HIV/AIDS: HOW GREAT IS
THE DANGER FOR YOUNG PEOPLE
The Case of the Conscripts
By Christian Fiala
It has long been recognised that young people face a particular risk of HIV infection, which is why they have been a target group for numerous preventative information campaigns. If one attempts to define and assess the risk for young people more accurately, one surprisingly comes up against the problem that there is little or no precise data on the subject. Statements of age on positive HIV tests are by no means representative, since they only exist for some of the tests and apart from which it is no clear how many of these are repeat tests. Apart from this, there has been no age-specific research into still unrecognised HIV-positive people.
In Germany it is known that the average age of all those suffering from AIDS at the time of the diagnosis is 38.9 years. In the last 15 years there have been 506 cases of AIDS in the 13-24 age group (out of a population of 81 million). This age-group thereby represents 3.6 of all AIDS cases recorded so far. At most, these data make it possible to derive assumptions. Precise statements, however, are not possible.
In this situation, we are fortunate to be able to rely on the analysis of HIV tests for conscripts in the Austrian army. Austria is the only western country with an obligatory military service and a screening for HIV of its conscripts. The results have a high validity as about three quaters of the male age-class of 19-21 years is screened in this programm every year since 1985.
True, the HIV test is not part of the call-up in Austria. However, practically all of the 40,000 annual conscripts out of a population of eight millions, are regularly tested for HIV, and this goes back to 1985. The basis for this is an agreement between the army, which is seeking a cost-effective method of determining the blood group of its soldiers, and the Red Cross, which exceptionally is prepared to determine the blood group of non-donors at no cost if it is guaranteed that the majority of conscripts take part in the blood-donor scheme. In order to ensure the motivation of the conscripts for this scheme, they are allowed to leave for the weekend on the Friday once they have donated blood. Non-donors, however, including occasionally those who are refused on medical grounds, have to wait until Saturday evening for their weekend leave, and usually no longer have any chance of travelling home by public transport.
This procedure, which has been rejected in other european countries as being involuntary, has thus far ensured the almost total testing of Austrian conscripts. As a result, there is now data on the frequency of HIV infection in three quarters of all males aged 19 to 21 for the last twelve years.
A few qualifications need to be taken into account in interpreting the data:
- Members of the groups most affected - homosexuals and intravenous drug users - are, to some extent, in the course of the call up, exempted from military service, as are all haemophiliacs;
- Conscripts who know they are HIV positive, possibly resist the enormous pressure and refuse to take part the blood donor scheme;
- To a limited extent, professional soldiers also give blood. Some of the positive tests could come from them.
- Young men who have already tested positive for HIV may have attempted to avoid military service by applying for alternative community service instead;
- It was unfortunately not possible to include findings from the province of Salzburg (Austria has nine provinces). In view of the fact that the surrounding federal provinces of Tyrol and Upper Austria have so far not had a single HIV-positive blood donor from the barracks, and that their neighbouring province, Carinthia, has only had two, the reliability of this survey is only insignificantly affected by the absence of the Salzburg figures.
All things considered, it shows that blood donors from the barracks are largely representative for heterosexually active, non intravenous drug dependent male youths after completion of schooling or apprenticeship. The proportion of homosexuals or i.v. drug addicts seems to be rather limited.
If one were to assume the spread of HIV among the young heterosexual population, then a significant, and in recent years an increasing number of HIV positive tests should manifest itself in the group tested.
HIV positive blood donations from army barracks in Austria
Number of recruits*
* Defence Ministry figures
No data are available from the Salzburg blood bank.
As is well known, unprotected passive/receptive anal intercourse and the sharing of needles and syringes carries the greatest risk of infection with HIV. It can be assumed that only a small section of the conscripts were exposed to this risk situation. Thus a low number of HIV positive tests was to be expected in this group, above all in the big cities. Actually, it turns out as an average of 2.3 positive results per year. Almost all cases, 25 of the total of 27, came from the Vienna blood bank, which also covers Lower Austria and Burgenland. (Vienna is the only big city in Austria.) In Carinthia, since 1985 there has been a total of two HIV-positive blood donors from army barracks. Since the survey began, in 1985, there has not been one single HIV-positive blood donor from army barracks in the other provinces, Upper Austria, Styria, Tyrol and Vorarlberg.
