AIDS Fight is Skewed by Federal Campaign Exaggerating Risks
By Amanda Bennett and Anita Sharpe
Wall Street Journal, 1 May 1996
In the summer of 1987, federal health officials made the fateful decision to
bombard the public with a terrifying message: Anyone could get AIDS.
While the message was technically true, it was also highly misleading. Everyone
certainly faced some danger, but for most heterosexuals, the risk from a single
act of sex was smaller than the risk of ever getting hit by lightning.
In the U.S., the disease was, and remains, largely the scourge of gay men,
intravenous drug users, their sex partners and their newborn children.
Nonetheless, a bold public-relations campaign promised to sound a general alarm
about AIDS, lifting it from a homosexual concern to a national obsession and accelerating
efforts to eradicate the disease. For people devoted to public health, it seemed
the best course to take.
But nine years after the America Responds to AIDS campaign first hit the airwaves,
many scientists and doctors are raising new questions. Increasingly, they worry
that the everyone-gets-AIDS message -- still trumpeted not only by government agencies
but by celebrities and the media -- is more than just dishonest: It is also having
a perverse, potentially deadly effect on funding for AIDS prevention.
No Allocation for Gays
The emphasis on the broad reach of the disease has virtually ensured that precious
funds won't go where they are most needed. For instance, though homosexuals and
intravenous drug users now account for 83% of all AIDS cases reported in the U.S.,
the federal AIDS-prevention budget includes no specific allocation for programs
for homosexual and bisexual men. And needle-exchange programs, widely seen as among
the most effective methods available in fighting infection among drug users, are
denied any federal funding.
Much of the Centers for Disease Control's $584 million AIDS-prevention budget
goes instead to programs to combat the disease among heterosexual women, college
students and others who face a relatively low risk of becoming infected. Federally
funded testing programs alone, which primarily serve low-risk groups, account for
roughly 20% of the entire budget.
Some scientists charge that tens of thousands of infections a year could be
averted if only practical assistance were directed to the right people. Instead
of aiming general warnings at non-drug-using heterosexuals, these critics say, the
government should use the bulk of its anti-AIDS money to teach homosexual men to
avoid unprotected anal sex and to dissuade addicts from sharing infected needles.
"You can't stop this epidemic if you spend the money where the epidemic
hasn't happened," says Ron Stall, associate professor of epidemiology at the
University of California in San Francisco.
Helene Gayle, who is in charge of AIDS prevention at the CDC, agrees that "increasingly,
it is important to shift strategies to meet the epidemic." She says that the
CDC, by giving communities more freedom to decide how to spend federal AIDS money,
is now seeking to direct more help to those who need it most.
But she defends the CDC's pivotal decision in 1987 to emphasize the universality
of AIDS: "One should not underestimate the fear and confusion this disease
caused early on," Dr. Gayle says. "We needed to build a base of understanding
before we could go for the jugular."
Certainly, powerful political and social forces at work nine years ago made
it nearly impossible for health officials to focus attention on those most at risk,
a reconstruction of events of that year shows. And though, as Dr. Gayle says, the
CDC is now trying to revamp its AIDS-prevention efforts, the same forces that shaped
public policy in 1987 are making it difficult for the government to change directions,
Clear Picture of Risks
By 1987, CDC officials already had a fairly clear picture of where and how
AIDS was spreading -- and how much risk different groups faced. The disease was
proving less likely to be transmitted through vaginal intercourse than many had
feared. A major study that was just being completed put the average risk from a
one-time heterosexual encounter with someone not in a high-risk group at one in
five million without use of a condom, and one in 50 million for condom users.
Homosexuals, needle-sharing drug users and their sex partners, however, were
in grave danger. A single act of anal sex with an infected partner, or a single
injection with an AIDS-tainted needle, carried as much as a one in 50 chance of
infection. For people facing these risks, it was fair to say AIDS was truly a modern-day
A key player in the CDC's earliest AIDS-prevention efforts was Walter Dowdle,
a virologist who was a veteran of the war on herpes and had helped create the CDC's
anti-AIDS office in the early 1980s. Like most people in his operation, he understood
that AIDS had to be fought hardest in the places it was most prevalent.
