Risk of HIV Infection Exaggerated?

[AmateurScientist]

I suspect this has been discussed here before, but I hope everyone will forgive me for bringing it up again. I do not recall such a discussion.

Is it obvious that during much of the 80's and 90's the risk of HIV infection to the general population was outrageously exaggerated and overstated?

If one is not in a high risk group--gay men, intraveneous drug users, Haitians, native equatorial Africans--are you really at grave risk of being infected with HIV from straight hetero sex?

What are the odds of being infected with HIV from straight sex if neither you nor your partner is in any of the high risk demographic groups?

Why were the risks so exaggerated? Who played a part in the scare mongering?

Was it deliberate on the part of gay rights activitists to get the attention of the larger community for funds for research? If so, was fear mongering the best way to do that?

I don't mean to minimize the tragedy of the AIDS epidemic. It seems horrible, however, that such terror was inflicted on innocent persons that so many lived--and many still do--in abject terror of being infected from perfectly natural activities. A very real chill was unnecessarily placed on everyone, when in truth, the high risk groups were really the ones whose behavior was in desparate need of examining. Don't get me wrong. I don't regard this as a moral issue at all. I'm not anti-gay at all.

I do have serious doubts about the motives of and methods promoted by some gay rights activists when it comes to the AIDS epidemic, however. It's horrible to scare so many people to death unnecessarily. It's something of a scorched earth policy. Isn't that what really happened?

AS

[Luke T.]

My brother died from AIDS in 1993. In 1992, we heard on CNN about a doctor in Atlanta who was looking for patients for an experimental cure. We made an appointment and took my brother there. My brother was an IV drug abuser and shared needles and that is how he got it. He had given up the IV drugs a year before he found out he had AIDS, but it was too late, of course. He was still living a highly self-destructive lifestyle, and so the doctor turned him down with the cold statement, "Why should I try to save your life if you are going to just go out and kill yourself again?"

The doc could only take so many patients. As it turned out, his experiment failed. The idea was to pump the patient's blood through some kind of machine and elevate it to like 116 degrees Farenheit or some such thing, and then cool it back down and cycle it back into the patient. The idea being that the high temp would kill the virus.

So anyway, I was living a pretty high-risk lifestyle myself at the time, and I figured since I was in the presence of a leading authority on AIDS at the time, I asked him a few questions, some of which relate to this very topic.

The doc said that it is much easier for a woman to get AIDS from hetero sex than a man. He said the odds of a man getting AIDS from an infected woman were like 5000 to 1. But this was the early nineties, and was probably as much a guess as a fact. So take it for what it is worth.

I hesitate to even explore this question because a part of me fears that someone out there may end up taking an unneccessary risk one dark and drunken night, remembering only that I said "5000 to 1" and decide to risk it. And yet this same person will probably play the Powerball lottery with odds of 120 MILLION to 1 and already be spending the money in their mind.

Don't chance it, folks.

[AmateurScientist]

Originally posted by Luke T.
My brother died from AIDS in 1993. In 1992, we heard on CNN about a doctor in Atlanta who was looking for patients for an experimental cure. We made an appointment and took my brother there. My brother was an IV drug abuser and shared needles and that is how he got it. He had given up the IV drugs a year before he found out he had AIDS, but it was too late, of course. He was still living a highly self-destructive lifestyle, and so the doctor turned him down with the cold statement, "Why should I try to save your life if you are going to just go out and kill yourself again?"

The doc could only take so many patients. As it turned out, his experiment failed. The idea was to pump the patient's blood through some kind of machine and elevate it to like 116 degrees Farenheit or some such thing, and then cool it back down and cycle it back into the patient. The idea being that the high temp would kill the virus.

So anyway, I was living a pretty high-risk lifestyle myself at the time, and I figured since I was in the presence of a leading authority on AIDS at the time, I asked him a few questions, some of which relate to this very topic.

The doc said that it is much easier for a woman to get AIDS from hetero sex than a man. He said the odds of a man getting AIDS from an infected woman were like 5000 to 1. But this was the early nineties, and was probably as much a guess as a fact. So take it for what it is worth.

