TIME: Almanac 1993/TIME Almanac 1993.iso/time/112591/1125990.000

Text File | 1992-08-28 | 10.8 KB | 227 lines

                                                                                SOCIETY, Page 72

How Safe Is Sex?


When Magic Johnson announced that he had the AIDS virus, he put
the risk of heterosexual transmission squarely in center court

By PHILIP ELMER-DEWITT -- Reported by Elaine Lafferty/Los Angeles,
Andrew Purvis/New York and Dick Thompson/Washington


    As long as the epidemic didn't touch anyone close to
them, many Americans found it easy to put AIDS out of mind. For
all the suffering and pain and lives cut short, it just seemed
like someone else's problem. AIDS was something that happened
to ghetto dwellers, drug addicts or gays, not to middle- and
upper-class folks who limited themselves to straight sex.

    Now it's harder to ignore AIDS. When Magic Johnson stepped
forward to announce that he had tested HIV positive, his plight
suddenly seemed like everybody's nightmare. Johnson's claim that
he picked up the AIDS virus heterosexually, rather than through
intravenous-drug use or homosexual contact, dramatically raised
some of the most crucial health questions of the 1990s: How easy
is it to get AIDS from straight sex? How fast can it spread?
Could an AIDS epidemic like the ones sweeping through Third
World nations take root in the general U.S. population as well?

    According to the latest figures from the Centers for
Disease Control, the risk to most American heterosexuals is
still small, but it is real and growing. About 11,000 reported
AIDS cases -- or less than 6% of the 200,000 Americans afflicted
over the past decade -- have arisen from heterosexual contact.
But while the number of heterosexual cases is relatively tiny,
it jumped 40% last year, faster than any other category. As many
as 1 million Americans may be infected with the virus that
causes AIDS but not yet suffering from the disease. And no one
knows how many of those people were exposed heterosexually.

    The epidemic has hit the U.S. in three waves. The first
occurred among homosexual men and is now leveling off. The
second swept through pockets of IV-drug users, especially in
certain East Coast cities, and has yet to reach its peak. The
third wave is just taking off among heterosexual men and women
who have had sexual contact with one or more of the high-risk
groups. The question now is how far -- and how fast -- it will
travel into the rest of the population.

    One cause for concern is that heterosexual transmission is
the rule, not the exception, in most countries affected by the
disease. Figures released by the World Health Organization last
week show that 75% of the people who have the AIDS virus
worldwide were infected heterosexually. In Africa, where
one-tenth of the world's population accounts for half the
estimated 10 million AIDS infections around the globe,
heterosexual transmission is responsible for more than 8 out of
10 cases. In Southern and Southeast Asia, where the epidemic is
growing more rapidly than anywhere else, heterosexual contact
is also the dominant mode of transmission. Among the prostitutes
in Bombay's red-light district, 25% to 30% are HIV positive. In
the poorer sections of Nairobi, Kenya, infection rates among
prostitutes run higher than 90%.

    Most experts attribute the prevalence of heterosexual AIDS
transmission in Africa to widespread venereal diseases such as
syphilis and chancroid. These diseases cause sores and
infections that make it easier for the virus to pass from one
person to another -- a problem exacerbated by a medical system
that is shockingly inadequate. Gonorrhea rates in Africa are as
much as 20 times those of the industrialized West, and yet there
are one-sixtieth as many doctors per capita as there are in the
U.S. A case that would be treated promptly in a young American
is likely to become chronic in his African counterpart. "After
a couple of weeks, the person gets used to it and resumes having
sex," says Dr. Myron Essex, chairman of the Harvard AIDS
Institute. In crowded African urban centers, the virus has
become ubiquitous, threatening to kill off almost an entire
generation of young adults.

    Few experts believe anything like that is going to happen
in the U.S. Most Americans do not have the venereal diseases
that make it so much easier for the virus to be transmitted
through heterosexual intercourse. The general level of hygiene,
the relative isolation of the pockets of infection from the
rest of the population and the widespread availability of
treatment for sexually transmitted diseases, even among the
poor, make it unlikely that an African-style epidemic could
sweep across America.

    But the U.S. does have trouble spots: the largely
African-American and Hispanic ghettos in the East. Widespread
needle sharing among drug addicts allowed the AIDS virus to get
a solid foothold in major U.S. cities in the 1980s, and now
practices such as trading sex for drugs threaten to broaden the
problem. AIDS is already epidemic in the poorest neighborhoods
of New York City, Newark, Baltimore, Washington and Miami,
places where social problems and the lack of good medical care
mimic Third World conditions. "The fact that we see sexually
transmitted diseases rising in our inner cities is an ominous
sign," says Helene Gayle, an international AIDS expert at the
Centers for Disease Control.