But by the spring of 1987, Dr. Dowdle had already been rebuffed repeatedly
in efforts to prepare AIDS warnings aimed directly at high-risk groups. TV networks
were refusing to air announcements advocating the use of condoms. And Dr. Dowdle
had failed in his attempt to disseminate a brochure that mentioned condoms as effective
in slowing the spread of AIDS. At the time, all AIDS material had to be cleared
by the president's Domestic Policy Council, and the Reagan White House objected
to pro-condom messages on moral grounds. The 1986 brochure went into the White House
for review and never came out.
Help on Marketing
Searching for clues about how to proceed, CDC officials began a series of internal
meetings at their red-brick headquarters on Clifton Road in Atlanta. They also reached
outside for high-powered marketing help, retaining Steve Rabin, then a senior vice
president of the advertising giant Ogilvy & Mather. In August, Mr. Rabin, openly
gay and deeply committed to the effort, ran focus groups in a half-dozen cities
to gauge attitudes toward the disease.
The results were discouraging: In city after city, the focus groups made clear
that concern about AIDS hadn't taken hold in much of the country, despite the widely
publicized announcement two years earlier that Rock Hudson had the disease. With
some exceptions in big cities like New York and San Francisco, homosexuals continued
to engage casually in unprotected sex, as did heterosexuals everywhere. The prevailing
attitude: It was somebody else's problem.
For gays and drug users, this view was flatly wrong and potentially fatal.
Moreover, the focus-group results highlighted a huge policy issue: Would the public
support funding for AIDS prevention and research if the majority of heterosexuals
believed they and their families were only minimally at risk? Would they be compassionate
toward the victims of the disease?
Poll data suggested otherwise. A 1987 Gallup Poll showed that 25% of Americans
thought that employers should have the right to fire AIDS victims. In that same
poll, 43% felt that AIDS was a punishment for moral decline. In meetings within
the CDC, many people, including Messrs. Dowdle and Rabin, expressed particular concern
about the growth of housing and job discrimination against people with AIDS.
It was in this environment that the idea of presenting AIDS as an equal-opportunity
scourge began to form. Politicians, including Republican Sen. Jesse Helms of North
Carolina, were blocking campaigns aimed at gays anyway. And homosexual and minority
groups were concerned about being linked too closely with the disease. Some CDC
scientists, watching the spread of the disease among heterosexuals in Africa, worried
that AIDS might yet make inroads among non-drug-using heterosexuals in the U.S.
In any event, CDC officials believed that fighting AIDS was everyone's responsibility,
even if everyone wasn't equally at risk of getting it.
"We were drawing on gut instinct," recalls Paula Van Ness, who had
come to the CDC after serving as chief executive of the AIDS Project, a community
program in Los Angeles. "The aim was, we thought we should get people talking
about AIDS and we wanted to reduce the stigma." Earlier, in Los Angeles, she
had reached out directly to high-risk groups: "Don't go out without your rubbers!"
warned a motherly woman in one announcement the AIDS Project had sponsored. But
now, on the national scene, she too felt that such a direct approach was impossible.
Dr. Dowdle, burned by the response to his earlier, more targeted efforts, agreed
with his colleagues that the CDC's best bet was to present AIDS as everyone's problem:
"As long as this was seen as a gay disease or, even worse, a disease of drug
abusers, that pushed the disease way down the ladder" of people's priorities,
After considerable soul-searching and debate, officials fixed on a dramatic
approach they believed would do the most good in the long run: a high-powered PR
and advertising campaign to spread a sobering yet politically palatable message
Touching Their Hearts
In subsequent meetings in the summer and fall of 1987, the CDC team developed
the idea of filming people with AIDS and building a series of public-service announcements
around what they had to say. Subjects wouldn't be identified as gay, and the dangers
of intravenous drug use would get little attention.
