AIDS, we have been told, is not just a “gay disease,” or a disease of intravenous (IV) drug abusers passing contaminated needles. It can break out into the general heterosexual population at any time, and when it does it will become (in the words of one concerned clergyman) “a national disaster as great as a thermonuclear war.” Indeed, to judge by a poll taken last May indicating that AIDS has replaced cancer as the nation’s most feared disease, it would seem that most Americans believe the “breakout” has already occurred.
Well they might, if they have been following the lead of our major newsmagazines:
Newsweek, April 18, 1983: “AIDS is creeping out of its well-defined, epidemiological confines. . . .”
Life, July 1985 (cover): “Now No One Is Safe From AIDS.”
Time, August 12, 1985: “. . . the threat to heterosexuals appears to be growing.”
U.S. News & World Report, January 12, 1987: “The disease of them is suddenly the disease of us. The slow death presumed just a few years ago to be confined to homosexuals, Haitians, and hemophiliacs is now a plague of the mainstream, finding fertile growth among heterosexuals.”
Time, February 16, 1987: “The proportion of heterosexual cases . . . is increasing at a worrisome rate. . . . The numbers as yet are small, but AIDS is a growing threat to the heterosexual population.”
U.S. News & World Report, April 20, 1987: “Now, however, the disease is spreading so rapidly beyond homosexuals and drug abusers that the old rules no longer apply.”
U.S. News & World Report, June 15, 1987: “With an approximate seven-to-ten year latency period before the symptoms become evident, compelling evidence of a breakout of AIDS may come too late. That’s a ‘breakout’ into what the government calls ‘the general population.’ That’s you, Mr. President. That’s heterosexuals. Put most simply: AIDS is a fatal disease—always—and everyone is at risk.”
Most articles like the ones from which these quotations come tend to begin with anecdotes, then to add a few statistics showing that the incidence of AIDS among heterosexuals has doubled in the past two years, then to cite experts predicting the rate will soon rise much higher.
Clearly such articles have taken their toll in terror, as clinics that test for the AIDS Human Immunodeficiency Virus (HIV) have reported being swamped by heterosexuals. Yet the very figures used to demonstrate the supposed spread of AIDS into the general population also happen to illustrate the old saying about lies, damned lies, and statistics.
Thus, we may read that heterosexual AIDS victims at one time comprised 2 percent of the total, but that this figure has now doubled to 4, and that the Centers for Disease Control (CDC) in Atlanta predict that by 1991 it will have increased to 9 percent. What we are not told is that the jump from 2 to 4 percent came about not through an increase in the number of victims but by a lumping together of two different categories of victim which had previously been kept distinct—native-born Americans (2 percent) and Africans and Haitians who have recently moved to the United States.
CDC originally classified the recently arrived Africans and Haitians as a separate category unto themselves, because it appeared that the disease was following a different pattern in their native countries from that in the United States. As the classification turned into a stereotype, however, the Haitian government lobbied the National Institutes of Health (NIH), a subunit of the U.S. Public Health Service, to “redesignate” this category. At first the Haitian-African groups were shifted to the cases labeled “undetermined.” But in July 1986 CDC arbitrarily placed them into the heterosexual category—despite strong evidence that many of the Haitians probably acquired the illness homosexually and that much of the transmission among Africans was also not attributable to heterosexual activity. The supposed 100-percent jump from 2 to 4 percent in the number of heterosexual transmissions was thus nothing more than a statistical artifact.
As for the figure of 9 percent, this comes from the Coolfont conference held in June 1986. Within four months of that conference, two papers presented at it were released in Public Health Reports. One, by CDC’s chief statistician Meade Morgan and CDC’s AIDS program director James Curran, predicted that by 1991 the heterosexual-transmission category will have increased from 4 to 5.3 percent. The other, published anonymously but under the official title of “The Coolfont Report,” put the percentage at 9. The media have almost universally ignored the lower in favor of the much more ominous higher figure.
