WOMEN AND AIDS
The ethics of exaggerated harm
By Mary Ann Sushinsky (1), David Mertz (2) & Udo Schüklenk (3)
Bioethics April 1996
(1) University of Massachusetts, Dept. of Philosophy, USA, (2) University of Massachusetts, Department of Philosophy, USA, (3) Monash University, Centre for Human Bioethics, Australia.
Introduction
The amount of money and public resources spent in the last ten years for
the fight against AIDS is unique. Last year a record $2.5 billion was approved
by Congress for AIDS prevention and research.[1] No other disease in history, killing
relatively so few people, has generated such a large amount of research monies,
so much public attention, nor so many new professional journals, as AIDS has
done.[2] AIDS is a predominantly male disease in all so-called First World countries,
restricted to limited risk-groups.[3] It will remain so limited, since, as we show
below, there is no significant First World pattern of heterosexual transmission
of AIDS. Political calculations, not epidemiological warning signs, have led
to the pervasive ideology of the imminent eruption of a heterosexual AIDS
epidemic and thereby the inevitable extension of AIDS to large numbers of
women.
Both scientific and popular literature have exaggerated the
significance of the number of women with AIDS, and of the
epidemiological danger of sex for women. We argue that many feminist
ethicists have accepted these exaggerations, and have used them in
supporting the view that women are victimized by a system of oppression
which permeates the medical and political establishments. However
pervasive oppression of women may be in medicine and politics, this
conclusion is not supported by reliance on the faulty premises AIDS
ethicists have employed. We further argue that these incorrect
assertions about AIDS, and their endorsement by women's advocates, are
concretely harmful. Current AIDS ideologies and policies cause
resources to be wasted, rather than used efficiently to alleviate the
sufferring of those with AIDS and to prevent its spread among those who
are truly at risk. Psychological harm is additionally done to women who
are needlessly encouraged to identify as victims, and to fear and avoid
sexuality.
Inventing the epidemic of women with AIDS
Variations on the theme "women are the fastest growing
risk-group for AIDS" appear virtually everywhere, in the scientific
no less than the popular press. Sometimes these statements are literal
untruths; at other times they merely insinuate untruths in their equivocation
between rates of disease and rates-of-change in population-specific disease
rates.
For example, the medical journal The Lancet
[4] asserted in a 1993 article that "Women
are the fastest growing group with HIV infection in the USA." But the
basis for this claim is obscure. Estimates of the prevalence of HIV infection
are well-known to be unreliable, and have been continually revised downwards.
In 1990, the CDC estimated that 1 milllion Americans were infected with HIV.
This 1 million figure represents a reduction from earlier CDC estimates of 1.5
million.[5] The latest report from the CDC
puts the number at approximately 600,000 to 800,000.[6]
The claim that women are the "fastest growing group," whether of
the HIV-infected or of AIDS patients, is misleading and alarmist to the lay
reader. Wording that obscures the distinction between proportional rate of
growth and absolute increase is often made by popular articles stressing the
size or urgency of the problem among women. For example, Suki Ports[7] states that, "the fastest growing
numbers of AIDS cases are among women." Other writers merely insinuate
patterns that don't exist, without outright misstatement. A Panos Institute[8] book informs us, "where HIV has so far
spread mainly among gay (homosexual) men and injecting drug users [IDUs]--women
now account for just over 10% of AIDS cases." One should observe that a
contrast is drawn between hitherto spread "mainly among gays and
IDUs" and the current 10% among women. Even leaving aside the fact that
most of those 10% of female cases are IDUs themselves,[9] 90% continues to constitute
"mainly" by anyone's definition. Nothing has changed according to
the Panos Institute statement, and yet that very fact is used to indicate an
imminent epidemic among women.
If we look at the figures for total AIDS diagnoses, we see that although women
show a percentage growth rate higher than other broad categories of people with
AIDS, they still represent a small proportion of the increase in numbers of
people with AIDS in the latest reporting period. Many times more men are newly
diagnosed with AIDS each year than are women (hence the actual increase in
cumulative AIDS cases is greater among men than among women). Compared to the
6,153 women in October 1991-September 1992 and 14,792 in October 1992-September
1993 who were diagnosed with AIDS, 36,833 and 81,707 men were diagnosed in the
respective intervals.[10] In Australia the
percentage increases over the same period among women are higher than among
men, but the numerical increases are still less than those among men by an
order of magnitude.[11]
A November 1993 CDC report shows a change in new AIDS cases among male
injecting drug users from 8,621 in October 1991-September 1992 to 19,142 in
October 1992-September 1993.[12] This is an
increase of 10,521 AIDS cases, most of them due to the extended 1993
surveillance definition.[13] Female IDUs go
from 2,815 to 6,891 new AIDS cases in the same interval, an increase of 4,076.