I hesitate to even explore this question because a part of me fears that someone out there may end up taking an unneccessary risk one dark and drunken night, remembering only that I said "5000 to 1" and decide to risk it. And yet this same person will probably play the Powerball lottery with odds of 120 MILLION to 1 and already be spending the money in their mind.

Don't chance it, folks.

I'm sorry about your loss, Luke. I had no idea. Thanks for not taking offense.

Again, I'm not trying to be insensitive by posing the question. I think it's legitimate.

I'm not sure how much stock I'm willing to put in your brother's doctor's estimate. It does seem like a pure guess. I think the only way to get a real handle on it would be to carefully examine unbiased and accurate statistics on the incidence of HIV infection among the relevant demographic groups and correlate them with frequency and types of sexual activity engaged in.

I don't know if such statistics exist.

AS

[Dancing David]

AS great question,

The problem that seems to come up is:

Does your partner fool around or use IV drugs?
Does your partner then have anal sex with you?

There are many hetero women who have recieved HIV because thier partner engaged in anal receptive sex, used IV drugs and then had unprotected anal sex with them.

Then there is the whole 'rough' sex, 'dry' sex and fisting risk. Anytime that there is damage to the skin of the penis, the vagina or rectum, the risk rises greatly.

In africa hetero sex seems to be the main form of transmission, so there is something to be VERY worried about.

[Luke T.]

Originally posted by AmateurScientist


I'm sorry about your loss, Luke. I had no idea. Thanks for not taking offense.

Again, I'm not trying to be insensitive by posing the question. I think it's legitimate.

I'm not sure how much stock I'm willing to put in your brother's doctor's estimate. It does seem like a pure guess. I think the only way to get a real handle on it would be to carefully examine unbiased and accurate statistics on the incidence of HIV infection among the relevant demographic groups and correlate them with frequency and types of sexual activity engaged in.

I don't know if such statistics exist.

AS

There was no reason for me to take offense, AS. This is indeed a legitimate question.

I sometimes wonder how they come up with statistics. I would think you'd have to know how many people are even infected first. And we don't even have those numbers. That is my biggest issue with the gay community. They get uptight about privacy issues, but if I know my history right, one of the methods used to get the syphillis and gonorhea epidemics under control in the middle of the 20th century was to test anyone and everyone who went to the doctor's office or hospital, even if they went there for a broken leg or a chest cold. We need to do the same with AIDS, especially since it is far more life-threatening.

[AmateurScientist]

Originally posted by Dancing David
AS great question,


Thanks. I think today is some HIV awareness day or something.


The problem that seems to come up is:

Does your partner fool around or use IV drugs?
Does your partner then have anal sex with you?


I realize these activities can place one into a high risk group inadvertently. Still, I think the approach by the HIV scare mongers with respect to the general populace has been to claim that anyone who is sexually active is at grave risk. That's simply irresponsible, in my opinion. It's not true.


There are many hetero women who have recieved HIV because thier partner engaged in anal receptive sex, used IV drugs and then had unprotected anal sex with them.


I don't doubt there are some. What's "many?" In raw numbers, I suspect there are indeed many. In proportion to the general populace, however, I also suspect that those cases are statistically insignificant.

That would say a lot about the real risk involved. It's probably minuscule.


Then there is the whole 'rough' sex, 'dry' sex and fisting risk. Anytime that there is damage to the skin of the penis, the vagina or rectum, the risk rises greatly.


I'm sure the risk of transmission of STDs, including HIV transmission, increases. Nevertheless, if neither partner is a carrier the risk is 0. Considering the method of sex ignores the fact that if you aren't in a high risk demographic and neither is your partner, then the risk of infection is much much smaller than the risk for someone who is in such a demographic group.


In africa hetero sex seems to be the main form of transmission, so there is something to be VERY worried about.

This does seem odd. Why would this be the case in one isolated part of the world? It's puzzling. I suspect we aren't getting the whole picture with this claim.

AS

[garys_2k]

Originally posted by AmateurScientist


In africa hetero sex seems to be the main form of transmission, so there is something to be VERY worried about.


