Reprinted from The Wall Street Journal, 1997
Dangers Real and Imagined
By Ronald Bailey
“How risky is unprotected sex 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 a year for being 12 pounds overweight.”
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
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 publichealth
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."