This 9-percent figure, however, includes an entirely new set of cases, those in which the origin of exposure is unexplained. In this category are patients who either have no idea what the source of contact was, blame prostitutes, refuse to be interviewed, or have died. Because some scientists think a portion of these unexplained cases is attributable to heterosexual contact, the statistician who created the 9-percent figure simply aggregated them all to form a “worst-case” projection. Yet how many, if any, of the unexplained cases belong in the heterosexual category is surely debatable, and the fact that our public-health authorities would classify all as heterosexual transmissions is, to put it mildly, curious. When I asked Dr. Morgan about this he replied that “the report was prepared in only a day and a half to two days,” that “it was probably an omission” not to state explicitly that cases of undetermined origin had been lumped together with the heterosexuals, but that “if somebody called we’d set them straight.” Virtually no one has called.
Surgeon General C. Everett Koop is among those who have asserted that AIDS is “exploding” into the heterosexual population. In one magazine interview he estimated that AIDS cases overall were “going to increase ninefold between now and 1990. But among heterosexuals there are going to be twenty times as many cases, so that perhaps 10 percent of the patients will be heterosexual.” He said that “the curve for heterosexuals contracting AIDS is going up more than twice as fast because they are not taking the precautions homosexuals have learned are essential.” But the real reason the curve is going up “twice as fast” is to be sought elsewhere, in the aforementioned shoddy statistical practices.
The only plausible argument that has been offered for expecting an “explosion” into the heterosexual population rests on the fact that the average incubation period for the HIV infection to become either AIDS or AIDS-related complex (ARC)1 is thought to be about five to seven years; hence, heretofore hidden infections contracted in 1982 might suddenly show up in 1987. But the word “average” means exactly that: the cases making up the average incubate in anywhere from several months to perhaps ten years or more. Hence, infectious contacts made in 1982 will show up a few percent a year each year up to and well past the five-year point, not suddenly and all at once.
This is why CDC’s chief epidemiologist, Dr. Harold Jaffe, has stated that “Those who are suggesting that we are going to see an explosive spread of AIDS in the heterosexual population have to explain why this isn’t happening.” The question needs to be asked first of all of Dr. Jaffe’s boss, the Surgeon General.
The reason AIDS is not “exploding” is that, contrary to public belief, it is a disease that is extraordinarily difficult to transmit or contract, even by the standards of other sexually transmitted diseases (STDs). Whereas mere juxtaposition of genitalia is enough to transmit syphilis, gonorrhea, herpes simplex II, and chlamydia, all of which require only direct contact with the mucous membrane, HIV (like hepatitis B) is bloodborne, the most inefficient mode of transmission an STD can enjoy. A sore, even an undetectably small one such as often accompanies herpes, might offer a passageway for these viruses, but some sort of passageway is needed and in the case of most Americans such passageways do not exist.
Even where they do, moreover, AIDS is more difficult to contract than, for example, hepatitis B. Thus, while approximately 27 percent of hospital workers who have accidentally been stuck with hepatitis B-contaminated needles contract the disease, HIV infection occurs in less than 1 percent of those stuck with HIV-contaminated needles. One hapless worker who was stuck with a needle containing both the hepatitis B virus and HIV quickly developed the former but remained free of HIV-indicating antibodies.
That HIV is a bloodborne virus obviously explains the high incidence of AIDS among hemophiliacs and intravenous drug users who share needles, as well as among homosexuals. (Hepatitis B has also primarily plagued homosexuals and IV drug abusers, as opposed to heterosexuals. From 35 to 80 percent of homosexual men attending STD clinics, and 60 to 80 percent of IV drug users, are found to be carrying hepatitis B.)
Why homosexuals? Because with sexually-transmitted AIDS, the overwhelming risk factor, especially for the passive or recipient partner, is anal sex. According to B. Frank Polk, director of the Johns Hopkins University’s component of the Multicenter AIDS Cohort Study, “In gay men, 95 percent or more of the infections occur from receptive anal intercourse.” A study published in the April 1987 American Journal of Public Health (AJPH) found that of 240 men who became infected over the course of the study, all but four had engaged in receptive anal sex.
