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.

mailto:poz-editor@poz.com 

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.

Viral Load, Circumcision, and Heterosexual Transmission

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.

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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

 
Viral Load and Heterosexual Transmission of Human Immunodeficiency Virus Type 1

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.


To determine the influence of viral load compared to other risk factors for HIV transmission through heterosexual sex, researchers from the National Institute of Allergy and Infectious Diseases, Johns Hopkins University, Makerere University in Uganda, and Columbia University in New York studied 415 couples in Uganda in which one partner was HIV-1- positive and the other was initially HIV-1-negative. The couples were followed for 30 months, with 90 of the 415 initially HIV-negative partners seroconverting during the study. The incidence of seroconversion was greatest among partners aged 15 to 19. While the incidence was 16.7 per 100 per-years among the 137 uncircumcised male partners, no seroconversions took place among the 50 male partners who were circumcised. The average serum HIV-1 RNA level was higher among the HIV-positive subjects whose partners seroconverted than those who partners did not seroconvert. There were no cases of HIV transmission among the 51 individuals with serum HIV-1 RNA levels under 1,500 copies per milliliter. The study found a strong correlation between increased serum HIV-1 RNA levels and a greater risk for transmission of the virus. The researchers concluded that viral load is the primary predictor of the risk of heterosexual transmission of HIV-1, with transmission uncommon in individuals with levels below 1,500 copies of HIV-1 RNA per milliliter.

Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group [see comments]

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.


Abstract: BACKGROUND AND METHODS: We examined the influence of viral load in relation to other risk factors for the heterosexual transmission of human immunodeficiency virus type 1 (HIV-1). In a community-based study of 15,127 persons in a rural district of Uganda, we identified 415 couples in which one partner was HIV-1-positive and one was initially HIV-1-negative and followed them prospectively for up to 30 months. The incidence of HIV-1 infection per 100 person-years among the initially seronegative partners was examined in relation to behavioral and biologic variables. RESULTS: The male partner was HIV-1-positive in 228 couples, and the female partner was HIV-1-positive in 187 couples. Ninety of the 415 initially HIV-1-negative partners seroconverted (incidence, 11.8 per 100 person-years). The rate of male-to-female transmission was not significantly different from the rate of female-to-male transmission (12.0 per 100 person-years vs. 11.6 per 100 person-years). The incidence of seroconversion was highest among the partners who were 15 to 19 years of age (15.3 per 100 person-years). The incidence was 16.7 per 100 person-years among 137 uncircumcised male partners, whereas there were no seroconversions among the 50 circumcised male partners (P<0.001). The mean serum HIV-1 RNA level was significantly higher among HIV-1-positive subjects whose partners seroconverted than among those whose partners did not seroconvert (90,254 copies per milliliter vs. 38,029 copies per milliliter, P=0.01). There were no instances of transmission among the 51 subjects with serum HIV-1 RNA levels of less than 1500 copies per milliliter; there was a significant dose-response relation of increased transmission with increasing viral load. In multivariate analyses of log-transformed HIV-1 RNA levels, each log increment in the viral load was associated with a rate ratio of 2.45 for seroconversion (95 percent confidence interval, 1.85 to 3.26). CONCLUSIONS: The viral load is the chief predictor of the risk of heterosexual transmission of HIV-1, and transmission is rare among persons with levels of less than 1500 copies of HIV-1 RNA per milliliter.
 
Heterosexual Spread: In NYC, it is a growing factor in HIV cases

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
Operskalski EA; University of Southern California, Los Angeles, CA.


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.)

 
Heterosexual transmission of HIV in the Czech Republic.

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.


Abstract: The epidemiological surveillance of HIV/AIDS has been applied in the CR since 1985. At that time, only homo/bisexual men were found to be affected by this infection. The first case of heterosexual transmission was diagnosed in 1987 in a couple were the woman had been infected via contaminated blood and infected her husband by unprotected sexual intercourse. In the 5 years period, between 1988-92, altogether 9 cases of heterosexual transmission have been reported. In 1993 solely, 9 other cases of heterosexual transmission of HIV have been found. Altogether, heterosexual transmission has been proved in 15 women and 4 men infected by HIV. None of the heterosexually infected cases has been linked to a sexual contact with a drug addict which might be explained by the fact that so far only 3 cases of HIV infection among drug users were detected in the CR. The percentage of heterosexually acquired HIV infections increased from 2% (1987) to 11.2% (in 1993). Further spread of HIV infection in the country via heterosexual transmission may be expected.
 
