]]]]]]]]]]]     AIDS: LETTER TO THE AMERICAN SPECTATOR     [[[[[[[[[[[
                        By Jane Orient, M.D.               (4/22/1989)
                        (Freeman 85716ORIE)
                                                        April 15, 1989
The American Spectator
PO Box 10448
Arlington, VA 22210

To the Editor:

     Michael Fumento got a few things right in his article "The 
Incredible Shrinking AIDS Epidemic" (TAS, May 1989).  For 
example, it is clearly ridiculous to assume that an epidemic  
can remain indefinitely in its exponential growth phase.  
Eventually, it has to level off.  But unfortunately, the
endpoint may be the death of all susceptible individuals in the 
population at risk.  Fumento notes that the rate of new 
infections among homosexuals in major cities is now between 0 
and 4 percent.  He finds that very encouraging, but 
unaccountably fails to comment on the fact that the total 
infection rate in that population may be higher than 50 
     Outside the high-risk groups, the disease spreads much 
more slowly.  But there is no evidence that the epidemic is 
"shrinking"; the number of heterosexual cases doubles every 14 
to 16 months (see JAMA, Oct. 7, 1988, p. 1927).  The rates of
seropositivity are not cause for complacency. Between October, 
1987, and March, 1988, the rate of seropositivity in civilian 
applicants for military service was 0.12 percent or 1.2 per 
1000, not "0.02 percent or less, or 1 in 5000," as Fumento 
states.  In men between the ages of 25 and 29, the rate was 3.8 
per 1000.  At what point will he start to worry?
     The problem with all projections of this epidemic is that 
they are based on assumptions and sadly insufficient data.  But 
if the CDC's totals are too high one year, the cases they 
predict may yet occur, just a little later.
     Fumento ought not restrict his vision to New York and San
Francisco.  In Africa, the situation with heterosexual spread 
is truly alarming.  In the southwest provincial capital of 
Masaka, Uganda, 30 percent of the adult population tests 
positive.  Productivity in the mines in the "copper belt" of 
central Africa is down substantially; expatriates are refusing 
to work there due to the widespread disease in the mining 
camps.  Some argue that Africa is different.  But the most 
important difference may be the time elapsed since the 
appearance of the disease.  
     We know that sexually transmitted diseases can reach very 
high levels in the general population, even in the US.  Human
papilloma virus (the cause of genital warts and of cancer of 
the cervix) and chlamydia (a cause of pelvic inflammatory 
disease leading to infertility) already afflict 30 percent or 
more of sexually active women in some areas.  So AIDS 
transmission is "extremely inefficient"?  In one study, 82 
percent of spouses of infected persons converted their blood 
test in less than two years of continued, unprotected marital 
relations.  In the same study, 17 percent of those who used 
condoms converted, and none of those who abstained.  Other 
studies have shown lower rates of conversion.  Would Fumento 
like to bet his life on which percentage is correct?
     The time for containing an epidemic is in its early 
stages.  If we want to prevent sickness and death, rather than 
conducting an experiment to test Fumento's hypothesis, then 
rational fear, not wishful thinking, is clearly indicated.  

Jane M. Orient, MD

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