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Reprinted from Details Magazine, March 2004
Whatever Happened to AIDS and Straight Men?
By Kevin Gray
“Health officials have known this for years, but the
politically incorrect truth is rarely spoken out loud: The dreaded
heterosexual epidemic never happened. The result is a conspiracy
of silence. And it’s not in anybody’s interest to clear
this up.”
===
In 1987, America was obsessed with sex. On the radio, the average
high school rocker heard the command to “push it” and
eagerly obliged. On Friday nights he put on acid washed jeans and
took his date to see Glenn Close boil rabbit. He received stud lessons
from a beer-guzzling, model nailing pooch named Spuds Mackenzie.
He channel-surfed in parachute pants and saw Jessica Hahn bring
televangelist Jim Baker to his knees. In between, he found TV’s
first ever condom ads. Yes, sir, sex was on his mind. And it was
about to turn deadly.
That fall, federal health officials sounded a terrifying alarm:
AIDS could kill anyone. For six years we had known that the disease
was stalking America’s gay men and intravenous-drug users.
It deposited purple blotches on their skin, sent their minds into
spirals of dementia, reduced their bodies to withered skeletons.
Our high-schooler had heard about it but he didn’t give it
much thought. Like most of America, he vaguely worried that he might
catch it from a toilet seat, a sneeze, or a handshake. But it didn’t
truly…concern him.
Until the panic landed with a thump at newsstands. Stacks of U.S.
News & World Report heralded “the dawn of fear,”
telling him “The disease of them suddenly is the disease of
us.” AIDS, it seemed, was spreading through the heterosexual
population—through straight sex!—at a fearsome rate
that health experts likened to the Black Plague. Surgeon General
C. Everett Koop called it “the biggest threat to health this
nation has ever faced.”
Suddenly, wherever our kid turned—MTV, Time Magazine—he
saw a parade of walking dead, people who looked and talked like
him, grimly recounting one-night-stand horror stories. The message:
Whether you’re a Berkeley co-ed or a Portland plumber, plain
old vanilla intercourse can kill you. And in case he still didn’t
get it, from daytime TV came a voice so grave, so full of maternal
concern, it stopped him dead in his Reeboks. “Aids has both
sexes running scared,” Oprah Winfrey said. “Research
studies now project that one in five--listen to me, hard to believe—one
in five heterosexuals could be dead from AIDS at the end of the
next three years…believe me.”
The idea was staggering: Nearly 44 million people dead in less time
than it takes tofinish college. AIDS anxiety suddenly gripped the
country. Our young guy recalled last Saturday’s bar pick up,
a buddy’s too easy sister, even his new girlfriend. How well
did he know her? Some mornings he saw, or thought he saw, a red
rash spreading across his flesh (hadn’t it just been a vigorous
romp?) and bolted to the nearest clinic for a blood test, joining
a brotherhood that doctors called “the worried well.”
Sex was no longer just a game; it was Russian roulette.
Since doctors first reported the outbreak of a mysterious new disease
in 1981, an estimated 900,000 Americans have been diagnosed with
AIDS. Nearly half of them were men who had sex with other men, 27
percent were IV-drug users, and another 7 percent were both. But
the politically incorrect truth is rarely spoken out loud: The dreaded
heterosexual epidemic never happened.
Straight men and women make up 90 percent of the population, but
they account for only 15 percent of non-childhood AIDS cases. Only
6 percent of men with AIDS, the Centers for Disease Control and
Prevention says, contracted the virus from straight sex. And even
that figure doesn't hold up to a closer look. Several studies now
suggest that most men who claim they got the virus this way are
lying. They got it from sex with other men or sharing needles with
addicts. Those studies also show that many women listed in the straight-sex
category are either IV-drug users themselves or have likely contracted
AIDS from sex with an IV drug user.
Health officials have known these things for years. A growing pile
of federally funded reports on HIV transmission, published over
the past decade and available to anyone who has the time to read
them, shows that men almost never get HIV from women. In fact,
according to a 1998 study in the Journal of the American Medical
Association, a disease-free man who has an unprotected one-nighter
with a drug-free woman stands a one in 5 million chance of getting
HIV. If he wears a condom, it’s one in 50 million. He’s
more likely to be struck by lightning (one in 7000,000).