This does seem odd. Why would this be the case in one isolated part of the world? It's puzzling. I suspect we aren't getting the whole picture with this claim.

AS
African sexual practices are different. IIRC it's common for partners to use a drying agent to reduce lubricating effects (more pleasure for the guy, as I'd heard it), leading to more vaginal chafing and irritated skin.

[MRC_Hans]

There is no AIDS epidemic in industrial countries. This is no consolation for those who have been struch by this horrible disease and for those close to them, but it is a matter of small concern for the great majority of the populations who are in extremely low risk if they behave sensibly.

Africa and several Asian countries, however, are being devastated, with great portions of their populations being taken away. Finding a vaccine and an affordable treatment for those already infected is still an important quest, if these areas are ever to emerge from their ordeal and become democratic, well-functioning nations.

Hans

[RichardR]

Originally posted by Dancing David
In africa hetero sex seems to be the main form of transmission, so there is something to be VERY worried about. I posted this in the other AIDS thread:

According to this Royal Society of Medicine (http://www.rsm.ac.uk/new/pr135.htm) press release:

Currently, anti-AIDS education in Africa focuses on 'heterosexual transmission', usually taken to mean vaginal sex. According to Brody and Potterat, the fact that health warnings have avoided mentioning anal sex - despite its "substantially greater" risk of HIV transmission - may have contributed to the AIDS epidemic. Their research suggests that both men and women in Africa have receptive anal intercourse, often believing it to be 'safe' since it is not featured in public health education programmes.(My emphasis.)

I don’t know if that is true. I just offer it as a possible explanation.

[reprise]

The figures which used to be quoted regarding the chances of contracting HIV from a single exposure to the virus were primarily used to illustrate how much transmissibility is affected by how one is exposed to the virus.

Exposure to infected blood is far and away the highest risk factor for contracted HIV, but all blood exposures are not equal. I've just done recertification for my first aid qualifications and the single exposure risk for infection from a needlestick injury by a syringe carrying infected blood is still quoted as 1 in 200 - the same figure being quoted over 10 years ago. The risk for vertical transmission (ie, transmission to a baby in utero) was at that time regarded as the highest, followed by tranfusion with infected blood products.

Australia developed its HIV/AIDS management plan in the mid-1980s, and at that point in time 12% was the magic figure in respect of the injecting drug user population - if HIV infection rates reached 12% among injecting drug users our health authorities believed that we'd have an out of control epidemic on our hands.

As things stand now, our injecting drug user population has a high rate of Hepatitis C infection (indicating that people are still sharing neeles at an alarming rate), but a low rate of HIV infection. One possible reason for this is that at the same time extremely aggressive measures were being taken here to contain the spread of HIV (massive changes to our blood bank protocols, the introduction of needle exchanges, widespread AIDS education programmes in the both the gay community and in mainstream society), those who were already infected were getting sick very quickly. Not only were many of those people modifying their behaviour anyway, but their increasing morbidity reduced opportunities for those with failing health to engage in the activities which would spread the virus. Put simply, those infected in the "first wave" got sick and died quickly, which dramatically reduced the pool of infected people in the community (including the pool of people who were unaware of their seropositivity until they had an AIDS-defining illness).

We have only begun to understand HIV immunity and non-progression relatively recently, but most of what health authorities conjectured about HIV/AIDS at the beginning of this epidemic has been vindicated. In Australia (and I believe in the US), we are starting to see infection rates rising in some subcultures where they had previously fallen. This seems to be related to both lack of exposure to people living and dying with AIDS (everyone even remotely connected with the gay community in the late 80s and early 90s watched multiple acuaintances and friends succumb to AIDS) and the perception that AIDS is now a chronic, manageable illness.

In countries where public health and public education strategies have not been as aggressively applied as in Australia and the US, the epidemic remains out of control.

[Luke T.]

Did I mention my brother impregnated two women when he had AIDS? Neither the mothers or the children got AIDS. Amazing.

[Denise]

Originally posted by garys_2k


This does seem odd. Why would this be the case in one isolated part of the world? It's puzzling. I suspect we aren't getting the whole picture with this claim.

