The Prevention of Acquired Immunodeficiency Syndrome in The U.S.
(This is an Excerpt of a very EXTENSIVE and well documented report by
Donald P. Francis, MD, DSc, and James Chin, MD, MPH)
TRANSMISSION OF AIDS
“AIDS is one of the most viruent infectious agents ever encountered.
This virus, esitmated to kill up to half of those infected, has spread
to more than 1 million Americans. There is no safe and effective
treatment. Nor is there a vaccine.
AIDS has been isolated from fluids obtained from a variety of body
sites, including blood, semem, vaginal fluid, tears and saliva.
Epidomiologic studies have established that those fluids that provide
sufficent virus for transmission seem to be limited to blood, semen, and
vaginal secredtions. Presumably, the presence of lymphocytes in these
fluids increases the concentration of infectious virus and may be
important, or even essential, for transmission.
The exact risk of infection for a suspectible person having a single
sexual encounter with an infected partner is unknown. Yet there are
those who report having only one sexual encounter and have then
developed AIDS. In addition, a report from Australia that four of eight
women developed an infection after they were inseminated with semen from
an infected sperm donor, and a report of infection of a female
chimpanzee by intravaginal inoculation, suggest that a single encounter
with AIDS is sufficient in some situations to infect.
The major determinant of outcome of exposure appears to be the amount
of virus inoculated. Large inocula given in the form of transfused
blood almost universally result in infection.
A single episode of possible intrahousehold transmission between two
brothers has been reported.
Two out-of-hospital instances of AIDS transmission to individuals who
performed duties similar to hospital nurses.
PREVENTION OF TRANSMISSION
At the present time, there are no effective vaccines or
chemoprophylatic drugs for the prevention of AIDS infections. Likewise,
no effective treatment exists for AIDS infection once established.
Since there are no know animal or insect vectors and the virus is not
transmitted by the respiratory or fecal-oral route, prevention of AIDS
transmission must be directed at person-to-person spread via sexual,
blood-borne, and perinatal routes.
THERE IS NO RISK OF SEXUAL TRANSMISSION OF AIDS FOR THOSE WHO
PRACTICE SEXUAL ABSTINENCE. Furthermore, there is no risk of infection
if neither partner is infected. This would be the case for couples who
have been mutually monogamous since the introduction of AIDS in the
United States (presumably in the mid-1970’s).
However, as with the use of condoms for pregnancy prevention,
failures can be expected, espically if the condoms are not used
consistently and continuously with all sexual partners.
Transmission among homosexual men appears to be due almost
exclusively to receptive anal intercourse. The prevalence of infection
in this group today is extermely high in most urban areas. Even with
profound decreases in the number of sexual partners, the risk of
infection in this community remains high because of the present high
chance that any single sexual partner is infectious.
Controversy has surrounded the issue of homosexual bathhouses. Any
setting that encourages unsafe sexual practices between individuals will
increase the transmission of AIDS. As such, those bathhouses that
encourage such practices adversly affect AIDS prevention.
The current risk of infection of a given heterosexual contact in the
United States is low, but infections and AIDS cases art certainly being
acquired by heterosexual contact. Logic would dictate that those
outside of mutually monogamous relationships who wish to minimize their
risk should limit their total number of partners and practice protective
sex all the the time.
Infection with this virus has potentially dire consequences;
therefore, sexual partners should carefully weigh the risks of
unprotected sexual encounters outside of mutually monogamous
Prostitutes are a major source of infection in central Africa and
probably in some European countires.
The message for AIDS prevention is obvious: stop the use of IV drugs,
or, at a minimum, eliminate sharing of unsterilized injection
Intravenous drug abusers, if AIDS transmission persists, will likely
serve as a major entree of the virus into a segment of the heterosexual
community, most prominently in the urban poor communities.
The use of drugs in association with sexual practices is prevalent in
many communities, including the homosexual community.
Of surveys conducted 1985-1986, 72% of Homosexual men in STD clinics
in San Francisco are reported as having AIDS. 49% of Homosexual men in
San Francisco had AIDS, 59% of IV drug users surveyed in New York and
40% of the homosexuasls.
(For the sake of easier reading, AIDS was subsitiuted in-place of Human
immunodeficiency Virus (HIV) and inserted sub-headings)