Combined, this is an increase of 14,597 cases among IDUs of both sexes. As
stated above, adult/adolescent women as a whole go from 6,153 to 14,792 cases,
an increase of only 8,639 during the same interval. While this increase
among women is still, perhaps, cause for alarm, it is numerically less than the
increase among male IDUs, let alone IDUs in general. Even men who have sex
with men went from 24,334 cases to 46,025 cases in the intervals mentioned, an
increase of 21,691. These increases are largely an artifact of the changed
1993 surveillance definition, which reflects an underlying net decrease under
constant definition; however we report them to show that even according to the
official numbers, the growth of AIDS cases among women is small compared with
the increases in other groups.
AIDS Ethicists
Christine Overall, a distinguished Canadian philosopher with a remarkable
record of publications in practical ethics, has also attempted to make the case
that the AIDS threat to women has not been sufficiently addressed.[14] The central claim of her article,
"The (Hetero)Sexual Politics of HIV Infection," is that
"little attention has been paid to misogynous themes in AIDS policy,
commentary, and education, which are rendered virtually invisible by the almost
exclusive focus on men."[15] She goes
on to lament the fact that "the situation of men with AIDS is taken to be
the norm, and the issues that concern women--particularly with respect to
reproduction and sexuality--are regarded as specialized, marginal, and less
significant."[16] Overall wants to
establish that AIDS policy should focus more on the problem of heterosexual
AIDS transmission to women.[17] She
therefore purports that the official figures "may well under-represent
the number of female Canadians with full-blown AIDS."[18]
On all of these points, we disagree with Overall. When we examine the actual
numbers of women vs. men with AIDS, it appears less plausible that it is
"misogyny" that led to the focus on men with AIDS as the
"norm," than that it is a realistic appraisal of the situation. As
of January 1991, about a year after the time we assume Overall's article to
have been written, 4,647 persons (mostly gay men and injecting drug users) had
contracted or died from AIDS in Canada. Of these, 175--approximately 3.76%--were
women, the vast majority of whom had reported injecting drug use as their AIDS
risk category.[19] Such is not really a good
argument for the significance of "the heterosexual politics of HIV
infection," as Overall's use of the title implies.
The actual Canadian data, in failing to support her argument, leads Overall to
her speculation that the reported number of women with AIDS must be too-low to
be true. She, however, offers no empirical evidence for this claim. Empirical
science allows no way to disprove the a priori assumption of
underreporting, made by those, like Overall, who do not accept the officially
published numbers. By postulating an unobserved, and unobservable, empirical
reality, Overall makes her arguments unfalsifiable. Nonetheless, there are
considerations which diminish the plausibility of Overall's claim. Overall's
committment to the view that there are many women with unreported AIDS assumes
that a major mode of transmission is heterosexual intercourse. Yet, medical
scientists all over the world have been paying close heed for ten years for the
first signs of a heterosexual epidemic, but have failed to announce one. In
fact, as we have pointed out elsewhere, the heterosexual AIDS epidemic has
effectively been called off by epidemiologists and health authorities of most
Western countries.[20]
Another consideration to bear in mind when assessing the risk of heterosexual
transmission to women involves the notion of "tertiary
transmission." Primary transmission is transmission of HIV within a
primary risk group; secondary transmission is from a member of a primary group
to his or her sexual partner. Tertiary transmissions involve the spread of the
disease out of the secondary non-high-risk-group to another non-high-risk-group
individual. According to Michael Fumento, "One key indicator of whether
AIDS was becoming epidemic among heterosexuals would have been the amount of
tertiary transmission. Yet, at the height of the media heterosexual AIDS flap,
the concept of tertiary transmission was ignored by both the media and public
health authorities. . . . The media simply assumed the existence of such
transmission."[21] However Fumento, in
examining the health department records of cities including New York and San
Francisco was unable to discover a single case of documented tertiary
transmission.[22] Given the rarity of
tertiary transmission, the belief that most women are at risk for AIDS is
unfounded.