    There are already indications that AIDS fostered in the
inner cities may be beginning to creep into outlying areas. In
parts of Georgia and Texas, mini-epidemics are appearing. "The
fastest growth is in rural areas and small cities," says Sten
Vermund, chief of AIDS epidemiology at the National Institutes
of Health. Investigators suspect that drug users who contracted
AIDS in the city have started to move back to their hometowns,
either to be cared for by family members or to try to straighten
out their lives. Once there, they may start a chain reaction of
local AIDS infections.

    But while health officials caution against complacency,
they emphasize that there is no need for most people to panic.
The fact is that unless a person has a chronic venereal disease
-- or engages in a high-risk activity such as needle swapping or
anal sex -- the AIDS virus is not that easy to get. Medical
literature is filled with cases in which husbands and wives had
sex hundreds of times over several years without passing the
virus from one to the other.

    It is especially difficult for the virus to move from an
infected woman to an uninfected man, as a study published last
September in the Journal of the American Medical Association
makes clear. A team of scientists, led by Nancy Padian of the
University of California at San Francisco, studied AIDS-virus
transmission among 379 heterosexual couples. While the
scientists found 61 cases in which an HIV-infected man gave the
virus to a woman, they saw only one case of an infected woman's
giving it to a man. And in that case, the couple engaged in some
particularly unsafe practices, including unprotected anal sex
and swapping sex partners with members of a "swinging" club.

    The initial skepticism that greeted Magic Johnson's
explanation of how he had contracted the AIDS virus stemmed from
such studies -- and from his reluctance to speak directly to the
rumors of bisexual activities in the past. Johnson finally
addressed those rumors last week. "I have never had a homosexual
encounter," he wrote in SPORTS ILLUSTRATED. "Never."

    Such denials are sometimes questioned by medical
professionals. Doctors and nurses who minister to AIDS patients
say that a heterosexual man who has contracted HIV will often
tell his wife and children he got it from a prostitute. But
close to death, these same men will sometimes confide that they
did have a homosexual experience. Or that they flirted, many
years ago, with intravenous drugs. At Sherman Oaks Hospital in
California, which has been caring for AIDS patients since 1980,
the nurses are no longer surprised. "When a guy says he got it
from a woman, we just nod," says a nurse. "It's probably not
true, but that's the way most of them want to handle it. And
that's fine."

    In the end, it doesn't matter whether Magic Johnson got
the AIDS virus through heterosexual or homosexual sex. The fact
remains that people can get infected through heterosexual
contact and that a few simple precautions can sharply reduce --
or eliminate -- those risks. If Johnson can get that message
across to those who need it most -- sexually active teens and
young adults -- then his outspokenness will have done an
immeasurable public service.

    There were signs last week that Johnson has already
started to make a difference. In schools across the country,
teachers hastily organized classes and assemblies to answer the
flood of student questions. At Inglewood High School near Los
Angeles, where the Lakers frequently practice and Magic's name
is magical, Jesse Jackson spoke to the students about AIDS, and
the school passed out free condoms. "I hope everyone got one,"
says Rashieda Lane, 16. "I don't want my friends to catch it."

    Americans are likely to hear a lot more about condoms in
the coming months. Fox Broadcasting, the fourth largest TV
network, reversed a long-standing policy and became the first
national broadcaster willing to accept paid condom advertising
-- provided the ads stress the health benefits and not birth
control. CBS is also reviewing its condom-ad policies.

    Government policymakers could be coming around as well. In
New York City, where a program that provided drug addicts with
clean needles had been canceled, Mayor David Dinkins announced
that he had changed his mind and endorsed a new needle-exchange
scheme. Even President Bush, who has done little of substance
to support prevention campaigns, made the symbolic gesture of
inviting Magic Johnson to fill a vacancy on his National
Commission on AIDS. Johnson quickly accepted.

    Efforts are also being accelerated on the research front.
The World Health Organization, which had held up field trials
of several experimental AIDS vaccines pending tests on animals,
announced last week that it would skip the time-consuming lab
trials and test the vaccines on humans in Brazil, Rwanda,
Thailand and Uganda, perhaps within two years. In the U.S. the
Centers for Disease Control is considering doing the same thing
in the country's AIDS hot spots.

    Until there is a vaccine or a cure, responsibility for
AIDS in America will have to remain where it is now: with the
people in danger of getting and spreading it. For the individual
considering a casual sexual encounter, wearing a condom -- or
abstaining altogether -- can mean the difference between
acquiring a deadly virus and avoiding one. For the country as
a whole, it can spell the difference between a contained health
problem and one that is out of control.