Early on, the staffers stumbled on their defining slogan when they interviewed
the son of a rural Baptist minister. As Ms. Van Ness recalls it, the man said, "If
I can get AIDS, anyone can." His remark "wasn't scripted. That's what
he actually said." Other similar public-service announcements were prepared,
all with the same personal approach. "If you want your audience to be more
receptive about this, you had to touch their hearts," Ms. Van Ness says.
The CDC's award-winning campaign, deftly pitched to a general audience, was
launched in October 1987 and featured 38 TV spots, eight radio announcements and
six print ads. The initial ads steered clear of specific advice on how to avoid
AIDS, instead focusing on the universality of the disease and counseling Americans
to discuss it with their families.
It wasn't until the spring of 1988, when the government mailed its "Understanding
AIDS" brochure to 117 million U.S. households, that the risks of anal sex and
drug abuse were underlined. But even this brochure accentuated the broader risk;
it featured a prominent photo of a female AIDS victim saying that "AIDS is
not a 'we-they' disease, it's an 'us' disease."
As public relations, the CDC campaign and parallel warnings from other groups
proved to be remarkably effective, particularly because these messages were reinforced
by various public agencies and the media. According to one poll, during the last
three months of 1989, 80% of U.S. adults said they saw an AIDS-related public-service
announcement on television.
Everyone at Risk
Millions of people were thus sold and resold on the message: Though AIDS started
in the homosexual population it was inexorably spreading, stalking high-school students,
middle-class husbands, suburban housewives, doctors, dentists and even their unwitting
In late 1991, Magic Johnson dramatically boosted the perception that everyone
was at risk when he announced that his infection was due to promiscuous heterosexual
behavior. Talk shows and magazines pursued the theme relentlessly. Even late last
year, Redbook magazine -- written for a largely middle-class female audience --
carried a major story about married women called, "Could I have AIDS?"
In it, the author wrote: "My mind automatically telescopes to AIDS every time
I get sick."
Meanwhile, the CDC itself was producing research that made clear that heterosexual
fears were exaggerated. And some CDC scientists, including then-epidemiology chief
Harold W. Jaffe, publicly railed against the everyone-gets-AIDS message and urged
that assistance be targeted to those who most needed it. But his opinion, along
with the internal research on which it was based, was typically drowned out by the
countervailing mass-media campaign.
Fear of AIDS spread -- and remains. Gallup surveys
show that by 1988, 69% of Americans thought AIDS "was likely" to
become an epidemic, compared with 51% a year earlier, before the PR campaign got
in full swing. By 1991, most thought that married people who had an occasional affair
would eventually face substantial risk.
Yet, as CDC officials well knew, many of the images presented by the anti-AIDS
campaign created a misleading impression about who was likely to get the disease.
The blonde, middle-aged woman in the CDC's brochure was an intravenous drug user
who had shared AIDS-tainted needles, although she wasn't identified as such in the
brochure. The Baptist minister's son who said, "If I can get AIDS, anyone can,"
was gay, although the public-service announcement featuring him didn't say so.
Ryan White, perhaps the epidemic's most compelling symbol, had been diagnosed
in 1984, at the age of 13, after receiving a transfusion from an AIDS-tainted blood-clotting
agent used in the treatment of hemophilia. Barred by his school, shunned by neighbors,
he emerged with his family as a forceful opponent of discrimination against AIDS
patients. But five years before he died in 1990, the availability of a blood test
for the human immunodeficiency virus, which causes AIDS, had nearly eliminated the
infection from America's blood-products supply. (Similarly, activist Elizabeth Glaser,
who spoke at the 1992 Democratic Convention, was infected through a blood transfusion
well before AIDS testing began.)
Meanwhile, Kimberly Bergalis became famous for a particularly rare case: She
and five other Florida patients apparently acquired their infections from their
dentist, who later died of AIDS. But although the CDC has tracked down and tested
thousands of patients of hundreds of HIV-positive doctors and dentists, that single
Florida dentist remains the only documented case in the U.S. of a health professional's
passing the virus on to patients.