Female to male transmission is very inefficient, says Dr. Nancy
Padian a professor in the department of obstetrics, gynecology and
reproductive science at the University of California, San Francisco
and the author of a 1996 10 year study of HIV infected heterosexual
couples, the nation's longest and largest. She points out that “its
two to three times easier for men to infect women.” But even
so, if there are no other risk factors involved, the rate at which
an infected man will transmit the virus to a woman is one in 1,100
sex acts.
Today it’s clear that the AIDS epidemic in the United States
peaked in 1993 when 106.000 new cases turned up [A & W note:
The 106,00 new cases referred to above were added by reclassifying
past and present HIV positives under an expanded definition of AIDS
instituted in 1993. This broadened definition included more types
of pneumonia, women with cervical cancer, and the non-illness criteria
of a lab test of 200 or less T cells that has since been the determining
factor for an AIDS diagnosis in at least 50% of all new cases. AIDS
cases had actually leveled off by 1992 and increased only due to
the expanded definition, a fact omitted from this article]. Then
it began a slow decline and has now leveled off to 40,000 new cases
a year. Thanks to powerful anti-retroviral drugs that allow HIV-infected
people to live longer, AIDS deaths have plummeted 14 percent since
1998, falling in 2002 to a new low of 16,371.
[A & W note: The figure cited above of 40,000 new AIDS cases
a year is an error. Rather, official estimates claim there are 40,000
new HIV infections annually in the US. The notion there are 40,000
new HIV positives each year however is derived from an unsubstantiated
estimate and calculated by dividing the high end total of estimated
HIV positive Americans (around 900,000) by the number of “AIDS
years” (around 20). Also, the “powerful new AIDS drugs”
thought to be responsible for decreased deaths were introduced in
1996, not 1998 as the articles states, which is a year after AIDS
deaths had already peaked. Futher, there is still no published data
in the mainstream medical literature showing that these new drugs
increase life expectancy, improve clinical health, or prevent the
illnesses associated with AIDS. And no AIDS drug since 1986 has
ever been tested against a true placebo control.]
Clearly, a single death from this illness is one too many. But AIDS
is not killing Americans at the levels of cancer (554,000 deaths
in 2001), diabetes (71,000), or Alzheimer’s (54,000). In fact,
the CDC has not put the disease on its list of the top 15 killers
since 1998.
America may be winning the war on AIDS, but not without collateral
damage. After two decades, we are still overwhelmed with misinformation
and misconceptions about how the virus spreads. Straight men are
still haunted by the notion that old-fashioned sex can be lethal.
Among the biggest fear factors, some AIDS educators say, is shoddy
federal health data. The CDC statistics are only good as the local
health departments that gather them. But many of those departments
don’t have time or resources for “surveillance”
staff to investigate every person’s claim of how they contracted
the virus. If a man wants to lie about having had sex with other
men, he can, and that makes it look like more people get AIDS from
straight sex than really do. By re-interviewing victims, their doctors,
and their families, Chicagohealth officials found in 1997 that in
85% of the cases the city had blamed on heterosexual transmission,
other risk factors were present. This phenomenon became a source
of black humor at New York City’s overworked health department
in the late eighties. “What do you call a man who got HIV
from his girlfriend?” the joke went. “A liar.”
The truth is out there, but its not reaching people who have been
needlessly scared—the result, some critics charge, of a conspiracy
of silence. “It’s not in anybody’s interest to
clear this up,” says Joseph Sonnabend, a physician who treated
some of New York City’s first AIDS cases. Sonnabend, helped
found what later became the American Foundation for AIDS Research
(AmFAR), But he quit the group in the mid-eighties when it claimed—falsely,
he believed—that a heterosexual epidemic could be coming.
“Gay men don’t want it fixed because they’ll be
blamed again for the disease,” Sonnabend says. “Charities
like AmFAR don’t want it fixed because they’ll lose
their funding. And “straight” men with HIV certainly
don’t want it fixed because then everybody will know they’ve
been having sex with men. Those are the ones who will scream bloody
murder if you print all this stuff. You’re outing the poor
bastards.”