Overreporting of Heterosexual Risk for AIDS
In the USA, the nation with the largest number of AIDS cases,[23] adult and adolescent women have made up
40,702, or 12% of the cumulative 334,344 AIDS cases as of November 1993.[24] However, within these forty thousand
cases, the cases of heterosexual transmission have been exaggerated and are far
disproportionately discussed in the popular press and by bioethicists.
Overall's title is merely one example. Many books and articles contain similar
language on "heterosexual AIDS in women."[25] Heterosexual transmission, however, makes
up a minority of female AIDS cases, with injecting drug use constituting
the majority of transmissions. For the most recent reported interval
from October 1992 to September 1993, 6,891 female cases with injecting drug use
as mode of transmission were reported, while 5,545 were reported with
heterosexual contact as the risk-category.[26] This still may seem like a large number of
heterosexual transmissions, but if we look beneath the surface of these
figures, we find reason for doubt.
Of the allegedly heterosexually-transmitted female AIDS cases, where the risk
category of the male partner was identified, the majority of the
partners--2,474--were IDUs. Only 423 of the male partners were bisexual men,
while 2,131 of the male partners were HIV-infected persons with unspecified
risks.[27] Is it reasonable to accept that
all these women partners of IDUs could have contracted AIDS only via
heterosexual transmission as they reported? Particularly in light of the
argument we have made elsewhere[28] that
there is substantial overreporting of heterosexual risk category in men,
we strongly suspect that many of the female reports of heterosexual
risk-category are misreports. For all the same reasons that other people lie
to doctors about stigmatized activities, such as male-male sex, women with AIDS
lie about use of injected drugs.[29] It
therefore seems highly likely to us that a substantial number of the reported
cases of heterosexual transmission in the partners of injecting drug users, in
particular, are themselves injecting drug users.
Evidence that misreporting occurs lies in the fact that the majority of women
who report heterosexual transmissions claim to have been infected by male IDUs.
While men who have sex with men account for over twice as many AIDS
cases as men who use injected drugs, the heterosexual transmission reports
assume them to be about six times less likely to transmit AIDS to women
(see above discussion).[30] A cumulative
183,344 men who have sex with men have developed AIDS in the USA, while a
cumulative 80,713 injecting drug users have developed AIDS.[31] If the above mentioned 2,474 female AIDS
cases actually contracted AIDS via heterosexual transmission from their
intravenous drug-using partners, as reported, then either (A) HIV/AIDS is
significantly more heterosexually transmissible by IDUs than by bisexual men;
or (B) no more than 1/12th of men who have sex with men also have sex with
women. In the absence of a plausible biochemical explanation, we must reject
(A); (B) contradicts familiar sexological surveys from Kinsey on.[32] Studies have consistently shown that most
men who have sex with men also have sex with women. Our conclusion, therefore,
must be that there is underreporting of non-heterosexual risk among partners of
IDUs. None of this demonstrates that women are at less of an overall
risk than CDC data suggest; it does, however, suggest that the AIDS risk to
women is not in significant part the risk of heterosexual intercourse so widely
publicized popularly and professionally.
Feminist Ethics' Misleading Focus on Sexuality
Despite the relative rarity of sexually transmitted AIDS in women, indicated
above, articles by feminist ethicists frequently stress sexual risk for AIDS.
Ironically, Overall herself is aware that increased sexual activity does not in
itself translate into increased risk for AIDS. According to Overall, the focus
by the AIDS establishment on prostitutes as possible "vectors of
transmission" overlooks the low incidence of AIDS in this group and
further causes an ideological belief that it is only "bad" (i.e.,
promiscuous) women who get AIDS. Overall correctly reminds us that it is not
the number of partners that increases risk, yet she goes on to assert that it
is heterosexual activity that women must fear. Women are put at risk,
according to Overall by ". . .the kinds of sexual activities engaged in:
a woman could easily be infected by one HIV-positive individual with whom she
has a long-term unprotected monogamous relationship."[33] Even here, what is crucial is not
"the kind of sexual activity," but with whom, a fact which
Overall obscures. Since most women are not involved in "long-term
unprotected monogamous relationships" with IDUs or bisexual men, the risk
of heterosexual acquisition of HIV/AIDS is slight to most women.
