Spread of Aids, The | Introduction
In June 1981, the U.S. Centers for Disease Control (CDC) published the first reports of a strange disease contracted by five men in Los Angeles. The men suffered from weight loss, high fevers, and pneumocystis, an unusual lung infection. The disease eventually became known as AIDS (acquired immunodeficiency syndrome). Additional investigation and research revealed that this deadly disease was not confined to the United States. It is now believed that HIV (human immunodeficiency virus), the virus that is widely acknowledged to be the cause of AIDS, originated in Central Africa and evolved from a similar virus that has been present in certain monkey populations for over fifty-thousand years. Since its discovery in 1981, the disease has spread dramatically. By the end of 1995, the CDC had reported that the total number of AIDS cases in the United States had grown to 513,486 and that 319,849 of those cases had already resulted in death. The World Health Organization estimates that as many as 40 million people worldwide may become infected with HIV by the beginning of the twenty-first century. If this estimate is accurate, humanity may face one of the most devastating plagues in recorded history.
While the possibility of a cure or vaccine for AIDS remains uncertain, most experts agree that society must rely on other strategies to control the spread of the disease and that these strategies must take into account the atypical process by which people become infected with HIV. Many other infectious diseases are spread through the inhalation or ingestion of, or physical contact with, a virus or bacterium. In contrast, HIV spreads only through the exchange of certain bodily fluids—most commonly, semen and blood. These fluids can be exchanged during a variety of activities. However, the three activities in which they are most commonly passed in amounts large enough to transmit the virus are sex, blood transfusions, and the sharing of needles by intravenous drug users. Health officials have instituted various measures to protect the blood supply and reduce HIV transmission via blood transfusions. However, because sex and needle sharing are typically voluntary actions that are the result of personal decisions, individual behavior is a major factor in the spread of the disease by these means. Consequently, most of the strategies put forth to control the spread of AIDS have focused on changing behavior that places individuals at risk of contracting HIV via sex and needle sharing.
One frequently suggested AIDS prevention strategy is to encourage abstinence from high-risk behaviors. Many commentators argue that the most effective way to avoid HIV infection is to eliminate practices such as promiscuous sexual activity and intravenous drug use. William F. Buckley, a conservative columnist and editor-at-large of the National Review, asserts, “Since over 70 percent of those who contract AIDS do so via sex, why does it not make sense, in the course of affirming our dedication to fighting the virus, explicitly to discourage such sexual activity as risks spreading the virus?”
Other AIDS prevention strategists believe that it is unrealistic to ex- pect individuals to abstain from high-risk behavior such as promiscuous sex. They contend that people will continue to be involved in high-risk behavior and, therefore, AIDS prevention strategies should attempt to minimize the risk experienced while engaging in such behavior. Many advocate the use of condoms to reduce the risk of HIV transmission during sexual intercourse. In addition, some public health experts promote safesex education and condom distribution programs in schools. They believe that such programs will not only lower the incidence of HIV, but will also provide individuals—and particularly teenagers—with a foundation on which to develop responsible sexual values and the ability to make more informed and intelligent decisions regarding sex.
Opponents of safe-sex education and condom distribution in schools contend that such programs encourage sexual activity and provide a false sense of security about the protection offered by condoms. These critics argue that sex education programs teach teenagers that premarital sex is acceptable and even expected. In addition, many question the effectiveness of condoms in preventing HIV infection. Commentators cite a study published in the New England Journal of Medicine that involved married couples in which one partner was HIV-infected and condoms were used regularly. Within two years, 10 percent of the healthy partners had also become infected. In response to such findings, critics of sex education and condom distribution programs contend that sexual abstinence and self-control are the only truly effective solutions for controlling the spread of AIDS.
In addition to attempting to lower the risk of becoming infected with HIV during sex, AIDS prevention strategists also seek to reduce the risks associated with intravenous drug use. To that end, many experts advocate needle-exchange programs, in which addicts are given sterile needles in exchange for their used ones. Proponents argue that needle-exchange programs have proved to be an effective means for controlling HIV infection among addicts. A study conducted by the National Research Council (NRC), a division of the National Academy of Sciences, concluded that needle-exchange programs considerably reduce the spread of AIDS among intravenous drug users and that they do not encourage drug abuse. The authors of the study state that “for injection drug users who cannot or will not stop injecting drugs, the once-only use of sterile needles and syringes remains the safest, most effective approach for limiting HIV transmission.” In addition, needle-exchange advocates maintain that by providing assistance and education for addicts through the exchange programs, society sends a positive message and demonstrates compassion for a group of individuals who are usually neglected and ostracized.
Critics question the effectiveness of needle-exchange programs and contend that providing addicts with needles encourages and legitimizes drug abuse. They argue that the success of needle-exchange programs has been exaggerated by their proponents. In addition, opponents insist that even if the programs did reduce the sharing of needles, they would do nothing to slow the spread of HIV from infected addicts to their sexual partners. They believe that the primary factor that leads to the spread of HIV among intravenous drug users is their unwillingness to accept responsibility for their actions. In an article in the New York Times, Dr. Mitchell Rosenthal, an expert on drug rehabilitation programs, asserts, “Indeed, clean needles aren’t going to alter any of the irresponsible and antisocial ways in which drug abusers threaten society.” Exchange opponents maintain that by supplying addicts with needles, society pushes them further away from treatment, as well as from any hope of ever becoming productive and responsible human beings.
Preventing the spread of AIDS is one of the most formidable and important challenges humanity has ever faced. Opinions among health care professionals, laypersons, religious leaders, and gay rights activists on how to deal with this problem vary greatly, ranging from mandatory AIDS testing to sexual abstinence to the implementation of programs to make high-risk behavior safer. At Issue: The Spread of AIDS explores these and other proposed strategies for responding to the complex and controversial issue of AIDS control and prevention.
