Special Report: Good and Bad News About AIDS

By John Langone

The barrage of scary rhetoric and hyperbole began not long after young homosexual men started dying by the thousands in the early 1980s. Dire warnings of an AIDS apocalypse came not only from headline writers but also, uncharacteristically, from scientists and health specialists. Declared one: "We have not seen anything of this magnitude that we can't control except nuclear bombs." In 1987 Otis Bowen, then Secretary of Health and Human Services, said AIDS would make black death -- the bubonic plague that wiped out as much as a third of Europe's population in the Middle Ages -- "pale by comparison." In a frightening, controversial book, sex researchers William Masters and Virginia Johnson contended that toilet seats could transmit the AIDS virus and that the deadly disease would run rampant among heterosexuals.

The public understandably became terrified and overreacted. Children with AIDS from Queens to Kokomo were barred from attending school. Police officers donned rubber gloves when apprehending drug abusers thought to be infected with the AIDS virus. Churchgoers declined the Communion wine they had once quaffed from their common cups. Everything from Florida's mosquitoes to food touched by gay waiters was suspected of carrying the virus.

Now, eight years into the epidemic, it is increasingly clear that much of the panic and scaremongering was not justified. AIDS is not the black death, and never will be. Unlike the plague or the common cold, AIDS is not easily spread. The virus is transmitted only through blood and sexual intercourse. No one has been found to get the virus from saliva, tears or toilet seats. As a result of education about AIDS and changes in sex habits, the rate of new infections has sharply dropped in some gay communities. And while the virus can sometimes be transmitted in heterosexual intercourse, the evidence does not indicate that AIDS is about to break out in a big way into the mainstream population.

Nonetheless, there is ample cause for concern. Unlike many other diseases, AIDS remains fatal; there is no known cure. It is still spreading rapidly among intravenous drug abusers. They pass along the virus to those who share needles with them or to sexual partners, both male and female. Women who are part of the drug scene often transmit the virus to their unborn children, almost surely dooming them to an early death. Some researchers fear that AIDS could eventually spread, through heterosexual intercourse, from addicts to the population at large. But so far the epidemic has confined itself, for the most part, to gay communities, to the drug cultures of inner cities, and to hemophiliacs and others who have received tainted blood products and transfusions.

While most people can guard against the AIDS virus, the disease has undeniably created a disaster of monumental and mounting proportions. Up to 1.4 million Americans, and perhaps 10 million people worldwide, are already infected with the AIDS virus. Since the virus may lie dormant in the body for years before causing the disease, the number of AIDS cases -- and the death toll -- will continue rising for years.

In the U.S. the epidemic has progressed more or less as the experts expected. New cases increased from about 22,000 in 1987 to 32,000 in 1988. Most of these victims picked up the virus years ago, before the dangers of AIDS became known. The Public Health Service forecasts that by the end of 1992, 365,000 Americans will have come down with AIDS, and 263,000 of these will have died.

Outside the U.S., the incidence of AIDS varies wildly: an estimated 1 million Brazilians may be infected with the virus, but only 1,200 Japanese. The epidemic is still raging in Africa, where many scientists believe the disease originated. AIDS in sub-Saharan Africa, unlike anywhere else, is a heterosexual scourge that affects men and women equally. One reason is that in some countries of the sub-Sahara men practice polygamy, while in other regions men commonly have multiple sexual partners. Moreover, the continent is rife with other sexually transmitted maladies, such as genital ulcers and lesions caused by syphilis. Such breaks in the skin make it easier for the AIDS virus to penetrate the body and enter the bloodstream. As many as 5 million Africans are thought to harbor the virus, and at least 175,000 have developed AIDS.

In many countries the spread of information about how the AIDS virus is transmitted has helped slow down the march of the disease among some groups. Gay communities around the world have made "safe sex" the watchword, and the use of condoms is up -- with dramatic results. From 1983 through 1985 in West Berlin, one-fourth of the homosexuals and bisexuals at a single clinic tested positive for the virus. In 1988 the figure had dropped below 10%. In San Francisco up to 5,000 people first tested positive for the virus in 1981; last year the number of newly discovered infections was down to about 100. Asserts Andrew Moss, an epidemiologist at the University of California at San Francisco: "The epidemic is all but over with gay men."