Similarly, ethicist Nora Kizer Bell echoes the received wisdom that
heterosexual intercourse is dangerous, especially for women.[34] Bell admonishes all heterosexuals to be
wary, quoting those who have warned that "The message for individuals
engaging in heterosexual intercourse outside of longstanding mutually
monogamous relationships is clear. Human immunodeficiency virus infection is
present in the heterosexual community . . . it would behoove both men and women
to protect themselves."[35] Bell, like
Overall, explicitly recognizes that the threat of heterosexually acquired AIDS
depends upon the HIV/AIDS status of one's sex partner, but she (again, like
Overall) fails to credit this fact when she stresses that heterosexual
intercourse, unless it is with a "longstanding monogamous" partner,
is risky.[36] Actually, the risk of
heterosexual transmission is also a function of frequency of exposure. In
fact, heterosexual transmission has been shown to be quite difficult, requiring
upon average over one thousand, unprotected acts of intercourse with an
infected partner for seroconversion to occur.[37] A woman faces a much greater risk of
HIV-seroconversion from a long-term monogamous relationship with an IDU than
from "promiscuous" or "casual" sexual contacts with
non-IDUs. Yet, again and again, it is "promiscuous" or
"casual" sex, i.e., sex outside of a longstanding relationship,
which is characterized as most dangerous by bioethicists like Bell and
Overall.
Just how "dangerous" is the AIDS-risk of heterosexual sex--even if
we are incorrect about the degree of misreporting--when understood against the
background of other public health concerns? Even if all of the 3,328 men and
5,545 women with AIDS who report heterosexual contact as their sole risk are
making accurate reports, it is important to notice that these numbers would
contribute only in small measure to the total health risks facing
heterosexuals. These 8,873 new cases from October 1992 through September 1993,
most reported under the greatly expanded 1993 AIDS surveillance definition,[38] correspond to somewhat fewer than 5,000
AIDS deaths per year. This approximate 5,000 may be put in perspective by
comparison with the annual 496,000 American cancer deaths, 734,000
heart-disease deaths, 146,000 stroke deaths, or 43,500 automobile fatalities[39]--most of each occurring, presumably, among
heterosexuals. The usual rejoinder to such perspectivizing is that "even
one death is too many;" and of course we agree. While "one
death" is indeed "too many," such an observation does not
logically give AIDS a distinctive significance apart from those of other
causes, as the phrase rhetorically insinuates.[40]
Lesbian Sex and AIDS
The heterosexual threat of AIDS is not the only concern expressed in bioethics
and feminist literature. Extending the theme of "risky sex," much
has been made of the risk of AIDS infection to lesbians. The New York City Gay
Men's Health Crisis has implemented a "Lesbian AIDS
Project"--presumably to avert feminist arguments about the male-dominated
Gay Men's Health Crisis. The coordinator immediately started producing
"lesbian safe sex kits, which will include a range of relevant
products--gloves, cots, condoms, dental dams, lube and literature." The
next project is said to be a "comic book illustrated by gay and lesbian
cartoonists." However, the known facts do not support an ideology of
fear. In fact, the risk of a lesbian contracting AIDS by means of
woman-to-woman sex is miniscule. There have been only two case reports of
alleged female-to-female transmission of HIV within the last decade.[41] Later reviews of AIDS cases in the USA in
women who reported having sex only with other women found that all had a
history of injecting drug use or receipt of blood transfusions.[42]
The lack of actual woman-to-women transmission of HIV/AIDS has not prevented
feminist medical ethicists from criticizing mainstream AIDS education for not
addressing what they regard as a significant problem. Nora Kizer Bell laments
"that reliable safe sex information for lesbians is neither widely
distributed nor widely known to be available."[43] Bell is mistaken about this. Every book
we can find mentioning "women" and "AIDS" in the title
has sections on AIDS in lesbians, with an inevitable section on lesbian
transmission of AIDS. The book AIDS: The Women[44] predates Bell's proclamation by four years,
and contains a chapter entitled All That Rubber, All That Talk: Lesbians
and Safer Sex[45] whose tone clearly
assumes safe sex knowledge to be ubiquitious among lesbians. Women &
AIDS[46] makes the same assumption, while
praising the virtues of dental dams. Lesbian magazines such as On Our
Backs also provide instructional material, and moral guidance, on safer
sex.[47] Our personal experience has shown
largely locally produced materials urging the use of dental dams and other safe
sex equipment in gay and lesbian bookstores (and similar lesbian-oriented
establishments) worldwide; and we have found all lesbians of our acquaintance
to be quite familiar, at least intellectually, with safe sex practices--although
few feel these measures are worth personally conforming to. Given the
non-existent to minuscule risks of HIV/AIDS transmission in lesbian sex, we
find these judgements generally more rational than those of bioethicists like
Bell.
