AIDS AND SEX
The unsigned letter, from a divorced 37-year-old woman, appeared in The Vancouver Sun on Aug. 8 in response to a series of articles that the newspaper had published in June on Acquired Immune Deficiency Syndrome (AIDS). The woman said that she had a strong sex drive but had become too frightened to engage in intercourse. The Sun reports had made even kissing sound risky, she said. “I’m getting more and more terrified,” the woman wrote. “Right now the loneliness has me in such a depression I don’t know what to do; I don’t want to die of AIDS nor do I want to die of loneliness.”
Fear: The anguished sentiments in that five-paragraph letter would have been dismissed as hyperbole as recently as two years ago. By 1985 there were 385 diagnosed cases of AIDS in Canada and 27,509 reported around the world. But since then the number of AIDS cases recorded in Canada has nearly tripled, to 1,239. The global count has risen sharply to 55,278 and now is forecast to reach as high as three million by 1991. At the same time, the num-
bers of reported cases outside the traditional high-risk groups—mainly homosexual men and intravenous drug abusers—are increasing. Against a background of alarming statistics, disagreement among scientists and relentless coverage of AIDS in the media, a new element—fear—is now firmly associated with the spread of the disease.
Some of the fear is irrational, most of it is unanswerable and—with no cure in sight—all of it is understandable. It is reflected in the desperate actions of governments, the hesitant statements of politicians and the pleas for reassurance from ordinary people. The emotional appeal of a frightened divorcee no longer seems exaggerated. Instead, it is a sign of the times.
Clearly, there is reason to be concerned about a disease that was unknown eight years ago and has since —according to unofficial estimates— killed as many as 75,000 people around the world, including 657 in Canada. In fact, it has only been four years since scientists positively identified the virus that causes the disease. Called Hiv
(for human immuno-deficiency virus), that organism has been found in blood, semen, saliva and even tears—and it kills indirectly by weakening the body’s natural immunity to a variety of infections and malignancies. It can be transmitted by oral, anal or vaginal sex, by transfusions of infected blood—a risk greatly reduced since health agencies, such as the Canadian Red Cross, began screening donated blood—and by using contaminated needles to inject drugs.
Infected: Two facts are mainly responsible for transforming concern into fear. First, scientists simply do not yet know enough about the disease to appease the worldwide clamor for reassurance. And second, the virus behaves in a uniquely threatening way: AIDS is the only communicable disease that gives no evidence for years of its presence. In the Aug. 19 issue of the British journal Nature, University of London researcher Graham Medley published a study indicating that the virus may lie dormant for an average of eight years in people who had been infected by blood transfusions.
However, Medley said his findings did not necessarily apply to those infected by other means. Earlier studies in laboratories around the world have estimated that the overall incubation period for the virus could be anywhere from two to 15 years. And he added that carriers who are unaware that they are harboring the Hiv virus can unwittingly pass it on to others. But scientists do not yet know how many carriers will ultimately develop AIDS. One recent study involving 155 homosexual males in San Francisco has provided a basis for estimates: it showed that about 30 per cent of those with the Hiv virus came down with AIDS within seven years.
Epidemic: At the Third International Conference on AIDS in Washington in June, Dr. Jonathan Mann, director of the World Health Organization’s (WHO) special programs for AIDS, said that as many as 10 million people worldwide have probably been infected with the HIV virus. Said Mann: “We are imminently facing a precipitous increase in the number of cases.” On the assumption that from 10 to 30 per cent of those who now carry the HIV virus will develop AIDS in the next five years, the world faces from 500,000 to three million new cases.
But that was not the only cause for worry, said the WHO scientist. There is also a global “epidemic of economic, social, political and cultural reaction to HIV infection” that the spread of highly visible AIDS cases would intensify. He said that he saw a “rising wave of stigmatization” against Westerners in Asia and against Africans in Europe; against homosexuals, prostitutes, and even hemophiliacs and others who had been infected by blood transfusions.
Some draconian suggestions gaining support in various parts of the world, he said, included giving people “sex cards” as evidence of their supposed freedom from infection, tattoos to identify those who carried the virus and allowing HIV carriers to remain free only as long as they agreed not to marry, work or travel.
Declared Mann: “Sometimes bewildered, sometimes frightened peoples and their leaders are seeking answers, perhaps simple answers, to complex disease control and ethical questions.” Added Mann: “Fear about AIDS has become a direct threat to free travel among countries and to open interna-
tional exchange and communication.” Certainly, the signs of fear at all levels of society, are readily apparent. Some recent examples:
• In Montreal, a gynecologist who specializes in sexually transmitted diseases and the former managers of a discotheque will open a singles club this fall for people who test negative for the Hiv virus. Members will pay $250 a year to belong, and they will have to undergo a test when they sign up and another test three months later. Said Dr. Alain Campbell: “This is not a prostitution club, very far from it.”
