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<text>
<title>
(1988) Just How Does AIDS Spread?
</title>
<history>
TIME--The Weekly Newsmagazine--1988 Highlights
</history>
<link 07033>
<link 05684>
<link 00093>
<link 00017>
<article>
<source>Time Magazine</source>
<hdr>
March 21, 1988
MEDICINE
Just How Does AIDS Spread?
</hdr>
<body>
<p>Amid all the confusion, some answers are beginning to emerge
</p>
<p> First there was the news everybody wanted to hear: a New York
physician writing in Cosmopolitan reassured women that there is
practically no risk of contracting AIDS through ordinary vaginal
or oral sex, even with an infected man. The vaginal secretions
produced during sexual arousal, he wrote, keep the virus from
penetrating the vaginal walls. His explanation: "Nature has
arranged this so that sex will feel good and be good for you."
Then came the news nobody wanted to hear: Sex Gurus William
Masters and Virginia Johnson proclaimed in their new book about
AIDS that "the epidemic has clearly broken out into the broader
population" of heterosexuals, and that far more people are at
great risk than previously thought. Even kissing, they
declared, is not safe.
</p>
<p>Who is to be believed?
</p>
<p> If anything is clear about the AIDS epidemic, it is that anal
sex among homosexual men and needle sharing among drug addicts
are still the major ways the AIDS virus is transmitted in the
U.S. American victims are still overwhelmingly male: 92%. And
though there is no doubt that heterosexual intercourse between
intravenous drug users or bisexual men and their lovers is
contributing to the spread of the disease, the number of AIDS
cases traced to sex between men and women not in these high-risk
groups is very low--about 4%--and has remained stable. But just
what is the risk? How contagious is AIDS? What are the odds
of picking up the virus from a single sex act if one's partner
turns out to be infected?
</p>
<p> There are no certain answers to these questions, and that is
part of the problem; it is misleading, and perhaps even
dangerous, to pretend that there are. The best advice, most
AIDS experts agree, is to use condoms and cut down on the number
of sex partners. Reason: promiscuity increases the likelihood
of encountering the virus as well as other sexually transmitted
diseases that may increase susceptibility to AIDS. Some people
have picked up the virus from a single sexual encounter, while
others have escaped despite hundreds of sexual exposures to an
infected spouse. No one knows why. The risk figures that
Masters and Johnson offer--a 1-in-400 risk of a man
transmitting the virus to a woman through an act of unprotected
vaginal intercourse, and a 1-in-600 risk of a woman to a man--are supposedly based on a series of assumptions and
statistical projections first described in 1987 by Nancy Padian
and Jim Wiley of the University of California, Berkley. The
projections are already outmoded. Says Wiley, "A single number
cannot describe the rate of transmission. There are too many
variables."
</p>
<p> And too many unknowns. Research is making it abundantly clear
that people differ, often inexplicably, in their vulnerability
to the virus and in their tendency to transmit it to others by
various routes. An AIDS carrier's infectivity--his or her
ability to pass the virus on--may vary over time. Only now are
researchers beginning to understand these differences and their
implications for preventing the spread of the disease.
</p>
<p> Striking new research, published last week in the quarterly
journal AIDS Research and Human Retroviruses, may help explain
why some AIDS carriers can go on having unprotected sex for
years without passing the virus to a regular partner. Although
it is known that enough of the virus appears in the bloodstream
shortly after infection to spread the disease via blood
transfusions, sexual transmission is a different matter. The
new study, of 24 hemophiliac AIDS carriers, shows that despite
repeated sexual contact without condoms, the wives or steady
female partners of these men generally remained free of the
virus for several years. But when signs of severe immune
deficiency began to appear in the men, four of the women became
infected.
</p>
<p> Although they may have finally contracted the virus simply
because of repeated exposure, researchers doubt it. Had that
been the case, the women who have become infected should have
been those who had sex most often. But frequency of intercourse
did not seem to matter. Says Researcher James Goedert of the
National Cancer Institute: "The study demonstrates that the
infected population gets more infectious as time passes, and
that the level of risk increases as time goes on." That led
Goedert and his colleagues to speculate that early treatment
with AZT, the only approved anti-AIDS drug known to inhibit
replication of the virus, may actually make AIDS less
contagious. "That's among the most urgent questions we have to
answer," says Samuael Broder, director of clinical oncology at
the National Cancer Institute.
</p>
<p>-- By Denise Grady.
</p>
</body>
</article>
</text>