Any overhaul in America’s AIDS policies has to begin with
an overhaul of public perception away from the anyone-can-get-AIDS
mentality. That means looking at the cultural forces that originally
shaped that perception and continue to do so today. Many scientists
now say that the first major public awareness program, 1987’s
America Responds to AIDS campaign, was not only largely wasted on
mainstream America but deadly to those most at risk, drawing precious
funds from the very people AIDS was attacking: gays, bisexuals,
drug addicts, and the poor.
Certainly the horizons of the AIDS epidemic were less clear in 1987.
“With diseases like this you’re working with a moving
target,” says Walter Dowdle, who helped start the CDC’s
anti-AIDS office. “We knew the groups hardest hit were gay
men and drug addicts. But we didn’t have a lot of information
about heterosexual spread.”
Nevertheless, by 1987 the CDC knew that vaginal intercourse was
an extremely inefficient way of transmitting the virus. The agency
had already produced research that showed the widespread fears of
contagion were exaggerated. Less than two months before it launched
its AIDS campaign, the CDC’s epidemiology chief, Harold Jaffe,
publicly criticized the everyone-gets-AIDS message, noting the risk
to straight America was “very small.”
“People would talk about the hypothetical housewife in Des
Moines,” says Jaffe, now the director of the CDC’s AIDS-prevention
program. “Was she at risk? The answer was ‘not really,’
unless her husband happened to be a drug user or a bisexual.”
In trying to address groups at risk—gay men and drug addicts—the
CDC’s Dowdle had already run into political and cultural roadblocks.
Broadcasters refused to carry announcements advocating condom use.
Ronald Regan remained infamously silent of AIDS almost until the
end of his presidency, and moral objections led his White House
to quash the publication of a 1986 brochure prepared by the CDC
that touted condoms. “We were getting virtually nowhere with
the Regan administration,” Dowdle says. “They paid no
attention to it at all.”
Congress, though, had become increasingly alarmed by the CDC’s
reports loudly disseminated by gay activists and charity groups
like AmFAR that AIDS was killing off straight Americans. In 1987,
Congress ordered the CDC to send out a nationwide mailing to educate
Americans about the dangers of AIDS.
Dowdle, who was put in charge of this mission, knew that mainstream
America cared little for the plight of drug addicts, prostitutes,
and homosexuals. William F. Buckley Jr. had suggested that anyone
with HIV be tattooed to protect the healthy. Liberace died of the
disease without ever admitting he had it. When Americans were asked
by Gallup pollsters if AIDS was God’s punishment for immoral
behavior, 43 percent of the respondents said yes.
There was only one way to make all Americans concerned about AIDS:
Put out the word that the disease was an equal-opportunity killer,
one that could get your best friend or your mom. Otherwise, straight
America would never support the kind of funding desperately needed
for research and care. “Only by democratizing the epidemic,”
says Dr. Ronald Bayer, a professor of public health at a Columbia
university, “by saying we’re all equally at risk, would
anyone pay attention.”
To do this, the CDC needed professional help. After putting a $27
million campaign out to bid, it hired one of the nations largest
ad agencies, Ogilvy & Mather, and specifically the services
of a bright 32-year-old ad man named Steve Rabin, who headed the
agencies health unit in Washington, D.C. Rabin, an openly gay man
who had seen friends die of AIDS, held 20 focus groups around the
country that August and found that nearly all Americans—straight
and gay—thought of AIDS as someone else’s problem. He
knew, and his CDC bosses agreed, that they had to underscore the
universality of AIDS to make it a public-health priority.
That fall, Rabin shot a series of 38 TV spots, many of which featured
men and women with AIDS. They were not identified as gay or as IV-drug
users, and the ads addressed their high-risk activities only in
veiled ways. During the filming, one young man, the son of a Baptist
minister, looked into the camera and said, “If I can get AIDS,
anyone can.” The line was an unscripted surprise, and it became
the unofficial slogan for the campaign—the TV spots, along
with eight radio announcements and six print ads, all of which made
a personal, heartfelt appeal to Americans to talk to their family
about AIDS. What the CDC knew, but kept from the public, was that
the young man was gay. Instead he was presented as an equal-opportunity
victim—a preacher’s son!—of the burgeoning pandemic.