• In Halifax, a heart surgeon at Victoria General Hospital refused last April to perform elective surgery on a homosexual patient until he was tested for the HIV virus —even though he had tested negative a few weeks earlier. The second test was also negative but another surgeon performed the operation.
• In Winnipeg, city Councillor Harry Lazarenko told a July 30 council meeting that known carriers of the HIV virus and AIDS patients alike should be quarantined. Said Lazarenko: “These people—it’s a documented fact—will be dying anyway. Why expose them to the public?” But Mayor William Norrie, who was quarantined
for six months when he caught polio as a child, said that he disagreed with Lazarenko. And at a subsequent meeting, council voted to spend $144,000 to open an AIDS information office. Said Councillor Shirley Timm-Rudolph: “People are absolutely panic-stricken.”
• In Richmond Hill, Ont., near Toronto, businessman Michael Newman proposed that the bodies of AIDS victims be irradiated to kill the Hiv virus before mortuary employees began preparing them for burial. “I feel there is a genuine business opportunity, as morbid as that may sound,” said Newman. But Dr. Alastair Clayton, director of the Laboratory Centre for Disease Control in Ottawa, said that the proposal reflected “a bit of an overreaction” to the disease. Besides, said Clayton, the virus becomes inactive three to four hours after death.
• Iraq refuses to admit travellers who cannot produce a certificate confirming that they are free of AIDS. And about a dozen other countries require AIDS-free certificates from students and immigrants from certain countries. China, for one, demands a certificate from anyone who plans to live in the country for an extended period.
• In Milan, a judge ordered the operators of a senior citizens’ home to hire a woman medical orderly. They had withdrawn a job offer when they found out that she was an HIV carrier. Anna Maria Dadda said that the HIV test was done during what she took to be a routine pre-employment physical exam. The court noted that there was no medical evidence that the virus
could be passed on by normal contact.
Still, the medical evidence surrounding AIDS is often conjectural, contradictory or inconclusive. Governmentsponsored television campaigns in Canada and other countries promote the use of condoms to achieve ______
safe sex. But Victoria Leonard, executive director of the Washington-based National Women’s Health Network, a consumer advocacy group, said that studies have shown that, even if condoms are used by couples in which one partner has AIDS, five per cent of the healthy partners will become infected in the first year. Said Leonard:
“We need to eroticize cuddling”—the only completely safe sex.
Kissing: After studying the cases of 97 women whose sex partners carried the HIV virus,
Dr. Nancy Padian of the University of California at Berkeley concluded that a woman’s chances of being infected by a Read: single episode of intercourse with an infected man were about one in 1,000. But, warned Dr. Stanley Read of Toronto’s Hospital for Sick Children, “statistics give a false sense of security.” Added Read, a pediatrician and AIDS specialist: “You could be infected by one episode.”
At Harvard University, Dr. Myron Essex, chairman of the department of cancer biology, said that it is virtually impossible to get the HIV virus from an infected partner’s saliva. However, said Essex, deep kissing might trans-
mit the virus if the kissing produces abrasions in the mouth. Still, medical specialists at the U.S. Centers for Disease Control in Atlanta say that kissing with the mouth closed will not transmit AIDS.
Continuing uncertainty, disagreement and revised conclusions from experts, coupled with the realization among the general population that AIDS is not the exclusive hell of homosexuals, have helped to spread the fear of contamination. But Dr. Robert A. Buckingham, the head of psychiatric emergency services at the Toronto General Hospital, said that many people who seem to be knowledgeable about the disease also exhibit fear “that is out of proportion to the danger.”
The hospital has an AIDS educational program for its staff members. Despite that, said Buckingham, “When they are in a situation of having to confront someone with AIDS for the first time, they experience fears that information has not prepared them to deal with.”
Worried: According to Buckingham, several factors lie behind what he describes as “primitive fears.” For one thing, AIDS is one of the few diseases since the great plagues of the Middle Ages to be perceived as a death sentence. And although there has been a flood of information about AIDS, nearly all of it lacked certainty. “People don’t want probabilities or statistics, they want certainties,” Buckingham said. “That is part of the fear: the faith that people put into science and medicine has somehow let them down.”
