]]]]]]]]]]] AIDS: LETTER TO THE AMERICAN SPECTATOR [[[[[[[[[[[ By Jane Orient, M.D. (4/22/1989) (Freeman 85716ORIE) April 15, 1989 Editor 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 percent. 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. Sincerely, Jane M. Orient, MD * * *
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