In July 1988, the CDC mailed its “Understanding AIDS”
brochure to 126 million American Households. Coming from C. Everett
Koop’s desk, it finally used the frank language activists
had sought, talking about anal sex and discussing the use of condoms
and lubricants (even warning against items like Crisco because they
break down the latex in condoms).
But despite the plain talk, the brochure still blurred the line
between mainstream Americans and those who were at high risk. A
middle aged blonde stared out from one page, telling those Des Moines
housewives and Dallas freshmen that AIDS is not a “they”
disease, it’s an “us” disease.” What the
brochure didn’t mention was that she was an IV-drug user.
The media heard the alarm and dispatched its legions of camera crews
and producers. The three major networks ran graphic coverage of
the brochures on their nightly newscasts. “We jokingly called
it the anal-sex triple crown,” Rabin says, noting it was the
first time that these words had been uttered on national TV. The
campaign, along with the media coverage, transformed AIDS from “the
gay cancer” into a mainstream obsession.
The vision of a heterosexual plague fit nicely with the goals of
two other camps, which agreed on almost nothing else: The gay left,
which saw it as the only way to make straight America pay attention,
and the Christian right, which found in it a powerful weapon to
beat back the sexual revolution. If sex-crazed Americans couldn’t
be shamed into chastity and monogamy, by God, they could be scared
into it. This was a message that a nation hung over from the binges
of the sixties and seventies was ready to hear.
“I used to say we were like the body of a bird being beaten
to death by the left and right wing,” says James Currin, who
was head of the CDC’s AIDS program at the time and is now
dean of Emory University’s Rollins School of Public Health.
“The gay community had its civil-rights agenda and people
on the right had a political, traditional-values agenda.”
As a result, in the public mind AIDS was now swiftly spreading through
the entire population.
A decade and a half has passed, but that belief hasn’t gone
away. Indeed, it has been pushed by health experts urging condom
use to protect against all STDs, by feminists seeking to make men
more responsible for their sexual behavior, by TV news shows looking
for scare ratings, and by a national hunger for innocent victims.
How could anyone imagine that God was punishing Ryan White, the
13 year old who contracted HIV from a tainted blood-clotting agent
in 1984 and died in 1990? White’s specter continues to haunt
the AIDS landscape. Though HIV was virtually wiped out from the
nation’s blood supply by 1985, the Ryan White National Youth
Conference attracts more than 600 people each year to such uncontroversial
workshops as HIV prevention through the arts.
Heterosexual AIDS even acquired a celebrity spokesman in 1991 when
Magic Johnson announced that he had contracted HIV through promiscuous
sex with women. Activists trotted him out to warn America of the
AIDS boogyman lurking at the foot of the bed, a role he still serves
today (Johnson did not respond to several interview requests). Meanwhile,
red ribbons flutter down red carpets. The paparazzi regularly shoot
Liz Taylor and Liz Hurley, Macy Gray and Tim Robbins heading into
the latest AmFAR fund-raiser in Cannes to net another million at
events sponsored by Volkswagen and De Beers.
But more than any other force, television news, that bastion of
American skepticism and objectivity, has fanned the heterosexual
panic from the start. One 1992 study found that the AIDS victims
shown on the nightly news were almost never gay men or IV-drug users,
despite the overwhelmingly greater incidence of the disease in those
groups. The disparity, says Michael Fumento, a conservative science
writer and former AIDS analyst for the U.S. Commission on Civil
Rights, is the fault of journalistic “crusaders,” reporters
who peddle sentiment rather than skepticism, cherry picking victims
who look like the viewers. Media outlets boost ratings by keeping
us glued to the tube out of terror, and along the way they reinforce
the idea that we are all equally at risk.
