Conference turris::womannotes-v3

    The following seven notes contain the text of the newest 
    *comprehensive* brochure I've found (copyright 1990) titled:  
    "HIV INFECTION AND AIDS - What Everyone Should Know."

    I've broken it up into these sections:

	* The Spectrum of HIV Infection
	* HIV and its Transmission
	* Protecting Yourself
	* It's What You Do, Not Who You Are
	* The HIV Antibody Test
	* Minorities, Friends, Women & Gay/Bisexual Men
	* For Further Information...

    Please feel free to request copies of this brochure from:

	American College Health Association
	1300 Piccard Drive, Suite 200
	Rockville, MD  20850
	(301) 963-1100    

HIV INFECTION AND AIDS - What Everyone Should Know  (part 1 of 7)
--------------------------------------------------
(posted w/o permission)

	ABOUT HIV INFECTION AND AIDS

AIDS stands for:
	A quired	not inherited

	I mmune		a breakdown of the body's
	D eficiency	defense system

	S yndrome	a group of related disorders and symptoms

   The virus that causes the syndrome AIDS is called human immunodeficiency
virus (HIV).  Having HIV infection is not the same as having AIDS.  HIV
causes a spectrum of conditions and symptoms.

THE SPECTRUM OF HIV INFECTION [color bar graph]

    	Infected     No Symptoms     Mild Symptoms     AIDS

   AIDS is the most severe, life-threatening form of HIV infection.  Most
people infected with the virus seem healthy, and many do not realize they
have been infected.

   People who have HIV infection may not have symptoms for many years.  The
period of time from infection to serious symptoms seems to average nearly
10 years.  However, people with HIV infection can transmit the virus to
others - even if they have no symptoms and even if they do not know they
have been infected.

   Given currently available information, it appears that, without treatment,
most people with HIV infection will develop serious symptoms at some point
in the future.  However, anti-viral drug therapy can slow down the pro-
gression of HIV infection significantly, and there are many things that
people who have HIV can do to preserve their health.  In addition, new
medical strategies can prevent many complications and postpone serious
problems.  While it is a chronic medical problem, HIV infection is rapidly
becoming manageable.  Using better treatments and strong partnerships with
health care providers, people with HIV infection are staying healthy longer.
Meanwhile, research is providing better treatments for people in all stages
of HIV infection, including AIDS itself.

HIV INFECTION AND AIDS - What Everyone Should Know  (part 2 of 7)
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(posted w/o permission)

			   * * * * * * * * * *

		HIV IS NOT TRANSMITTED BY CASUAL CONTACT 

   Repeated, carefully designed and monitored scientific studies prove
   that there is no risk of transmitting HIV by sharing the same space,
   classroom, athletic or recreational facilities, sauna, swimming 
   pool, bathroom, food, eating utensils, clothing, or books with some-
   one who has HIV infection.  Ordinary objects and surfaces used by
   people with HIV infection present no danger and need not be feared.
   HIV is not transmitted by coughing or sneezing.  Neither animals
   nor insects can transmit HIV.

			   * * * * * * * * * *


	HIV AND ITS TRANSMISSION

   HIV is a fragile virus.  It primarily infects a group of white blood cells
that manage the operations of the immune system.  But it can also infect
cells in the nervous system, colon, and blood vessels.

   Nobody "catches" HIV infection the way people "catch" a cold.  HIV does not
survive long enough outside the body to be caught from the air, or in water, 
or off objects and surfaces.  It is transmitted by semen, blood and blood 
products, and vaginal and cervical secretions.  HIV is not transmitted by 
saliva, sweat, tears, or urine.

   HIV can be transmitted 1) by particular kinds of sexual contact, 2) by
direct exposure to infected blood, and 3) from an HIV infected woman to her 
fetus during pregnancy or childbirth or, possibly, to her infant during 
breastfeeding.

1) SEXUAL CONTACT

   Anal and Vaginal Intercourse:  HIV is more likely to be transmitted by 
unprotected anal or vaginal intercourse than by other sexual activities. 
Anal intercourse is more likely to allow HIV transmission, because HIV can
attach itself to cells in the lower rectum.  HIV may be easier to transmit
to the receptive partner than to the insertive partner.  HOWEVER, AN
INTACT LATEX CONDOM, PROPERLY USED, SUBSTANTIALLY REDUCES THE RISK OF
TRANSMITTING HIV during anal or vaginal intercourse.

   Oral Sex:  The risk of acquiring HIV infection by performing oral sex on
a man is uncertain.  There seems to be some risk, but it is clearly much
lower than the risk of vaginal or anal intercourse.  Since pre-ejaculatory
fluid ("pre-cum") may contain HIV, it is not necessarily any safer to stop
before the man ejaculates.  The chance of acquiring HIV by performing oral
sex on a woman is not precisely known, but also seems small.  Whether you
are a woman or a man, the risk of contracting HIV by having oral sex per-
formed on you seems extremely low.

   Kissing:  Although HIV is very rarely present in the saliva of people with
HIV infection, there is absolutely no evidence that kissing can transmit the 
virus.  NO CASE OF HIV INFECTION HAS BEEN TRACED TO EXPOSURE TO SALIVA IN ANY 
CIRCUMSTANCES.

   There is no chance of transmitting HIV through sexual activities that do
not involve direct contact of semen, vaginal secretions, or blood with
mucous membranes.  Touching, stroking, massage, and masturbation, alone or 
with a partner, do not transmit HIV.

2) BLOOD

   Needle sharing: No matter what substance is in the needle, if you share
needles with others, you may be directly exposed to their blood.  People
share needles for intravenous drug use (such as heroin and crack), and
for shooting anabolic steroids to build bulk and power for athletic per-
formance.  HIV may also be transmitted if needles are "shared" when used
for tattooing, ear piercing, or acupuncture.

   Accidents in health care: A small number of health care workers who par-
ticipated in the care of people with HIV infection have also acquired HIV.
Usually, they were infected as a result of injuries involving needles con-
taining the blood of people with HIV infection.

3) MOTHER-TO-INFANT

   WOMEN WHO HAVE HIV INFECTION CAN TRANSMIT THE VIRUS TO THEIR BABIES.
Most of these infections seem to occur during pregnancy, but some may happen
during the birth process.  A few babies *may* have been infected through
breast feeding.

HIV INFECTION AND AIDS - What Everyone Should Know  (part 3 of 7)
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(posted w/o permission)

	PROTECTING YOURSELF

  You can reduce your risk of acquiring HIV by:

* MAKING CAREFUL CHOICES ABOUT SEXUAL ACTIVITY.  Not having anal, vaginal
  or oral sexual intercourse provides 100% protection against the sexual
  transmission of HIV.  If you do have intercourse, YOUR SPECIFIC SEXUAL
  PRACTICES ARE JUST AS IMPORTANT AS THE NUMBER OF PARTNERS YOU HAVE.
  Unsafe intercourse without a condom with one or two partners may be more
  likely to result in HIV infection than safer sex with several partners.
  Plan to protect yourself.  Don't let one thing just lead to another --
  decisions about sexual activity should be active ones.

* COMMUNICATING ASSERTIVELY WITH YOUR SEXUAL PARTNER AND NEGOTIATING FOR
  SAFER SEXUAL PRACTICES.  Many people are unskilled in discussing sexual
  matters or activities or in managing relationships.  Talking about sex
  can seem embarrassing and uncomfortable.  Telling the truth about your
  sexual past may be difficult.  Communicating assertively about your
  desires in a sexual relationship is a real challenge.

     DEVELOP SKILLS TO EXPRESS YOUR FEELINGS AND CONCERNS; consider *in
  advance* what you would say and do in particular situations.  For 
  example, what would you say to someone who wanted to have intercourse
  without a condom?  Asking a partner about past sexual experiences may
  be helpful too, but, in general, you cannot depend on that information.
  IT IS MUCH SAFER TO TAKE PRECAUTIONS WITH EVERY PARTNER.  Communication
  alone is not enough to protect you.

     Don't give up safer sex as a way to show your love or commitment to
  a relationship.  Safer sex practices will help protect you through the
  early dating period, rough times in the relationship, and the ending of
  the relationship if that should occur.

* REMOVING ALCOHOL AND DRUGS FROM SEXUAL ACTIVITY.  Alcohol and drugs may
  make sexual activity seem easier; they may alleviate uncertainty, anxiety, 
  and ambivalence, but they caneliminate decision making too.  Know your 
  limits when you drink, and learn skills for keeping yourself safe.  At a 
  party, consider a "buddy system," in which someone does not drink alcohol 
  (as in designated driver programs).  Remember, SUI (Sex Under the In-
  fluence) is dangerous just as DUI (Driving Under the Influence) is 
  dangerous.  Drunk sex is rarely safer sex.

     Alcohol and drugs can make communication difficult -- and they can
  blur the issue of consent.  Acquaintance rape ("date rape") is quite
  common.  When men or women are coerced into sexual activity, or are
  unable to give consent (often because they are intoxicated), there are
  usually no precautions taken to prevent transmitting HIV.

* USING LATEX CONDOMS FOR INTERCOURSE.  Whenever you engage in anal or 
  vaginal intercourse, use a latex condom.  Animal membrane (skin) condoms 
  cannot be counted on.  Condoms are not perfect, and they do not provide 
  "SAFE sex."  Nonetheless, a latex condom provides high levels of pro-
  tection against the transmission of HIV if it is used properly:

	** Put the condom on the erect penis prior to any direct
	   contact of the penis to the vagina or anus.

	** Use condoms that have a reservoir tip, or pinch half an
	   inch at the tip of the condom to collect semen.  Put a
	   drop of spermicidal jelly in the tip and then unroll the
	   condom carefully, smoothing out air bubbles, all the way
	   down over the penis.

	** Use adequate amounts of water-based, rather than oil-
	   based, lubricants.  KY Jelly is water-based and safe;
	   hand lotions, Vaseline, and shortening are oil-based
	   and unsafe.

	** After ejaculation, withdraw the penis while it is still
	   erect; hold on to the base of the condom carefully,
	   avoiding spilling its contents.

     Spermicides containing Nonoxynol-9 (jellies, creams, foams used for
  contraception) may increase the protection provided by a condom, but are
  NOT adequate by themselves to prevent transmission of HIV.  A diaphragm,
  or cervical cap, with or without foam, does NOT protect against HIV.
  Birth control pills provide no protection against HIV.

     Latex squares and dental dams are rubber devices that may be used 
  during oral-genital or oral-anal sexual contact.  The level of pro-
  tection they provide is not known, but it is logical to assume that they
  might reduce the risk of acquiring HIV if they are carefully and con-
  sistently used.

HIV INFECTION AND AIDS - What Everyone Should Know  (part 4 of 7)
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(posted w/o permission)

	HIV IS NOT TRANSMITTED BY CASUAL CONTACT

   Repeated, carefully designed and monitored scientific studies prove
that there is no risk of transmitting HIV by sharing the same space,
classroom, athletic or recreational facilities, sauna, swimming pool,
bathroom, food, eating utensils, clothing, or books with someone who
has HIV infection.  Ordinary objects and surfaces used by people with
HIV infection present no danger and need not be feared.  HIV is not
transmitted by coughing or sneezing.  Neither animals nor insects can
transmit HIV.

	IT'S WHAT YOU DO, NOT WHO YOU ARE

   It's what you do, not who you are, that matters in HIV infection. "Risk
behaviors" are much more important that "risk groups."  Anyone who en-
gages in unsafe sexual behavior or shares needles for any reason can
become infected with HIV.  HIV can be transmitted during sexual inter-
course among people who define themselves as gay, bisexual or straight.
HJIV can be transmitted during needle sharing by people who may or may 
not be "addicted" to drugs.  And "risk behaviors" means the *past* as
well as teh present.  Unsafe sex or needle-sharing a few years ago still
matters now, even if someone no longer has unsafe sex or shares needles.

   Some people know a great deal about HIV and AIDS.  But people "in the
know" still acquire HIV infection.  A lot of people think HIV infection
is a problem for "other" kinds of people in "other" places, and they feel
invulnerable.  But behaviors, not groups, transmit HIV.

HIV INFECTION AND AIDS - What Everyone Should Know  (part 5 of 7)
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(posted w/o permission)

	THE HIV ANTIBODY TEST

   Many people emisunderstand blood tests used to detect HIV infection.
There is no "AIDS test."  The tests that are available indicate whether
someone has antibodies to HIV.  If the tests are confirmed as positive,
then the person tested has antibodies to HIV and is considered to have
HIV infection.  If the tests are negative, no antibodies to HIV were
found.  Ordinarily, a negative test result means that the person does
not have HIV infection.  BUT A NEGATIVE TEST SHOULD NOT BE A SUBSTITUTE
FOR SAFER SEX.

