POZ Magazine Misinformation
In the October edition of Poz Magazine. They have done our community a great injustice by spreading false information about HIV heterosexual transmission.
On the cover of the magazine they have a picture of 5 women with the statement
These women thought they had killer vaginas. Then they learned girls don't give guys AIDS. Now they're sticking it to the officials and advocates who made the myth of "hetero AIDS". Here comes female trouble
The problem we have with this article is this isn't true as many studies prove. Also they fail to take in account by CDC (Center for Disease Control) guidelines how they determine how people are infected. If you state you have any history of Intravenous Drug Use they mark you as IVDU. If you have had any gay experiences they consider you as being infected by gay sex.
So lets suppose when you are very young you try a few time of IVDU. Does this really mean you contracted HIV by IVDU or does this really just mean you have a history of it. I am willing to agree it would be easier to contract HIV by IVDU But that certainly cant be the rule.
Now lets suppose you do some experimenting. You have a few gay experiences. Would this also absolutely mean you caught HIV from this limited exposure. Wouldn't that then have to mean every gay male is HIV positive to be able to transmit the virus? How do they know the gay male you had any experience with is HIV positive.
As for myself I have never used IV drugs in my life. I have smoked pot and drank plenty of beer. So I am not claiming to be a saint. But this doesn't put me in any of the factors I would need to be in to make this true by POZ Magazine.
I urge everybody to contact POZ magazine. To let them know how upset you are with this misinformation that they are spreading. I wouldn't want anybody taking chances that could infect anybody.
or you can write them at
POZ Editor
One Little West 12th St. 6th Floor
NY, NY, 10014
Fax 212-675-8505
Below I have listed several studies proving they're theories as wrong and below that I have listed the article POZ Published.
Thomas C. Quinn, M.D.
The Hopkins HIV Report - May 2000
At the recent San Francisco Retroviral Conference and in a report published in the New England Journal of Medicine [March 30, 2000, vol. 34, pp. 921-929], Ugandan and American investigators presented their findings on the risk of heterosexual transmission among 415 HIV serodiscordant couples. As part of a larger study entitled "The Sexually Transmitted Diseases Control for AIDS Prevention Study," which was conducted in the Rakai District of Uganda between November 1994 and October 1998, the investigators observed the effects of mass antibiotic treatment of sexually transmitted diseases on HIV transmission in 15,127 persons. The original study published in Lancet [1999; 353:525-535] found that despite reductions in sexually transmitted diseases, HIV incidence was unaffected in the intervention arm of the study. In subsequent analyses it was determined that the attributable risk of HIV transmission due to STDs was in fact quite low, explaining the negative results of the original study. It was observed that the most frequent transmission of HIV within this community occurred among HIV serodiscordant couples in which one partner was HIV positive and the other partner was HIV negative at enrollment into the study. To determine the risk factors associated with heterosexual transmission, a retrospective analysis was performed on these 415 HIV-discordant couples and a comparison group of over 4,000 couples who were concordantly negative for HIV infection at baseline.
As part of the original study design, all 15,127 persons in this rural district of Uganda consented to participate in the study and were visited every ten months to complete a demographic and behavioral questionnaire as well as a complete physical examination for the presence of STDs including HIV. All symptomatic individuals were referred to the study's local clinic for immediate treatment. Extensive HIV education and counseling were provided throughout the entire study by trained project counselors, and individual and couple counseling was strongly encouraged throughout all villages. Free condoms were made continuously available in the communities. At each ten-month visit, blood and genital samples were collected and screened for HIV and a wide variety of STDs. At the end of the study, archived samples were analyzed for serum levels of HIV-1 RNA using a molecular amplification assay capable of detecting the multiple subtypes of HIV-1 that exist in Uganda (predominantly subtypes A and D).
Of the 415 serodiscordant couples, the male was infected in 55%, and the female partner was infected in 45% of the couples at enrollment. Ninety or 22% of the HIV-negative partners seroconverted during the course of this study for an incident rate of 11.8 per 100 person-years. The rate of transmission from male to female was identical to the rate of transmission from female to male with one exception. If the seronegative male partner was circumcised, (there were 50 such men), no seroconversions occurred, in contrast to an incident rate of 16.7% among the 137 uncircumcised male partners. The median age at enrollment was 30 years of age, but the highest incidence of seroconversion occurred in couples between the ages of 15 to 19 years, with an incident rate of 18.6%. The incident rate declined with the age of both the HIV-negative and HIV-positive partners. Very few behavioral characteristics were associated with transmission within these couples. There were also no significant differences in the rate of acquisition or transmission in relationship to the presence or absence of diagnosed STDs. However, symptoms of STDs in the HIV-infected partner (such as vaginal or urethral discharge or dysuria) were associated with a greater risk of transmission to the uninfected partner. Similarly, the presence of AIDS-defining symptoms or signs was also significantly associated with an increased rate of transmission (incidence = 27.3% vs. 11.4%).