Analysis of virological and immunological parameters involved in HIV heterosexual transmission.

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.


Abstract: Objective. The aim of this study is to analyse the virological and immunological parameters involved in the heterosexual transmission of HIV-1. Methods. We studied 38 established couples in which at least one of the partners (index case, IC) was infected and unprotected sexual intercourse was the only risk factor for transmission. Clinical characteristics of IC and sexual practices at risk were analysed. The following virological parameters were studied: levels of p24-HIV antigen in serum, viral isolation by conventional culture, titration of HIV-DNA from PBMCs and RNA quantitation by RT-PCR. In some uninfected partners, the presence of protective antibodies, cellular response against "in vitro" HIV infection and CKR-5 polymorfism were analysed. Results. HIV heterosexual transmission was detected in 10/38 couples. There were no differences in the number of intercourses or sexual practices between both groups. No protective responses against "in vitro" HIV infection using both a reference viral strain (pNL43) and viral isolates from their own partner were detected in subjects sexually exposed to HIV-1 and uninfected. The presence of polymorphism in the CKR-5 chemokine receptor was not significantly increased in exposed uninfected subjects as compared to general population. In contrast, virological data were different between both groups. Viral isolation was obtained in 9/10 transmitter IC vs 8/18 in non-transmitter IC (p is less than 0.001, Fisher exact test). Viral load was above 15000 RNA copies/ml in 7/10 transmitter IC vs 9/28 non-transmitter IC (p is less than 0.05 Fisher exact test). Conclusions. These results suggest that heterosexual transmission of HIV is highly dependent on the biological characteristics of viral strains from the infected index case: viral load and levels of replication in culture.
 
Heterosexual transmission of human immunodeficiency virus (HIV) in northern California: results from a ten-year study.

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.


Abstract: To examine rates of and risk factors for heterosexual transmission of human immunodeficiency virus (HIV), the authors conducted a prospective study of infected individuals and their heterosexual partners who have been recruited since 1985. Participants were recruited from health care providers, research studies, and health departments throughout Northern California, and they were interviewed and examined at various study clinic sites. A total of 82 infected women and their male partners and 360 infected men and their female partners were enrolled. Over 90% of the couples were monogamous for the year prior to entry into the study; < 3% had a current sexually transmitted disease STD). The median age of participants was 34 years, and the majority were white. Over 3,000 couple-months of data were available for the follow-up study. Overall, 68 (19%) of the 360 female partners of HIV-infected men (95% confidence interval (CI) 15.0-23.3%) and two (2.4%) of the 82 male partners of HIV-infected women (95% CI 0.3-8.5%) were infected. History of sexually transmitted diseases was most strongly associated with transmission. Male-to-female transmission was approximately eight-times more efficient than female-to-male transmission and male-to-female per contact infectivity was estimated to be 0.0009 95% CI 0.0005-0.001). Over time, the authors observed increased condom use (p < 0.001) and no new infections. Infectivity for HIV through heterosexual transmission is low, and STDs may be the most important cofactor for transmission. Significant behavior change over time in serodiscordant couples was observed.
 
The efficiency of male-to-female and female-to-male sexual transmission of the human immunodeficiency virus: a study of 730 stable couples. Italian Study Group on HIV Heterosexual Transmission [see comments]

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.


Abstract: To compare the efficiency of male-to-female and female-to-male sexual transmission of human immunodeficiency virus (HIV), we studied 524 female partners of HIV-infected men and 206 male partners of HIV-infected women in 16 Italian clinical centers. All of the partners had had a sexual relationship with the index case lasting for at least 6 months and presented no other risk factor than sexual exposure to the HIV-infected partner. Among the 730 couples, 24% of the female partners were HIV positive, in comparison with 10% of the male partners. Using logistic regression analysis, including gender and controlling for condom use, frequency of intercourse, anal sex, partner's CD4+ cell count and clinical stage, sexually transmitted diseases, genital infections, and contraceptive use, we found that the efficiency of male-to-female transmission was 2.3 (95% confidence interval = 1.1-4.8) times greater than that of female-to-male transmission. Between-gender differences in the contact surfaces and the intensity of exposure to HIV during sexual intercourse are possible reasons for the difference in efficiency of transmission.
 