Research continued to show that AIDS among heterosexuals had largely settled
into an inner-city nexus, a world bounded by poverty and poor health care and beset
by rampant drug use. AIDS was also on the rise in some poor rural communities. Yet
government ads typically didn't address the heterosexual group at greatest risk,
a group that a CDC researcher would later define as "generally young, minority,
indigent women who use 'crack' cocaine, have multiple sex partners, trade sex for
'crack' or other drugs or money, and have [other sexually transmitted diseases]
such as syphilis and herpes."
'Less Likely to Fool Around'
Though scientists and anti-AIDS activists knew that the government-nurtured
fear of AIDS among upscale, non-drug-using heterosexuals was exaggerated, not everyone
thought this was a bad thing. Indeed, many credited rampant fear with achieving
pro-family goals that no amount of moralizing alone could have accomplished. In
a 1991 Gallup Poll, 57% of respondents said they believed that AIDS had already
made their married friends "less likely to fool around." Singles reported
being less apt to have one-night stands and more reluctant to date more than one
Moreover, there was no question that even mainstream heterosexuals bore some
risk of AIDS and that greater caution would reduce their already-low rate of infection.
"I don't see that much downside in slightly exaggerating [AIDS risk]"
says John Ward, chief of the CDC branch that keeps track of AIDS cases. "Maybe
they'll wear a condom. Maybe they won't sleep with someone they don't know."
The marketing campaign also appeared to be having another key desired effect:
to mobilize support for public funding of AIDS research and prevention. Federal
funding for AIDS-related medical research soared from $341 million in 1987 to $655
million in 1988, the year after the CDC's campaign began. (This year, the figure
stands at $1.65 billion.) Meanwhile, the CDC's prevention dollars leapt from $136
million in 1987 to $304 million in 1988; $584 million was allocated for 1996.
Even the gay community, though not specifically targeted for assistance, began
to see the wisdom of the everyone-gets-AIDS campaign. "This was a time of decreases
in government funding," according to Jeff Amory, who headed the San Francisco
AIDS Office in the 1980s. "Meanwhile, AIDS money was increasing."
Rush to Testing
It took a while before people realized that much of the money pouring in wasn't
reaching the groups most at risk. In 1990, Mr. Amory took part in a telephone survey
of about 50 HIV/AIDS groups funded by the CDC. Fewer than 10% even mentioned gay
men as among their constituencies. (Mr. Amory died in November, after his interview
with this newspaper.)
Meanwhile, the rush to testing meant that people at low risk were using up
more and more of the available AIDS-prevention money just to discover they weren't
infected. In 1994, 2.4 million tests were administered at government-funded locations,
more than 10 times the number in 1985. Only 13% of those tests were given to homosexual
or bisexual men or intravenous drug users.
As the CDC's biggest single prevention program, AIDS testing in 1995 accounted
for about $136 million of the agency's total $589 million AIDS-prevention budget
for that year. "It was not efficient or effective in picking up HIV-positive
people," says Eric Goosby, director of the HIV/AIDS Policy Office of the U.S.
Public Health Service, which oversees the CDC and other health agencies.
Moreover, because treating drug-addiction wasn't directly part of the CDC's
mandate, stopping the spread of AIDS among needle-sharing addicts fell "between
the cracks," says Dr. James W. Curran, who was director of the anti-AIDS office
at the CDC until late last year and is now dean of the School of Public Health at
Emory University in Atlanta.
Funding for Prevention
State funding for AIDS prevention -- tracking public attitudes toward the disease
-- was also being directed largely toward low-risk groups, says Patricia E. Franks,
a senior researcher at UCSF, who spearheaded a study of California AIDS spending
between 1989 and 1992. The study found that while 85% of AIDS cases were concentrated
among men who had sex with men, programs targeting this group received only 9% of
all state AIDS prevention dollars.