AS
African sexual practices are different. IIRC it's common for partners to use a drying agent to reduce lubricating effects (more pleasure for the guy, as I'd heard it), leading to more vaginal chafing and irritated skin. [/B][/QUOTE]

Also the practice of FGM has contributed to the epidemic in certain regions in Africa.

[reprise]

I'm sure the risk of transmission of STDs, including HIV transmission, increases. Nevertheless, if neither partner is a carrier the risk is 0. Considering the method of sex ignores the fact that if you aren't in a high risk demographic and neither is your partner, then the risk of infection is much much smaller than the risk for someone who is in such a demographic group.

If neither of you is infected with HIV the risk is zero, irrespective of the demographic group to which you belong and irrespective of your sexual proclivities. Sexual and drug using practises become relevant once one of you is infected.

The problem, however, is that people lie about their risk-taking activities. Even if you think that the statistics regarding the number of people who have extramarital sex are somewhat inflated, they at least indicate that a whole lot of people out there are potentially putting themselves and their partners at risk without their partners being aware of it. Plenty of recreational injecting drug-users also manage to hide the fact of their drug use from their partners, too. Clearly, not all of these people are having safe sex or using clean needles.

The comparisons to the public health measures taken in respect of other STDs in the past (or even TB) aren't really valid. We had ways to treat those diseases which made those people with them non-infectious. We do not have that same capacity with HIV and so our only effective option for controlling the spread of the virus is individuals ensuring that they do not place themselves at risk of contracting it (I'm leaving medical transmission out of the equation here, as that has its own set of stringent controls in place).

I'm not sure whether the behavioural studies which were done during the early 90s have been superceded, but when I was presenting AIDS education seminars the research indicated that while women would tend to insist on condoms for the first few sexual encounters with a new partner, a significant number of them would cease using condoms well before the "window period" for seroconversion had expired.

[Shane Costello]

Michael Fumento has written extensively (www.fumento.com/suaids.html) on the subject of AIDS and penned a book called "The Myth of Heterosexual AIDS".

Originally posted by LukeT:
The doc said that it is much easier for a woman to get AIDS from hetero sex than a man. He said the odds of a man getting AIDS from an infected woman were like 5000 to 1. But this was the early nineties, and was probably as much a guess as a fact. So take it for what it is worth.

IIRC the reasoning behind this stat is that the female vagina is quite an acidic environment, and the virus isn't very viable there.

[AmateurScientist]

Originally posted by Shane Costello
Michael Fumento has written extensively (www.fumento.com/suaids.html) on the subject of AIDS and penned a book called "The Myth of Heterosexual AIDS".


Thanks for the link, Shane.

I'm interested in this subject for several reasons. One of the them is that I'm old enough to remember very well the mystery surrounding what AIDS was when it first became a reported issue. In fact, as it was first recognized in the gay male North American population, at first it was called GRIDS--Gay Related Immuno Deficiency Syndrome. No one understood what its cause was, specifically how it was transmitted, or what exactly it was doing to the body. At first, it was just this mysterious killer of gay men.

Within a few short years, the thing became a sexual bogeyman to everyone. My first year or two in college AIDS was widely talked about, and it put a serious damper on relations between men and women. By the time I was graduated, many prudent girls wouldn't touch you without three condoms.

By then--in 1985--many widely reported estimates of the spread of the disease predicted that by 2000 something on the order of one third to one half of the population of the world would be infected, and that 100s of millions, if not billions (American usage), would be dead. It was scary as hell.

This, of course, never materialized. Either such predictions were flawed from the start, or they were part of a hysterical scare campaign of propaganda. Perhaps they were a little of both.

I'm sick of scare-mongering and I hate hysteria. I'm sorry for its sufferers, but AIDS no longer has my attention.

AS

[Luke T.]

Originally posted by reprise


If neither of you is infected with HIV the risk is zero, irrespective of the demographic group to which you belong and irrespective of your sexual proclivities. Sexual and drug using practises become relevant once one of you is infected.

