AIDS And YOU (May 1987)

By Martin H. Goodman MD
(this essay is in the public domain)
Introduction:
AIDS is a life and death issue. To have the AIDS disease is
at present a sentence of slow but inevitable death. I’ve already
lost one friend to AIDS. I may soon lose others. My own sexual
behavior and that of many of my friends has been profoundly
altered by it. In my part of the country, one man in 10 may
already be carrying the AIDS virus. While the figures may
currently be less in much of the rest of the country, this is
changing rapidly. There currently is neither a cure, nor even an
effective treatment, and no vaccine either. But there are things
that have been PROVEN immensely effective in slowing the spread
of this hideously lethal disease. In this essay I hope to
present this information.
History and Overview:
AIDS stands for Acquired Immune Defficiency Disease. It is
caused by a virus. The disease originated somewhere in Africa
about 20 years ago. There it first appeared as a mysterious
ailment afflicting primarily heterosexuals of both sexes. It
probably was spread especially fast by primarily female
prostitutes there. AIDS has already become a crisis of STAGGERING
proportions in parts of Africa. In Zaire, it is estimated that
over twenty percent of the adults currently carry the virus. That
figure is increasing. And what occurred there will, if no cure is
found, most likely occur here among heterosexual folks.
AIDS was first seen as a disease of gay males in this
country. This was a result of the fact that gay males in this
culture in the days before AIDS had an average of 200 to 400 new
sexual contacts per year. This figure was much higher than
common practice among heterosexual (straight) men or women. In
addition, it turned out that rectal sex was a particularly
effective way to transmit the disease, and rectal sex is a
common practice among gay males. For these reasons, the disease
spread in the gay male population of this country immensely more
quickly than in other populations. It became to be thought of as
a “gay disease”. Because the disease is spread primarily by
exposure of ones blood to infected blood or semen, I.V. drug
addicts who shared needles also soon were identified as an
affected group. As the AIDS epidemic began to affect increasingly
large fractions of those two populations (gay males and IV drug
abusers), many of the rest of this society looked on smugly, for
both populations tended to be despised by the “mainstream” of
society here.
But AIDS is also spread by heterosexual sex. In addition,
it is spread by blood transfusions. New born babies can acquire
the disease from infected mothers during pregnancy. Gradually
more and more “mainstream” folks got the disease. Most recently,
a member of congress died of the disease. Finally, even the
national news media began to join in the task of educating the
public to the notion that AIDS can affect everyone.
Basic medical research began to provide a few bits of
information, and some help. The virus causing the disease was
isolated and identified. The AIDS virus turned out to be a very
unusual sort of virus. Its genetic material was not DNA, but
RNA. When it infected human cells, it had its RNA direct the
synthesis of viral DNA. While RNA viruses are not that uncommon,
very few RNA viruses reproduce by setting up the flow of
information from RNA to DNA. Such reverse or “retro” flow of
information does not occur at all in any DNA virus or any other
living things. Hence, the virus was said to belong to the rare
group of virues called “Retro Viruses”. Research provided the
means to test donated blood for the presence of the antibodies
to the virus, astronomically reducing the chance of ones getting
AIDS from a blood transfusion. This was one of the first real
breakthroughs. The same discoveries that allowed us to make our
blood bank blood supply far safer also allowed us to be able to
tell (in most cases) whether one has been exposed to the AIDS
virus using a simple blood test.
The Types of AIDS Infection:
When the AIDS virus gets into a person’s body, the results
can be broken down into three general types of situations: AIDS
disease, ARC, and asymptomatic seropositive condition. The AIDS
disease is characterized by having one’s immune system devastated
by the AIDS virus. One is said to have the *disease* if one
contracts particular varieties (Pneumocystis, for example) of
pneumonia, or one of several particular varieties of otherwise
rare cancers (Kaposi’s Sarcoma, for example). This *disease* is
inevitably fatal. Death occurs often after many weeks or months
of expensive and painful hospital care. Most folks with the
disease can transmit it to others by sexual contact or other
exposure of an uninfected person’s blood to the blood or semen of
the infected person.
