually go on to develop the disease. Current estimates range from 25% to 75% and, unfortunately, could be conservative. Studies of those who test positive for viral exposure but have no symptoms are showing a wide variety of sub-clinical immune deficiencies, demonstrable in the laboratory, increasingly severe as the time from exposure lengthens. --- Well-conducted studies in Africa are now demonstrating extraordinary levels of exposure in groups who could be characterized as at high risk only because they are sexually active and non-monogamous. In Lusaka, Zambia, the peak prevalence rate for the AIDS antibody in men, 32.9%, was found in those 30 to 35 years old. For women, the peak rate, of 24.4%, was in those aged 20 to 25. The background rate in people at no particular risk in the population studied was 9%. The African experience, where sexual orientation seems to be essentially irrelevant, has been consistently running numerically ahead of the U. S. However, were merely the 9% figure to be attained here, with 50% of those positive going on to develop the disease, we would be facing about nine million advanced cases of AIDS. The emotional, social and economic consequences are staggering to contemplate. Public and private health education is an overwhelming priority, and needs to be bold and aggressive in an unprecedented manner. Early efforts in this regard are under way; they must begin with pre-adolescents and continue through all adult age groups. Candor may be tempered with tact, but it cannot be diluted without grave consequences. Time is of the essence: With an indefinite incubation period, we need three to five years just to assess the damage to date -- and to care for those already positive and at risk. Historically, plagues have shaken human relations, religions, governments and economic institutions to their very foundations. The 20th century has yet to indemnify those who ignore grave threats to their own well-being. --- Dr. Robinson is a physician in Washington with a background in immunology. (This article is made available here by Dow Jones Co. for the personal and non-commercial use of callers to this bbs, in the hope that it will be of some help to those who are suffering from the disease and others who are seeking to help them.)