Heterosexual transmission of HIV in a European cohort of couples. The European Communities Study Group on Heterosexual Transmission of HIV.

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.


Abstract: OBJECTIVE: To determine risk factors and rates of HIV transmission in serologically discordant couples receiving regular safe-sex counselling. METHODS: From 1987 to 1991, 563 couples were recruited from 9 countries in a cross-sectional study. 378 HIV(-) partners recruited in settings where follow-up was achievable were included in the prospective study. At each interview, partners were tested, interviewed and counselled. Only partners presenting no risk factors for HIV infection other than sexual contacts with the index (HIV(+) partner) were included. RESULTS: The follow-up rate was 80.4% (304/378). 128 couples 42%) stopped sexual contacts (less than 3 months after inclusion for 59), mostly because of death or severe disease of the index. 245 couples still having sexual contacts 3 months after inclusion were followed for a median of 22 months. 123 (50.2%) couples used condoms for each episode of vaginal or anal intercourse. No seroconversions occurred among these 123 partners [95% Cl: 0-1.5/100 person-years]. 12 seroconversions occurred among the remaining 122 partners (seroconversion rate = 5/100 person-years [95% Cl: 2.6-8.8], or 1.2 per 1000 unprotected contacts [95%, Cl:0.6-2.1]). Cumulative rates of seroconversion at 24 months SR) were compared using Kaplan-Meier survival analysis. Among irregular condoms users, SR were similar whatever the frequency of condom use, and the sex of the partner (12.5% for females versus 11.0% for males). For partners of symptomatic (or with T4 < 220/mm3) index cases, SR was 36.7%, compared to 8.5% for partners of asymptomatic index cases with T4 > 200/mm3 (p < 0.01). SR were different (p = 0.05) between partners reporting 1) no STD (9.5%), 2) non-ulcerative STD (25.0%), and 3) ulcerative STD (40.0%). The SR for female partners were different (p = 0.02) according to the frequency of sperm ejaculation by male index cases: no ejaculation (0%); ejaculation for about half of sexual contacts (6.7%) and nearly always ejaculation (29.7%). CONCLUSION: 1. No seroconversion occurred in regular condom users. 2. The observed transmission rate of 1.2/1000 unprotected contacts should be interpreted with caution since it may greatly vary according to the presence or absence of risk factors: Advanced stage of infection for the index and partners STD were found to increase the risk, whilst avoidance of sperm ejaculation showed some protective effect.
 
 
Probability of heterosexual transmission of HIV: relationship to the number of unprotected sexual contacts. European Study Group in Heterosexual Transmission of HIV [see comments]

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.


Abstract: The objective of this study was to investigate the relationship between the number of unprotected heterosexual contacts with an HIV-infected person and the probability of HIV transmission. Data from a European study involving 563 heterosexual partners of HIV-infected subjects were analyzed. The number of unprotected contacts could be estimated for 525 couples (377 with male index case, 148 with female index case) from the reported frequency of unprotected contacts and an estimate of the length of the period during which transmission could have occurred. Nonparametric (isotonic regression) and parametric (Bernoulli model) analyses were performed on data at study entry and on follow-up data (121 couples). The nonparametric analysis resulted in several exposure groups, with the proportion of infected partners increasing with the number of contacts. For example, the percentage of female partners infected ranged from 10%, among those with < 10 unprotected contacts with an infected male, to 23% after 2,000 unprotected contacts. The parametric estimates of (assumed constant) per-contact infectivity were higher for male-to-female than for female-to-male transmission, but not significantly so. However, in comparison with nonparametric estimates, the model assuming constant infectivity appears to seriously underestimate the risk after very few contacts and to seriously overestimate the risk associated with a large number of contacts. Our results suggest that the association between the number of unprotected sexual contacts and the probability of infection is weak and highly inconsistent with constant per-contact infectivity. Probable explanations for these findings include large variability in infectivity between couples and within individuals over time. Estimates based on partner study data under the hypothesis of constant infectivity can, therefore, be highly misleading at a public health level, particularly when extrapolated to multiple casual contacts.