The most important variable that was associated with both transmission and acquisition was the viral level of HIV in the infected partner prior to seroconversion in the HIV-negative partner. Among couples in which there was a documented sero-conversion, the mean serum HIV RNA level in the positive index partner was significantly higher than in the couples in which no seroconversion occurred (90,254 c/ml vs. 38,029 c/ml).
The investigators observed a significant dose response effect with respect to both male-to-female transmission and female-to-male transmission (see figure, p. 1). The rate of transmission rose from 2.2% among individuals with viral RNA levels <3,500 c/ml to 23.0% at levels >50,000 c/ml. There was also a threshhold below which no transmissions occurred in this study. Among the 51 couples in which the HIV-positive partner had a viral level <1,500 including those undetectable, no transmissions occurred. Similar to previous reports from the U.S. and Europe, serum levels of HIV RNA were significantly higher among the HIV-positive men (59,591 c/ml) compared to the mean level in women (36,875 c/ml). Of interest, there was no significant difference between male-to-female and female-to-male transmission rates after adjustment for viral load or within strata of viral load.
When the above variables were entered into models to predict transmission of HIV within the serodiscordant couples, viral load was the factor that most strongly predicted the risk of transmission. When viral load was analyzed as a continuous variable, the risk of transmission increased 2.45 for each log10 increment in viral load. This dose-response relationship is almost identical to that described between maternal viral burden and vertical transmission to infants in previous perinatal HIV studies. Age was inversely associated with risk of transmission. Finally, the other significant predictor of reduced transmission was circumcision in the HIV-negative men.
The results of this study have important implications for furthering our understanding of heterosexual HIV transmission and for development of means to prevent such transmission and to hopefully slow the spread of HIV globally. Heterosexual transmission remains the most common mode of transmission of HIV throughout the world. Over 85% of new infections are acquired heterosexually, with the greatest predominance still in sub-Saharan Africa. Prospective studies of HIV discordant couples provide perhaps the best information on the efficiency of transmission and the biological and behavioral variables that influence infectiousness of and susceptibility to HIV. It is well known that consistent condom use is the most important measure for preventing HIV transmission. Unfortunately, despite over ten years of education and counseling, condom use still remains low throughout all of sub-Saharan Africa and was similarly low in this rural district of Uganda. Current condom use increased over the four-year study period from approximately 5% to 16%, but was obviously not high enough to prevent the transmissions that were subsequently observed. The desire for increased fertility within these couples and the lack of a cultural support system for consistent condom use are issues that need to be directly addressed if transmission is to be prevented through behavioral means.
The major finding of the study that serum viral levels predicted increased risk of transmission was remarkably similar to observations for the risk of perinatal transmission. The dose-response effect of viral level on heterosexual transmission was almost identical to that observed in studies of mother-to-infant transmission. The finding that there were no instances of transmission by seropositive subjects with viral levels <1,500 c/ml raises the possibility that reductions in viral level through the use of antiretroviral drugs or with the development of effective therapeutic vaccines could reduce the rate of transmission throughout this population and globally.
A word of caution must be made clear. Although reductions in transmission with the use of antiretroviral drugs have been documented in studies of perinatal transmission, this has not been well studied in sexual transmission. Consequently, individuals who have reduced viral levels as a result of antiretroviral drug use may still be infectious to their partners, and until we understand the kinetics and efficiency of transmission in individuals taking antiretroviral drugs, safe sex coupled with consistent condom use must be vigorously practiced to prevent any transmission. An accompanying editorial by Myron Cohen in the New England Journal of Medicine emphasizes the need for further studies measuring the effects of antiretroviral drugs on sexual transmission. The concern is that there may be compartmentalization of viral levels in the genital secretions that may not necessarily correlate with reductions in the peripheral blood viral load due to antiretroviral drugs. This issue needs to be carefully studied in the near future.
For Africa, where the epidemic continues to ravage many communities, the use of expensive antiretroviral drugs does not provide an economically feasible method of prevention. Consequently, the development of an effective vaccine, which either prevents transmission altogether or results in an immunologically-mediated lowering of the viral load in infected individuals remains an important research goal for slowing the spread of HIV. Due to the lack of availability of such a vaccine, use of microbicides and treatment of symptomatic STDs may provide more immediate means for slowing the sexual transmission of HIV in these areas.