“It’s the same thing with the SARS hysteria,”
says Fumento, a debunking specialist who wrote the controversial
1990 book The Myth of Heterosexual AIDS. “Scientists said
over a million people could die. CNN claimed it could overwhelm
the US hospital system. Not a single American died. The media likes
a good story and it doesn’t understand its own limitations.
It doesn’t look under the rug.”
For all its lethal impact, HIV is a weak virus. Left at room temperature
for a week, it has only a 10% chance of survival. Simple cleansers,
such as dish soap, can kill it. Unlike herpes and gonorrhea, which
can be contracted through genital contact, HIV is transmitted when
blood or semen makes its way into tears in the mucus membranes or
the skin. STDs that cause open sores help HIV enter the body: such
concurrent infections are now understood to be crucial in spreading
AIDS.
AIDS works like this: HIV, the human immunodeficiency virus, attaches
itself to lymphocytes, including T4 cells, which are responsible
for calling other immune cells into action during an infection.
The virus then starts incubating inside the host cell, avoiding
detection by patrolling antibodies. During this time, which can
last a decade, the virus is dormant but can be transferred to other
people through these infected T4 cells.
The question of what triggers an HIV infection to become AIDS is
controversial. What is known is that at some point, the virus replicates
by taking over the T4 cells, doubling its numbers every 12 hours.
Eventually, such work in the service of its enemy exhausts the T4
cell and it dies like an overworked motor. With its T cells devastated,
the immune system breaks down, leaving the body vulnerable to the
opportunistic cancers and infections that typify AIDS. One such
cancer, Kaposi’s sarcoma, ravages such internal organs as
the lymph nodes, brain, lungs, and digestive tract.
But if HIV can’t reach the lymphocytes, there’s no infection.
This is why it’s so hard to contract the virus through old-fashioned
vaginal sex. The vagina is a rugged structure, built to withstand
everything from a thrusting penis to the passage a baby's head during
childbirth. Its walls are muscular, covered by a thick layer of
epithelial cells that resist tearing and that secrete a lubricating
mucus that contains enzymes for fighting off bacteria. Its blood
vessels run well below the surface, barring HIV from direct contact
with the blood and thus from the lymphocytes
“The vagina is an organ that is essentially designed to prevent
abrasion,” says Robert Root-Bernstein, a professor of physiology
at Michigan State University and recipient of a MacArthur Genius
Fellowship. “The blood vessels are buried quite deep, so there
are no lymph nodes present. It's very difficult to get anything
vaginally into the blood.”
The rectum, on the other hand, offers almost no protection. It is
lined with extremely thin tissue, no thinner than a lambskin condom,
and can easily tear. It is part of the lower intestine, which has
evolved to perform one major task—uptake nutrients and water
from your bowels into your circulatory system—and so it is
intertwined with capillaries. To keep out the bacteria that thrive
in the colon, half your immune system surrounds your gut in the
form of lymph nodes whose sole job it is to monitor the water and
nutrients re-entering the body.
The rectum has no mucus-secreting cells to help ease the passage
of a penis. The subsequent tearing in the cell walls (which lubricants
do little to prevent) offers HIV-carrying ejaculate easy access
to lymphocytes that cluster just beneath the surface. From there
HIV enters the bloodstream. Dildos, sometimes used before such penetration,
do further damage and increase the likelihood of transmission, as
do hemorrhoids. A constant hazard of anal sex, hemorrhoids can rupture
and bleed, providing the virus with another gateway the bloodstream.
Semen also has enzymes that help it bore through these cell walls,
even in the absence of tearing. (Anal intercourse is far less risky
for the active partner)
Interestingly, for healthy men and women, oral sex carries practically
no risk of infection. Enzymes in saliva attack and deactivate many
types of bacteria and viruses. Even those infectious agents that
pass this first line of defense are typically destroyed by stomach
acids. When semen is swallowed, those gastric juices reduce it to
little more than its chemical components, and it largely gets digested
as simple protein.
In all three types of sexual activities—vaginal, anal, oral—things
get more complicated when other sexually transmitted diseases are
present. Those that cause open sores such as syphilis, chlamydia,
gonorrhea, and herpes, increase the chances of both contracting
and spreading HIV. If there’s a syphilitic sore on the penis,
and army of blood vessels grow around it to bring lymphocytes to
the area and eliminate the infection. Not only does HIV get an open
door to stroll right in, it also gets an inviting welcome from the
lymphocytes, which it clings to like a grateful party crasher.