Journal of the American Medical Association (09/25/91) Vol. 266, No. 12, P. 1695
Allen, James R. and Setlow, Valerie P.


Abstract: It will continue to be impossible to impede the progress of HIV transmission if nothing is done to investigate new cases of infection, write James R. Allen and Valerie P. Setlow. The Centers for Disease Control reported 10,279 cases of heterosexual transmission through July 1991. Among the cases reported during the last year, 1148 cases in men and 1824 cases in women are considered heterosexual transmission. A recent prediction states that in contrast to other risk categories, the infection rate among non-drug using heterosexuals will increase in the next five years, doubling the number of heterosexual AIDS cases. Transmission risks and patterns must change to prevent this from happening. In addition, we need better information from studies about why people make the choices they do, what information they have about HIV that might influence their choices, and how public groups can provide more education on the issue. Data from these studies must be used to provide more effective prevention programs, the authors conclude.

 


910925
AD911741

Behavioural factors associated with heterosexual transmission of HIV to individuals without risk factors within the UK.

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.


Abstract: BACKGROUND: To improve understanding of factors associated with heterosexual transmission, detailed behavioural interviews are sought with people whose only risk for HIV infection was from heterosexual contact in the UK, and whose partners were neither at high risk nor from a country where HIV infection is common. METHODS: Newly diagnosed and reported HIV infections and AIDS cases in England, Wales and N. Ireland are followed-up if they meet the above criteria. Confidential semi-structured interviews are conducted if the clinician and patient agree. RESULTS: By the end of December 1997, 92 (54 men and 38 women) of 248 cases investigated were interviewed. Data from these interviews were compared with data from 1990/91 National Survey of Sexual Attitudes and Lifestyles (NATSSAL). HIV infected cases reported more partners (a median of 13 rather than five lifetime partners for men and six rather than three for women). Thirty-nine percent of the HIV positive men and 42% of the HIV positive women reported attending a STI clinic in the past compared to 14% of the men and 8% of the women from NATSSAL. Condom use was uncommon and they believed, before their diagnoses, their HIV risk to be much lower than the NATSSAL participants (7% compared to 46% for men and 5% compared to 32% for women). Only two men and one woman reported anal sex regularly. About a third of the men (17) and almost a quarter of the women (8) reported an illness consistent with seroconversion. The majority of men (34) were tested because of HIV related symptoms and half the women (18) sought testing because of a partner or child being HIV positive. Only seven men and one woman sought HIV testing of their own volition because they perceived themselves to be at risk for HIV. CONCLUSIONS: Heterosexuals with a higher rate of partner change and a history of STIs are at increased risk of HIV infection. Condom use was infrequent and those who reported anal sex as their usual sexual practice were rare. Few sought HIV testing of their own volition because they did not perceive themselves to be at risk. The number of HIV infections detected in such persons through voluntary confidential testing may underestimate, therefore, the extent of heterosexual transmission within the UK.
 

The increase in heterosexually transmitted AIDS cases in Galicia, Spain.

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.


Abstract: OBJECTIVES: To analyse the changes in epidemiological risk factors in 302 AIDS cases in the La Coruna area of 500,000 inhabitants (Galicia, Northwestern Spain). METHODS: 320 AIDS diagnosed patients, meeting the CDC (Atlanta, 1987) criteria, were studied between 1984 and 1994. Annual variations in relation to heterosexual risk factor were analysed. These case were studied in the Juan Canalejo Hospital (La Coruna). RESULTS: Heterosexual transmission represented 15.6% of 302 cases, being the second highest risk factor after intravenous drug abusers (70.9%). Studying annual variations heterosexual transmission dos not appear until 1987, progressing steadily to 21.9% by 1993; with a similar progression in the number of AIDS cases (TABLE). The heterosexual group comprised 35 men and 12 women, with a mean age of 35.7 +/- 11 year. CONCLUSIONS: 1. AIDS continues to increase in Galicia, with no indication of stabilizing. 2. Heterosexual transmission accounts for a higher percentage of cases than in others areas of Spain. 3. Sexual transmission of HIV-1 from women to men is probably significant given that the majority of heterosexual group were men. 4. We are possibly witnessing an epidemiological change in HIV-1 infection, with heterosexual transmission becoming increasingly important. TABULAR DATA, SEE ABSTRACT VOLUME.
 