The finding that circumcision afforded protection against HIV infection, with no infections among 50 HIV-negative circumcised men as compared to 40 infections among 137 uncircumcised men, suggests another potential biological method of HIV prevention. Previous studies among high-risk populations have shown that uncircumcised men have an increased risk of heterosexual acquisition of HIV compared to circumcised men. This is probably due to the biological characteristics of the foreskin of an uncircumcised man, which is prone to microulcerations, is associated with an increased frequency of STDs, and provides an increased surface area of epithelial tissue that is susceptible to HIV. Of interest, this association between male circumcision and decreased risk of acquisition may partially explain the relatively lower risk of female-to-male transmission in the U.S. since the vast majority of men in the U.S. are circumcised. In his accompanying editorial, Dr. Cohen suggests that "countries where HIV infection is endemic or epidemic might well consider promoting circumcision for its public health benefits. However, the promotion or institution of a procedure that has profound cultural implications, risk of complications, and benefits that are realized only decades later, represent a formidable public health and political challenge."
In summary, heterosexual transmission involves a complex interaction between biological, behavioral, and cultural variables. This study identified a number of factors associated with the risk of transmission which could potentially be modified to reduce the spread of heterosexual HIV transmission. The challenge now is to move forward on the results of this study to implement more cost-effective behavioral and biological measures to prevent HIV transmission worldwide.
20000501
JH20000501
Epidemiology: Gender Makes A Difference In Risk Of
HIV
Transmission
AIDSWEEKLY Plus; Monday, October 22 & 29, 2001
Staff Medical Writers
NewsRx -- In heterosexual couples where one
partner is HIV
positive, viral load, or the amount of detectable virus in the
blood, is a much stronger predictor of the risk of transmission
in women than in men, according to a study by researchers at the
University of Alabama at Birmingham (UAB).
Details of the study were published in the journal AIDS Research
and Human Retroviruses1.
"Although we've known that high viral loads are associated with a
person's risk of transmission, it appears that women with high
viral loads are much more contagious than men with high viral
loads," says Dr. Susan Allen, associate professor of epidemiology
and international health with the School of Public Health at UAB.
In the United States, heterosexual transmissions of HIV represent
a rapidly increasing number of new infections. And in sub-Saharan
Africa, where the study was conducted, heterosexual transmission
is the primary means by which the virus is spread.
The study followed 1022 heterosexual couples for periods of two
to 67 months over the course of six years. Couples enrolled in
the Zambia-UAB HIV Research Project in Lusaka, Zambia, received
counseling, free condoms and primary health care. In 162 couples,
the infected partner transmitted the disease to the initially
uninfected partner.
On average, those who transmitted the disease had significantly
higher levels of virus in the blood than those who did not
transmit the disease. However, women who transmitted the disease
had four times the viral load of those who did not, while men who
transmitted the disease had only one-and-a-half times the viral
load of those who did not. These findings may have important
implications for the role of HIV therapies and vaccines in
reducing viral loads and the spread of the disease.
"The study indicates that therapies to lower viral loads could
have a significant impact on reducing the risk of transmission,
particularly from women to men," says Allen. "However, the
majority of the world's HIV infections are in the poorest
countries where therapies are not available. The development of a
vaccine is urgently needed to stem the HIV pandemic."
The lead investigator of the study was Ulgen Semaye Fideli, MSPH,
with the department of epidemiology and international health at
UAB. In addition to Allen, other researchers who collaborated on
the study are: Rosemary Musonda, PhD, with the Tropical Disease
Research Center in Ndola, Zambia; Stan Trask, Beatrice Hahn, MD,
and Heidi Weiss, PhD, with the division of hematology and
oncology at UAB; Joseph Mulenga, MD, with the Zambia National
Blood Transfusion Service; Francis Kasolo, PhD, with the Virology
and Immunology Laboratory at University Teaching Hospital in
Zambia; Sten Vermund, PhD, with the department of epidemiology
and international health at UAB; and Grace Aldrovandi, MD, with
the department of pediatrics at UAB.
This article was prepared by AIDS Weekly editors from staff and
other reports.
Reference
1. Fideli US, Allen SA, Musonda R, Trask S, Hahn BH, Weiss H,
Mulenga J, Kasolo F, Vermund SH, Aldrovandi GM, "Virologic and
immunologic determinants of heterosexual transmission of human
immunodeficiency virus type 1 in Africa", AIDS Res Hum
Retroviruses 2001 Jul 1;17(10):901-10
011022
AW011008
New England Journal of Medicine (www.nejm.org) (03/30/00) Vol. 342, No.
13, P. 921
Quinn, Thomas C.; Wawer, Maria J.; Sewankambo, Nelson;
et al.
N Engl J Med. 2000 Mar 30;342(13):921-9. Unique Identifier : AIDSLINE
MED/20183102
Quinn TC; Wawer MJ; Sewankambo N; Serwadda D; Li C;
Wabwire-Mangen F; Meehan MO; Lutalo T; Gray RH; National Institute of Allergy
and Infectious Diseases, Bethesda,; MD, USA.
Newsday - February 1, 1995
Laurie Garrett. Staff Correspondent
Washington - New York City's AIDS epidemic is becoming increasingly
heterosexual, and in at least one part of the metropolis - the South Bronx -
heterosexual transmission is the leading way the virus is now being spread.