The Harm of Ethics
If, as we have argued above, the belief that we are on the verge of an
out-of-control epidemic of AIDS among heterosexual and lesbian non-IDU women is
unfounded, one might ask whether the existence and continued promotion of such
a belief really does harm. Is it not, after all, better to err on the side of
caution and prudence, and to urge safer sex, less promiscuity, and less casual
or uncommited sex? Perhaps the attempt by women's advocates to appropriate
AIDS as a threat to all women is for women's own good.
First of all, there is a basic material injustice which is perpetuated by the
current AIDS response. The policy of supporting the spread of AIDS hysteria
among those not at significant risk causes more suffering to those who are at
significant risk. If talent and resources are being put to use on behalf of
women who don't need them, there is less to be utilized where they are needed.
The belief that AIDS threatens most women fuels public policy like the
following proposal put forward by Guinan and Hardy that "it is important
to educate all women about their risk of sexually acquired AIDS and to
encourage risk-reducing behavior."[48]
The vast majority of women are simply not at risk for HIV/AIDS. In times of
scarce health care resources we believe that it is an irresponsible waste of
such monies to keep women who aren't at any real risk of contracting AIDS
informed about it. And once again it turns out that those most shortchanged by
such a policy are those who are least empowered in our society. Women are
dying of AIDS, but it is not because of heterosexual or lesbian sex. Rather,
AIDS disproportionately affects those women who inject drugs, and thereby
largely suffer other diseases, poverty, and malnutrition. It is to these women
that a just expenditure of public health care funding would go for both
education and treatment--education primarily of the risks of IV drug use, not of
sex, and treatment of the health problems characteristic of IDUs, male or
female.
Second, women who are not at great risk for AIDS are also harmed by the
current AIDS response. Many women who aren't at risk of AIDS inevitably, each
time they have sexual encounters, think of AIDS. Anxiety, depression, hundreds
of thousands--probably millions--of unnecessary HIV-tests, and broken
relationships are the results of such campaigns. Chapman correctly questions
the appropriateness of such campaigns:
Is a government program of scaring people--especially when there is little basis
for them to be scared--something that public health should see as a relatively
benign means to a more important end? Or is the intrusion of this concern into
every sexual encounter some form of state-sanctioned mass neurosis? Is it not
worth asking seriously about the social and emotional costs involved in public
health efforts attempting to have all sexually active people become
sufficiently anxious about acquiring HIV to insist on condoms in every
sexual encounter?[49]
The amount of needless anxiety provoked around AIDS in those not at risk is
truly remarkable. Women, and men, consistently tell pollsters that their fear
of AIDS ranks well above that of many dangers posing much greater objective
risks. One recent poll, for example, showed 32% of respondents worrying
"a great" deal about getting AIDS from people they date, while an
additional 35% worried "somewhat" or "a little."[50]
Third, the portrayal of women as objects of society's indifference to their
suffering often contributes to an ideology of female victimization and
powerlessness which is ultimately harmful to the cause of women's liberation.