A healthy man or woman with no STDs and few activated T cells is
highly unlikely to contract HIV even if exposed to it through oral
or vaginal intercourse (of course anal sex can be just as deadly
for a woman as it is for a gay man). Without activated T cells to
invade, the virus will normally die.
“You need these other diseases in order to transmit HIV vaginally,”
says Donald Capra, an immunologist at Oklahoma Medical Research
Foundation, who was among the first to publicly question the exaggerated
heterosexual HIV figures. “To the extent that American men
have STDs, they also have access to health care. So it’s extraordinarily
rare for them to have untreated venereal disease. A woman with herpes
gets Valtrex. A guy with gonorrhea gets penicillin. While there
is certainly the young lady who meets a guy, has sex and gets AIDS,
and makes the front pages of the newspaper, that’s an exceedingly
rare event.”
Because HIV is so hard to transmit, it hasn’t spread with
the Black Plague ferocity predicted by Oprah and others in the eighties.
The news, however, isn’t good for everyone. Among those who
were always the highest risk for infectio—gay men, bisexuals,
IV-drug users, and their sex partners—AIDS is making a stealthy
comeback. A large part of the blame falls on the misguided notion
that AIDS is now a “manageable” disease, thanks to powerful
drug cocktails that stave off its progression and steroids that
make victims appear healthy. But an equal part can be pinned directly
on all the fear-mongering about heterosexual AIDS. By emphasizing
the universality of AIDS—a message fueled by government warnings,
celebrity crusaders, and a crisis-craving media—and paying
for awareness programs at wealthy college campuses, the country
has diverted precious funds from those who need them the most. The
Bush administration, experts charge, will only hurt matters if it
succeeds in increasing the $100 million already spent on abstinence-only
sex education. This program, favored in Bush’s home state
of Texas, bans discussion of the dangers of specific sex acts and
the effectiveness of condoms.
In parts of the third world, AIDS has, in fact, exploded among heterosexuals.
But it has taken hold only in some regions, and among people whose
immune systems are already crippled. For instance, the African epidemic
is largely confined to the sub-Sahara, where malnutrition, poor
health care, and such diseases as malaria and tuberculosis are rampant.
In addition, because of their country’s history of apartheid,
many South Africans live and labor in squalid camps hundreds of
miles from their homes. There, men with untreated STDs will often
have sex with HIV infected prostitutes, contract the virus themselves,
and bring it home to their wives, who, when they get pregnant, pass
it along to their children. (Rural China, where similar conditions
exist, is also suffering.) Oprah and Bono have lured TV crews to
blighted African villages where the heterosexual epidemic is real.
Viewers at home are left with the impression that AIDS—always
the equal opportunity killer—could yet make its way into their
own bed if they’re not careful.
HIV has indeed crept into American bedrooms, but only those within
pockets of poverty, malnutrition, and poor health care. It has become
“ghettoized,” and is spreading fastest among black and
Hispanic men (some of them hiding their bisexuality) and black women.
The CDC duly reports these facts, but in media coverage the behaviors
that put people at risk are glossed over.
Many of the new cases involving black women are simply blamed on
heterosexual contact. But it turns out that a number of these infected
women have resorted to prostitution to make ends meet. That means
they are having unprotected sex, often anal sex, with needle-sharing
drug users, and are likely using drugs themselves. But when the
New York Times tells us in a front-page story on July 3, 2001, that
HIV is taking a toll on rural black women via heterosexual sex,
we have to wait until the 36th paragraph to learn that they are
turning tricks.
“These are not women who stand on a street corner. They go
out when they need drugs,” says Root-Bernstein, who wrote
the 1999 book Rethinking AIDS: The Tragic Cost of Premature Consensus.
“They’ll go to a crack house and basically bend over
and let anybody do whatever they want to for 2 hours. And the men
who are having sex with them will have anal sex because they can
do it there and they can’t get it elsewhere, so why not? And
when you’re high you don’t care, either. So now we have
behaviors that maybe they don’t want to admit to.”