A 1992-94 study of more than 1,000 people admitted to the emergency room or inpatient service of Bronx-Lebanon Hospital found that 47.7 percent of those who tested positive for the human immunodeficiency virus probably were infected through heterosexual sex.
Of those people, a quarter had lived in a country where HIV is primarily a heterosexual disease - typically in the Caribbean; another 11.4 percent had had sex with an intravenous drug user; and 4.5 percent were involved sexually with a person who came from a country where AIDS was rampant.
Further, the Bronx researchers found that, compared to people who were not infected, patients who tested HIV-positive were three times more likely to have had sex with a drug user. They were also more likely to be African-American or black Hispanic. And they were far less likely to be married.
Two other New York City studies, conducted jointly by the federal Centers for Disease Control and Prevention and by the city Department of Health, produced further evidence of heterosexual spread of the virus. One study showed that heterosexual transmission from women to men increased in New York City between 1992 and 1994 by 47 percent. It also found that in the same period, AIDS cases among 13to 19-year-olds climbed by 4 percent.
The other study, at the city's sexually transmitted disease clinics, monitored 700 people for infection over a three-year period and further confirmed that heterosexual transmission was the leading cause of new HIV infections in 1994.
Department of Health researcher Victor Coronado said that the heterosexual increase was real but that its size was exaggerated by New York authorities' previous skepticism about claims of heterosexual infection. "In the past if a man said he got the virus heterosexually we said, uh-huh, sure," Coronado said.
By 1993, however, the city started keeping the heterosexual statistics seriously. And then they saw the jump in numbers. Last year 233 men in New York City had the AIDS virus as a result of sex with an infected woman.
(BW) (UCSF/HIV-RISK) Risky Sex, STDs, and Condom and
Drug Use Affect HIV Risk for Straight Couples, Says UCSF Researcher
BUSINESS WIRE - 44 Montgomery St, 39th Floor, San Francisco, CA 94104;
Tel: (415) 986-4422; FAX: (415) 788-5335 - Monday, 25 August 1977.
SAN FRANCISCO--(BW HealthWire)--Aug. 25, 1997--In the nation's largest and
longest study of heterosexual HIV transmission, UC San Francisco researchers
found that the practice of anal sex, lack of condom use, injection drug use
and the presence of a sexually transmitted disease (STD) are the strongest
predictors of infection. In addition, UCSF researchers found that male-to-female transmission rates
continue to remain extremely low, about 9 out of every 10,000 unprotected
sexual encounters, and even lower for female-to-male infections. Females are
about eight times more likely than males to become infected by their
HIV-positive partners, said study principal investigator Nancy Padian, Ph.D.,
UCSF assistant professor of obstetrics, gynecology and reproductive sciences.
"We now know many of the risk factors that affect the likelihood of
transmission between infected individuals and their heterosexual
partners," she said. "Elimination or modification of these factors
would result in reduced transmission of HIV."
Final results of the long-term UCSF study of Northern California
heterosexual couples with one HIV-infected partner are published in the
current (August) issue of the American Journal of Epidemiology.
From 1985 to 1995, Padian and her research colleagues enrolled 82
HIV-infected women and their male partners and 360 HIV-infected men and their
female partners into a study to examine rates of and risk factors for
heterosexual transmission of HIV. Study participants were interviewed and
given physicals at the start of the study and every six months. The couples
were also counseled during each visit about safe sexual practices, and study
staff were available at any time by phone.
While no new HIV transmissions occurred during the course of the study, 68
women and two men were infected by their HIV-positive partners prior to the
start of the study.
The UCSF study showed that a history of STDs and injection drug use greatly
increased HIV transmission risk from the HIV-positive male to his female
partner. Of the 77 HIV-positive male injection drug users, 22 percent
transmitted the virus to their partners. Of the 163 women who had an STD, 25
percent became infected.
Only two men had become infected by their HIV-positive female partners. In
the first infection, both partners reported several instances of post-coital
bleeding from the genital area. In the second case, the woman appears to have
infected her partner with both HIV and chlamydia within a short period.
"Because there were only two instances of female-to-male transmission,
we could not examine risk factors for these events statistically," Padian
said. "However, the fact that chlamydia was transmitted simultaneously
with HIV is striking."
Researchers observed dramatic behavior changes during the course of the
study. At the start of the study, no couple abstained from sex, only 32.2
percent ever used a condom, and 37.9 percent had anal sex. At the final
follow-up visit 10 years later, 14.5 percent abstained from sex, 74 percent
used condoms, and only 8.1 percent had anal sex.
The fact that no transmission occurred among the 25 percent of couples who
did not consistently use condoms shows that there is very low infectivity
among heterosexual couples with one HIV-positive partner, according to the
UCSF study. Infectivity increases greatly with injection drug use and the
presence of an STD, as well as other factors such as risky sexual practices
and lack of condom use.