Assuming a participation of about 95% of conscripts in the blood-donor scheme, this results in a rate of six positive HIV tests per 100,000 blood donors. (For all male first-time donors in Germany in 1993, the rate was 11.6).
The studies published by the German and the French Ministry of Defence also show a similar result. The data there, however, are not so reliable, because conscripts' participation in the blood-donor scheme was significantly lower because it was voluntary.
The spread of HIV among young males outside those involved in the recognised classical risk behaviour cannot be observed on the basis of available data.
In order to assess the risk for young women, it makes sense to draw on the anonymous, unconnected testing of new-born babies. After the birth, blood remaining in the umbilical cord is anonymously tested for HIV antibodies. The results provide information on any HIV infection of the mother. Since 1993, this survey has been carried out in almost all births in Berlin, the German city with the most per capita AIDS cases. In the meantime, similar surveys have been running in Lower Saxony and Bavaria. The Robert Koch Institute in Berlin, which is responsible for the evaluation of the German figures, has come to the following conclusion: "The results - HIV prevalence significantly under one per thousand among women giving birth - confirm the assumption of a low distribution of HIV in the general heterosexual population so far."
Against this background it would appear necessary to rethink sex education and AIDS prevention. It can hardly be productive, after 18 years of HIV, to warn heterosexual, non i.v drug-dependent young people by means of undifferentiated and alarmist preventative information against a danger that does not exist to any subjectively or objectively provable degree. It is much more likely to endanger the credibility essential to all sex education. On the other hand, most preventative information lacks explicit advice on the dangers of unprotected passive/receptive anal intercourse, for women as much as for homosexual men. For sexually active people, protection during sex was always an important subject even before the arrival of AIDS. It seems necessary to continue this tradition and place protection against unwanted pregnancies and the classical sexually transmitted diseases in the foreground of sex-education information again. Of course, this should be done in a way that corresponds to young people's subjective experiences. Further, any alarmism should be dispensed with, as it has already been shown that no lasting change in sexual behaviour can be achieved in this way.
In this connection it should be recalled that the Church also attempted to use alarmist information to induce people to a restrictive sexual morality. The last major campaign of this type took place 35 years ago and was intended to hinder the introduction of the pill. The horror scenario employed by the Church, purgatory, "going blind", loss of moral fibre, and moral decay, corresponded just as little to people's experience as the supposed AIDS epidemic among the heterosexual population today. The Church's insistence on these empty threats has, as we now know after 2,000 years, neither changed our sexual behaviour nor led us to Sodom and Gomorrah. Accordingly, the credibility of the Church and, in consequence, its influence have shrunk to an extent that was unimaginable at the time. *
This research would not have been possible without the support of the Austrian Society for Family Planning and the blood banks of the Austrian Red Cross. I would like to thank them for their cooperation.
Dr. Christian Fiala M.D. is living in Vienna, Austria and is the author of the book "Lieben wir gefaehrlich? - Ein Arzt auf der Suche nach den Fakten und Hintergruenden von AIDS" ("Do we live dangerously? - A doctor in search of the facts and background to AIDS") Deuticke Verlaag, Vienna, ISBN 3-216-30293-8.
Robert Koch Institut, Berlin, Bericht zur epidemiologischen Situation in der Bundesrepublik Deutschland. 31.12.1996
Walther M. et al, AIDS in der Bundeswehr - epidemiologische Daten, Prevention und Therapie, Wehrmedizinische Monatsschrift; 1997, February-March: 38-41
Abgrall J. et al., Évolution de l'infection à VIH, du SIDA et des maladies sexuellament transmissibles chez les Militaires Français, bulletin épidémiologique hebdomadaire, 1997, no 50: 221-2