Not only are such behaviors hidden from mainstream America, but
the disease itself is beginning to disappear into these crack houses
and poverty shacks, just as a 1993 National Research Council report
predicted. At this time, the NRC said that the United States would
remain largely untouched by AIDS, while those most affected would
continue to be “socially invisible” and “beyond…the
attention of the majority population.” That warning “provoked
howls of protest,” says Ronald Bayer, the Columbia professor
who sat on the NRC panel that wrote the report. “People said
we’d have blood on our hands.” Critics charged that
the NRC’s message would cause the government to “neglect
the places where AIDS might occur,” Bayer says. In fact, the
opposite has happened: The places that have been neglected are precisely
those that have been most devastated.
The CDC, acknowledging that prevention efforts have stalled, announced
last year that it would focus more money and energy on people already
carrying HIV in effect, shifting to them the burden of stopping
the virus’s spread. By diverting $42 million in funding, the
move threatens to dismantle, or at least cut the budgets of 211
community-based groups, most of which serve at-risk minority communities.
Among programs that would be affected are workshops that target
urban teens, those that teach safe sex in San Francisco’s
Mission district, and a counseling program for poor black women
in Baltimore where syphilis rates are skyrocketing. Critics say
the move is a dangerous shift away from proven prevention methods;
one black AIDS activist said the policy was “Insane and, I
feel, genocidal.”
“The CDC’s message is to get tested and know your status,”
says Dr. Judy Auerbach, AmFAR’s vice president for public
policy. “But that message is not focused explicitly on the
traditional at-risk groups. It’s much more generic, and so
you could argue that it’s not reaching the people it needs
to.”
To this day, anyone who talks honestly about the true risks of HIV
among heterosexuals is asking for the same attacks the NRC report
ignited. The most vocal opponents are often those with political
agendas or those with the most to lose. “The right wingers
like the heterosexual message because it is pro-family and warns
against extramarital affairs,” says Michelle Cochrane, a visiting
scholar at the University of California, Berkeley, and author of
When AIDS Began, a recent book that examines some early scientific
and cultural misunderstandings of the disease. “Gay men like
it because it keeps people aware and keeps funds coming in. And
the feminists like it because it gets condoms on the guys and forces
them to take greater sexual responsibility.”
It is true that AID does not discriminate: anyone can get it. But
not everyone is at equal risk. AIDS is an opportunistic disease
in every sense. Not only does it attack the human body at its weakest
points; it infects the social body in the same way. AIDS hits hardest
where social institutions, such as health-care facilities and drug
treatment programs, are most scarce—among the poor and disenfranchised.
As the disease continues to kill Americans, it will not cut across
class, racial, or ethnic lines. Instead it will target those who,
as the NRC report noted, “have little economic, political
and social power.” This will be the ultimate cost of an AIDS
policy that emphasizes moral instruction and abstinence over accurate
education about the real risks.
“If you want to stop heterosexual transmission, you focus
on poor ghetto communities because that ‘s where it is, among
the drug users,” Bayer says. “Your not going to stop
AIDS by spending money where it is non-existent.”
Increasing numbers of researchers say thousands of lives could be
saved every year by spending more on AIDS prevention among at-risk
groups: reminding gay men to avoid unprotected anal sex, persuading
drug addicts to use clean needles, and teaching prostitutes to insist
on condoms. In 1996, James G. Kahn, an epidemiologist at the University
of California, San Francisco, brought out a statistical model showing
that by spending just $1 million among these high-risk groups over
five years, the United States would avert 150 new infections. Targeting
low-risk groups would prevent three.
“The public dollar is limited,” Bayer says. “Obviously,
if you spend more in ghetto communities, you have less to spend
in Scarsdale, New York. And it may be that someone in Scarsdale
doesn’t get the message. But there’s a better likelihood
that you will have a greater impact if you focus on where the epidemic
is. It seems to me that the ethics of public health require you
to take care and to protect the greatest number of people. Not scare
the hell out of everyone.”
FAQ's
References
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