Other similarly conducted studies have reported higher rates of
heterosexual transmission, particularly from females to males, Padian said,
adding that geographic differences in sexual practices and co-factors for
infection (such as intrauterine contraceptive devices) and misclassification
of transmission due to other sources (such as needle sharing) may explain the
UCSF study's lower transmission rates.
Co-authors of the UCSF study are Stephen C. Shiboski, Ph.D., UCSF assistant
professor of epidemiology and obstetrics; Sarah O. Glass, UCSF research
specialist; and Eric Vittinghoff, Ph.D., San Francisco Department of Public
Health.
--30--jm/sf
CONTACT: University of California, San Francisco Rebecca Higbee,
415/476-2557
Today's News On The Net - Business Wire's full file on the Internet with
Hyperlinks to your home page. URL: http://www.businesswire.com Role of viral load in both transfusion- and
heterosexual-transmission of HIV-1 infection. 3rd Conf Retro and Opportun Infect. 1996 Jan 28-Feb 1;:58. Unique
Identifier : AIDSLINE AIDS/96920031 Abstract:
Background. In the TSS, 90% of recipients of components from HIV-1 positive
donors became infected. In contrast, 32% of long-term heterosexual partners of
the recipients became infected. We examined the importance of plasma viral
load in these two contexts representing very different mechanisms and
probabilities of transmission. Methods. Donors' sera stored at donation and
recipients' sera collected throughout the period of possible transmission to
their partners were evaluated for quantitative HIV-1 RNA using the Amplicor
HIV Monitor AssayTM (Roche Molecular Systems, Inc.). Results. Mean RNA levels
for transmitting and non-transmitting donors were 3.4 and 3.0 log l0 copies/m
L (p= 0.0l). Levels for sexually transmitting and non-transmitting recipients
were 4.3 and 3.6 logl0 copies/mL (P= 0.05). Conclusion. Viral load appears to
be the identifiably important determinant for both transfusion- and
heterosexual-transmission of HIV-1 infection. (Supported by NHLBI Contracts
NOl-HB-4-7002,4-7003, and 9-7074.)
Operskalski EA; University of Southern California, Los
Angeles, CA.
Int Conf AIDS. 1994 Aug 7-12;10(1):296 (abstract no. PC0112). Unique
Identifier : AIDSLINE ICA10/94370100
Jedlicka J; Bruckova M; Tomasek L; Natl. Inst. Publ.
Hlth., Czech Republic.
4th Conf Retro and Opportun Infect. 1997 Jan 22-26;:157 (abstract no.
501). Unique Identifier : AIDSLINE MED/97926142
Pedraza MA; Del Romero J; Roldan F; Alcami J; Centro de
Investigacion, Madrid, Spain.
Am J Epidemiol. 1997 Aug 15;146(4):350-7. Unique Identifier : AIDSLINE
MED/97416464
Padian NS; Shiboski SC; Glass SO; Vittinghoff E;
Department of Obstetrics, Gynecology and Reproductive Sciences,; University of
California, San Francisco, USA.
Epidemiology. 1994 Nov;5(6):570-5. Unique Identifier : AIDSLINE
MED/95143318
Nicolosi A; Correa Leite ML; Musicco M; Arici C;
Gavazzeni G; Lazzarin A; Department of Epidemiology and Medical Informatics,
National; Research Council, Milan, Italy.
Int Conf AIDS. 1993 Jun 6-11;9(1):83 (abstract no. WS-C02-1). Unique
Identifier : AIDSLINE MED/93336382
de Vincenzi I; European Centre for the Epidemiologcal
Monitoring of AIDS, Paris,; France.
J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Apr 1;11(4):388-95.
Unique Identifier : AIDSLINE MED/96183603
Downs AM; De Vincenzi I; European Centre for the
Epidemiological Monitoring of AIDS,; Hopital National de Saint-Maurice,
Saint-Maurice, France.
Journal of the American Medical Association (09/25/91) Vol. 266, No.
12, P. 1695
Allen, James R. and Setlow, Valerie P.
910925
AD911741
Int Conf AIDS. 1998;12:416 (abstract no. 23374). Unique Identifier :
AIDSLINE ICA12/98395404
Louise V; Evans GB; PHLS AIDS and STD Centre, Communicable
Disease Surveillance; Centre, London, UK.
Int Conf AIDS. 1994 Aug 7-12;10(1):296 (abstract no. PC0110). Unique
Identifier : AIDSLINE ICA10/94370103
Pedreira J; Castro A; Pereiro C; Juega J; De la Iglesia F;
Internal Medicine Service, La Coruna.
Int Conf AIDS. 1996 Jul 7-12;11(1):129 (abstract no. Mo.C.1427). Unique
Identifier : AIDSLINE MED/96921487
Barreira D; Lauria LM; Health Secretariat of Rio de
Janeiro City, Rio de Janeiro, Brazil.; Fax: 55 21 293-3210. E-mail: laur@uclink2.berkeley.edu.