<snip>

The comparisons to the public health measures taken in respect of other STDs in the past (or even TB) aren't really valid. We had ways to treat those diseases which made those people with them non-infectious. We do not have that same capacity with HIV and so our only effective option for controlling the spread of the virus is individuals ensuring that they do not place themselves at risk of contracting it (I'm leaving medical transmission out of the equation here, as that has its own set of stringent controls in place).



I think we still need to take the public health measures I desribed near the top of this topic. If you go to the doctor for a broken leg, you still get tested for HIV.

How can we know the risks if we don't even know who is infected? Surely, awareness of the infection rates is critical.

You say the HIV risk is zero if neither person is infected. But what if they don't even know they are infected? Then they have no idea of the risk they are taking. I think most people would radically change their sexual behavior if they knew they were infected, or if they found that a greater part of the popluation was infected than is currently known.

The more knowledge we have at our disposal, the better. I can't see any logical argument against not testing everyone who seeks medical attention of any kind.

[reprise]

Luke, people should be modifying their sexual and other risk-taking behaviour if they have done anything to put themselves at risk of contracting HIV, not waiting until they are tested and seropositivity is established some time down the track.

People undergoing surgery here are tested for a number of blood-borne diseases, including HIV but it's worth bearing in mind that a single seronegative antibody test is not conclusive proof that there is no HIV infection.

I don't know of any health system in the world which could afford to test people for HIV (and why only HIV, Hep C is reaching alarming levels here, too) every time they present for medical treatment - some individuals would be being tested several times a week, and we'd be testing a great many others who have placed themselves at risk of acquiring HIV. Many hospitals do conduct sentinel testing, however, which gives us an indication of the incidence of seropositivity in the general population.

An aside to AS. Many of the projections made in the early days of HIV/AIDS were based on worst-case scenarios (and I agree that some of those may have been overly pessimistic). While I can only really speak for my own nation, it is largely the public health measures which were put into place which ensured those worst-case scenarios did not eventuate.

[Shane Costello]

Originally posted by AmateurScientist:
By then--in 1985--many widely reported estimates of the spread of the disease predicted that by 2000 something on the order of one third to one half of the population of the world would be infected, and that 100s of millions, if not billions (American usage), would be dead. It was scary as hell.

Wasn't this around the time Rock Hudson passed away? From what I've read (I can remember back that far but it would have been well past my bedtime whenever AIDS was discussed) wasn't a big deal was made of the fact that Ropck Hudson kissed Linda Evans on "Dynasty" while HIV positive?

This, of course, never materialized. Either such predictions were flawed from the start, or they were part of a hysterical scare campaign of propaganda. Perhaps they were a little of both.

There's an interesting parallel with vCJD (www.newscientist.com/hottopics/bse), which represents the other great mass health scare of our time, on this side of the world anyway. Predictions of millions of deaths in Britain from vCJD comtracted from beef tainted by BSE were predicted. Estimates of future deaths have been constantly reduced, to the latest figure (www.newscientist.com/hottopics/bse/bse.jsp?id=ns99993440) of 7,000 deaths (worst case) or less than 100 (best case scenario).

I suppose there are a lot of different strands at work. Hysterical scare campaigns make for good copy and headlines. OTOH it seems that more benign revisions of doomsday scenarios rarely ever make the news bulletins or end up buried on the back pages. While I'm loathe to say that scientific research is big business, it's an inescapable fact that there are millions of dollars worth of research funding up for grabs, and scientists aren't adverse to using scare tactics to give themselves a competitive edge when the grants are being allocated.

[AmateurScientist]

Originally posted by reprise

An aside to AS. Many of the projections made in the early days of HIV/AIDS were based on worst-case scenarios (and I agree that some of those may have been overly pessimistic). While I can only really speak for my own nation, it is largely the public health measures which were put into place which ensured those worst-case scenarios did not eventuate.

Yes. This is one reason I cannot stand projections based on current trends. They never take into account that current trends usually do not continue unabated. Conditions change and trends change and/or reverse.

It just isn't realistic to rely on long-term predictions based on current trends.

Doomsday scenarios are often self-correcting. The YK2 scare comes to mind, as does the spread of AIDS. I remember a couple of friends asking back in early 1998 my opinion of what would happen on January 1, 2000. My answer even then was, "Biggest non-event in history." It was pretty accurate, I think. I never tried to claim any million dollar prize for it.