   It ordinarily takes three to six months for people who have acquired
HIV infection to develop enough antibody for the test to turn positive.
If they were tested too soon, before enough antibody developed, they
would have an inaccurately negative (false negative) test.  Very rarely,
it may take longer than six months--even years--for the test to turn
positive.  So test results must always be interpreted in the context of
a person's history of sexual and needle-using behaviors.

   SHOULD YOU BE TESTED?  IF YOU ARE CONCERNED, FIRST CONSULT A
KNOWLEDGEABLE HEALTH CARE PROFESSIONAL OR COUNSELOR FOR INFORMATION AND
ADVICE.  If you feel there is a chance that you have acquired HIV 
infection, you should seriously consider testing.  It is important to 
know that you have HIV infection as early as possible so that you and an
expert health care provider can work together to preserve your health.
If you are a woman and have engaged in unsafe sexual behavior or shared
needles, you should be tested before becoming pregnant.

   HIV ANTIBODY TESTING MAY HAVE NEGATIVE SOCIAL AND PSYCHOLOGICAL
CONSEQUENCES--depression, anxiety, loss of job, social ostracism, and
even suicide.  TO MINIMIZE THE RISK OF DISCRIMINATION, SEEK ANONYMOUS
TESTING (where you do not have to give your name or other identifier)
rather than confidential testing (where you do give your name or social
security number).  BE AWARE OF STATE LAWS REGARDING REPORTING OF
POSITIVE TEST RESULTS.  And protect yourself psychologically; get tested
where you have not only both pre-test and post-test counsellilng, but 
also access to referral services for further psychological assistance
and support.

   NEVER USE BLOOD DONATION AS A WAY TO BE TESTED.  If you were infected
very recently, your test might still be negative even if you had acquired,
and could transmit, HIV infection.

HIV INFECTION AND AIDS - What Everyone Should Know  (part 6 of 7)
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	RACIAL MINORITIES AND HIV INFECTION

   HIV infection and AIDS have become serious problems for Africa-Aamericans
and Latinos, especially in the inner cities.  Both African-Americans and
Latinos are over-represented among people with AIDS.  Most women and infants
with AIDS in the United States are people of racial minorities.

   African-Americans and Latinos are not at greater risk of HIV infection
because of their race.  The explanations lie in social and economic factors:
higher rates of intravenous drug use, urban poverty, and limited access to
health care.  

    Some racial minorities, such as Asian-Americans and Native Americans,
do not have high rates of infection now.  But the risk of HIV infection is 
in what you do, not who you are.  Just as race does not cause greater risk,
race does not bring safety.

	WHAT IF A FRIEND HAS HIV INFECTION OR AIDS?

   People with HIV infection hope for the same kind of support and friend-
ship you always provided before.  Their needs will vary, depending on their
personality and their place along the spectrum of HIV infection.  Although
they may feel hopeful and optimistic much of the time, people with HIV in-
fection may sometimes feel isolateld, frightened, and uncertain about
relationships, their future, and their health.

   You can help by continuing to talk, do things together, and share 
experiences.  A health educator, clinician, or counselor may help you if
you have questions about HIV, or need suggestions about what to say or do.

	WOMEN AND HIV INFECTION

   Increasing numbers of women are acquiring HIV infection and developing
AIDS.  Women acquire HIV through unsafe sexual contact or needle sharing,
just as men do.  YOUR BEHAVIOR CHOICES ALSO DETERMINE YOUR RISK.  

   Lesbian and bisexual women may have special concerns.  It is important
for you to acknowledge to yourself all of your sexual behaviors so you can
plan effectively to protect yourself and others.  The chance of transmit-
ting HIV from woman to woman during sexual encounters is difficult to
evaluate; the risk seems low but uncertain.

   Since a woman with HIV infection can transmit HIV to her fetus, and possi-
bly to her infant by breast-feeding, women with HIV should avoid pregnancy.

	GAY AND BISEXUAL MEN AND HIV INFECTION

   Feeling that you are gay or bisexual does not mean you have had sex with
other men, or that you have unsafe sexual intercourse, or that you are likely
to acquire HIV infection.  The label you use for your sexual orientation
doesn't matter either.  YOUR BEHAVIOR CHOICES DETERMINE YOUR RISK.

   Now that many gay and bisexual men have significantly reduced their risk
of HIV infection by changing their sexual behaviors, THE CHALLENGE IS TO
STAY SAFE.  If you are gay or bisexual, the support of your community, com-
bined with your own self-esteem, will  help you avoid taking risks.

   Bisexual men often feel isolated from both gay and straight communities.
They may not feel the same support that self-identified gay men experience
from their peers.  If you are a bisexual man, remember the importance of
safer sexual practices in all of your relationships.

HIV INFECTION AND AIDS - What Everyone Should Know  (part 7 of 7)
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(posted w/o permission)

	FOR FURTHER INFORMATION

   Contact your health service, sexual health program, peer sexuality
educators, lesbian/gay organizations, or health care provider.  Additional
information and support can be obtained from community-based AIDS service
organizations.  The following national hotline services are also available:

	Centers for Disease Control Hotline		1-800-342-AIDS
	Spanish-Language Hotline			1-800-344-SIDA
	Hotline Deaf and Hearing-Impaired People	1-800-243-7889
		Monday-Friday, 10am-10pm		TDD/TTY

   For more information about AIDS:

	AIDS ACTION Line				(617) 536-7733
	     Toll free (Massachusetts)			1-800-235-2331
	Latino AIDS Hotline				(617) 262-7248
	Bilingual AIDS Hotline				1-800-637-3776
	     (English/Spanish in Springfield)
	AIDS Project Worcester				(508) 755-3773
	Alternative Test Site Program (Mass.)		(617) 522-4090

***********************************

American College Health Association
1300 Piccard Drive, Suite 200
Rockville, MD  20850
(301) 963-1100

    
    
    Thanks Deb for all that EXCELLENT information!
    
    I know a LOT of women who think that it's just a "gay man's" disease...
    So many times I hear, "It won't happen to me, I don't associate with
    'that type' of person."  (As if a person that has AIDS is
    dirty or bad...GGGrrr, that attitude really GETS me.....)
    
    What they don't know is that it could be anyone of us that gets
    it...and we should ALWAYS practice safe sex....because, it's better
    safe than sorry.
    
    kath

    Great stuff, Deb!
    
    AIDS became a very personal issue for me when people I loved began to
    ail and die.
    
    It became _very_ personal to me when I realised that what was literally
    choking the life out of a dear friend was an inability to fight off
    candida.
    
    You can bet that with my supreme affinity for yeast infestations that
    that hit home.  A pest to me, a killer in other circumstances.
    
    When I began to study and read up on other opportunistic infections,
    Toxoplasmosis emerged as a cause of death.  I have cats.
    
    Happily for me my behaviours were/are not high risk. 
    
    Talk about keeping me honest ...
    
      Annie

    I've been reading "And the Band Played On" by Randy Shilts 
    
    It's about the early years of the AIDS epidemic, mostly about the US
    but also tells part of the story of European and African efforts in
    research.  It is a frightening, sobering, and rage-provoking book.  So
    little was done, so many died horribly before the disease was taken
    seriously.                                         
    
    We have talked in =wn= about how little research (comparatively)
    is done on women and our diseases or our variety of "male" diseases
    such as heart and lung problems.  Because AIDS first became apparent
    in the US in the gay community (and a few blacks and drug users
    who were assumed to be homosexual but not admitting it) very little
    was done to research or take care of the early sufferers.  Even
    when the disease turned up in babies and hemophiliacs the doctors
    who realized what it was were not believed.  It was considered a
    gay disease and was not written about in the national press, not
    funded for medical research beyond a very paltry sum, not cared
    about.
    
    If you can stand the anger and the information, I recommend the
    book.  I thought of posting this in the book string, but this seems
    much more appropriate.  Mods, move it, if you want.
    
        Margaret

    "And the Band Played On" was *great* reading.
    
    I especially liked the style.  Shilts follows the actual
    chronology of events.  I have heard some criticism that the
    style led to too much jumping around...e.g., in SF this was
    happening, then in Europe, that was happening, then back
    to SF...  But it was fascinating to read it the way it
    was really happening.  (Well, not quite...we now know what
    they were stumbling across, but still, I liked the real-life
    chronology style.)
    	
    	Pennie

    Elisabeth Kubler-Ross, the death and dying specialist, has written a
    fine book on AIDS as well. She looks at all aspects of society and how
    they are affected.
    
    mdh

	Deb, thanks so much for typing all that in.

	"Longtime Companion" is an excellent movie about AIDS, and
	the first semi-mainstream movie to deal with the subject.

	Carla

    
    
    I, too, will vote for each of the three previous movies/books.  Bring
    lots of hankies if you plan on seeing "Longtime Companion".  I found it
    to be very realistic.  It also, I think, showed the real love that is
    possible between two men.  "And the Band Played On" isn't exactly easy
    reading, I found.  Part of it is the style; part of it is the very
    honest way the material is treated.  It's definitely not for the
    squeemish.
    
    Thanks, Deb, for all the work!  (Do you have a scanner????)
    
        Greg

    Thanks Kath and Annie for your comments.  No Greg, I don't have a
    scanner, I just type over 100 wpm!  8-)

    "And the Band Played On" is a very comprehensive history about the
    AIDS epidemic, and has been said, is not for the squeamish.  It is
    very powerful and brought out a lot of emotion when I read it.
    Shilts has taken a lot of grief from both gay and straight critics -
    for his criticism of the government and CDC, and for his portrayal of
    some aspects of some gay men's metropolitan lifestyles.  I recommend it, 
    and it's available at most bookstores.

    "Longtime Companion" was in movie theaters last year - it may be out 
    on video now.  It's a well done 'slice of life' about a group of 
    friends (mostly gay men) in New York City.  One of the criticisms I 
    heard was that it didn't represent all gay men, but (according to a 
    review interviewing the film's makers and actors) it wasn't supposed 
    to - any more than "Donna Reed" represented all white people or "The 
    Godfather" represented all Italians.  What bothered me about it is 
    that they never got around to mentioning safe sex or HIV testing - 
    they implied that the only fate of these guys was a life of celibacy.  
    It's a very moving film, and I'd definitely recommend seeing it (and
    do bring a kleenex or two).  It's the only movie I've ever seen where
    *no one* moved out of their seats until *all* the credits had rolled
    by and the lights came on.  No one even talked.

    Marge, I haven't read Ross' latest book, but judging by her earlier
    ones, I'm anxious to read it.  I think she's terrific.

    deb

Reprinted/paraphrased without permission from 12/16/90 _Boston Globe_
written by Richard A. Knox, Globe Staff.

Washington--Women with AIDS are dying faster than men with the disease,
according to new studies, a disturbing trend that may be explained by
mounting evidence that the HIV virus affects women in unique ways.

Many women are missing their opportunity for life-extending care because
most doctors are not aware that cervical cancer and other gynecological
problems can be manifestations of HIV-virus infection, say researchers,
care givers and AIDS activists.

    Change the Definition!

At a landmark national conference on AIDS and women here last week,
criticism focused on the federal government's official definition of AIDS,
which recognizes no woman-specific illnesses associated with the HIV virus.
While the definition was developed to keep track of the number of cases of
AIDS, it also heavily influences decisions on treatment and eligibility for
Medicaid and Social Security disability programs.  Under the current
definition, many women with AIDS are prevented from qualifying for 
disability and medical payments.

Government AIDS researchers acknowledge thre is reason for concern.  Critics
complain that the government's failure to study and define HIV's effects on
women is delaying care and elevating death rates.  

    Women die sooner

New San Francisco data show the median survival time among women wth AIDS is
only 7 months, while the comparable figure for men is 2 years.  Women are
also more likely to die within a month after AIDS is diagnosed, said Dr.
Ruth L. Berkelmanof the US CDC.

    Impact on women is worsening

The first National Conference on Women and HIV Infection in the history of 
the 9 1/2 year old epidemic reported:

**  AIDS in women is increasing by 29% a year, versus 18% among US men,said
    US Surgeon General Antonia Novello.

**  The AIDS death rate is 9 times higher for black women than white women,
    reflecting a crisis in getting basic medical care to HIV-infected women
    in the cities most hard-hit by the epidemic.

**  So far, 15,000 US women have met the official government definition of
    AIDS, and more than 100,000 women are believed infected with HIV.  But
    there is widespread suspicion that the definition undercounts both AIDS
    cases and HIV infection among women.