The reason anal as opposed to vaginal sex is so dangerous has to do with the difference in tissue construction between the male urethra and rectum and the female vagina. While the vagina is constructed of tough platelike cells that resist rupture and infectious agents, and are designed to withstand the motions of intercourse and childbirth, the urethra and rectum are constructed primarily of columnar cells which tear or rupture easily. This allows semen to enter the more readily accessible blood vessels of the rectum or, conversely but much more rarely, allows blood from a ruptured rectum to seep into the urethra of the active partner. (The April 1987 AJPH study found that men who reported rectal bleeding were far more likely to become HIV-positive than those who did not.)
There are other factors in the AIDS-anal sex connection. The vagina provides natural lubrication, whereas there is little in the anus. Anal douching, a practice many homosexuals engage in prior to intercourse, can remove what lubrication there is. The absence of lubrication not only increases the chance of rupture, but at the same time it reduces the efficiency of condoms by allowing them to tear. For heterosexuals, condoms are extremely effective in preventing all forms of sexually transmissible diseases, from the nonlethal but bothersome and incurable herpes simplex II to the deadly AIDS virus. But even the condom, which many have touted as the way to turn unsafe homosexual sex into safe sex, has an alarmingly high breakdown rate during anal intercourse. According to one Australian study reported in the July 1987 AJPH, 27 percent of homosexuals using condoms reported “a few” or “many” breaks, with an additional 4 percent indicating “other problems” with condom strength.
Discussing the sexual transmission of AIDS without mentioning homosexual behavior in general and anal sex in particular is like discussing syphilis without mentioning intercourse. But this is precisely what the media and other responsible authorities do. Most articles and wire-service stories on AIDS do not so much as mention the words anal sex, much less indicate that it is the overwhelming risk factor. Similarly, one AIDS book designed for use by elementary-school students refers to heterosexual sex while making no reference to homosexuality, and one sex-education text formerly distributed in Seattle took the final step by stating that “AIDS is not a sexually transmitted disease.”
The prevalence of AIDS among homosexuals is traceable to other considerations as well. Chief among these is the degree of promiscuity characteristic of many homosexuals. Lately, thanks to AIDS, the word “promiscuity” has begun to acquire an unfavorable connotation among homosexuals, but not so long ago it was carried as a badge of honor, if not a defining condition of homosexuality itself. It is certainly a defining characteristic of AIDS sufferers. Thus, a 1981 CDC study of homosexual AIDS victims whose median age was thirty-five found that they had had an average of 61 sexual partners a year. On the assumption that sexual relations begin at age seventeen, this means that the average lifetime number of partners (up to age thirty-five) would have amounted to 1,098. If each partner was equally promiscuous, the size of the pool of partners and partners-once-removed comes to a staggering 1,205,604.
In February 1987 the Atlantic carried a lengthy feature article ominously titled “Heterosexuals and AIDS: The Second Stage of the Epidemic.” The most terrifying line in this terrifying essay ran, “. . . given the alarming accounts of hepatitis B and HIV contracted after a single encounter, it may well be that hepatitis and HIV are more readily transmissible than either gonorrhea or syphilis.”
Were this comparison valid, AIDS would now be surging through the heterosexual population, since the transmission rate of gonorrhea and syphilis is believed to be from 20 to 50 percent, depending on the disease and whether it is passing from male to female or vice versa. But the statement is absurd. Aside from the obvious mistake of lumping together hepatitis B and HIV, there are no “alarming accounts [of infection] contracted after a single encounter”; quite to the contrary, so far there seems to be only one reported case in the United States of a person contracting HIV after a single exposure. To compare this with syphilis and gonorrhea is like saying that because an occasional gambler wins on the first spin of the roulette wheel, the chances of winning at roulette are better than 20 to 50 percent.
Indeed, the falsity of the comparison is revealed in the opening section of the Atlantic article itself. There the author cites a study, overseen by CDC epidemiologist Thomas Peterman, of 70 couples who continued to have unprotected sex even though one member was known to be carrying HIV. Despite repeated acts of vaginal intercourse, as often as several times daily and over a period of years, only eight of the 50 infected men transmitted the virus to their wives; of the 20 infected wives, only one passed it on to her husband. A 13-percent infection rate over a period of years hardly suggests a single-exposure transmission rate of higher than 20 to 50 percent.
