No Fragments Archive 10: Diskmags/nf_archive_10.iso/MAGS/MEGA/MEGA_02A.MSA/ISSUE_2.PAK/AIDS-1.PK1/AIDS-1.PK1

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 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 country, 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.