For instance, when researchers at the US CDC examined death certificates 
earlier this year, they found that only 35% of women who died of AIDS and
related causes actually met the official criteria.  This implies that 65%
may not show up in the government's tally of female AIDS cases.

Those who direct federally funded AIDS rsearch did not deny that the
government has neglected the impactof AIDS on women.

"Frankly I can say very little about the treatment of AIDS in women," 
confessed Dr. Daniel Hoth of the National Institute of Allergies and
Infectious Diseases, who directs the AIDS Clinical Trials Group. "I stand
before you stating: We simply haven't done enough. It certainly wasn't
intentional. But what is important is the future. We will do everything we
can to get answers to the questions women and their doctors need to know."

Women currently constitute 10% of subjects enrolled in federally sponsored
AIDS studies, and about 12% of reported AIDS cases.  Since enrollment of
women in studies has increased only recently, relatively little is known
about the disease and its treatment in women.  Meanwhile, the proportion
of women among total AIDS cases is expected to grow throughout this decade,
according to the CDC's Berkelman.

    A far more aggressive disease

HIV-infected women suffer from a number of diseases that can easily be missed 
by physicians as early signs of AIDS...preliminary evidence suggests that 
they more often have yeast infections of the vagina, mouth and esophagus; 
severe and chronic pelvic inflammatory disease; bacterial pneumonias unlike 
the pneumocystis pneumonia most often associated with AIDS in men; and "HIV 
wasting," or severe weight loss.

Most attention is focused on cervical cancer.  Small-scale studies suggest
HIV-infected women may be at risk of an unusually aggressive form of
cervical cancer or cervical dysplasia that is particularly stubborn and
hard to treat.  The rate of abnormal Pap smears was 8-10 times higher in
HIV-infected women at a study done at Beth Israel Hospital in New York.

    The following note was extracted from another notes file and
    is posted here (in edited form) with the permission of the
    author, who requested anonymity.

    The information is a report on a panel discussion on AIDS
    and sex practices sponsored by the AIDS Action Committee. 
    The panelists were AIDS health educators and a member of the
    Shanti Project, which helps people with AIDS die with
    dignity.  

    The information is about sex practices and is therefore
    explicit. I have inserted numerous form feeds. Do NOT
    continue if you are easily offended. Do NOT read any more of
    this note if you are bothered by explicit sexual information
    and language.

    
                       **** WARNING ****

                Explicit sexual language follows.  
             Do NOT continue if you may be offended. 
                       You are warned.






    Is fellatio (oral stimulation of a penis) safe to perform or
    receive?  Well, according to the panel, they (AIDS
    researchers and education experts) still are not sure.  
    
    They are sure that it is not completely safe, only low risk. 
    There _are_ a few documented cases of people getting HIV (the
    virus that causes AIDS) from _performing_ oral sex. 
    
    One man got it from being sucked (having fellatio performed
    on him).  Most of these cases have been pretty thouroughly
    researched and  tracked.  None of the people infected through
    fellatio had had intercourse. 

    Canadian health officials started  the controversy a few
    years ago when they implied that it was safe to perform oral sex
    on a man and swallow semen.  This was later changed with
    several disclaimers.
    
    The bottom line is that swallowing is not recommended. 
    Spitting it out is  better.  Not taking semen in your mouth
    is better.  Only sucking for a short time, early in the
    process is better.  Not taking the head of the penis in  your
    mouth is best.  You have to decide for yourself what you feel
    safe doing.
    
    Can a man get HIV from being sucked?  Yes.  A man can get
    other diseases quite  easily this way.  Some of these
    diseases create large amounts of lymphocytes in semen, precum
    (The substance that "leaks" or "beads" out of a man's penis
    _before_ he orgasms.)  and discharge.  The white blood cells
    that travel with the  lymphocytes can carry HIV.  The urethra
    is very easily penetrated by  these other diseases (gonorrhea
    is one.)

    (NOTE: Yes, diseases can be transmitted _from_ the person
    sucking _to_ the man whose penis is being sucked.  AIDS is
    just one of the diseases that can be transmitted this way.)

    One thing that was pointed out was that it is FRUSTRATING
    that there are so few  facts.  

    One question asked was whether there was HIV in precum.  
    Fenway Community Health Center is researching this with
    Harvard.  They haven't  been able to find any yet. BUT they
    have not been able to test very much yet. AND they also said
    that semen from a positive person can test positive one day 
    and negative on another day.  So is precum safe?  No.  It's
    still low risk,  but not safe.
    
    Stomach acids do not destroy HIV.  AIDS Action Committee 
    says use condoms.  One panelist says decide for yourself.

    A follow on to .18 - may be offensive.
    
    
>>    (NOTE: Yes, diseases can be transmitted _from_ the person
>>    sucking _to_ the man whose penis is being sucked.  AIDS is
>>    just one of the diseases that can be transmitted this way.)
    
    Doesn't this mean that the virus can be transmitted via saliva, ie by
    the person who is just using their mouth?  Does this imply that it
    could be passed on via kissing etc?
    (Sorry if this point's already been discussed - I didn't check back).
    
    Also, is there any evidence that the virus can be passed on via
    cunnilingus?
    
    Ken
    

...and btw, to the author of .18, thankyou for the warnings of explicit
language.  I was reading this at home, with my 8 yr old daughter looking
over my shoulder...

as a point of interest, when she asked me a year ago how AIDS is transmitted,
I explained to her about both IV drug use, and the mechanics of the sex act
between men and women (which she thought was hysterically funny).  As she gets
older I will of course explain more of what .18 describes; I just think that
.18 has more info than she needs/wants/can understand at this age.

    
    RE .18
    
    EXPLICIT WARNING - SPECIFICS FOLLOW
    
    
    >Doesn't this mean that the virus can be transmitted via saliva, ie by
    >the person who is just using their mouth?  Does this imply that it
    >could be passed on via kissing etc?
    
    I too am confused here.
    In my book on women and AIDS they list kissing as a "minimal risk"
    area, oral sex as a "medium risk" and penetrative sex as "high risk".
    I cannot see why the body fluid *given* by a person sucking i.e.
    saliva should be "minimal" in one case and "medium" in the other....
    Can someone enlighten me about this?
    
    >Also, is there any evidence that the virus can be passed on via
    >cunnilingus?
    
    Classified as "medium" also - the same rating as fellatio.
    Certainly the gay wmns community has taken positive safe sex action
    around cunnilingus - dental dams etc. Also any vaginal contact
    sex moves into the "high risk" area during menstruation, according
    to my information...
    
    'gail
    

    
    cautioned reponse
    
    
    
    
    although i'm not completely sure, `gail, i wonder if this has to do
    with sliva/saliva transfer vs saliva/genital transfer.  with saliva
    being a minimum risk if it's coupled with another minimum risk, vs the
    minimum risk being coupled with a "higher" risk = medium?  that's what
    i was thinking anyway.  anyone else know for sure?
    
    ~r

>    Doesn't this mean that the virus can be transmitted via saliva, ie by
>    the person who is just using their mouth?  Does this imply that it
>    could be passed on via kissing etc?
 
It's not so much that the virus is being transmitted through saliva, it is 
that it might be 'hitching' a ride with other diseases.  The important thing 
to remember is that when an activity is listed as low risk, that does not mean 
NO risk.  Deep kissing is listed as low risk, but there is still a risk 
involved.  What also is important is that cases of transmission through low 
risk activities are now beginning to surface.  They have been carefully 
screened and tracked so the data is pretty reliable.

Should one be frightened by this?  No, instead they should respond by weighing 
their activities against the facts and risks.  

I hope this clears a few things up.  If not, most AIDS hotlines can give more 
detail.  The AIDS Action Committee in Boston is another excellent source.  
Remember, HIV has to get into your bloodstream to do anything.  There are many 
ways to avoid having this happen.  Most don't require 'giving-up' much of 
anything.  Instead, it's being smart about what you are doing, and who you are 
doing it with.  It's finding alternatives that might broaden ones experience 
with a partner.

Randy


   

    As stated in .3, HIV is *very rarely* present in the saliva of people
    with HIV.  In the few instances it has been detected, it has been
    in *miniscule* quantities, so that a person would need *quarts* of
    saliva - *into* a cut or sore - to become infected.  The risks with oral 
    sex occur not with the saliva but with infections, cuts, sores, etc. in 
    the mouth.  Even brushing or flossing your teeth can puncture the gums 
    and cause some bleeding - without even being noticed.  It's the *blood*
    mixing with the semen or vaginal secretions that may transmit HIV to
    either the giver or receiver of oral sex (on a male or female).  
    Receiving is the lower risk activity of the two.  All safe sex 
    literature advocates latex condoms on males and dental dams on females
    (NOT natural skin condoms or saran wrap, since they have been shown
    to be ineffective in preventing the transmission of HIV). Unprotected 
    oral sex on a woman who has her period is unwise.

    HIV is transmitted via blood, semen (including pre-cum), and cervical
    and vaginal secretions (and needs a means to *enter* the other person's
    bloodstream) - not by tears, saliva, sweat and urine.  For women, the
    riskiest activities are:

	* Sharing needles or IV drug works

	* Having unprotected sex

	* Having used semen for donor insemination from a donor who is 
    	  HIV+ or whose HIV status is unknown

	* Having received blood transfusions or blood products between
	  1979 and 1985

		- source: "Lesbians and AIDS - What's the Connection?"
		  San Francisco AIDS Foundation, Women's AIDS Network
		  333 Valencia St., 4th Floor, PO Box 6182
		  San Francisco, CA  94101-6182
		  July 1988

    deb

    Deb, thanks for posting this very important information in the file. 
    If even one person takes the time to internalize and act on the
    information you've presented, you've made a big difference by caring. 
    
    thank you,
    Marge

	* Having unprotected sex

On of the things that has most consistently annoyed me about safe sex
info is their use of the word "sex".  Unprotected sex, eh?  What does
that mean.  What *is* "sex"?????

D!

    	D!
    
    	We had a professor at Abilene Christian who was fond
    	of saying, "You don't have sex. Sex is something you're
    	born with. If you mean the act of sexual intercourse,
    	then say `sexual intercourse.' "
    
    	Scott

    re: .28
    Why is this so different from 'social intercourse'?
    
    I mean, anyone can play.

    RE: .28
    
    Doesn't "intercourse" mean "communication"?  The people in 
    Intercourse, PA, probably think so.
    
    I don't think it has anything to do with anatomy.
    
    --DE
    

    Errr... if anyone wants to know what sex is, send me a mail and I'll
    try and explain.
    
    Ken
    

    re .26  D!
    
    In this case, "unprotected sex" means sexual intercourse without
    condoms, fellatio without condoms or cunnilingus without dental dams,
    and avoiding exposure to your sex partner's body fluids and waste
    (including blood, menstrual blood, semen, pre-cum, vaginal secretion 
    and feces).
    
    In other words: f*cking, s*cking, licking, rimming, fisting (anal or
    vaginal).  Also, sex toys should be thoroughly cleaned after use, and
    sharing insertive toys is not recommended (unless you use a condom on
    'em!).
    
    Safer sex can be fun - use your imagination!  8-)
    
    deb

    National Women and AIDS Conference was held in Boston on April 19-20.
    There were 800 participants.

    "Women are the fastest growing population segment being diagnosed
    with AIDS in the US.  In all, nearly 20,000 women have been diagnosed
    with AIDS, although many experts feel that that number is articifially
    low.  Of women who die of AIDS-related conditions, it is estimated
    that only 55% are diagnosed before their deaths.

    "The average life expectancy of a man following an AIDS diagnosis is
    two to three years, while for a woman it is four to six months.  In
    New York City, AIDS is the leading cause of death among women 25 to 44,
    while for men in the same age group, it is the second leading cause of
    death.

    "Currently, the Centers for Disease Control do not recognize
    gynecological manifestations of HIV infection as AIDS-defining illnesses.
    ... Because of this, there is no data on the actual numbesr of cases of
    opportunistic infections that only strike women, and there are no
    ongoing investigations of drugs to combat them.

    "While over 10% of AIDS cases are among women, less than five percent
    of clinical trial participants are women.  The FDA bars women from
    phase I toxicity studies during their childbearing years. ... 
    Aerosolized pentamidine, which is the primary prophylaxis for the
    prevention of pneumonia in people with AIDS, is not give to women who
    are pregnant, which gives those women a choice: abort the fetus, or
    carry the fetus to term risking a life-threatening case of pneumonia.

    "One of the most chilling sessions of the conference was the final
    keynote address, when Jonathan Mann, director of the International
    AIDS Center at the Harvard AIDS Institute [and former director of WHO],
    gave the global projections for AIDS cases in the 1990s.