With this and similar studies in mind, Drs. Curran and Peterman estimated that the “likelihood of [heterosexual] transmission to a partner with a single exposure must be quite low, probably less than 1 percent per contact.” This estimate, which appeared in October 1986 in the Journal of the American Medical Association (JAMA), was reprinted by the Public Health Services of the U.S. Department of Health and Human Services for distribution to the press. The Atlantic made no mention of the article, and with the exception of one story in the New York Times, it was ignored by the media at large.
The figure of less than 1 percent per contact was later reduced almost by a factor of ten in a study conducted by Nancy Padian of the Berkeley School of Public Health. Dr. Padian’s study of 96 women who had sexual contact with HIV-infected men found that a woman’s chance of infection was approximately one in one thousand. Although the corresponding odds for men could not be determined since there were too few male heterosexual infections to calculate, all such partner studies have shown that transmission from a woman to a man is even more difficult than from a man to a woman. The virus has indeed been found in vaginal secretions, but at levels considerably lower than in semen and blood, both of which contain large numbers of white blood cells, the usual abode of the AIDS virus. Researchers have come to a consensus that the amount of virus in tears is not enough to cause transmission, and the same may well be true of vaginal fluid.
In fact, the risk to the male, or penetrating, partner of acquiring AIDS in vaginal intercourse is so small that this alone could be enough to prevent any substantial heterosexual spread of the disease. Women, in other words, act as a “firebreak” against the spread of the virus.
How, then, is AIDS transmitted among heterosexuals? Some studies have shown that there too anal sex can be the culprit. (In the August 14, 1987 JAMA, Dr. Padian reported that female partners of infected persons who engaged in anal as well as vaginal and oral sex were 2.3 times more likely to acquire the infection than those who did not.) HIV infection may also be transmissible through oral sex, entering the blood system through bleeding gums or sores in the mouth—though several studies of homosexuals have found no HIV positives which could conclusively be traced to oral sex, and some researchers are unwilling to state that oral sex is a risk factor, even a small one.
More researchers are becoming convinced of the importance of STDs as co-factors in the spread of AIDS. Not only do these diseases raise the levels of white blood cells in the genital secretions of both sexes, they also cause ulcerations which allow the virus direct access to the bloodstream. While most spouse studies to date have not measured for this co-factor, one that did so found a very high correlation between HIV infection and previous infection with syphilis or gonorrhea; spouses who did not test HIV-positive had no such history. A study presented at the Third International AIDS Conference this past June indicated that persons with genital herpes run three to four times the risk of acquiring HIV infection. Those suffering from syphilis, which also causes lesions, appear to have four to five times the risk.
These, then, are the sexual practices that facilitate the spread of AIDS: high incidence of anal sex, high rates of promiscuity, and high level of STDs. It is clear from the list why the disease has spread like wildfire in the homosexual population, and why, pace the Surgeon General, it will not “explode” into the heterosexual population.
But (cry the doomsayers) what about Africa, where the heterosexual transmission rate is alleged to run at 90 percent, in a supposedly clear portent of things to come in the United States? (See the cover of the November 24, 1986 Newsweek: “AIDS in Africa: The Future Is Now.”)
There are two serious problems with this theory. First, it assumes that the African epidemic is more mature than ours. In fact, however, while there is evidence of some HIV-related virus in Africa as early as 1959, there is no evidence that AIDS cases began showing up there much earlier than in the United States; the epidemic was first recognized on both continents in 1981.
Second, it assumes that Africa has gone through an epidemiological pattern similar to ours. But the evidence indicates otherwise. In the United States, AIDS has always been concentrated among homosexuals, IV drug users, receivers of blood products, and the sexual partners of members of these groups. As an article in the March 13, 1987 JAMA was able to report: “Indeed, since the arrival of HIV in the United States, the transmission patterns have remained remarkably consistent.” They also remain remarkably consistent in Africa, where AIDS appears to have been concentrated from the first among the same groups it currently afflicts. Even in areas of Africa, such as Ghana, where the epidemic began only recently, the pattern of spread is similar to that in areas where it has raged for years.