Am J Epidemiol. 1995 Feb 15;141(4):305-11. Unique Identifier : AIDSLINE
MED/95142082
Nakashima K; Kashiwagi S; Kajiyama W; Hirata M; Hayashi J;
Noguchi A; Urabe K; Minami K; Maeda Y; Department of General Medicine, Kyushu
University Hospital,; Fukuoka, Japan.
Int Conf AIDS. 1992 Jul 19-24;8(2):C272 (abstract no. PoC 4165). Unique
Identifier : AIDSLINE ICA8/92401879
Rehmet S; Staszewski S; Muller R; Doerr HW; Bergmann L;
von Wangenheim EB; Helm EB; Stille W; Universitat sklinikum, Frankfurt/M,
Germany.
POZ Magazine Article
Susan Rodriguez and her doctor, Joseph Sonnabend,
MD, are an unlikely couple.
Sonnabend, 69, is the openly gay "clap doctor"
of the 70s who was one of the first to identify AIDS. An elder statesman of the
epidemic, he is as legendarily controversial for founding‑and resigning
from‑‑the American Medical Foundation (later amfAR) and the
Community
Research Initiative (later CRIA) as for pioneering his still‑relevant
"multifactorial" theory of how HIV causes AIDS.
SEX,
L ! E S &
TRANSM ISSI0 N
This
month, the SMART Five‑Rodriguez, Mary Hanerfeld,
issue of empowerment. He described an intentional
deceptionthe '80s "heterosexual AIDS" hysteria‑floated by the troika of a mostly gay AIDS establishment, a
crisis‑craving media and a federal government playing catch‑up. At
the center of this maze is a pile of 15‑year‑old statistics
carefully compiled by the DoH and conclusively showing that women almost never
spread "heterosexual AIDS" to men. Men who report "hetero
AIDS" get it from gay sex or dirty needles.
"When Joe told us about all this, it really
fucked with my head," Rodriguez says. Until that moment, she had assumed
that because "HIV is an equal‑opportunity virus"‑she may
well have transmitted the virus first to her husband and then to her child. Her
self‑blame was staggering. Now Rodriguez began to fit the pieces of her
AIDS puzzle into a starkly different picture: Her husband got infected through
sharing needles. So, all along, her conviction that she was at no risk for HIV
because she was in a monogamous marriage with an uninfected man had been an
utter delusion. "I was so naive and in denial," she says. "If 1
had known any of this in 1992‑not from my lying husband but from the lying
health officials‑1 would have done a lot of things very differently"
THE
MYTH OF HETERO
A
I
D
S
When I phone Joseph Sonnabend, he sounds wary as well
as weary. Since the early '90s, he has mailed out numerous drafts of a paper
about this scandal to both the scientific and popular press, only to have New York, Gear and
even POZ pass. But as Sonnabend begins his tale, he warms to his topic.
"Men get AIDS from women in Africa and other developing nations, but they
do not get AIDS from women in the developed world to any great extent," he
says, though he emphasizes that men may be exposed
to HIV from
women (see "Negative Exposure," page 32). "If we are talking
about a heterosexual epidemic, transmission efficiency would have to go both
ways. It doesn't. It stops with a woman and her children, and while that will be
a personal tragedy for the infected, it will not cause an epidemic."
These facts are not new. Two pieces of
evidence‑a 1990 CDC study that found "very little" transmission
from women to men during vaginal intercourse, and the nation's largest study, a
1997 University of California at San Francisco report that found the risk of
transmission from women to men "too small ...to calculate
accurately"‑were widely reported. The facts do, however, run counter
to received wisdom.
"Plenty of people have known and denied this
from the beginning," Sonnabend says impatiently. "It all started as a
way for AIDS advocates to raise funds because little public or private money was
coming in. 1 know this because the American Medical Foundation (later the
American Foundation for AIDS Research, or amfAR), an organization I incorporated
in 1983, a year later started putting out the word that 'no one is safe from
AIDS.' Very good publicity it was, too," he adds with a harrumph.
"They had no evidence to justify the huge public‑relations campaign.
All they had were predictions by sonic AIDS researchers. This led to my
resignation from amfAR. But, of course, the terrifying messages worked."
In fact, the messages proved spectacularly successful
in raising public panic, or "awareness," and forcing the feds to throw
serious money at HIV prevention. The CDC, predicting that the AIDS
Sonnabend's reading of history is, by conventional
standards, eccentric. Many survivors, mindful of the "by any means
necessary" desperation of PWAs, naturally feel that the ends justified the
means: Advocates did the right thing in scaring straightsespecially men‑so
that an epidemic of fags, junkies and whores could finally get respect and
resources. And there were extenuating circumstances, too: phobia of food
handlers, threats of quarantine, galloping irrationality in response to limping
science. Amidst the babble, amfAR's Krim came to represent the grandmotherly
voice of reason. While Krim declined to comment to POZ, Deborah Hernan, VP of
communications, strongly defends her organization's spearheading of
so‑called heterosexual AIDS. "In 1984,
the
scientific community was aware that this disease was spreading heterosexually in
Africa," she says carefully. "And while heterosexual transmission was
not then a primary factor in the U.S., scientists correctly concluded that it
would be a forthcoming factor. Based on this information, amfAR did create a
publicawareness campaign to highlight that no one was safe from this
disease‑and it has been proven that we did the correct thing."