    "Mann said that by 1995, there will be between 8 million and 10 million
    HIV infected individuals worldwide and just under 40% of those will be
    women.  By the year 2000, he predicted, 60% of those HIV infected will
    be women and children while 40% will be men.

    "Safer sex education targets commercial sex workers and pregnant women,
    not all women, he said.  Women are under represented in the highest
    levels of policy and planning around the epidemic and are still
    stigmatized as a vector to both men and their unborn children."

	- posted w/o permission from 4/25/91 _Bay Windows_

    I am crying.

A recent issue of the World Health Organization publication
    "World Health" had articles on the worldwide threat of
    AIDS to women (and the heterosexual population in general).
    
    I'll post a couple here, with apologies for the length.
    
    Richard
    
    =================================================================
The special threat to women. (AIDS) (Cover Story)
 Erben, Rosmarie
 World Health p7(3) Nov-Dec, 1990

    The special threat to women

     Men can protect themselves against the sexual transmission of HIV.
Women find it more problematic. This is the difficult issue that challenges
health promotion.

     The condom is seen at present as the only effective preventive measure
against sexual transmission of HIV. Yet, for many women -- whatever the
cultural context -- to suggest to their husband or partner that he use a
condom is seen as evidence of the woman's infidelity or is felt by the man
as defiance or insolence. This results at best in painful discussions and a
breach in the relationship, or at worst in the woman being beaten and
abandoned. In cultures where the married woman is traditionally expected to
bear many children, insisting on safer sex or refusing to engage in sexual
relations is impossible.

     These "facts of life" become even more dramatic when we look at the
statistics. Some 200,000 women are expected to become ill with AIDS in
1990-1991 -- more than the total of all those who have developed AIDS since
1980; a seroprevalence of 20 per cent in pregnant women causes infant
mortality rates to increase by 36 per cent; about three million women are
currently HIV-infected; and finally, over 100 million cases of sexually
transmitted diseases are reported each year, pointing to the enormous
potential for sexual transmission of HIV.

     With the AIDS pandemic, as with many other health problems, women have
often been viewed as "reservoirs of infection," posing a threat to men, and
also to their babies, since vertical transmission has been recognized. This
concept has denied the reality that women get infected either through
sexual contact with men who, too often, refuse to use condoms, or through
unsterile injection equipment used either in the medical environment or to
inject psycho-active drugs.
     The way we perceive ourselves and others, the way we express ourselves
with our bodies, the way we use our bodies and protect ourselves or not
from health hazards are all developed in relation to the culture in which
we live, within an overall framework of individual and collective ways of
living. The choices we are able to make vary from culture to culture, and
are dependent on the living and working conditions common to our society.

     Negative influences

     The ability of women either to protect themselves from infection or,
in case they are infected, protect others, is negatively influenced by
several factors: psychosocial, cultural, and legal barriers to women's
decision-making or independent action; the relative lack of economic
alternatives for women, and their consequent dependence on men for support;
women's role as primary caretakers of children, husbands or partners and
parents; women's generally lower literacy, limited mobility, and limited
access to information; and last but not least, cultural and moral attitudes
towards sexuality. The vulnerable position of most women when it comes to
sexual practices has to be recognised. Confronted by this situation, what
can health promotion hope to achieve?

     With the advent of AIDS, health promotion has taken on a sense of
urgency. People have suddenly realised that behaviour -- individual and
collective -- can dictate a sentence of death. In recent years, health
promotion has helped gay men in the industrialised world to effect major
changes in individual and group sexual practices. But only as we move into
the 1990s has the world started to recognise the special threat that AIDS
poses to women.

     Health promotion uses five key areas as its framework for
intervention: they refer to public policy, supportive environments,
community action, individual skills and health services. In the public
domain it goes beyond health care. It aims to combine complementary
approaches, including legislation, fiscal measures and organizational
changes leading to health and social policy that in turn foster greater
equity.

     Present approaches vary widely. In one country, for example,
HIV-infected professional blood donors (virtually all men) are not isolated
or punished. Prostitutes who test positive, on the other hand, are
quarantined and held in prison long after their legally imposed sentences.
Thirteen states in the USA have passed laws making compulsory the testing
of individuals convicted of prostitution (85 per cent of those convicted
are women). Proposals to test men have not been enacted into law.
     Not really powerless

     The need for supportive environments arises because fear and prejudice
are the primary attitudes towards women who are HIV-infected or have AIDS.
They may be denied medical assistance, rejected by their family and
friends, and forced to leave their jobs. "If women can't get support from
their families, they can get it from traditional organizations and women's
groups. Women are not really powerless. It is a question of identifying our
strength," says an organizer of the Zimbabwe Women's AIDS Support Network.
The Network gives women the confidence to fight AIDS and suggests ways of
doing so in a society where women have little control over the sexual
behaviour of their menfolk.

     The need to change social attitudes towards women who are HIV-infected
or have AIDS, and to promote a more positive environment, is high on the
list of health promotion priorities. Indeed one main objective is to
establish closer communication between those affected by the virus and that
part of society that defines itself as healthy.

     An important aspect of supportive environments is "to make the
healthier choice the easier choice" and facilitate non-risk behaviour. In
the case of AIDS, this means easy access to condoms. Programmes of free
distribution exist in some countries and are supported by WHO.

     Examples of community action, especially through effective self-help
and support groups that women have set up, can be found in many countries.
Such groups in India, the Philippines, the Republic of Korea and Thailand
have worked for better information, education and treatment of women with
HIV infection. The have campaigned to have HIV-infected women released from
detention and lobbied for the free distribution of condoms to tourists.
They have fought for the rights of people with AIDS and their families.
"EMPOWER" is a support group run by and for women working as bar hostesses
in Bangkok. Women's community action groups can play a crucial role in
pressuring governments to change laws or reorient budgets to ensure that
funds are allocated for AIDS prevention and care. Increasing the
involvement of non-governmental organizations, particularly at the
community level, is a must.

     What about the individual? The process of "enabling people to increase
control over their health" is at the heart of health promotion. Hence the
focus on providing information and enhancing life skills. Most studies
carried out in various cultural and economic contexts reflect
misconceptions and considerable confusion about HIV transmission and AIDS.
So it is important to study the knowledge, attitudes, beliefs and behaviour
of women and link the results to information and education activities. How
to reach women in certain cultural settings and how to communicate with
them are also major questions for health promotion research.

     "Safer sex" workshops are an important component of health promotion,
both by encouraging women to think creatively about sexuality and by
providing practical information. They can be run by trained female health
educators, but members of peer groups can also be trained and usually prove
extremely effective. In developing personal skills, it is vital to use the
language of the women themselves and to rely on interactive processes.

     As for the health services, the prevention and control of HIV
infection must be closely tied with existing services for women, mothers
and children. All services providing maternal and child health care, family
planning and treatment of sexually transmitted diseases must ensure that
HIV/AIDS activities are integrated in their own activities. In addition,
women must have access to safe blood supplies and safe medical injections.
In the developing world, most blood transfusions are given to women and
young children in connection with childbirth and its complications.

     On the broader level, health services need to be more sensitive to
cultural needs and client expectations. Too often, health care is given
from the perspective of the health care providers irrespective of how
appropriate this may be for the patient. What women desperately need, very
often, is more attention and support.

     Finally, health promotion cannot be achieved by the health sector
alone. It demands coordinated action by governmental and voluntary
organizations, by local authorities, industries and the media. It offers
opportunities for new, broad-based health-oriented action. In the case of
women and AIDS, it is directed against the stigmatisation and social
disadvantage experienced by those affected by the disease. It seeks to
enable women to say "No" to sex risk behaviour, and this means giving them
knowledge, social support and economic independence. In short, health
promotion calls for concrete and efficient action, tolerance, equity and
solidarity.

         COPYRIGHT World Health Organization (Switzerland) 1990

Challenge of the nineties. (heterosexual transmission of AIDS)
 Chin, James
 World Health p4(3) Nov-Dec, 1990

    Challenge of the nineties

     AIDS was first recognized as a distinct disease entity among
homosexual men in the United States in 1981. As a result, it was initally
thought of as a disease which would be essentially restricted to men. Now
it is becoming increasingly clear that HIV, the etiologic agent of AIDS, is
a human retrovirus which in adults is primarily transmitted by sexual
intercourse (vaginal or anal) or by transfusions or injections of
HIV-infected blood, such as may occur in intravenous (IV) drug use.
     Up to this year, the majority (about 75 per cent or more) of HIV
infections throughout the world have been acquired via sexual intercourse,
mostly heterosexual. Epidemiological and virological studies from
throughout the world have clearly documented the transmission of HIV via
vaginal intercourse from an infected male to a female and from an infected
female to a male. The risk of HIV transmission from a single episode of
vaginal intercourse is not known, but has been estimated to be very low (1
per 500 or 0.2 per cent), compared to other sexually transmitted disease
agents such as gonorrhoea (about 30 per cent). Nevertheless, a single
heterosexual encounter is, in some instances, sufficient for transmission
of HIV infection. There is increasing evidence too that the presence of
other sexually transmitted disease (STDs), especially those associated with
genital lesions such as syphilis and chancroid, may increase the risk of a
single exposure by 10 to 20 times.

     Another key factor involved in heterosexual transmission of HIV is the
likelihood of exposure to an infected partner. In areas where HIV
infections are low to absent, there would be virtually no risk of acquiring
an HIV infection via sexual intercourse (or by any other type of exposure).
But, the prevalence of these infections is steadily increasing in most
areas of the world and so is the risk of exposure to an infected sexual
partner. Where HIV infections are known to be prevalent, selection of
sexual partners who are not at increased risk is of paramount importance
for avoiding acquiring an HIV infection. There is obviously an increased
risk with increased numbers of different sexual partners.

     There are also gradients of risk of HIV transmission associated with
different types of sexual contact. The highest risk is from being the
receptive sexual partner, whether this is heterosexual or homosexual
intercourse. So women, who are the receptive partners in sexual
intercourse, are thought to run a higher risk of acquiring an infection
from the infected male partner than men do from an infected female partner.

     The natural history of HIV infection has essentially been studied in
homosexual men and persons with haemophilia (also all males), and is known
to cause progressive damage to the body's immune system. When sufficient
damage to the immune system occurs, the infected person is then susceptible
to a vast array of opportunistic infections and rare cancers, which are the
clinical indicators of the underlying immune deficiency due to HIV. The
average period from infection to the late clinical stage (that is, AIDS) is
about ten years.

     Whether the natural history of HIV infection in women differs to any
significant degree from that outlined for men is not known, and the
detailed studies needed to answer this question are very difficult to plan
and put into effect. In the absence of such specific data, it is reasonable
to assume that no major differences exist between men and women. Although
some early reports suggested that pregnancy might accelerate the clinical
progression of HIV infection, subsequent studies suggest that pregnancy per
se is not a major factor.

     WHO has described several broad yet distinct epidemiological patterns
of HIV infections and AIDS cases. The factors responsible for these
patterns include the probable date of HIV entry and/or the period when HIV
began to spread extensively in the population; and the relative frequency
of the three modes of HIV transmission - sexual, parenteral (by injection)
and perinatal.

     In Pattern I, the primary population groups affected have been
homosexual men and IV-drug users; the extensive spread of HIV began between
the late 1970s and the early 1980s. Heterosexual spread of HIV also occurs
and has been increasing, but still accounts for only a minority of new
infections. This is the pattern currently seen in the countries of North
America, Western Europe, and Oceania.

     In Pattern II, HIV/AIDS is found predominantly among sexually active
heterosexuals; extensive spread of HIV probably began in the mid-to-late
1970s. This is the current pattern in sub-Saharan Africa and some parts of
the Caribbean.

     Areas currently classified as Pattern III include Asia, most Pacific
countries (excluding Australia and New Zealand), Eastern Europe, North
Africa, and the Middle East. In these areas, HIV was introduced in the
early-to-mid 1980s. Although indigenous spread of HIV has been documented
in most of these countries, the prevalence of both AIDS cases and HIV
infections was low at the end of the 1980s, and no clearly predominant mode
of HIv transmission has been documented in most countries. This situation
has changed markedly in some South-East Asian countries such as Thailand
and India, and as of mid-1990 there are an estimated 200,000 HIV-infected
women in Asia.

     Vulnerable groups

     In many Pattern I countries, HIV infection has, during the late 1980s,
been increasing in the most socially and economically vulnerable segments
of society. This is particularly true in the United States, where blacks
and hispanics in the inner city areas have become increasingly and
disproportionately affected, mainly due to the large numbers of intravenous
drug users (IVDUs) in these populations. So we may expect an increase in
the number of HIV-infected women as a result of sharing infected drug
injection equipment and as a result of heterosexual transmission from
HIV-infected male IVDUs to their sexual partners.