There is also a condition referred to as ARC (“Aids
Related Complex”). In this situation, one is infected with the
AIDS virus and one’s immune system is compromised, but not so
much so that one gets the (ultimately lethal) cancers or
pneumonias of the AIDS disease. One tends to be plagued by
frequent colds, enlarged lymph nodes, and the like. This
condition can go on for years. One is likely to be able to
infect others if one has ARC. Unfortunately, all those with ARC
are currently felt to eventually progress to getting the full
blown AIDS disease.
There are, however, many folks who have NO obvious signs
of disease what so ever, but when their blood serum is tested
they show positive evidence of having been exposed to the virus.
This is on the basis of the fact that antibodies to the AIDS
virus are found in their blood. Such “asymptomatic but
seropositive” folks may or may not carry enough virus to be
infectious. Most sadly, though, current research and experience
with the disease would seem to indicate that EVENTUALLY nearly
all folks who are seropostive will develop the full blown AIDS
disease. There is one ray of hope here: It may in some cases
take up to 15 years or more between one’s becoming seropositive
for the AIDS virus and one’s developing the disease. Thus, all
those millions (soon to be tens and hundreds of millions) who
are now seropositive for AIDS are under a sentence of death, but
a sentence that may not be carried out for one or two decades in
a significan fraction of cases. Medical research holds the
possibility of commuting that sentence, or reversing it.
There is one other fact that needs to be mentioned here
because it is highly significant in determining recommendations
for safe sexual conduct which will be discussed below:
Currently, it is felt that after exposure to the virus, most
folks will turn seropositive for it (develop a positive blood
test for it) within four months. It is currently felt that if
you are sexually exposed to a person with AIDS and do not become
seropositive within six months after that exposure, you will
never become seropositive as a result of that exposure.
Just to confuse the issue a little, there are a few folks
whose blood shows NO antibodies to the virus, but from whom live
virus has been cultured. Thus, if one is seronegative, it is not
absolute proof one is not exposed to the virus. This category of
folks is very hard to test for, and currently felt to be quite
rare. Some even speculate that such folks may be rare examples
of those who are immune to the effects of the virus, but this
remains speculation. It is not known if such folks can also
transmit the virus.
Transmission of AIDS:
The AIDS virus is extremely fragile, and is killed by
exposure to mild detergents or to chlorox, among other things.
AIDS itself may be transmitted by actual virus particles, or by
the transmission of living human CELLS that contain AIDS viral
DNA already grafted onto the human DNA. Or both. Which of these
two mechanisms is the main one is not known as I write this
essay. But the fact remains that it is VERY hard to catch AIDS
unless one engages in certain specific activities.
What will NOT transmit AIDS?
Casual contact (shaking hands, hugging, sharing tools)
cannot transmit AIDS. Although live virus has been recovered
from saliva of AIDS patients, the techniques used to do this
involved concentrating the virus to extents many thousands of
times greater than occurs in normal human contact, such as
kissing (including “deep” or “French” kissing). Thus, there
remains no solid evidence that even “deep” kissing can transmit
AIDS. Similarly, there is no evidence that sharing food or
eating utensils with an AIDS patient can transmit the virus. The
same is true for transmission by sneezing or coughing. There just
is no current evidence that the disease can be transmitted that
way. The same may be true even for BITING,though here there may
be some increased (though still remote) chance of transmitting
the disease.
The above is very important. It means that there is NO
medical reason WHAT SO EVER to recommend that AIDS suffers or
AIDS antibody positive folks be quarrantined. Such
recommendations are motivated either by ignorance or by sinister
desires to set up concentration camps. Combined with the fact
that the disease is already well established in this ountry,
the above also means that there is no rational medical basis for
immigration laws preventing visits by AIDS suffers or antibody
positive persons.
The above also means that friends and family and coworkers
of AIDS patients and seropostive persons have nothing to fear
from such casual contact. There is no reason to not show your
love or concern for a friend with AIDS by embracing the person.
Indeed, there appears still to be NO rational basis for
excluding AIDS suffers from food preparation activity. Even if
an AIDS suffer cuts his or her finger and bleeds into the salad
or soup, most of the cells and virus will die, in most cases,
before the food is consumed. In addition, it is extremely
difficult to get successfully attacked by AIDS via stuff you
eat.