Trends of heterosexual transmission of HIV in Rio de Janeiro City, Brazil.

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.


Abstract: Objective: To evaluate the changes of HIV transmission patterns in Rio de Janeiro City from 1982 to 1995. Methods: We performed a cross-sectional analysis of 6522 AIDS cases reported to the Health Secretariat between 1982 and 1995. All cases were classified by sex, age groups, year of diagnosis and categories of transmission (homo/bisexual males, heterosexual, IVDU, transfusion recipients). Results: Analyzing the first decade 1982-89) of AIDS epidemic we observed that Rio de Janeiro experienced an increment in all categories of HIV transmission especially among homo and bisexual males. The number of HIV-infected women was still small. During the second decade 1990-95) regression analysis shown a significant increasing trend for heterosexual transmission. All other categories pointed out to a trend of stabilization or reduction. Concerning women, the trend for heterosexually transmitted AIDS cases was still more important. During the 90's heterosexual transmission in men was the category that showed the sharpest growing trend. Among women the total number of AIDS cases was twice bigger than all other categories together (443 and 204 respectively). Discussion: Although the absolute number of heterosexual AIDS cases is still lower than homosexual and bisexual AIDS cases the data have been shown an increasing number of AIDS cases acquired by heterosexual intercourse. These data have been demonstrating a consistent trend through the years and could be explained as a consequence of the HIV spread among bisexual males and intravenous drug users and their sexual partners, and the failure of the measures to control the HIV epidemic among those risk groups. Conclusions: As a consequence of heterosexual transmission of HIV an increasing number of HIV infections and AIDS cases in children is expected in Rio de Janeiro City. Future epidemiological investigations should identify heterosexual populations at a greater risk for HIV exposure. Those groups must have a priority for implementing specific Public Health prevention activities
 
Sexual transmission of human T-lymphotropic virus type I among female prostitutes and among patients with sexually transmitted diseases in Fukuoka, Kyushu, Japan [see comments]

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.


Abstract: The authors investigated the prevalence of antibody to human T-lymphotropic virus type I (anti-HTLV-I) in 409 female prostitutes, 446 patients with an episode of sexually transmitted diseases, and 17,345 control blood donors. All subjects were Japanese and all studies were done in Fukuoka, Kyushu, Japan, in 1989. The prevalence of anti-HTLV-I was significantly higher in the prostitutes (5.1%, p < 0.001), in the male patients (2.8%, p < 0.05), and in the female patients (5.7%, p < 0.05) than in the controls (males 1.4%, females 2.2%). Prevalence of anti-HTLV-I in the prostitutes increased with the number of years spent in prostitution, but the increase was not statistically significant. Among the subjects with sexually transmitted diseases, female prostitutes with syphilis, male patients with non-gonococcal urethritis, female patients with syphilis, and female patients with gonorrhea had a significantly higher prevalence of anti-HTLV-I than did the controls. A longitudinal study was done on the 168 prostitutes. Two (1.3%) of the 158 initially seronegative subjects seroconverted over the period of 2 years. These data suggest that the risk of male-to-female transmission of HTLV-I through sexual contact is high among high risk groups in Japan, and they support the possibility of female-to-male transmission of HTLV-I.
 
Transmission rates and co-factors of heterosexual HIV infection.

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.


Abstract: OBJECTIVES: To investigate cofactors of heterosexual HIV-1 transmission in monogamous couples; to evaluate transmission rates and, in a prospective part of the study, seroconversions after unprotected sexual contacts. PATIENTS AND METHODS: In an open partner study from 1984 until December 1990, we observed and investigated 208 heterosexual couples with known index person by means of a baseline examination and long term follow-ups (at least every 6 month). Objective was to evaluate transmission rates and possible cofactors, such as sex of index person, exposure category, CD4 cell count and stage of disease, progression of disease, p24 antigen, duration of relationship, previous infections with other STDs. 37 discordant copies reporting unprotected sexual contacts were prospectively monitored for seroconversion. RESULTS: Overall HIV-1 transmission rate was 23% (48 our of 208 copies). Male to female transmission was 4 times higher than female to male transmission (31% vs. 8%). Transmission of HIV-1 was significantly higher in patients who had positive serum titers for HIV p24 antigen (42% vs. 14%), and CD4 cells at first examination below 200/mcl (52% vs. 22%). Patients having infected their partners also had a more aggressive course of disease (more rapid drop of CD4 cells and higher incidence of full-blown AIDs during the observation period). We found no correlation to the duration of relationship nor to previous infection with hepatitis B/lues. Long-term monitoring of 37 discordant couples reporting unprotected sexual contacts showed 2 seroconversions (5%) during 728 months of partners' exposure.
 