To exaggerate society's neglect of women's suffering is to essentialize women
as victims and therefore to buy into the same gender stereotypes against which
Overall and other feminist ethicists have written. Many critics now speak
against this trend in the women's movement toward what Naoimi Wolf has called
"victim feminism." "Victim feminism" sees women as
"beleagured, fragile, intuitive angels,"
[51] and attempts to gain power for women
primarily by advancing for them a status of moral superioriority as victims of
a misogynist culture. Although it is certainly true that women have suffered,
and continue to suffer many injustices, to dwell on the ways in which women are
shortchanged can, at best, be a first step toward change. It is little helpful
to women to overplay the ways in which society neglects and harms them--or
indeed to invent harms from thin air as AIDS ethicists have done. Ultimately,
this strategy cannot help but lead to the adoption of an identity of
powerlessness and victimhood, an identity which, as a self-fulfilling prophecy,
tends to erode further women's self-confidence and initiative. Perhaps what
women need if they are to break out of the limitations on their opportunities
and abilities unjustly imposed by sexism are more models of themselves as
competent adults, rather than as merely imperilled and downtrodden. Although
we believe that many of the articles written by feminist ethicists and women's
advocates have been motivated by the desire to help women, the real results
have been the misdirection of resources, the promotion of unnecessary fear and
anxiety, and the fostering of victim identities. We think the
exaggeration by ethicists of the threat of AIDS to women contributes more to
their oppression than their liberation. *
References
[1] San Francisco Examiner 20 October
1993: A-10.
[2] Schüklenk U, Mertz D. Christliche Kirchen und AIDS.
In: Dahl E. (ed.) Die Lehre des Unheils. Hamburg: Carlsen, 1993:
263-279, 309-312.
[3] Chapman S. Dogma Disputed: Potential Endemic
Heterosexual Transmission of Human Immunodeficiency Virus in Australia.
Australian Journal of Public Health 1992; 16: 128-41; US National
Research Council. Social Impact of AIDS. Washington DC: National Academy
Press, 1993.
[4] Editorial. Heterosexual AIDS: pessimism, pandemics, and plain hard
facts. Lancet 1993; 341: 863-4.
[5] Centers for Disease Control and Prevention (CDC).
Estimates of HIV Prevalence and Projected AIDS Cases: Summary of a Workshop,
October 31-November 1, 1989. Morbidity and Mortality Weekly Report
1990; 39: 110.
[6] Altman LK. Obstacle-Strewn Road to Rethinking the Numbers
on AIDS. New York Times March 1, 1994: C3.
[7] Ports S. Needed (For Women and Children). AIDS:
Cultural Analysis/Cultural Activism. October 1987; 43.
[8] Panos Institute. Triple Jeopardy: Women &
AIDS. London: Panos Publications, 1990.
[9] US National Centers for Disease Control and Prevention
(CDC). HIV/AIDS Surveillance Report. November 1993.
[10] CDC. HIV/AIDS Surveillance Report., op.cit.
[11] National Centre in HIV Epidemiology and Clinical
Research. Australian HIV Surveillance Report 1994; 10(1): 7, 15.
[12] CDC. HIV/AIDS Surveillance Report. op.cit.
[13] CDC. HIV/AIDS Surveillance Report. op.cit.
[14] Overall C. AIDS and Women: The (Hetero)Sexual Politics
of HIV Infection. In: Overall C, Zion WP. (eds.) Perspectives on AIDS.
Ethical and Social Issues. Ontario: Oxford University Press, 1991: 27-42.
[15] Overall. op.cit. 27.
[16] Overall. op.cit. 28.
[17] Overall's introduction states, [[yen]]Discussion will
be chiefly confined to issues pertaining to the sexual transmission of AIDS,
since this means of infection is responsible for at least 59 percent of AIDS
cases in Canadian women.[[pi]] Overall. op.cit. 28.
[18] Overall. op.cit. 27.
[19] Federal Centre for AIDS. Surveillance update: AIDS
in Canada. Ottawa: Federal Centre for AIDS, January 1991. (Courtesy of Gwen
Bird, Pacific AIDS Resource Centre, Vancouver, B.C.)
[20] Schüklenk U, Mertz D, Richters J, The Bioethics
Tabloids: How Professional Ethicists Have Fallen for the Myth of Heterosexual
AIDS, Health Care Analysis 1995; 3(1): forthcoming. Independent
confirmation is given in the following recently published Associated Press
newpaper article: [[yen]]. . . there is no sign that AIDS has spread to any
extent into the mainstream of American life, and many believe it probably never
will. As for the typical American_someone who is straight, who is not very
promiscuous, who does not shoot drugs or knowingly sleep with those who do_most
experts agree the risk of AIDS falls somewhere between low and
infinitesimal[[pi]] AP. April 17, 1994.