AIDS cannot be transmitted by the act of GIVING blood to a
blood bank. All equipment used for such blood donation is
sterile, and is used just once, and then discarded.
How is AIDS transmitted?
Sexual activity is one of the primary ways AIDS is
transmitted. AIDS is transmitted particulary by the transmission
of blood or semen of an infected person into contact with the
blood of an uninfected person. Sex involving penetration of the
penis into either the vagina of a woman or the rectum of either
a woman or a man has a very high risk of transmitting the
disease. It is felt to be about four times MORE likely for an
infected male to transmit AIDS to an uninfected woman in the
course of vaginal sex than it is likely for an infected woman to
transmit AIDS to an uninfected male. This probably relates to
the greater area of moist tissue in a woman’s vagina, and to the
relative liklihood of microscopic tears to occur in that tissue
during sex. But the bottom line is that AIDS can be transmitted
in EITHER direction in the case of heterosexual sex.
Transmission among lesbians (homosexual females) is rare.
Oral sex is an extremely common form of sexual activity
among both gay and straight folks. Such activity involves
contact of infected semen or vaginal secretions with the mouth,
esophagus (the tube that connects the mouth with the stomach)
and the stomach. AIDS virus and infected cells most certainly
cannot survive the acid environment of the stomach. Yet, it is
still felt that there is a chance of catching the disease by
having oral sex with an infected person. The chance is probably
a lot smaller than in the case of vaginal or rectal sex, but is
still felt to be significant.
As mentioned above, AIDS is also transmitted among
intravenous drug users by the sharing of needles. Self righteous
attitudes by the political “leaders” of this country at local,
state, and national levels have repeatedly prevented the very
rational approach of providing free access to sterile
intravenous equipment for IV drug users. This measure, when
taken promptly in Amsterdam, was proven to greatly and
SIGNIFICANTLY slow the spread of the virus in that population.
The best that rational medical workers have succeeded in doing
here in San Francisco is distribute educational leaflets and
cartoons to the I.V. drug abusing population instructing them in
the necessity of their rinsing their “works” with chlorox before
reusing the same needle in another person. Note that even if you
don’t care what happens to I.V. drug abusers, the increase in the
number of folks carrying the virus ultimately endangers ALL
living persons. Thus, the issue is NOT what you morally think of
I.V. drug addicts, but one of what is the most rational way to
slow the spread of AIDS in all populations.
Testing of donated blood for AIDS has massivly reduced the
chance of catching AIDS from blood transfusions. But a very
small risk still remains. To further reduce that risk, efforts
have been made to use “autotransfusions” in cases of “elective
surgery” (surgery that can be planned months in advance).
Autotransfusion involves the patient storing their own blood a
couple of weeks prior to their own surgery, to be used during
the surgery if needed. Similary, setting up donations of blood
from friends and family known to be antibody negative and at low
risk for AIDS prior to schedualed surgery further can decrease
the already small risks from transfusion.
AIDS and SEX: What are the rational options?
The “sexual revolution” of the 1960’s has been stopped
dead in its tracks by the AIDS epidemic. The danger of
contracting AIDS is so real now that it has massively affected
the behavior of both gay and straight folks who formerly had
elected to lead an active sexual life that included numerous new
sexual contacts.
Abstinence
The safest option regarding AIDS and sex is total
abstinence from all sexual contact. For those who prefer to
indulge in sexual contact, this is often far too great a
sacrifice. But it IS an option to be considered.
Safe Sex
For those who wish to have sexual contact with folks on a
relatively casual basis, there have been devised rules for “safe
sex”. These rules are very strict, and will be found quite
objectionable by most of us who have previously enjoyed
unrestricted sex. But to violate these rules is to risk
unusually horrible death. Once one gets used to them, tho, the
rule for “safe sex” do allow for quite acceptable sexual
enjoyment in most cases.