Spending for women, in contrast, grew to 29% of the state money in 1992 from
13% in 1989, even though HIV rates among women of childbearing age held steady at
less than one-tenth of 1% from 1988 through 1992.
California health officials say they believe spending on high-risk groups has
improved in the past few years. But Wayne Sauseda, director of the California Office
of AIDS, concedes that "it's hard to take money away from groups already receiving
grants." In California's last three-year state funding cycle, "we were
being deluged by proposals from low- and no-risk population groups," Mr. Sauseda
says. "We got two proposals for every one from a high-risk group."
Typical of the requests from low-risk groups, he says, were proposals to offer
education on college campuses. "No one would say coeds are not at any risk,"
says Mr. Sauseda. "But in California, that's not our first priority."
Tough to Redirect Funds
AIDS officials in other states report similar frustrations. In 1994, the CDC
turned to a community- planning process for dispensing AIDS funds, a system that
theoretically allows local people to allocate dollars to groups most in need. But
various community planners say it has been tough to redirect the funds, in large
part because public attitudes have become so entrenched.
In Oregon, for example, many community AIDS workers "are unwilling to
acknowledge that youth who are truly at risk [are] young gay men," says Robert
McAlister, the state's HIV program manager. Thus, most of Oregon's AIDS-prevention
money is still spent on counseling and testing that primarily serves low-risk individuals.
"When Magic Johnson made his statement, we got overwhelmed with clients demanding
service," Dr. McAlister says. "You start to cut corners. If we try to
serve everybody, we wind up serving everybody poorly."
Having helped shape current attitudes and set AIDS-prevention policies in motion,
the Centers for Disease Control finds itself in a serious bind. So far, AIDS has
killed 320,000 Americans, according to the CDC. Between 650,000 and 900,000 others
are currently infected with the virus that causes the illness.
Overall, rates of new HIV infections appear to be declining from their peak
in the mid-1980s. Nonetheless, as many as 40,000 people, mostly gay men, drug users
and their sex partners, will contract the virus this year alone. Despite this, the
CDC aims its current education campaign, called "Respect Yourself, Protect
Yourself," at a broad spectrum of young adults, rather than targeting the high-risk
groups. A current focus of the campaign is to discourage premarital sex among heterosexuals.
Women at Risk
The CDC also has been emphasizing that women constitute a growing proportion
of AIDS cases. But close analyses of the data indicate that the vast majority of
these victims are drug users or sex partners of drug users. Also, the data partly
reflect a statistical quirk: Because the number of infections among gay men has
declined, other groups -- such as women -- now represent a larger percentage of
victims. Yet the infection rate among women not in high-risk groups appears to be
holding roughly steady.
Meanwhile, unpublished research by the CDC itself concludes that "the
most effective efforts to reduce HIV infection will target injecting drug users
on the Eastern seaboard, young and minority homosexual and bisexual men, and young
and minority heterosexual women and men who smoke crack cocaine and have many sexual
Numerous studies have shown significant behavior changes in gay men who have
been counseled by gay-outreach programs. Susan M. Kegeles, a behavioral scientist
at UCSF's Center for AIDS Prevention Studies, reports that an eight-month program
in Eugene, Ore., reduced one of the highest-risk acts, unprotected anal intercourse,
by 27% in young gay men. The program used leaders in the gay community to demonstrate
and consistently reinforce safe-sex practices.
Other studies have shown that drug users need even more intense behavioral
counseling to break their addiction. But "only 15% of active drug users are
in treatment on any given day, and there are not enough treatment slots to meet
the demand from drug users, according to, a report by the Federal Office of Technology
Assessment. Further, the ban of federal funding for needle exchanges continues,
even though most reports conclude that locally funded efforts to distribute sterile
needles or needle-cleaning supplies have been effective in reducing the spread of
An epidemiologist at UCSF, James G. Kahn, recently created an academic model which,
he says, shows that over five years, $1 million spent in a high-risk population
averts 154 infections, compared with two or three infections if the money is spent
in a low-risk population. Moreover, he argues that reducing infections in high-risk
groups will "almost certainly" benefit low-risk groups by reducing the
pool of people who could potentially infect others.