[21] Fumento M. The Myth of Heterosexual AIDS.
Washington: Regnery Gateway, 1993: 78.
[22] Fumento. op.cit. 79.
[23] World Health Organization (Global Programme on AIDS).
Semi-Annual Statistics 1992; 67: 201-204. Fifty-three African nations,
for example, report a combined cumulative incidence of 152,463 AIDS cases,
while the US reports 218,301 all by itself. National reports to the 1992
report are typically through only early 1992, or even 1991, with a somewhat
greater delay on average in the reporting of African than US figures. However,
it is clear that the US has many more AIDS cases than any single African
nation, and most likely more than the continent as a whole.
[24] CDC. HIV/AIDS Surveillance Report. op.cit.
According to this report, pediatric AIDS cases are approximately evenly divided
between the sexes, as one would expect. However, these cases account for only
4,906 of all cumulative cases, and hence do not significantly affect the
percentages.
[25] For example: Rieder I, Ruppelt P. (eds.) AIDS: The
Women. San Francisco: Cleis Press, 1988; Richardson D. Women &
AIDS. New York: Methuen, 1988; Panos Institute, op.cit; Lester B.
Women AIDS: A Practical Guide for Those Who Help Others. New York:
Continuum, 1989.
[26] CDC. op.cit.
[27] CDC. op.cit. Since we have no reason to believe that
the breakdown of the actual risk-categories of those partners who did not
specify risk is significantly different from those of partners with specified
risk, we can safely assume that the vast majority of the men who allegedly pass
AIDS on to their female partners, including those with unspecified risk, are
IDUs.
[28] Schüklenk U, Mertz D, Richters J. op.cit. In
essence, our argument there is that studies of sexual transmission efficiency
of HIV male-to-female versus female-to-male, taken together with the base rates
for potentially infective partners, are inconsistent with the total numbers of
men and women reported in the heterosexual transmission category.
[29] We know that at least some men lie about their risk
categories. According to New York pulic health official Rand Stoneburner,
[[yen]]of 63 men (as of January 1989) who reported prostitute contact but
denied other exposure, 42 were later found to have a history of contact with
homosexual men or had engaged in intravenous drug abuse.[[pi]] Outside of New
York City, thorough repeat interviews and contact tracing, which would reveal
such initial misreports, are not performed. See Fumento. op.cit. ch.7.
[30] CDC. HIV/AIDS Surveillance Report. op.cit.
[31] Some of these 80,713 IDUs are women, however. The CDC
document does not provide directly cumulative numbers of IDU female AIDS cases,
but from October 1992 through September 1993, there were 6,891 female IDU AIDS
cases and 19,142 male IDU AIDS cases. The cumulative 80,713 IDU AIDS are
likely to break down in a ratio similar to this 1:3 ratio, i.e. there should be
approximately sixty thousand male IDU AIDS cases cumulatively. See CDC.
HIV/AIDS Surveillance Report. op.cit.
[32] Kinsey AC, Pomeroy WB, Martin CE. Sexual Behavior in
the Human Male. Philadelphia: WB Saunders, 1948. Kinsey, for example,
shows only 2.9% out of 19.8% of 25-year-old men who have some homosexual
history are exclusively homosexual. The remaining 16.9% of all men, or 85% of
men with some homosexual contacts, have some heterosexual contacts as well.
This study shows a similar pattern in other age groups, with 30- and
35-year-old men with some homosexual history being exclusively homosexual at an
even lower rate than 25-year-old men (but 20-, 40- and 45-year-old men having
somewhat higher ratios). Kinsey's exact numbers have been disputed, but all
reputable quantitative sexologists have found that a significant majority of
[[yen]]men who have sex with men[[pi]] also have sex with women. See, for
example, Masters WH, Johnson VE. Homosexuality in Perspective, Boston:
Little, Brown and Company, 1979; Harry J, DeVall WB. The Social Organization
of Gay Males, New York: Praeger Publications, 1978; Hite, S. Hite
Report on Male Sexuality, New York: Alfred A. Knopf, 1981; Johnson AM,
Wadsworth J, Welling K, Field J. Sexual Attitudes and Lifestyles.
Oxford: Blackwell Scientific, 1994.
[33] Overall. op.cit. 32.
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