In what sense history has proved amfAR correct is
hard to say, given that, according to the CDCs surveillance report for 2000, of all estimated U.S. AIDS cases, only 3 percent
were "heterosexually transmitted"‑hardly a "primary
factor" even now. Sonnabend himself recalls that in 1988, when
the ACT U I' Women's group was zapping Cosmo's Helen Gurley Brown for running an
article minimizing women's sexual risk from men, he notified an organizer about
the little‑publicized female‑to‑male transmission facts. The
ACT UPer urged him to burn the evidence. Then, as now, it seemed reasonable that
men would be less motivated to use condoms if it was common knowledge that
barebacking a la
Adam and Eve was safe for them.
Today, to the extent that
female‑lo‑male HIV transmission fears
"What on earth could account for this sudden surge in
heterosexually transmitted AIDS in men but not in women?" they ask in mock
shuck. Their conclusion? "Of' course, the rather banal answer is that the
Doll statistics ...are an artifact of Shoody AIDS surveillance practices. From
the earliest days of the epidemic, it seemed clear that
female‑to‑male transmission of AIDS was
extremely inefficient and
unlikely to sustain a heterosexual epidemic here. Instead of a biological
evolution, the sudden surge in heterosexually transmitted cases among men after 1991 probably results from changes in
the way the DoH investigated and reported new AIDS cases." That was the
year, Sonnabend explains, when the DoH stopped its practice of categorizing all
men who claimed that they were straight and had been infected by a woman as
"No Identified Risk." Until then, follow‑up interviews with the
man, his family and friends had been required to confirm that he had not shared
needles or had sex with men.
"It's stupid to think
people are just going to admit to shooting up or having homosexual sex,"
Sonnabend tells me. "So the city health department was pretty smart. They
found that in most cases these men turned out to have another risk and could not
be classified as heterosexual transmission." According to one former
"No Identified Risk" investigator, Anastasia Lekatas, the interviews
rarely confirmed the man's initial report. "Among the first 15,000 city
AIDS cases, there were only eight female‑to‑male
transmissions," she told The New York Times
at
the time. "And 1 have doubts about seven."
In 1993, under
the Office of AIDS Surveillance watch of Pollv Thomas, MD, the practice of
classifying all men who claimed that they were straight and had been infected by
a woman as "female‑to‑male"‑‑no further
questions asked‑became official DoH policy. Although Thomas did not
respond to requests from POZ for comment, Sonnabend and Berkowitz report that in
a 1993 response
to Donald Capra, MD, a leading immunologist suspicious of her surveillance data,
Thomas acknowledged the new policy‑"Men claiming heterosexual
transmission are placed in that category before an investigation"‑and
apparently omitted mention that such investigations had stopped. Rosalyn
Williams, DoH's AIDS Surveillance Coordinator, confirmed the change in practice.
In an interview with Michelle Cochrane in her The Social Construction of HIV/AIDS
Knowledge (out from Routledge next month), Williams says, '‑we
stopped investigating all claims of AIDS in heterosexual cases [despite the fact
that] most of the men did have another risk. Other places like Florida were
classifying [similar cases] as heterosexual men. Why had New York City been
using a different classification?"
PREVENTION
PAYBACK
That's why, a decade later,
these "statistical shenanigans," as Sonnabend puts it, may matter more
than ever. There is, first of all, the moral question of fomenting a false
medical panic. "Quite apart from the fact that it is just plain
wrong," Sonnabend and Berkowitz write, "it may well weaken the
desperately needed efforts at targeting AIDS prevention to those who need it
most. This most definitely includes heterosexual women at risk from sex, but
does not include their male counterparts]." There is also the issue of
scientific accuracy and authority. "Furthermore," they write, "as
there is a street‑level realization that this group of heterosexual men
arc not getting AIDS in any meaningful numbers, trust is lost in the authorities
who overstated a risk. The serious danger here is that other warnings that arc
in fact real, such as the risk to women, will be discredited."