     Many Latin American countries (Central and South America) were
initially classified as belonging to Pattern I. But by the mid-to-late
1980s, sexual transmission among heterosexual s had increased to such an
extent that Latin America has been reclassified as a separate pattern -
Pattern I/II.

     In Pattern II areas, transmission continues to remain predominantly
heterosexual. The prevalence of HIV infection continues to rise in urban
areas and, increasingly, its spread to rural areas (where the majority of
the population lives) is being noted.

     In a few Pattern III countries previously only slightly affected
during most of the 1980s, extensive spread of HIV infection has been noted
among IVDUs and prostitutes during the late 1980s. Thailand has documented
extensive spread of HIV infection in Bangkok among IVDUs (mostly, but not
all, males) since early 1988, and HIV prevalence estimates have risen from
about one per cent in late 1987 to about 50 per cent up to early 1990. In
addition, focal increases of HIV prevalence ranging from ten per cent up to
70 per cent have been found during the last couple of years among female
prostitutes in several cities in Thailand and India.

     WHO estimates that to date a total of eight to ten million adults have
been infected with HIV. Based on the lower range of this estimate and on
reported male-to-female ratios of AIDS cases or of HIV serological data,
the numbers of HIV-infected females age 15 to 49 years were estimated for
al global regions. Of the global total of eight million infections, over a
third or three million are women, most of whom are of childbearing age. The
majority of infected women (more than 2.5 million) are in sub-Saharan
Africa. HIV prevalence ranges from a high of about one infection for every
40 women to a low of less than one infection for every 20,000 women in some
Pattern III areas such as Eastern Europe.

     Up to the present in most of the industrialised countries, the primary
population groups affected by the HIV/AIDS pandemic continue to be
homosexual or bisexual men and IV drug users (men and women). During the
1990s, transmission of HIV in homosexual and IVDU populations can be
expected to continue but, in general, not at the very high rates documented
during the 1980s. Heterosexual transmission of HIV is, up to 1990, the
predominant mode of HIV transmission worldwide, mainly because of the large
numbers of HIV-infected persons in sub-Saharan African countries.

     Heterosexual transmission

     Over the next several decades, heterosexual transmission will
increasingly become the predominant mode of HIV transmission in most
industrialised countries. However, the rate of increase of heterosexually
transmitted HIV infections in these countries will be low compated to the
very large increases observed among homosexual men and IVDUs during the
first half of the 1980s. Nevertheless, since the pool of heterosexuals who
may have multiple sexual partners is very large compared to homosexual men
and IVDUs, the number of heterosexually acquired HIV infections expected
during the 1990s will be greater than the total number of HIV infections
acquired through all routes of transmission during the 1980s. Worldwide, by
the year 2000 the annual number of AIDS cases in women will begin to equal
the number in men. It follows that HIV/AIDS prevention and control
programmes will need to develop appropriate education and other public
health measures to respond specifically to the growing problem of this
disease in women.

         COPYRIGHT World Health Organization (Switzerland) 1990

=================================================================== 
Women and AIDS: a challenge for humanity.
 Petros-Barvazian, Angele; Merson, Michael H.
 World Health p2(1) Nov-Dec, 1990

    Women and AIDS: a challenge for humanity

     Worldwide, WHO estimates that over eight million adults are now
infected with the human immunodeficiency virus (HIV), and that a little
over one-third -- three million -- are women. It is expected that 500,000
people will develop AIDS during the years 1990-1991, including about
200,000 women. By the end of 1992, a cumulative total of over 600,000 cases
of AIDS will have occurred among women. By the year 2000 the annual number
of AIDS cases in women will begin to equal that in men.

     High rates of HIV infection in pregnant women, such as are encountered
in sub-Saharan Africa and in some countries in the Caribbean, with
implications for perinatal infection and elevated infant mortality, could
in many countries have a devastating impact on the fabric of society.
Indeed, it is estimated that, during the 1990s, AIDS will kill 1.5 to three
million women of reproductive age in Central and East Africa, producing
several million orphans. In industrialised countries, the present rate of
HIV infection in women is still low, but it is increasing, especially in
urban populations with high rates of other sexually transmitted diseases
and intravenous drug use.

     However, the impact of AIDS on women is not just a matter of numbers.
AIDS affects women not only as individuals who are HIV-infected but also in
their multiple roles in society and the family, as health care providers,
educators, wives, mothers and income providers. The status of women within
the family and society makes them particularly susceptible to HIV
infection, a "social vulnerability" related to their generally low status.
The subordinate role of women in society might vary in degree in different
countries but its impact is similar everywhere. This includes the lack of
equal access or opportunity for education, information and services in
health, income, social rights, and so on. These undoubtedly affect their
access, for example, to information on how to protect themselves from HIV
infection. The stigma attached to AIDS can subject women to discrimination,
social rejection and other violations of their rights. In November 1989,
for the first time, an International Conference on the Implications of AIDS
for Mothers and Children was convened in Paris by the French government and
WHO, to discuss the policy consequences of HIV infection for these
important groups of people. It was attended by ministers of health or their
representatives and by scientists from all over the world. At the end of
the meeting, the participants in the conference, recognising that the AIDS
pandemic -- closely associated with problems of drug abuse -- has a
particularly adverse effect on women, children and families, issued the
Paris Declaration on Women, Children and AIDS, which appears in the centre
pages of this issue of World Health.

     An integrated approach

     In May 1990, the 43rd World Health Assembly also adopted a resolution
on women, children and AIDS -- to which the Paris Declaration was attached
-- emphasising the importance both of an integrated approach to the health
of women and of the determining role of women in development. This
resolution asked the 166 Member States of WHO to ensure that programmes for
the control of HIV infection and AIDS would be integrated with other
programmes for women, children and families.

     The low priority given to the health of women, particularly in
deprived societies, has been forcefully articulated in recent years in the
neglected example of maternal mortality -- the tragedy of large numbers of
women dying as a result of pregnancy and childbearing with no access to
adequate health and family planning care. Complications of pregnancy and
childbirth account for many deaths among women of reproductive age in the
developing world. In certain developing countries, each time a woman
becomes pregnant she runs a 200 times greater risk of dying than if she
lived in a developed country. Failure to time and space and limit the
number of pregnancies augments the risk of complications and death. Most
maternal deaths need not happen.

     The impact of HIV-related diseases among women will, if no action is
taken, inevitably worsen the situation everywhere, particularly in the
poorer communities. Mortality in young women from AIDS in some urban
communities is overtaking mortality from cardiovascular disease and cancer.

     The challenge, for all concerned, is therefore to meet the priority
health needs of women, with the participation of women themselves, as well
as women's organizations. This means assuring appropriate care during
pregnancy and childbirth, education on prevention of sexually transmitted
diseases and HIV infection, and advice on appropriate nutrition.
HIV-infected women should have access to health services, including family
planning, counselling and psychosocial support, so that they can personally
make informed decisions about their reproductive health and childbearing.
It is also important to ensure that HIV-infected women, as well as men and
children, are not discriminated against and receive compassionate care.

     As women will have to take upon themselves a large proportion of
caring for HIV-infected persons and people with AIDS, as well as for
orphaned children, and to carry much of the socio-economic consequences of
the AIDS pandemic, it is imperative that they be provided with information,
skills, knowledge and resources in order for their role as providers of
care to be less taxing, more humane and more effective.

         COPYRIGHT World Health Organization (Switzerland) 1990

    Coincidentally, I heard a report on "All Things Considered"
    last night on this very topic, probably based on this
    article.  --Richard
    ===================================================================
    
    
"AIDS:  the  growing  threat  to Black heterosexuals; no longer a disease of
     White,  gay males, AIDS is No. 1 killer of Black women under age 44 in
     New York and New Jersey."
    
 Brown, Roxanne
 EBONY  v46 p84(4) Jan, 1991

    "AIDS: The Growing Threat To Black Heterosexuals"

     When Janice got married to Jimmy Jirau in 1985, she hoped with all her
heart that her life was taking a turn for the better. Unfortunately, that
was not the case. Just days after her wedding, she met the real Jimmy--an
abusive alcoholic. And that was only the beginning.

     Less than three years later, Janice learned that her husband had
acquired immune deficiency syndrome (AIDS). Her worst suspicions were
confirmed when she found out he had contracted the virus as a result of an
intravenous (IV) drug habit that he had kept hidden from her. For some
partners, this clearly would have been the end of the line when it came to
spousal duty, but not for Janice. She didn't pack her bags and walk. She
didn't throw him out. Instead, she quietly went about the business of
taking care of her man until his death in May of 1989.

     She had cared for her husband at home for three months before finally
giving in to pleas from health professionals and family members to get
tested herself. Janice tested positive for antibodies to the human
immuno-deficiency virus (HIV), making her one of 30,000 U.S. women with HIV
infection or AIDS. For Black women the toll is worse: In New York and New
Jersey, AIDS is already the No. 1 killer of Black women between the ages of
15 and 44.

     The Numbers

     Once thought to be a plague of White, gay males, AIDS is now labeled
"an equal opportunity disease," and it is taking a devastating toll on many
ethnic minority communities. As with all health problems, the Black
community is afflicted in disproportionate numbers. September 1990 figures
from the U.S. Center for Disease Control (CDC) reveal that of 152,126
people who have been diagnosed with AIDS, 42,761 are Black. The U.S. Public
Health Service estimates that one million Americans are infected with the
AIDS virus, of which a large percentage are undiagnosed. It projects that
by the end of 1993, the total number of diagnosed cases will be between
390,000 and 490,000, with the number of deaths from AIDS between 285,000
and 340,000.

     While the rate of infection among White, gay males is declining, the
percentage of newly diagnosed cases among Blacks continues to rise,
particularly among women. Between 1980 and 1988, the AIDS death rate for
Black women rose from 4.4 to 10.3 per 100,000, making it nine times more
likely that a Black woman will die from AIDS than a White woman. If current
mortality rates continue in 1991, AIDS mortality rates continue in 1991,
AIDS leading causes of death among women of reproductive age.

     The Reasons

     The obvious question in the wake of such brutal statistics is why? Why
is AIDS wreaking destruction of lives in the Black community? Reasons are
multilayered and complex.
     AIDS is frequently referred to as a "behaviorally transmitted disease"
because certain behavior patterns sharply increase the risk of contracting
the virus. Risky behaviors are prevalent among the majority of those who
are infected. While the spread of AIDS among Black gay or bisexual males is
the result of risky sexual practices, most Black women who are HIV positive
or have AIDS are either IV drug users or sex partners of IV drug users. The
latter group is comprised of scores of women who, like Janice Jirau, are at
high risk of being infected and are not even aware of it.

     An articulate, bright 40-year-old, Janice had been fending for herself
long before she met Jimmy. With more than three years of college under her
belt, she reared three sons while working a series of government jobs in
Washington, D.C.

     Janice had known Jimmy only three months before they married.
Initially, she found him to be attentive, charming and dominant. "I was so
desperate for love; I just wanted a void filled," recalls Janice. Though
she soon suspected her husband was abusing more than just alcohol, thoughts
of him shooting drugs, sharing needles, or being at high risk of
contracting AIDS never entered her mind. She was too busy trying to "fix"
what was ailing their relationship.
     Even after Janice learned that her husband had AIDS, her focus was on
caring for him. She continued to have unprotected sex with him. "He
wouldn't use a condom; he was suffering and wounded, and all I could think
about was him," she says. "I submitted, thinking, `I'm his wife; whatever
comes I'm supposed to take it.'"

     After more than 20 months of psychotherapy, Janice now knows that it
was low self-esteem that attracted her to Jimmy in the first place, and,
subsequently, placed her at high risk for HIV infection. She traces her
anguish to a traumatic childhood that included sexual abuse and attempted
suicide.

     Today, sitting in her cheerfully decorated apartment in a Maryland
suburb, Janice is the picture of optimism and well-being. Though she is HIV
positive, which means the virus is present, Janice has remained virtually
asymptomatic. (When a person has AIDS, the immune system has been
destroyed.) She spends her days as an AIDS activist, encouraging community
groups and families to offer more support to AIDS victims, and warning
other women of the dangers of failing to protect themselves against
sexually transmitted diseases (STDs).

     Barriers To Control
     Whether they are homosexuals, or emotionally fragile individuals like
Janice, almost all Blacks who contract AIDS or HIV are already victims of
the health-care system, according to Black health practitioners. "We were
just beginning to address the issue of what to do to make a well community,
and then along comes HIV, and all gains are wiped out," says Iris Lee,
director of the District of Columbia Office of AIDS Activity.