The same cannot be said of intravenous drug abusers, who are generally oblivious to educational campaigns about the risk of sharing needles. "Either the message is not getting to them," says Moss, "or it's not getting to them in a way they can understand." Despite the specter of AIDS, the number of addicts is still rising. At drug treatment centers run by New York City's Beth Israel Medical Center, 13% of the patients currently seeking treatment had begun shooting heroin in the past two years. "Given the information that's out there, that's pathetic," says Dr. Stanley Yancovitz, director of clinical AIDS activity at Beth Israel. As gays have grown more cautious about sex, intravenous drug abuse has become the dominant mode of AIDS-virus transmission. New York State expects 3,500 new AIDS cases among addicts this year, vs. 2,700 among gays. In New Jersey 59% of those who developed the disease last year were intravenous drug abusers. Overseas the story is the same: addicts account for about 65% of the new AIDS victims in Spain and 67% in Italy.

The disturbing implication is that AIDS is becoming a disease of the disadvantaged. Blacks and Hispanics make up a disproportionate 40% of all AIDS cases, and that percentage is sure to rise. Says Dr. Harold Jaffe, chief epidemiologist in the AIDS division of the Centers for Disease Control (CDC) in Atlanta: "The evening-news segments about AIDS used to show gay men walking hand in hand down a San Francisco street. Now it may be appropriate to show the black child in Harlem."

Some 70% of the 7,136 U.S. women known to have AIDS are black or Hispanic, as are 75% of the 1,341 children who suffer from the disease. In Spain most of the 80 or so children with AIDS were born to mothers with heroin addictions. Observes Professor Delgado Rubio, the head of a center for pediatric AIDS in Spain's Basque country: "It is particularly cruel that children are brought into this world already infected with an illness from which their parents could have saved them." In Africa 200,000 children carry the virus, and most will die before turning two.

Clearly, economic deprivation can play an important role in the spread of AIDS. Explains Dr. Stanley Weiss of the department of preventive medicine at the University of Medicine and Dentistry of New Jersey in Newark: "If you talk to people in middle-class America, AIDS seems a significant threat because a lot of their other problems are under control. But if you approach the poor in the inner cities, they don't see the disease as such a threat. They have so many problems besides AIDS that it is hard to focus on this one issue." People do not pay much attention to guidelines about safe sex, Weiss points out, if they have no home and little to eat.

It is conceivable that AIDS will fan out from the ghettos into the general population, but not likely. If the spread occurs, it will be slow: many scientists believe the virus is passed along less readily in conventional intercourse than in homosexual encounters. Anal intercourse is by far the most likely means of sexual transmission. Although the evidence is sketchy, women seem to be more at risk than men of acquiring the virus from the opposite sex. So far, 1,757 U.S.-born women may have contracted AIDS from men, and 565 men from women.

Of the 32,000 new AIDS cases in the U.S. last year, only 4.9% were attributed to heterosexual transmission. And even that percentage may be overstating the danger: many of these victims, according to the CDC, were born in foreign countries where heterosexual AIDS may be linked to widespread venereal disease and other factors like malnutrition. Concludes Eve Nichols of the Institute of Medicine at the National Academy of Sciences: "Researchers do not expect to see an explosion of cases among non-drug-abusing heterosexuals in the U.S." In the forthcoming new edition of her book Mobilizing Against Aids, Nichols says that heterosexuals can have a "very low risk of contracting AIDS" if they use condoms and take the time to learn enough about their sexual partners to avoid drug abusers or the promiscuous.

The AIDS scourge has generated an all-out scientific effort to conquer the disease. While a cure is still out of reach, U.S. laboratories are investigating nearly 100 drugs, vaccines and diagnostic tests. One drug, AZT, has prolonged the life of adult AIDS patients and enabled some children with the disease to regain lost intelligence. But AZT has toxic side effects and is not a cure. Alpha-interferon, a naturally occurring substance in cells that has been reproduced in the laboratory, causes remission in adult Kaposi's sarcoma, a common manifestation of AIDS, in 25% of cases, but the cancer later reappears. Other promising drugs, like GM-CSF, a new immune-system booster that increases the number of infection-fighting white blood cells, are in early stages of testing. Researchers at Harvard Medical School and Biogen, a Cambridge, Mass., biotech company, reported in Nature last week that an experimental drug called CD4 can reduce levels of AIDS-like viruses in monkeys. Two potential vaccines are being tried on humans in the U.S.

The fact that AIDS may take ten years to develop after a person is infected offers encouragement to researchers. If scientists can find out how the body suppresses the virus for so long, they may be able to figure out how to strengthen that defense. But a cure may take years, if it comes at all. In the meantime, the message from scientists is mixed: AIDS will continue to devastate large segments of the population, but it is preventable. If people take proper precautions, the tragedy that has hit isolated groups will not spread throughout society.

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With reporting by Mary Cronin/New York and Joyce Leviton/Atlanta, with other bureaus