What is going on in Africa? To begin with, the 90-percent figure for heterosexual transmission which the U.S. Public Health Service has supplied is but another myth, as the number of African children with AIDS is alone probably enough to show (up to 22 percent in South Africa, according to an article in the British medical journal Lancet). In addition, a host of factors exist in Africa which do not exist here but which greatly facilitate the spread of HIV in nonsexual ways.
For example, because the cost of screening one blood donation in some poor African nations is approximately three times the entire per-capita expenditure for medical expenses, the procedure is virtually never performed and the national blood supply remains thoroughly contaminated. In some areas, the prevalence of HIV in the blood supply is estimated to be 8 to 10 percent; since the average transfusion requires several pints of blood, a person receiving a transfusion is practically guaranteed infection. Estimates of African AIDS cases attributed to transfusions range anywhere from 4 to 25 percent, depending on the area.
Unsterilized needles used by untrained medical workers also greatly facilitate the spread of the virus. These needles draw blood for transfusions, for vaccinations, and for administering therapeutic drugs such as penicillin, and they may be used hundreds of times without cleaning. A JAMA report (June 20, 1986) notes that 80 percent of the AIDS patients in Kinshasa, the capital of Zaire, told of receiving medical injections before the onset of the syndrome; 29 percent had gone to traditional practitioners, who also provide injections; and 9 percent had received a blood transfusion in the three-year period before the onset of the illness. Other studies have come up with similar findings in other parts of Africa suffering from an AIDS epidemic.
Native practices, such as ritual scarification of men and declitorization of women, must also be taken into account. If a group is so scarred, it is much more likely that anyone who carries the virus will pass it on.
Finally, there is some evidence that while pure homosexuality is rare in Africa, bisexuality is not. As Dr. Padian wrote in a letter to JAMA: “In the extreme case, if few males are exclusively homosexual in Africa and if most homosexual behavior is among bisexual males, then bisexual males could be largely responsible for the sexual transmission of AIDS.” Because, however, bisexuality is so taboo in Africa that African AIDS victims will seldom admit to it, Dr. Padian’s theory may remain just that.
All these different modes of HIV transmission make a mockery of the 90-percent figure for heterosexual transmission. Of course, they do not dispose of the fact that the African rates still remain very much higher than in the United States, but there are reasons for that. In order to avoid AIDS in the United States, heterosexuals must merely avoid IV drug abusers and bisexuals—a very small percentage of the population. In Africa, by contrast, there is (as we have seen) a vast number of conduits into the heterosexual population, and hence a vast number of infected heterosexuals. The final pieces of the puzzle are extreme promiscuity and venereal disease. According to a report in the February 13, 1986 New England Journal of Medicine (NEJM), prostitutes in Nairobi, Kenya, average over 900 partners a year (at 50 cents apiece); since the per-capita expenditure on medical treatment in central Africa is all of approximately two dollars a year, one can posit a tremendously high level of untreated STDs in the sexually active population. As noted above, a strong correlation has been shown among STDs, genital sores, and the transmission of the AIDS virus, and the NEJM article found just such a correlation.
The African AIDS epidemic is devastating. But it is uniquely African. We can no more deduce transmission patterns in the United States from Africa than we can assume that because Africans suffer periodic famine, we will too.
One key indicator that would tell us whether AIDS could become epidemic among heterosexuals has been ignored both by the media and, until very recently, public-health authorities: tertiary transmission.
Primary transmission is to a member of a high-risk group—homosexual, bisexual, IV drug user, hemophiliac. Secondary transmission occurs when the primary recipient passes the virus on heterosexually to a member of a non-high-risk group; most secondary recipients are steady female partners of IV drug users. Tertiary transmission occurs when the secondary recipient then passes on the virus to another heterosexual. Were tertiary transmissions to occur in significant numbers, they would portend an epidemic for heterosexuals, since tertiaries would beget fourth-generation recipients, and so on.