     Can this epidemic be controlled? If so, raising awareness and changing
behavior are key. In addition, medical experts agree that more
comprehensive health provisions must be available in the Black community.

     Oftentimes, women feel the need to practice safe sex, but are not
prepared to deal with reprisals from male partners who don't wish to use
condoms. As part of its education outreach campaign to promote safe sex,
the D.C. Office of AIDS Activity developed a successful radio show to help
women become more assertive when it comes to protecting themselves against
AIDS. "We broadcast a skit where the woman was negotiating with her man on
how to introduce the condom into their relationship," explains Lee.

     The responsibility of safe sex should not rest with the female,
according to Philadelphian Rashida Hassan, executive director of Blacks
Educating Blacks About Sexual Health Issues (BEBASHI). "The issue of
condoms is falling on the women, yet they don't have penises," she says.
"Education of our male population on sexual behavior and responsibility is
significantly lacking."

     One major barrier to fighting the insidious spread of AIDS in the
Black community is the unwavering taboo of homosexuality. Increasing
awareness as to ways that AIDS can be prevented is essential to changing
behavior that causes it to spread, yet the stigma attached to homosexuality
stands in the way. George Bellinger Jr., education coordinator of the
Minority Task Force on AIDS in New York City, says: "The double life
syndrome of Black gays is widespread because Black gays are more connected
to the Black community than the gay community. They help their families and
stay close to their families; they don't want to destroy family ties."

     Denial and moral judgment can be so strong among family members and
friends that gay men will often marry and continue to have sex with men.
These secretive sex lives contribute to the unknowing spread of AIDS that
ultimately affects women and children. "Eighty percent of children born
with AIDS or HIV infection are children of color whose mothers do not even
realize they are infected until the child has some identifiable symptom,"
says Hassan of BEBASHI. "There is focus on IV drug users or women who have
sex with them, but the part that is not being focused on is the bisexual
male who has sex with men and women and doesn't inform either group that he
has sex with the other."

     Most At Risk

     IV drug users, the hardest group to educate about AIDS and one that is
less likely to receive any kind of treatment once diagnosed, also happens
to be the group most at risk among the Black heterosexual population. AIDS
activists say this is the group that must be educated within the framework
of their troubled lives. "We are learning that one of the ways to target
the heterosexual population is to do it in the context of reaching people
about a drug problem or other STDs," says Vickie Mays, a professor of
psychology at the University of California, Los Angeles, and director of
the L.A. Black CARE Project.

     Encountering professional guidance may have made a difference for
Kathleen McPherson, who began shooting up heroin at 16. The 35-year-old
mother of two has been off drugs for more than a year now, partly because
she has been battling with AIDS.

     Her story is not atypical. Reared by an elderly, infirm grandmother,
Kathleen found herself pregnant at 15 and married a year later. Her
husband, an IV drug user who died of AIDS and double pneumonia three years
ago, introduced her to heroin. "When he shot dope, he wanted to fight.
Joining him was my way of getting along with him," recounts Kathleen.
"Little did I know it would be hell to pay later on down the road. If I had
had somebody to whisper a few words, I would have taken off in the other
direction as fast as I could."

     Though Kathleen did take off--leaving her husband a year-and-a-half
later--it was not so easy to leave behind her drug habit. She shoplifted
and had sex with drug dealers to support her habit. She also shared needles
and shot up under unsanitary conditions.

     In January of 1989, Kathleen was hospitalized with a severe muscle
infection in her lower back. She was hospitalized for four months, and
finally mustered the courage to get tested for AIDS. She had made a
connection between AIDS and IV drug use after reading her estranged
husband's death certificate. Prior to that, she says she didn't pay much
attention to AIDS and didn't think she could have it.

     While Kathleen's addiction accounts, in part, for her oblivion to the
threat of AIDS, Black youth have yet to learn that AIDS can affect them. A
study of sexually active Black college students reveals that 48 percent use
condoms "only rarely," 30 percent have done nothing to reduce their chances
of contracting a STD, and a majority view AIDS as a disease that Blacks are
significantly less likely to get than Whites.

     The Minority Task Force on AIDS in New York reaches about 10,000
people annually as part of its AIDS awareness program, one-fifth of whom
are 21 years and younger. "The first thing we do is destroy the myth that
they are immortal and that AIDS does not affect their lives," says George
Bellinger, in reference to the younger generation. "A 16-year-old and his
16-year-old girlfriend don't know anybody who has AIDS, but if I tell them
that the incubation period is 10 or 12 years, and at 28 it could hit them,
well, that scares them."

     Awareness And Education

     AIDS awareness and education in the Black community has come a ways
since 1981 when health officials first began to address the threat of the
virus.

     In the early '80s, AIDS education campaigns did not effectively reach
Blacks and other ethnic groups because the messages were developed by
people who lived outside the communities they were attempting to reach. "It
was a case of White people talking to Black people, using words and
language that weren't culturally appropriate, and it had no impact,"
recalls Dr. Wayne Greaves, chief of the Howard University Hospital
Infectious Diseases office.

     Today, Black churches, many of which were reluctant to do so early on,
have accepted their role in educating the community about AIDS. Some
churches offer information during Sunday services or insert AIDS
information in the weekly bulletins, while others have AIDS outreach
ministries and support services for PWAs. The important fact is that AIDS
is out of the closet in the oldest of Black community organizations. "As
the permission-granting body in the community, it is the church that tells
the community that it is okay to learn this information," explains
BEBASHI's Hassan.

     An increase in financial resources has also helped spread awareness of
AIDS among Blacks. But government funds were unavailable before 1988.
According to Dr. Greaves, who spearheaded the CDC-funded National AIDS
Minority Information and Education Program at Black medical schools, more
financing is needed so that Black medical professionals can deliver
services and support needed to treat Blacks. "We've only touched a tip of
the iceberg in working with Black medical schools," says Greaves. "Every
historically Black academic institution should have at least one [AIDS]
research and education project on that campus."

     The push is on to find a vaccine for AIDS, as well as drugs that make
it easier to live with the virus. A drug commonly referred to as AZT,
approved by the Federal Drug Administration in 1986, has proved effective
at thwarting the breakdown of the body's defense system.

     Generally administered in doses of 500 milligrams per day, AZT is not
without side effects, including headaches, fever and nausea. There is
concern that the effects of AZT and other AIDS drugs have not been
sufficiently tested on Blacks, who generally react differently to
medications than Whites, the group tested more often.

     According to Dr. Fred Daniels, a Chicago internist who has treated
about a dozen AIDS patients, this concern is secondary. "Our greater
concern is will we have these drugs available to us," he says. "They are
extremely expensive and many Blacks will not be able to afford them." The
average cost of a month's supply of AZT is $300, a prohibitive price for
poor Blacks hit by the virus.

     Dr. Daniels urges those with specific AIDS questions to contact the
Public Health Services AIDS Hotline, 1 (800) 342-AIDS.

     With AIDS being a chronic disease in our community, additional funds
for research and services will ease some of the pain. But it will take more
than money. People with HIV live longer based on the services they receive
and the attitudes of those persons with whom they come into contact. The
problem calls for a continued commitment from all--government, religious,
community, health and medical organizations. And we cannot overlook the
important commitment from each individual. Says Iris Lee of the Office of
AIDS Activity in D.C.: "When it comes to safe sex, we must each practice
the message that we bring, and make certain these messages are practiced in
our families. This is no time for hit and miss behaviors."


         COPYRIGHT Johnson Publishing Company Inc. 1991

    What follows is from the latest (March 1991) extract from the CDC's  
    "HIV/AIDS Surveillance Report."  Since it prints out to some 28 pages, 
    I'll just post some statistics from it...

    In the U.S, 6 cases of AIDS were diagnosed in children under 13 before 
    1981,and one died. In adolescents and adults, the pre-1981 numbers are
    77 cases and 30 deaths.  By the time former Surgeon General Koop issued 
    his statement on AIDS in 1985, 454 children had been diagnosed with AIDS 
    and 212 of them had died.  

    January-June of 1989 saw the most new cases of diagnosed AIDS of the
    six-month periods recorded with 18,046 new cases.  July-December 1989 
    has seen the most deaths in a six-month period, with 13,156.  So far in
    the January-March 1991 timeframe, the CDC reports 3,047 new diagnoses
    of AIDS and 2,116 deaths.

    As of March 1991, the total number of females with AIDS is 18,181 - or 
    11% of the total of 171,876 to date.  IV drug use accounts for about
    half of the female cases of AIDS; heterosexual sex accounts for about
    one-third.

    To date, 107,210 adults/adolescents and 1,521 children under 13 have
    died.  Most females are diagnosed between the ages of 25 and 39; most
    males between 25 and 44.

    The rate of increase in AIDS diagnoses is greatest in the states of:  
    D.C., New York, Florida and New Jersey.  If you count Puerto Rico, it'd 
    be #1 in the fastest-growing percentage category.  The states with the 
    most numbers of AIDS cases are: New York (36,549), California (32,547), 
    Florida (15,277), Texas (12,047) and New Jersey (10,955).

    The CDC report also lists cities (metropolitan areas with 500,000 or
    more population) with their reported number of diagnoses of AIDS:  

	New York (31,635), LA (11,409), SF (9,943), Houston (5,086), DC 
	(4,886), Miami (4,633), Newark (4,571), Chicago (4,236), Philadelphia 
	(3,597), Atlanta (3,526), San Juan, PR (3,414) in the over-3,000 
	category.  

	Baltimore, Boston, Dallas, Fort	Lauderdale,Oakland and San Diego 
	have 2,000-3,000 reported cases.  

	Cities having 1,000-2,000 case of AIDS are: Anaheim, Bergen-Passaic 
	NJ, Denver, Detroit, Jersey City NJ, Kansas City MO, Nassau-Suffolk 
	NY, New Orleans, Riverside-San Bernadino CA, Seattle, Tampa-St. 
	Petersburg, and West Palm Beach FL.  

	The cities with the least cases of AIDS (under 200) are: Akron OH,
	Allentown PA, Bakersfield CA, El Paso TX, Gary IN, Grand Rapids MI,
   	Greenville SC, Harrisburg PA, Knoxville TN, Lake County IL (*the*
    	lowest, at 82), New Bedford MA, Omaha NE, Oxnard-Ventura CA,
	Scranton PA, Syracuse NY, Toledo OH, Tucson AZ and Worcester MA.
   

re: .39

Aside -- these are *reported* cases, right?  I always wonder about those
"fewest cases" cities -- are they places where people feel least comfortable
reporting, and their obituaries say they died of pneumonia?

Until the disease does not have a stigma from those who feel compelled
to judge the person who got it, we'll never know the real numbers, I'm 
afraid.

(Not to mention the problem with even diagnosing AIDS.  All those women
who couldn't get diagnosed as having AIDS and therefore couldn't get
medication for it, because the women's symptoms weren't the same as the
men's.)

	MKV

    re .40  Mary,
    
    Yup - you're absolutely right...Those are the *reported* cases which
    fit the CDC's criteria of AIDS-related illnesses.  Since most women get
    some form of gynecological cancer instead of the KS that many men get,
    they're not considered "diagnosed" with AIDS unless they have PCP or
    another CDC-recognized manifestation of AIDS.
    
    The stigma and fear of discrimination is what prevents many people from
    getting tested for HIV antibodies in the first place. The anonymous 
    testing sites are mainly located in metropolitan areas, and some state
    (Colorado for one, I believe) records all positive tests and makes an
    effort to contact all known sexual contacts.  This is also a major
    inhibitor to getting tested.
    
    It is commonly believed that most of the 1 million or so HIV+ people in
    this country are unaware of their HIV status.
    
    deb
    

[borrowed w/o permission from the usenet]

A few items from a New York Times report on a Congressional hearing
about women with AIDS on 6/6/91:

Rep. Ted Weiss (D-NY) said that about 40% of those who are known to
be HIV-positive in New York City are women.

The Social Security Administration has not changed its definition of AIDS 
to include many disabling symptoms that affect only women, despite a 
recommendation in March to broaden the definition to include such 
symptoms as cervical cancer, candidiasis and pelvic inflammatory disease.

One witness noted that if a poor person is HIV-positive and has a single 
KS lesion, the SSA automatically begins paying disability benefits when 
applied for.  But if a woman is HIV-positive and has had bouts of 
bacterial pneumonia, the beginnings of cervical cancer, pelvic 
inflammatory disease and a severely depleted immune system, she does not 
automatically qualify.

Women, on average, die of AIDS in half the time of men with the disease.

This is copied without permission from For The People.  Interesting reading, 
to say the least!  I am in no way connected with the Strecker foundation 
and I receive no compensation or benefit in any form from them.  
That said, I don't find this article too difficult to swallow after having 
seen some of our beloved AMA's glorious handiwork.  :-(

Moderators, if this is placed inappropriately, move it.