Then there is the separate issue of honesty in government: Shouldn't the public
hear the truth, even if there might be adverse consequences? "When the public
starts mistrusting its public health officials, it takes a long time before they
believe them again," says George Annas, a medical ethicist at Boston University.
Yet many both inside and outside the government fear that speaking more directly
about AIDS transmission, and seeking federal programs to match, poses the same dangers
it did nine years ago. Congress controls the purse strings, and Sen. Helms, in particular,
still monitors every AlDS-related bill. Says a Helms staff member, "We would
certainly have a problem" with money going to gay-activist groups or to produce
materials that illustrate gay sex acts.
"There is a real concern that funding won't be shifted, it will be cut, that
if most people in the U.S. feel they are at very low risk, there will be little
support for any AlDS-prevention efforts," says Don Des Jarlais, director of
research at the Chemical Dependency Institute of Beth Israel Medical Center in New
York. Still, he and many others believe that prevention experts have no choice-and
that it is time to fight for programs based on candor. "You can't build a good
prevention program on bad epidemiology," he says.
Even back in the 1980s, Stephen C. Joseph, who was commissioner of public health
for New York City from 1986 to 1990, blasted the notion that AIDS was making major
inroads into the general population.
Today Dr. Joseph, who is assistant secretary of defense for health affairs at the
Pentagon, says: "Political correctness has prevented us from looking at the
issue squarely in the eye and dealing with it. It is the responsibility of the public-health
department to tell the truth.''
SCIENTISTS HONE KNOWLEDGE OF HOW VIRUS SPREADS
Scientists once feared that the AIDS would become an epidemic among non-drug-using
heterosexuals. Today, there is a broad consensus among experts that it probably
"Over 90% of the population is heterosexual. and most people are at zilcho
or very low risk." says Lyle Petersen, until recently chief of the CDC branch
that estimates the prevalence of HIV, the virus that causes AIDS.
This doesn't mean heterosexuals shouldn't take precautions, including condom use.
Cases have been documented of people contracting AIDS after a single heterosexual
encounter. Any individual's risk of contracting a disease is very different, and
much more specific, than the overall risk to a large group of people.
For a person to become infected with HIV, scientists believe the virus must pass
from the blood, semen or vaginal secretions of an infected person into the cells
or bloodstream of another.
People who share infected needles accomplish that quite readily: in one Connecticut
study. as many as 70% of drug-users needles contained HIV, which could be injected
directly into the blood of the next user. Between 1% and 2% of infections with.
HIV-tainted needles appear to result in infection, according Don Des Jariais. director
of research at the Chemical Dependency Institute of Beth Israel medical Center in
HIV is also transmitted fairly readily to the receptive partner in anal intercourse,
whether that partner is male or female. Scientists believe such transmission occurs
largely because the sex practice frequently leads to anal tears and abrasions. Scientists
estimate that O.5% to 3% of such acts with an infected person will lead to infection.
HIV apparently can also infect vaginal cells but, at least in the U.S. and Western
Europe. it doesn't appear to do so easily. Studies of couples in which only one
partner is infected show that about one in every 1,000 sexual acts results in infection.
Women appear to be infected during vaginal sex several times as often as men, although
still not, on average, very frequently.
For both men and women, it is much harder to transmit AIDS than to pass on other,
less serious sexually transmitted diseases. Some studies suggest that gonorrhea.
for example, passes from men to women in as many as 9O% of ail encounters with an
infected person, and from women to men about one-quarter of the time.
There is an insidious link, though. between venereal diseases and AIDS: people
with diseases such as syphilis and herpes, which may produce open sores, are much
more likely to become infected with AIDS or to transmit the disease to a partner.