For those who wish to indulge in pentration of the vagina
or rectum by a penis: The penis MUST be sheathed in a condom or
“rubber”. This must be done “religiously”, and NO exceptions are
allowed. A condom must be used by a man even when he is
receiving oral sex. Cunnilingus (oral stimulation of a womans
gentitals by the mouth of a lover) is NOT considerd to be safe
sex. Safe sex includes mutual masturbation, and the stimultion
of one genitals by another’s hand (provided there are no cuts in
the skin on that hand). But manual stimulation of another’s
genitals is NOT safe if one has cuts on one’s hands, unless one
is wearing a glove.
Note that even when one is conscientiously following the
recommendations for safe sex, accidents can happen. Condoms can
break. One may have small cuts or tears in ones skin that one is
unaware of. Thus, following rules for “safe sex” does NOT
guarantee that one will not get AIDS. It does, however, greatly
reduce the chances. There are many examples of sexaully active
couples where one member has AIDS disease and the other remains
seronegative even after many months of safe sex with the
diseased person. It is particularly encouraging to note that,
due to education programs among San Francisco gay males, the
incidence of new cases of AIDS infection among that high risk
group has dropped massively. Between practice of safe sex and a
significant reduction in the number of casual sexual contacts,
the spread of AIDS is being massively slowed in that group.
Similar responsible action MUST be taken by straight folks to
further slow the spread of AIDS, to give our researchers time to
find the means to fight it.
Monogamy
For those who would have sexual activity, the safest
approach in this age of AIDS is monogamous sex. Specifically,
both parties in a couple must commit themselves to not having
sex with anyone else. At that time they should take AIDS
antibody tests. If the tests are negative for both, they must
practice safe sex until both members of the couple have been
greater than six months since sexual contact with anyone else.
At that time the AIDS blood test is repeated. If both tests
remain negative six months after one’s last sexual contact with
any other party, current feeling is that it is now safe to have
“unprotected” sex. Note that this approach is recommended
especially for those who wish to have children, to prevent the
chance of having a child be born infected with AIDS, getting it
from an infected mother. Note also that this approach can be
used by groups of three or more people, but it must be adhered
to VERY strictly.
What to AVOID:
Unscrupulous folks have begun to sell the idea that one
should pay to take an AIDS antibody test, then carry an ID card
that certifies one as AIDS antibody negative, as a ticket to
being acceptable in a singles bar. This is criminal greed and
stupidity. First, one can turn antibody positive at any time.
Even WEEKLY testing will not pick this change up soon enough to
prevent folks certified as “negative” from turning positive
between tests. Much worse, such cards are either directly or
implicitly promoted as a SUBSTITUTE for “safe sex” practices.
This can only hasten the spread of the disease.
If you want to learn your antibody status, be sure to do
so ANONYMOUSLY. Do NOT get the test done by any agency that
requires your real name, address, or any other identifying
information. Fortunately, in San Francisco, there is a public
place to get AIDS antibody testing where you may identify
yourself only as a number. Tho that place has a three month long
waiting list for testing, there are other private clinics where
one may have the test done for cash, and may leave any false
name one wishes. The reason I suggest this is that currently
there are some very inappropriate reactions by government and
business to folks known to be antibody positive. Protect
yourself from such potential persection by preventing your
antibody status from being a matter of record. That information
is for you, your lover(s), and (if need be) your physician. And
for NO one else.
There currently is NO treatment for AIDS (this includes
AZT) that shows significant promise.
In Conclusion:
It is my own strongly held view, and that of the medical
and research community world wide, that the AIDS epidemic is a
serious problem, with the potential to become the worst plague
this species has ever known. This is SERIOUS business. VASTLY
greater sums should be spent on searching for treatments and
vaccines. On the other hand, we feel strongly that this is
“merely” a disease, not an act by a supernatural power. And
while it does not seem likely we will find either a cure or a
vaccine in the forseeable future, it may be that truly effective
treatments that can indefinitely prolong the life of AIDS
victims may be found in the next few years. When science and
technology do finally fully conquer AIDS, we can go back to
deciding what sort and how much sex to have with who ever we
choose on the basis of our own personal choice, and not by the
coercion of a speck of proteins and RNA. May that time come
soon. In the mean time, we must all do what we can to slow the
spread of this killer. This article is intended to help
accomplish that. Please circulate it as widely as possible.