			IS AIDS MAN-MADE?

	Strecker Memorandum claims AIDS was created and deployed by 
		scientists; with an on-going cover-up

	(Editors Note:  Dr. Strecker's research has bee both supported and 
	 disputed by noted "mainstream" experts.  Therefore, For The People, 
	 does not take a position on the AIDS issue.  The following is 
	 strictly Dr. Strecker's opinion.)

	INFORMATION WRITTEN AND PROVIDED BY THE STRECKER GROUP

	We have a story to tell you, a very strange story, one that affects 
you, me, and every other human being on earth.  A story that must be taken 
seriously by the governments of every nation in the world because there may 
not be many humans left to govern by the turn of the century, or shortly 
thereafter.  A story so bizarre, and so sinister that, if it were not the 
the fact that it is all true, it would make a great science fiction thriller.
(Interestingly enough, Lorimar Pictures of Hollywood has purchased the 
rights to Dr. Strecker's life story.)
	The story begins in 1983 with Dr. Robert B. Strecker, M.D. Ph.D.  
Dr. Strecker practices internal medicine and gastroenterlolgy in Los 
Angeles.  He is a trained pathologist and also holds and also holds a Ph.D. 
in pharmacology.  Dr. Strecker and his brother Ted, an attorney, were 
preparing a proposal for a health maintenance organization (HMO) for 
Security Pacific Bank of California.  They needed to know the long-term 
financial effects of insuring and treating AIDS patients.  In as much as 
this information was not readily available in 1983, both brothers began 
researching the medical literature to learn what they could about this 
relatively new disease.  The information they uncovered right from the 
beginning was so startling to them, so hard to believe, that it would 
dramatically alter both their lives and lead them on a five-year quest 
culminating with the creation of "the Strecker Memorandum," the most 
controversial videotape of our time, and a remarkable set or documents 
called "The Bio-attack Alert."

[] What they discovered
	Right there in the medical literature for anyone to read for 
themselves was, basically, proof that the AIDS virus and pandemic was 
actually PREDICTED years ago by a world-famos virologist, among others.  
They found that top scientists writing in the "Bulletin" of the World 
Health Organization (WHO) were actually _requesting_ that AIDS-like viruses 
be created to study the effects on humans. In fact, the Strecker's unearthed 
thousands of documents all supporting the man-made origin of AIDS.  
Meanwhile, the government was telling everyone that a green monkey in 
Africa bit some native and started AIDS.  As their research continued, it 
became obvious from the documentation that the virus itself was not only 
created as requested, but actually _deployed_, and now threatens the 
existence of mankind because it does what it was designed to do:  cause 
cancer in humans via contagious virus.  Eventually the Strecker's came to 
realize everything the government, the so-called AIDS experts and media 
were telling the public was not only misleading, but out and out lies.

		The truth of the matter is:

		o AIDS is a man-made disease

		o AIDS is not a homosexual disease

		o AIDS is not a venereal disease

		o AIDS can be carried by mosquitoes

		o Condoms will not prevent AIDS 

		o There are at least six different 
		  AIDS viruses loose in the world

		o There will never be a vaccine cure

	And on and on, but...

[] The Scariest Part
	The most dreaded fear that all oncologists (cancer doctors), 
virologists, and immunologists live with is that some day _cancer_, in one 
form or another, will become a contagious disease, transferable from one 
person to another.  AIDS has now made that fear a reality.  If you think 
you are safe because you are not gay or promiscuous, or because you are not 
sexually active, then you must watch "The Strecker Memorandum" very 
carefully.

[] Safe Sex?
	The most common misconception being foisted upon us right now 
concerns sexually active Americans.  We are told that if a man uses a condom 
the transference on the deadly virus is virtually eliminated.  Nothing 
could be further from the truth.  Of the body fluids that the AIDS virus is 
found in, semen contains the least.  As a matter fact, in every single 
study ever published on the subject, no one has found a significant amount 
in anyone's semen.  It just isn't there in huge numbers.  There is usually 
only about one virus per milliliter, a statistically irrelevant amount.  
One copious ejaculation might produce only one or two viruses.  This is 
substantiated in the medical literature.  But, just for argument's sake, 
let's say all the medical studies are wrong.  Let's pretend that there are 
countless millions of AIDS viruses in the ejaculation.  Are you aware that 
condoms are riddled with microscopic or larger holes?  Studies show that 
even the smallest holes found in condoms are two to ten times larger than 
the AIDS virus.  It's like shooting a golf ball through a basketball hoop.
Condoms have not, will not, and cannot prevent AIDS.

[] Thousands Already Dead
	Over one hundred thousand Americans have already died because they 
didn't know the truth about AIDS.  Between twelve and fifteen million 
Americans are already infected.  One in 60 babies in New York City is 
infected; one in 300 college students in America is infected; one in 20 
aliens applying for amnesty is infected, including men, women and children. 
These are just some of the facts you are not likely to hear about from the 
media.

[] Why a Videotape?
	One of the first things the Strecker's did was to try and tell their 
medical and legal colleagues what they were finding in the literature.  
Some were interested; most were not.  Certainly no one was prepared to risk 
their professional standing by making waves within the establishment.  Ted 
Strecker compiled some of the most damaging documents into a report called 
"The Bio-alert Attack" and sent it to every governor in every state, the 
President, the Vice-President (now President), the FBI, the CIA, the NSA, 
and selected members of Congress.  He got a grand total of three replies 
from three governors; nothing from the government.  Both he and Dr. Strecker 
were laughed at and ridiculed at every turn.  As an example, Dr. Strecker 
told the government in 1985 that virtually every person tested positive for 
AIDS would die prematurely and painfully.  The government said that was 
nonsense.  Their figures showed that maybe ten percent at most would die 
from the disease.  In 1986, the government said maybe 50 percent of those 
infected would die, in 1987 they said maybe 75 percent, in 188 they finally 
agreed with Dr. Strecker that AIDS is virtually 100 percent fatal.  We 
could go on with facts Dr. Strecker unearthed that the "experts" said were 
wrong and now accepted as the truth.  Dr. Strecker, like a good scientist, 
submitted paper after paper with his findings to all the prestigious 
medical journals in America.  They were refused.  He then tried having his 
findings published in Europe.  Again, closed doors.  What to do?  Dr. Strecker 
did not feel he could take the time from his practice and his research to 
to write a book.  On the other hand, everyone has a TV and now most 
households have a video cassette recorder (VCR).  The time involved to make 
a video is nothing compared to writing a book, and so the video "The 
Strecker Memorandum" was created.  It is 96 minutes of the most startling, 
controversial, and information packed video you will ever see.  It disputes 
virtually everything the American public is being told by the government, 
the so-called AIDS experts and the media.  In fact, after seeing it YOU 
will know more about AIDS than 99 percent of all doctors in America.

[] Music is Nothing if the Audience is Deaf
	With the video made, it seemed a simple matter to advertise it and 
the world would now become aware of what it was facing, right?  WRONG!  The 
fact that you are even reading about "The Strecker Memorandum" now is a 
minor miracle by itself, in as much as TV stations have refused to 
advertise it.  TV and radio time brokers that sell blocks of commercial 
time have refused to sell us time.  TV station managers have refused to 
even air programs containing interviews with Dr. Strecker.  A national 
radio network did an interview with a famous talk show host and Dr. 
Strecker and then refused to run it.  Virtually every big name network 
television magazine show and all the syndicated TV interviewers and talk 
show hosts have said NO to Dr. Strecker.  Big city newspapers will not take 
any print ads telling about it, and so it goes...WHY?  What is in "The 
Strecker Memorandum" that sends a cold chill down the spine of most media 
executives?

[] Why is Everyone Afraid of "The Strecker Memorandum?"
	The excuse that we hear over and over is that it is too 
controversial.  TOO CONTROVERSIAL?  They say that this information, if 
widely disseminated, will cause the public to panic.  If someone had 
poisoned your water supply and you and your family could die, wouldn't you 
want to know about it?  Would you panic?  Or would you more likely be 
outraged and try to find out who did it and punish them?  We feel the only 
persons who might panic are those scientists who willingly or otherwise 
created AIDS and are now promoting misinformation by covering it up.  After 
all, if you made AIDS would you tell anyone about it?

[] Think of your Family and Friends...Think of Them Dead
	It may take a while before he words "species threatening" sink in, 
because the term has rarely been used before to describe an existing human 
condition.  But once you realize the implications of that term, and realize 
that, unlike any other kind of disease ever known to man, past or present, 
AIDS can, if unchecked, kill every human on earth, then you outlook and 
attitude regarding everything in life must change.  Whether you like it or 
not, and despite all you precautions, the time will come when you will test 
positive for AIDS, and it can happen much quicker than you realize.

[] It's Out There
	The number of AIDS-infected people is doubling approximately every 
12 months, and in some areas even sooner.  With ten to fifteen million 
Americans carrying the virus, you don't have to be a rocket scientist to 
see how long we have here in the U.S.  Africa has, conservatively, 75 
million infected; some estimates double that.  Brazil as a country is in 
serious jeopardy because all through the 1970's they were buying their blood 
supply from Africa.  On top of that, the World Health Organization 
conducted a large smallpox vaccination program there in the 1970's (for the 
full implications of that see "The Strecker Memorandum").  Southern Japan 
has about 30 percent infected with HTLV I, the lukemia-causing virus 
(although you will never hear about that on TV).  Russia is now reporting 
AIDS as a problem and no one can enter Russia permanently without a current 
negative blood test for AIDS.  Cuba has already stet up concentration camps 
for the AIDS-infected and they are full (you won't see that on TV either).  
Haiti of course is ravaged by AIDS;  more than 20 percent of the people 
infected and getting worse every day.  And so it goes.  Virtually every 
nation on earth with few exceptions (Iran is one) is reporting a growing 
problem.  It's on every continent, every sub-continent, and every island 
chain, Atlantic and Pacific.
	So why won't the media or government tell you these things?  Is it 
too controversial for you to handle?  Are you going to panic?

[] Is There Any Hope?
	Yes and no.  NO, if you are waiting for the government to create a 
magic bullet.  As you will see in "The Strecker Memorandum," part of the 
problem is that all the various AIDS viruses are "recombinant retro-viruses." 
 Very simply, that means they have the ability to recombine with the genes 
of any cell they enter and the offsprings or new viruses they form are 
different from the parent viruses.  HTLV III alone (that's the most common 
American AIDS virus) has the mathematical ability to change itself 9,000 x 
9,000 x 9,000 x 9,000 times (which is 9,000 to the fourth power).  The 
common cold recombines much less frequently and we haven't found a cure for 
it after a hundred years.  Besides, does it make much sense to entrust the 
cure for AIDS to the same people that may have created it?
	YES, there is hope if Dr. Strecker and a growing number of 
realistic scientists are correct in looking at alternative, non-allopathic, 
non-drug modalities based on Raman spectroscopy.  In fact many experiments 
are going on now that offer great promise.  Unfortunately, our government 
takes a dim view of any type of treatment for any type of disease -- let 
alone AIDS -- that does not conform to its rigid rules for acceptance, 
registration, and legalization.  Of course the FDA would definitely like to 
see an allopathic drug treatment or cure presented by an ethical drug 
company or university.  Well, we don't think that's going to happen.  
Because of this attitude, much experimentation in America must go 
underground, underfunded, or out of the country entirely.  Again, this is 
explained further in "The Strecker Memorandum."

[] Mighty Forces Will Come to your AID, Or Mighty Forces 
   will Come and Kill You
	An ominous personal aspect of this story has been the sudden and 
unexpected deaths of two of the key players.  First, Dr. Strecker's brother, 
Ted Strecker, was found shot to death in his home in Springfield, Missouri, 
an apparent suicide, on August 11, 1988.  Was Ted Strecker suicidal?  
Perhaps.  In the past he suffered from depression and monumental 
frustration at the relative lack of interest in his findings.  Dr. 
Strecker spoke with him the night before his death.  Ted was cheerful, in 
good spirits, and looking forward to certain new developments that promised 
progress.  The next day he was found dead, his 22-caliber rifle next to him.  
No note, no message, no goodbyes to anyone.  Very untypical of him.  
Officially a suicide.  Next, Illinois State Representative  Douglas Huff of 
Chicago was found alone in his home, dead from an apparent overdose of 
cocaine and heroin, on September 22, 1988.  Representative Huff did 
everything in his power to make the Illinois State legislature and the 
people of Chicago aware of Dr. Strecker's work.  He was very vocal, gave 
many press interviews, was constantly on television and radio urging 
people to wake up to the cover-up concerning AIDS.  Did Representative Huff 
use drugs?  Perhaps.  Would he have known how dangerous a massive overdose 
of cocaine and heroin was?  Yes, of course.  Cause of death:  officially a 
stroke.  Dr. Strecker has serious doubts that his brother killed himself.  
Representative Huff's associates doubt he died accidentally, and yet they 
are gone.  Who's next?