For Catherine Hanssens, the
nationally renowned director of Lambda Legal Defense and Education Fund's AIDS
Project, the DoH's shady
data collection raises provocative legal questions. "Public health policy
has always involved politics," she begins,
The myth of
heterosexual AIDS has also given cover to each presidential
administration's meager HIV prevention outlay to the most stigmatized,
highest‑risk folks in favor of hand‑over‑fist waste for the
majority essentially safe from AIDS. During the AIDS‑at‑20 brouhaha,
when the new
stats shoving a disproportionate
rate of infection among young gay gay
and bisexual men of color announced, Hanssens points out, "Just look at the
response of Tommy Thompson, Bush's secretary of health and human services. He
said that he would increase funding for abstinence‑until‑marriage
prevention. Which effectively tells us that those the CDC has identified as most
at risk either don't exist at all or are not worthy of existence."
With the prospect of
an effective vaccine still a faint flicker, the only tool for
collaring the runaway virus is, of course, prevention. And with the
slow‑going research into microbicides which a woman can use free of a
man's consent‑grossly underfunded, the only prevention is, of course,
latex. But who controls condoms', "hen asked whether targeting young women
of color with the information that men pose a greater HIV risk to them than vice
versa will equalize the power imbalance behind condom negotiations, Rodriguez
laughs. "He wants to have sex, and he is in control, and either he's going
to wear one or he's not," she says disgustedly. "Come on, let's be
real."
PUSSY
POWER
In the early '90s, when the
English Collective of Prostitutes asked Sonnabend about his research, they were
outraged that the truth about unequal risk for women could not be publicized.
"'Give us the right information,' they told me," Sonnabend recalls,
"`then we can take care of ourselves."' Right non; the SMART Five are
confidently singing the same righteous chorus. "Women need to be put in
control of this information," Rodriguez says earnestly. "No matter how
the government or AIDS agencies may deny it, if women have empowerment, we are
not going to be in situations where a man is not going to wear a condom."
SMART's platinum‑haired,
high‑spirited Mary Hanerfeld has long worked the female empowerment angle.
She is adamant that the truth about girl‑to‑guy transmission's
inefficiency is leading HIV positive women to some much‑needed sexual
healing. Hanerfield was diagnosed in 1990, after donating blood at work. Her
Husband, a drug user who lied about his HIV test results, was drinking heavily
and acting violent. She was 38: her two daughters were 11 and 16. After leaving
her husband and going on a six month drinking binge, she sobered up and founded
a support group for women HIVers, most of whom had stories cut from same
lying-denying-husband cloth. Hanerfield saw that the women were acutely
alienated from their sexual feelings. Inresponse, she began her talks with some
version of I am a magnificent vagina putting out." Ten years later she is
still at it. "Sex is the closest we get to heaven," she tells me in
her cigarette‑gravelly Brooklyn accent "And they say we shouldn't do
this' What are they, nuts?"
Yet with the "We've Got the
juice!" campaign just gearing up, Sonnabend's Angels are only beginning to
answer the hard questions. Most practically, how will they translate their
consciousness raising sessions into political action? Even on the prevention
front, their task is daunting. At last June's historic U.N. General Assembly on
AIDS, expert after expert testified that women in the hardest hit nations are
overwhelmingly afraid to refuse to have unsafe sex with their husbands. But even
if there were a magic mantra that
made men want to slip on the latex, it would not address the fact that, as
Michelle Cochrane points out, the main risk of HIV transmission for straight
women is not sex with men but needle‑sharing. Still, drug‑addiction
services for women lag far behind those for men, and there is little harm
reduction tailored for women users. Who will advocate for these women
And who will persuade straight
men whose priority is getting high to take precautions to protect their female
partners? For several years, health workers have dealt with these men by doing
street outreach with drastically lowered goals‑anything other than harm
reduction is thought to be too demanding. Hanerfeld suggests that peer education
for straight men who shoot up or have sex with other men might be effective, but
leading advocates told POZ off the record that in their opinion it can't be
done. "we have to try," Hanerfeld responds.
Meanwhile, female vulnerability
to HIV during heterosexual intercourse remains an international health
emergency‑. The dire need for female‑controlled protection ought to
be dramatically clear to anyone who understands the implications of Sonnabend's
epidemiological sleuthing. But after 20 years. we have exactly one technological
innovation in AIDS prevention for women: the so‑called female condom. This
cumbersome device limits pleasure for both parties; its use is nearly impossible
to hide; and it's much easier than a diaphragm for an angry partner to
remove. "Tell me why microbicides are not getting adequate funding when
they've known all along about the unequal risk women," Rodriguez demands.
"What's that all about?"
Yet Rodriguez is under no illusions about either the ambition of her agenda or the power of the resistance‑not only from and government officials but from home‑grown advocates who are partners in the AIDS struggle. Still, this vivid survivor of a HIV and cancer is in it to win it. "I can't let go of this issue she says with feeling. It’s crazy. We’re fighting the government AIDS agencies, people in high places who don’t want this information out. But AIDS is big business, and funding, careers , even reputations are based on AIDS being a public health emergency for straight men. She shakes her head. But it just ain’t so.
Clinical Trials | Lab Tests | Advocate |