Scientists also now believe that most people with HIV are most infectious during
two periods: before any symptoms appear and later in the disease when the person
maybe very ill. Therefore, many scientists believe for widespread transmission to
take place, infected people have to have sexual contact with a large number of partners
in a fairly short period of time.
This is one of the reasons that AIDS spread rapidly among homosexuals in the early
days of the epidemic, as gay bath houses provided the venue for large numbers of
sexual contacts. In one San Francisco study published in 1987, for example. nearly
40% of the gay men studied had had 10 or more sexual partners in the previous two
years; an additional 25% had had more than 5O partners. Of those reporting more
than 5O partners, more than 70% had been infected.
All this also helps explain why AIDS hasn't spread rapidly among non drug-using
heterosexuals in the U.S. but has made bigger inroads in parts of Africa and Asia.
For one thing, prostitution is more widely practiced in the developing world. This
means that random heterosexual encounters in which partners may be infected with
a venereal disease are more widespread. "Good studies in Thailand show that
roughly one in five men reported visiting a prostitute in the last 12 months,' says
Bruce G. Weniger, a medical epidemiologist at the CDC who has studied the Asian
Even when prostitutes aren't involved, the developing world has a higher incidence
of venereal disease: in addition, in some areas, local sexual practices lead to
tearing of the skin, which contributes to the more-rapid spread of AIDS, many scientists
In the U.S., the use of prostitutes is low by comparison. In a major survey of
sexual practices, centered at the University of Chicago, fewer than 1% of the 3,432
people surveyed said they had paid for sex in the previous year. Even those who
think the true rate is much higher don't believe it approaches the level found in
developing countries. Moreover, in the U.S., outside of drug using communities,
HIV prevalence among prostitutes isn't as high as in developing countries.
The situation, however, is far different in inner-city neighborhoods where drug
use is high, access to good medical care is insufficient and trading sex for drugs
is relatively common. A recent study of crack users in New York. .Miami and San
Francisco, for example, found that more than one-third of the women and 15% of the
men had a history of syphilis; more than two-thirds of the women had traded sex
for money or drugs. More than 40% of the women who recently had engaged in unprotected
sex for pay were HlV positive.
But large surveys that systematically exclude drug users and gay men indicate that
the spread of HIV infections in the U.S. has either been leveling off or dropping.
In a 1992 CDC study at blood banks, which seek to block high-risk individuals from
donating, 0.0067% of blood donors were HIV-infected, down from 0.0223% in 1985.
Moreover, subsequent research shows that the rate has continued to drop.
Further, says the CDC's Dr. Petersen. who studied the bloodbank results, most of
the HIV-positive donors turn out, on investigation, to have engaged in some high-risk
Meanwhile, blood tests of newborns, which indicate the HIV status of the mother,
show that the overall percentage of infected women has remained stable nationally
for several years, and has actually begun dropping in New York, New Jersey and
Florida, three states with very high HIV/AIDS rates. Nationally, the HIV-infection
rate for women is 1.6 per 100.000 women.
Other surveys support the suggestion that most heterosexuals aren't seriously at
risk. The University of Chicago's sexual- practices survey turned up six people
out of the 3.432 surveyed who credibly reported themselves HIV positive. Of those
six. three were bisexual men, one a woman who injected drugs and one a woman who
had had more than 100 lifetime sex partners.
Some scientists argue that the U.S. still faces a big threat from strains of HIV
that are much more readily transmitted heterosexually than the strains that exist
here today. Max Essex, a professor of virology at Harvard University and chairman
of the Harvard AIDS Institute, says his research suggests that such strains are
contributing to the extensive heterosexual threat in Africa and Asia
But after attending a European conference on the topic, Roy Anderson, professor
of epidemiology at Oxford University, is unconcerned. "I find it plausible
but, as yet, scientifically unsubstantiated' that such strains exist, he says. Even
if they do, he adds, they probably won't lead to a heterosexual epidemic in the
U.S. or Western Europe.