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. Rodriguez, 42, grew up in New York City's Bedford‑Stuyvesant, was married and working as a high‑level paralegal when her hus­ band, a secret drug user, infected her. Rodriguez tested positive in 1995, after her middle child, Christina, 9, was diagnosed and before her husband died. In 1998, a year before undergoing chemo for breast cancer, Rodriguez founded SMART University (Sisterhood Mobilized for AIDS/HN Research and Treatment), a treatment education and advocacy group for women HIVers. Still, the willowy, reserved Rodriguez and rumpled, abstracted Sonnabend are clearly well matched in grit and guts. And it's a good thing, because they will need every bit to open deaf ears to their mes­ sage that a long‑known, much‑denied fact‑that women with HIV pose a negligible, nearly nonexistent risk of sexually transmitting the virus to men through vaginal sex‑not only was at the center of a mid‑'80s cover‑up but has a new, unexpected significance for the course of the epidemic today. As a blushing Rodriguez announced in a June speech in Washington, DC: "I don't have a killer vagina."

 

SEX,   L ! E S   &

TRANSM ISSI0 N

This month, the SMART Five‑Rodriguez, Mary Hanerfeld, Michelle Lopez, Petra Berrios and Mary Alexander‑will press this message into service of a pie‑in‑the‑sky agenda: to sexually empower women with HIV, to target new prevention to high‑risk women, to push for female‑controlled microbicides and to make the New York City Department of Health (DoH) and such sacred­ cow institutions as amFAR accountable for misinformation. Their "We've Got the juice" campaign's seed was planted last spring, when Sonnabend, lecturing SMART on current treatment options, mentioned off‑handedly that it's very rare for a man to get infected during vaginal intercourse with an HIV positive woman. The warren, stunned, exploded with emotional questions. It was as if, in a single moment, they began to shed their HIV stigma and sexual shame. "For a long time after I got diagnosed, 1 hated myself," Rodriguez says flatly. "I was in isolation because of the shame. I felt like poison‑I wouldn't even kiss anybody. And before, I had enjoyed sex," she says with sad eyes and a laugh. "I really did." Yet Sonnabend's history lesson that evening went beyond the

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 epidemic could exceed the Black Plague, launched an unprecedented national AIDS alert for heteros. Mathilde Krim, PhD, the amfAR chair, hit the networks with her tireless televangelism, and Life published its infamous "Now No One Is Safe" cover. Even Oprah Winfrey opined that one‑fifth of all heterosexual Americans could be dead by 1990. Then, in 1987, Surgeon General C. Everett Koop blitzed every American household with his long‑awaited "America Responds to AIDS" booklet, which turned out to be ominously devoid of a single reference to drug use or sexual orientation. Still, AIDS had hit prime time.

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.

The Smoking Stats

Today, to the extent that female‑lo‑male HIV transmission fears  still flame, it is on the fuel of those statistics that Sonnabend says were doctored. In the plainly titled "Heterosexual Men and AIDS," the paper he co‑authored with activist‑writer Richard Berkowitz, Sonnabend notes that until 1991, the total number of AIDS cases among New York City men was 30,210, while the cases tagged as heterosexually transmitted numbered 92, or 0.3 percent. "(But) in 1991," the writers continue, "The numbers of men acquiring AIDS from their female sex partners started to surge. In a single year, 1991, there were 58 cases! In each subsequent year the numbers kept jumping: 193 in 1993, 271 in 1994, 3115 in 1995.° In contrast, the cases among women due to sex with an infected man showed a slow, stable increase.

"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, "and the HIV epidemic has shown time and again that when politics rather than scientifically sound methodology determine how to categorize who's getting infected and how, we get self‑defeating measures like names reporting, not to mention too many messages targeting those who are not at risk and too few for those who are. This," she adds, in high dudgeon, "clearly represents an abuse of not only public funds but of public trust."

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

 

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