Sometimes, indeed, the media simply assume the existence of such tertiary transmissions; as one Washington Post columnist wrote matter-of-factly, “Prostitutes are spreading it to their customers, who then spread it to their spouses or girlfriends.” The most controversial aspect of Surgeon General Koop’s AIDS program, AIDS education for elementary schoolchildren, similarly assumes that tertiary transmission is a clear and present danger. Yet little children do not themselves shoot drugs, or sleep with IV drug users, or with those who do sleep with them. Asked how many cases of heterosexually transmitted AIDS have occurred among elementary-school students, a Koop spokesman replied, “None that I know of.”
Isolated incidents aside, tertiary transmission simply is not happening. AIDS began showing up among homosexuals in the United States in 1979; early in 1981, the CDC documented AIDS cases among IV drug users, and by June of that year in their heterosexual partners. At that rate tertiary heterosexual AIDS should have begun showing up as early as late 1981. By 1982, the first fourth-generation cases would have become manifest. Long before now, AIDS should have been cutting a swath through the nation’s heterosexual population. It is not doing so, and the reason is the lack of tertiary heterosexual transmission.
The CDC keeps no figures on this, so I contacted the four cities with the highest numbers of AIDS cases directly. In three of them the numbers of heterosexually transmitted cases were altogether so small—18 out of 3,661 cases in San Francisco, 30 out of 3,459 in Los Angeles, 12 out of 1,344 in Houston—as to leave little room for tertiary transmissions. New York City, with one-third of all reported AIDS cases, has the dubious distinction of being the nation’s AIDS capital; its epidemic is also thought to be slightly more mature than that in San Francisco or Los Angeles; and its tracking and identification of cases are probably the best in the world. Of 11,217 AIDS victims, New York reports that “zero” have been second-generation heterosexual.
Yet despite everything we know about the true pattern of AIDS in the United States, the effort to “democratize” this plague (in George Will’s phrase) nevertheless continues unabated. Mathilde Krim, founder of the AIDS Medical Foundation and one of the leading propagators of the idea of a heterosexual AIDS epidemic, says, “I think it’s a fluke that AIDS emerged in the gay community.” “Viruses,” she asserts, “do not discriminate on the basis of sexual preference.” In Britain, similarly, billboards proclaim, “AIDS Doesn’t Discriminate,” and American public-health officials and homosexual-rights advocates have likewise asserted, “We’re all in this together.”
The slogans have a satisfying ring to them, but quickly fall apart under scrutiny. True, viruses do not discriminate. Neither do bullets and knives, but you are far more likely to catch one walking through a dark South Bronx alley than strolling down a well-lit street on Manhattan’s Upper East Side. Most of those infected have indeed exercised a discriminatory preference which (a) brings them into contact with already infected persons and (b) involves them in acts that allow the virus to be transmitted. To be sure, the purpose of these acts is not to transmit the virus, any more than the purpose of walking through a dark alley is to be attacked. But one chooses whether or not to walk through the alley.
Homosexual-rights groups are of course painfully aware of the appeal exercised by the notion that AIDS is nature’s or God’s retribution on them, and this is one reason they have sought to tie AIDS to heterosexual sex. Thus, one San Francisco health official I spoke to, while admitting that AIDS is not now a substantial threat to heterosexuals in that city and will not become one in the foreseeable future, defended the practice of suggesting that heterosexuals were at risk because it made them “socially conscious” of the problems of homosexuals.
Another reason has to do with research money. Randy Shilts, the nation’s first full-time AIDS journalist (for the San Francisco Chronicle) and author of And the Band Played On: Politics, People, and the AIDS Epidemic, has observed that “A lot of gay people in AIDS organizations have spent years watching friends and lovers die” and are convinced that research money has been slow in coming because AIDS is not perceived as a general threat. Hence the “concerted effort” to create heterosexual panic that is being made by “gays, public-health officials, and scientists who want research dollars.”