AS

[BillyJoe]

Originally posted by Luke T.
.....one of the methods used to get the syphillis and gonorhea epidemics under control in the middle of the 20th century was to test anyone and everyone who went to the doctor..... We need to do the same with AIDS. This is surely an overreaction.

It is always important to do only what's reasonable. Resources are limited both funding and human resources. Money and manpower used in one area cannot be used in other areas which may be just as legitimate.

It is not reasonable to test everyone.

There has to be consent to testing and only at risk groups should be considered for testing.
What's the point, for example, in testing a monogamous couple who don't use IV drugs. Despite popular belief many people belong to this group.

regards,
BillyJoe. ;)

[reprise]

We are currently seeing HIV infections starting to rise again in some populations AS, and I think most health educators realise that it's going to be a heck of a lot harder to convince people in those subcultures to modify their behaviour now than it was 20 years ago, partly because people aren't as afraid of AIDS these days - 1) because they've had less exposure to people with AIDS and 2) because for many people, 15 years hence is too far away to worry about.

One of the heart foundations (probably the American one) did some research many years ago into what motivated people to reduce their risk factors - far and away the biggest trigger for people making lifestyle changes which reduced their risk of heart disease was people in their peer group suffering heart attacks (they even came up with an average number of heart attacks in a person's peer group which would motivate someone to reduce their risk factors - IIRC, the number was three although I don't remember over what time frame).

The fear factor can play a useful role in health education when we are dealing with diseases for which the risk factors are based on lifestyle choices (whether to have unsafe sex or to smoke), but we have to be extremely careful about creating such a climate of fear that people believe it isn't worthwhile modifying their behaviour because the disease will somehow "get them" anyway. If I had a dollar for every time I've heard someone opine that "EVERYTHING gives you cancer these days, so you might as well enjoy it", I'd be a wealthy woman by now.

[BillyJoe]

Originally posted by reprise
The fear factor does [play] a useful role in health education....How do you justify causing one illness (living in fear) in order to prevent another illness. :(

[toddjh]

Originally posted by reprise
We are currently seeing HIV infections starting to rise again in some populations AS, and I think most health educators realise that it's going to be a heck of a lot harder to convince people in those subcultures to modify their behaviour now than it was 20 years ago, partly because people aren't as afraid of AIDS these days - 1) because they've had less exposure to people with AIDS and 2) because for many people, 15 years hence is too far away to worry about.

There's also a third factor: treatments are always improving, and it's possible for HIV-positive people to live 20-30 years or more. In some areas and subcultures, people are starting to view AIDS as a chronic condition rather than a terminal illness. And it gets worse: people with HIV are often greeted with sympathy, support, and positive attention. That's not a bad thing in and of itself, of course, but in subcultures that are often a bit, er, dramatic to begin with, it has the side effect of creating HIV-positive cliques, and, insanely, there is sometimes peer pressure to contract HIV.

A friend of mine works closely with the gay community around Portland, Maine, and she's constantly amazed how many people are actively trying to get HIV so that they can fit in with their friends. It's sickening.

Jeremy

[Jon_in_london]

Originally posted by Luke T.
The idea was to pump the patient's blood through some kind of machine and elevate it to like 116 degrees Farenheit or some such thing, and then cool it back down and cycle it back into the patient. The idea being that the high temp would kill the virus.


It failed because most HIV is in the lymphatic system. Only a tiny % of viral titre is in the blood.

[reprise]

A friend of mine works closely with the gay community around Portland, Maine, and she's constantly amazed how many people are actively trying to get HIV so that they can fit in with their friends. It's sickening.

We had a similar problem here about a decade ago with marginalised youth actively trying to become infected with in order to access services not available to them as members of the general population.

[Jon_in_london]

Originally posted by toddjh
A friend of mine works closely with the gay community around Portland, Maine, and she's constantly amazed how many people are actively trying to get HIV so that they can fit in with their friends. It's sickening.

Jeremy

Literally! :eek: