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"Sex At Risk" review from the Wall Street Journal (December 8, 1997; p. A22)

Reprinted with permission of The Wall Street Journal (c) 1997 Dow Jones & Company, Inc. All rights reserved.

DANGERS REAL AND IMAGINED

by Ronald Bailey

Sex equals death. The puritans of both the left and the right have loudly promoted this message since the beginning of the AIDS epidemic. The left proclaims that everybody is at risk. Advancing a distorted egalitarian agenda, some decree that if everybody cannot enjoy sex safely, then nobody should. (At Antioch College one demonstrator's poster summed it up: "Social equality is more important than sexual pleasure.") Meanwhile, those on the right, who see AIDS as punishment for sexual sinners, are happy to go along because they hope it will curtail sexual dalliances outside marriage.

Early on, homosexual activists advanced the idea that all were at risk because they feared that if AIDS was seen as afflicting only their community, the larger society would stint on money for research. The campaign was successful. In 1995, 12 times more people died of cancer (538,455) and 17 times more of heart disease (737,563) than died of AIDS (43,115). Yet today at the National Institutes of Health, funding for AIDS research ($1.5 billion) is second only to cancer research ($2.2 billion) and exceeds the amount spent on heart disease ($1.4 billion).

Make no mistake about it, AIDS is a horrible disease. I have known several people who met cruel deaths from this malady. But the plain fact is that not all Americans are equally at risk. In Sex at Risk (Transaction, 232 pages, $32.95), clinical psychologist Stuart Brody reviews nearly all the studies dealing with AIDS, frequency of sexual intercourse and the lifetime number of sexual partners. The good news is that "the risk of transmitting HIV through vaginal intercourse is near zero among healthy adults."

But what about the increasing numbers of people claiming to have been infected through heterosexual intercourse? Mr. Brody explains why skepticism is in order: "Research and experience has shown us that people lie often and for many reasons, and that the content of these lies includes the IV [intravenous drug use] and anal intercourse risk factors for HIV transmission. Such lying is one of the factors contributing to an inflated estimate of vaginal HIV transmission."

Furthermore, many of the epidemiological surveys are badly flawed. Most ask merely whether the patient got the infection from heterosexual sex, failing to distinguish between vaginal and receptive anal intercourse. This leads to "spuriously higher rates of 'heterosexual transmission' for women. Heterosexual transmission is usually misinterpreted by most readers to mean vaginal intercourse."

According to Mr. Brody, most scientific evidence shows that HIV is spread almost exclusively through intravenous drug use (IVDU) and receptive anal sexual intercourse (excluding infants infected in the womb, transfusion patients and hemophiliacs). In particular, women who are not drug users are generally infected through receptive anal sexual intercourse with bisexual men or males who inject drugs.

What about the recent, much publicized outbreak of heterosexual AIDS in upstate New York? The man at the center of that mini-epidemic, Nushawn Williams, was trading drugs for sex with young women who reportedly regularly engaged in "at-risk" behaviors. Mr. Williams had apparently been diagnosed with the sexually transmitted disease chlamydia. Because of confidentiality laws, it is not possible to tell for sure, but it seems likely that many, if not most, of his sexual partners became infected with HIV with chlamydia acting as a strong cofactor.

This matters because the results from the largest study of heterosexual transmission of HIV in the U.S. "confirm the significant contribution of both injection drug use and infection with other sexually transmitted diseases." This study also confirms that it is difficult for HIV to be transmitted via vaginal sex, even in couples where one of the partners is known to be infected. "We estimate that infectivity for male-to-female transmission is low, approximately 0.0009 per contact, and that infectivity for female-to-male transmission is even lower," concludes the study.

So how risky is unprotected vaginal intercourse with strangers? One study calculated that having vaginal intercourse with 5,400 American partners would result in a lost life expectancy of 10 days. Compare this risk with a loss of six months associated with driving a car 10,000 miles per year or a loss of a year for being 12 pounds overweight.

Mr. Brody is not "blaming the victims" at all. He is making a strong case that we focus "AIDS education" on behaviors that are clearly dangerous rather than squander resources on scaring people who are at very low risk. This is the way to save lives. He notes that the "gross exaggeration of AIDS risk to healthy, non-IVDU heterosexuals is not only psychologically damaging, but also constitutes unethical behavior on the part of many public health officials, journalists, and others."

Puritans left and right will no doubt denounce Mr. Brody's conclusions, but as he writes: "Truth is no enemy of compassion, and lying is not an enduring friend."

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Mr. Bailey is a free-lance writer and television producer in Washington.

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