If homosexual activists and their sympathizers deploy the myth of heterosexual AIDS in order to destigmatize homosexuals, on the opposite side of the spectrum Christian fundamentalists deploy it in order to underline their vision of morality. Reverend Jerry Falwell, for example, has called for “immediate action [or] AIDS will prove to be the final epidemic—with millions dying each year—including your loved ones.” Others continue to cite alleged evidence that HIV can be casually transmitted, while in the same breath accusing homosexuals of bringing this plague down upon the rest of us. (A moment’s reflection would show that if the contagion were casually transmitted it would no more be a “homosexual” virus than is a cold or the flu.)
Conservative moralists in general have also seized upon the AIDS epidemic to promote a return to morality, urging chastity or monogamy as a means of avoiding the disease. Obviously, chastity reduces one’s chance of receiving AIDS sexually to zero, barring rape. But with monogamy things are not so simple. Indeed, the chance of exposure inside a steady relationship where one partner is already infected is considerably greater than outside. Practically all heterosexually transmitted AIDS cases are found in steadily monogamous or virtually monogamous relationships with IV drug users or, much less commonly, with bisexuals, since only such a relationship can expose one frequently to infection. By contrast, the risk of getting AIDS from a single heterosexual encounter, so long as neither partner is a bisexual man nor a drug abuser, has been calculated (by Jeffrey E. Harris of MIT) at less than one in a million. “Whether it’s one in a million, or one in a hundred thousand, or one in ten thousand, or one in ten million, I don’t know,” adds the CDC’s Meade Morgan. “But the risk is very low in any given instance.”
Conservative moralists are fond of concentrating their attention not just on heterosexuals but specifically on the sexual habits of the white middle class, and in this they are at one with the liberal media, with public officials, and with the condom industry.
“I’d do a lot for love,” says the attractive white middle-class woman in public-service announcements on TV and in magazines, “but I’m not ready to die for it.” AIDS stories on the covers of major newsmagazines invariably picture middle-class whites; the Atlantic article carried illustrations of seven individuals, all white and all dressed in yuppie garb; and AIDS victims in television dramas, in addition to being disproportionately heterosexual, are always white. Similarly, when ABC’s Nightline ran a four-hour program on AIDS, the segment on sexual transmission opened with a clip depicting nothing but white, middle-class heterosexuals discussing their fears; and a half-hour video on AIDS features Ron Reagan, the President’s son, with a beautiful blonde.
One would never know from all this that the profile of the typical victim of heterosexually transmitted AIDS is a lower-class black woman who is the regular sex partner of an IV drug user. White heterosexuals make up approximately one-half of 1 percent of all AIDS cases; as of September 14, 1987, of 41,250 cases reported, only 254 whites were listed as being heterosexually infected.
This is not to say that it is absolutely impossible for members of the white middle class to contract AIDS heterosexually. But it happens so rarely that one hears about it immediately and often. A family in which a hemophiliac gave the virus to his wife, who then transferred it to her child during pregnancy, has now been featured in no fewer than four national magazines and on 60 Minutes.
In another case, a national magazine told the story of a white middle-class married couple from the Houston area; the husband had reportedly acquired AIDS through sexual contact in one incident of intercourse with a woman before he married. On the cover ran the line, “AIDS, What Every Wife Must Know.”
I asked about this particular case at the Houston Health Department, which is required to document all area AIDS cases. I was told there was no report of such a man. Of the total of two males listed under the heterosexual-contacts category, one was a Haitian, and the other did match the victim in the article except that his relationship with the HIV carrier was not a single incident but “ongoing.”
The plague that has visited our country over the last few years is an extremely serious one, and people are dying from it in horrible ways. They deserve compassion, and every measure of scientific ingenuity and medical succor we can extend. Their rights need to be protected, and their suffering understood. But we also have a duty to be truthful about the pattern and the limits of this disease, not least in order properly to direct our resources to those afflicted with it or in danger of becoming afflicted. Every dollar spent, every commercial made, every health warning released, that does not specify promiscuous anal intercourse and needle-sharing as the overwhelming risk factors in the transmission of AIDS is a lie, a waste of funds and energy, and a cruel diversion.
Randy Shilts, who has rationalized the spread of the heterosexual-AIDS myth, is also frank to concede the irresponsibility of this approach: “In two or three years heterosexuals are going to wake up and see that they’re not getting the disease. Then what?” Then what, indeed?