That anxiety about AIDS finds expression in the questions put to provincial health ministries, municipal health departments and AIDS-related organizations across Canada. In Winnipeg, Margaret Fast, the Manitoba director of communicable disease control, said that her agency gets calls from “people who wonder about swimming pools, about trying on clothes in department stores; who wonder about mosquitoes. People who work in department stores are very worried about customers trying on bathing suits.” But she said that she reassures such callers that they are
not facing a risk. “Those are easy questions,” she said. “It is a little more difficult to say that there is no risk in acupuncture and electrolysis [the use of electric current for hair removal].”
In Montreal, where the city’s AIDS committee operates an AIDS hotline and a drop-in centre for victims and their families, spokesmen said that most of the centre’s 50 phone calls a day now come from worried heterosexuals. Communications co-ordinator Pierre Gignac said that one caller had told her neighbor that she was planning to visit a a friend in Toronto who had contracted AIDS. According to Gignac, the neighbor then promptly told the woman that their children could no longer play together. Added Gignac: “It still amazes me the questions we get.”
Tested: And Toronto’s Dr. Stanley Read recalled that a woman once called him “to ask if she should buy a house. She thought the owners were gay, and she was worried about the sauna.” Added Read: “People worry about eating in restaurants with a gay chef and ask what would happen if he cuts his hand and the blood drips into the salad. The answer is that it would be a small amount of blood, and it won’t get into your tissue by swallowing it.”
In Vancouver, the results of a poll published by the Sun on June 5 showed that more than 70 per cent of the 443 respondents were worried about AIDS, nearly 90 per cent thought immigrants should be tested, almost 50 per cent believed that the HIV virus could be transmitted by passionate kissing and almost one-third were afraid that they could get it from mosquitoes.
Condoms: Like Gignac, Vancouver’s Dr. Michael Rekart said that he had detected growing concern about AIDS among heterosexual men and women. Declared the director of the provincial health department dealing with sexually transmitted disease: “If you look at a
AIDS IN CANADA B.C. Alta. Sask. Man. Ont. Que. N.B. P.E.I. N.S. Nfld. Yukon N.W.T. RECORDED CASES: 1,239 263 71 17 18 460 377 21 1 DEATHS TO DATE: 657 133 38 10 10 234 217 5 Homosexuals/ 18 N/A Bisexuals 248 60 N/A 18 415 244 N/A IV Drug N/A N/A N/A Users Blood/ N/A 17 12 N/A N/A Blood Products £ Heterosexual Partners N/A lt; of High-Risk Group N/A 19 N/A a. From Endemic 3 Area N/A 68 N/A N/A O tc o Pediatric N/A 20 N/A N/A Unknown N/A 17 12 N/A N/A N/A = Information Not Available
thousand heterosexually active young adults and you tell them that chances are two of you are positive, that’s a very small percentage.” Added Rekart: “A lot of people know how AIDS is transmitted, but there are many more who don’t. Some don’t listen to the radio, others don’t read the newspapers, and there are people who don’t believe what they read.” But according to Harvard’s Essex, many heterosexuals do not consider themselves threatened by aids—and do not take precautions against the disease. Said Essex: “It is that alone which makes it certain that the infection will establish itself in the heterosexual population.”
But personal concern about AIDS is not limited to laymen. Dr. John O’Brien-Bell, president of the British Columbia Medical Association, said that doctors “have to accept the fact that when we’re near body fluids we’re at risk, and the closer you are to the body fluids the greater the risk.” If condoms are not leakproof, said O’Brien-Bell, then neither are rubber gloves, and the profession should look for gloves made of impermeable synthetic material. And Roy Thordarson, executive director of the B.C. College of Dental Surgeons, said that members have been reminded of the need to wear gloves and
glasses to limit the possibility of infection through a cut or in the eyes. Glove use among dentists, said Thordarson, “has increased dramatically,” and suppliers are having difficulty keeping them in stock.
Values: In Winnipeg, Glen Murray, a health educator for the Village Health Clinic, an AIDS counselling and information centre, said that the agency was midway through a survey of the city’s 250 dentists and had only found about six who would treat HIV positive patients. Said Murray: “It is amazing the amount of misinformation there is in the health care professions in this province. Nurses have been the best informed, and dentists have been the worst.” In April, Winnipeg’s Victoria General Hospital announced that it was considering the introduction of mandatory AIDS screening for all potential employees. But representatives of six other Winnipeg hospitals criticized the idea, and last week a Victoria General spokesman said that the idea was “on the back burner.”
Such emotional and psychological reactions to AIDS, as well as the disease itself, will make enormous demands on nations, according to the WHO’s Mann. Declared Mann: “How societies treat Hiv-infected people will test our fundamental values and the moral strength of our cultures.” As aids—and the fear of catching it— spread throughout the world, it appears that the test has already begun.
LISA VAN DUSEN