[] Ignorance is Bliss, or is it Suicide?
	We all know it is easier for a king to have a lie believed than a 
beggar to spread the truth.  Well, we are spreading the truth about AIDS.  
Unfortunately, it isn't pretty.  But the fact is you are not being told the 
truth by the government or the so-called AIDS experts.  The media, for 
reasons of their own, will not present information contradicting the 
official propaganda.  So you can choose to go along with the same people 
who gave us brain cancer (SV 40 virus) as a result of their contaminated 
polio vaccines in the early 1960's; a polio-like disease from their 
contaminated Swine Flu vaccine in the 1970's; and AIDS from their smallpox 
and hepatitis B vaccines; or, you can at least make yourself aware of the 
clear and present dangers that we all face by watching "The Strecker 
Memorandum."  The cost of the tape is nominal, but we submit that remaining 
ignorant can cost infinitely more.  

		For more information:
		The Strecker Group
		1501 Colorado Blvd.
		Eagle Rock, CA 90041
		(213) 344-8039
		or elsewhere in U.S. or Canada
		(800) 548-3198

    BULLSH!T.
    
    Reading this stuff makes me furious because it just increase the amount
    of hysteria already too prevalent about this disease.
    
    If AIDS could be transmitted by mosquitos, we'd all be dead now.
    
    What utter crap.
    
    D!

    
    while i am certainly willing to explore the idea that our political/
    medical establishment may not be displaying complete integrity in
    combatting aids (q.v.), i echo d!'s assessment.
    

what asinine garbage!!!  Wanna bet that little videotape costs an arm and
a leg??? who's getting rich??? why, I don't know, who do YOU think is getting
rich????  They probably have a whole library full of hysteria tapes for the
right price...

If AIDS was easy to catch, California, enmass, would be infected...and we'd
be dropping like flies.  Two of the biggest urban HIV+ population 
concentrations are S.F. and L.A.  Mosquitos are CERTAINLY NOT a vector for
this disease...if they were, virtually all the Southern USA would be HIV+.

This is another ploy by the "John Birch"ers of this world....find a commie
under your bed, get AIDS by going outside....

			GAAAAACK!!! 

    The most insidious thing about this piece of rubish is that parts of it
    are *true*.  It is *true* that the government and drug companies have a
    vested interest in an expensive vaccine or drug to fix the problem, and
    that cures that would result in less money for the drug companies are
    not being properly researched.
    
    It is also true that the government *has* spread misinformation and
    hysteria about AIDS; it is true that AIDS is not a homosexual disease;
    it is true that there is no such thing as SAFE sex.  But there *is*
    such a thing as SAFER sex, you can't get AIDS from mosquitos or shaking
    hands or bathroom seats or anything else like that.
    
    D!

    inre .43 in re .44
    
    I agree with what D! has said, it has definitely been proven that
    the AIDS virus cannot survive and replicate in mosquitos. Further,
    the epidemyology of the disease is not that of an insect born
    one. If it were, there would be equal numbers of old people, and
    small children and other low or non risk individuals infected.
    
    The rest of the article is similar scare mongering garbage.
    
    Bonnie

    Re .43

    Mostly hysterical crap with the odd badly bent fact added. But as they
    say there is a sucker born every moment and undoubtedly some poor
    ignorant fools will be taken in by it. 

    Jamie.

    What a lot of garbage! It's dangerous because it has many half-truths
    in it.
    
    manisha

    
    Such a complex virus is not something that just suddenly comes along
    naturally. 
    
    /prc

    not true, there are other similar viruses in nature, one that
    causes leukemia in cats for example..

    And one that has been killing dolphins recently....it just "appeared",
    but may be linked to any number of things - ocean temperature, toxic
    waste, I don't know what else.
    
    It's wonderful to be able to foist this on some human agent, perhaps
    that makes us able to believe there will be a cure or something.  But I
    *highly* doubt it.
    
    And if mosquito's spread it more rapidly, it would be more prevalent in
    communities OUTSIDE major cities of AIDS insidence, where the mosquitos
    must go and breed in ponds and pools and so forth.  I too recall
    hearing of scientific tests that proved it could not survive in a
    mosquito for transmission purposes.
    
    -Jody
    

    
re: .51
    
> all the various AIDS viruses are "recombinant retro-viruses." 
> Very simply, that means they have the ability to recombine with the genes 
> of any cell they enter and the offsprings or new viruses they form are 
> different from the parent viruses.  HTLV III alone (that's the most common 
> American AIDS virus) has the mathematical ability to change itself 9,000 x 
> 9,000 x 9,000 x 9,000 times (which is 9,000 to the fourth power).  The 
> common cold recombines much less frequently and we haven't found a cure for 
> it after a hundred years.
    
    	That doesn't sound very natural to me at all.
    
    	/prc

    peter
    
    many other viruses can do it, if not to the degree HLV can (and
    I'm dubious of the numbers given here)... so I guess that is
    natural..
    
    bj

    It will be one of the great urban myths in a few years...

    Re: .53
    
    Recombination is *very* natural - in fact, until the evolution of
    sexual reproduction it was the normal way for organisms to maintain
    their genetic heritage and introduce diversity at the same time.  There
    are still unicellular organisms that do it very well, scavenging bits
    of DNA from other cells to repair damaged segments in their own DNA. 
    
    Sexual reproduction is a "higher" form of recombination, in which every
    new organism's genes are a recombinant mingling of the DNA from two
    other organisms.
    
    The more primitive the organism, the more likely it is to practice
    recombination - hence the extremely primitive HIV viruses are more
    likely to do it than are the more sophisticated rhinoviruses, simply
    because the former haven't had as long to develop their own successful
    genetic identification.
    
    -d

    Yes it is B/S. It was fun to read. It may be an Illuminati plot (I'm
    re-reading that book just now. :-) The one thing I wanted to add to
    this and that was in the lost causes string, was that AIDS does have
    the potential to destroy the whole human race, but it won't. It will be
    beaten. I can't put it in there now because of the story and it will
    look like I believe it. Oh well. I didn't make the above statement. :-)
    
    PJ

    Some people seem to be thinking that if something is complex it has to
    be manmade.  Quite the contrary is true.  Man has made very little
    progress at equalling the complexities of nature.
    							- Vick

    
    Thanks for the insight...
    
    /prc

	Reminded me of the reports that come out of Communist newspapers
	claiming that HIV was created by the CIA...

						Tom_K

a suggestion to those who, like me, have a healthy fear of this disease:

Get thee to a library and begin to learn about viruses and how they evolve into
new forms, reproduce, etc.  The best tool to fight blind-ass fear is knowledge.
Learn about this disease and the research being conducted by reputable
scientists all over the world.  Learn what the Center for Disease Control is
learning about this disease everyday.

Yes, it can be spread by other than homosexual activity and we must all
protect ourselves.  The rash of dental surgery patients showing up HIV+ due
to a dental surgeon's failure to take proper precautions when working on his
patients is an example of flagrant disregard for the realities of this disease.
However, hysterical garbage like this, and the implied/spoken retaliation
against homosexuals, will not protect us either.

    Previous replies have referred to half-truths, errors, etc.  I
    noticed a lot of them myself.  I've also encountered similar articles
    with equivalent rhetoric before, in the pages of "The Skeptical Inquirer",
    where they were ruthlessly analyzed, investigated, and shredded.

    I'd thought I'd share some of my reactions with you:

    Here are Strecker's credentials:  Dr. Robert B. Strecker, M.D. Ph.D.  
    Practicing internal medicine and gastroenterlolgy in Los Angeles.
    Trained as a pathologist and holds a Ph.D. in pharmacology.

    Eventually I hit the following sentences:  "YES, there is hope if
    Dr. Strecker and a growing number of realistic scientists are correct
    in looking at alternative, non-allopathic, non-drug modalities based
    on Raman spectroscopy." and "Of course the FDA would definitely like
    to see an allopathic drug treatment or cure presented by an ethical drug 
    company or university."  The word "allopathic" set my alarm ringing.
    It is the term used in homeopathic medicine to refer to conventional
    medicine.  I think this is where the Streckers are `coming from':
    homeopathy, and the rejection of current medical beliefs.  Now take
    another look at his credentials, with an eye to their being homeopathy-
    based degrees.

    In one place they ridicule the suspected source of the AIDS virus:
    "Meanwhile, the government was telling everyone that a green monkey in 
    Africa bit some native and started AIDS."  Yet, when they are describing
    levels of infection, it's: "Africa has, conservatively, 75 million
    infected; some estimates double that.  Brazil as a country is in serious
    jeopardy because all through the 1970's they were buying their blood 
    supply from Africa."  I find a serious doublethink here.

    "The common cold recombines much less frequently and we haven't found
    a cure for it after a hundred years."

    IT?  There are estimated to be over 100,000 cold viruses running around.�
    Finding 100,000 cures for a non-fatal, non-disabling disease strikes me
    as a stunning waste of time.  I'm da%n sick of seeing this clich� trotted
    out even by non-scientists, and I jolly well don't respect it in the
    mouth of anyone claiming to be a scientist.

    Then, there's the hot button hit:
    "no one was prepared to risk their professional standing by making waves
    within the establishment"

    I hear or read this claim every time some incompetent jerk with a
    pathetic crank theory finds no one is stupid enough to take him seriously.

    "Strecker compiled some of the most damaging documents into a report
    called "The Bio-alert Attack" and sent it to every governor in every
    state, the President, the Vice-President (now President), the FBI,
    the CIA, the NSA, and selected members of Congress."

    Definitely crank material, in my opinion.

    							Ann B.

    � Assuming the original cold virus has only been around for 5,000 years,
    and only recombines once in fifty years, we still get 2 to the 100th
    power variations.  (100,000 is less than 2 to the 17th power.)

    
    Even if the dentist were not wearing gloves, what's the chance that he
    had an open cut or sore on his hands? I'd like to know how it was 
    transmitted to the patient. The patient is not the question, it's
    how it was transmitted TO the patient.
    
    /prc

>    Even if the dentist were not wearing gloves, what's the chance that he
>    had an open cut or sore on his hands? I'd like to know how it was 
>    transmitted to the patient. The patient is not the question, it's
>    how it was transmitted TO the patient.
    
three, at last count, of the dental surgeon's patients have turned up to
be HIV+.  The center for disease control was willing to discount the first
patient that turned up, she being a young single woman who claimed to have
not been sexually active (there were doubters about this due to her age,
not her behavior).  They are presuming at this time that the doctor's
surgical practices led to him getting wounded and bleeding into the open
wounds in the patient's mouths....however, if more patients show up HIV+,
then there are going to be some mumblings about intentional infection or,
perhaps worse, some real questions about just how contagious an infected
individual is once he/she has active AIDS.

For the record: one patient is a grandmother, never had a blood transfusion,
married to a man who is HIV- for 40 or more years...she definitely was not
exposes anywhere else.

    
    > They are presuming at this time that the doctor's surgical practices led 
    > to him getting wounded and bleeding into the open wounds in the patients
    > mouths
    
    	If that is not the case however, we are opening up an entirely
    	new can of worms.
    
    	/prc

    At the risk of downplaying the danger of infection from an HIV+
    health care worker, keep in mind that last year more Americans
    were struck and killed by lightning than all the patients to date 
    who have been infected by their health care professionals.
    
                                      L.J.

>    At the risk of downplaying the danger of infection from an HIV+
>    health care worker, keep in mind that last year more Americans
>    were struck and killed by lightning than all the patients to date 
>    who have been infected by their health care professionals.
    
EXACTLY!!! AND let us remember this dental surgeon was very successful AND
HAD LOTS OF PATIENTS.  So far, it seems that there have been only 3 people 
infected.  This further supports the theory that the method of infection was
unusual, not due to "normal" contact.

However, I will say that I would not allow an infected surgeon or dental 
surgeon operate on me.  I would certainly welcome them sharing their expertise
as consultants, but not performing the surgery.  I think that the health
care professions have to address the question of allowing HIV+ health care
professionals to work in positions where there can be an exchange of blood.
This is not acceptable, knowing what we do about the virus and how it is
transmitted.

    Re .43
    
    What is For the People?
    
    Scanning through the "article" reminded me of those full page ads
    (often found at the back of magazines) masquerading as scientific
    what-have-you.  Wish I'd worn one of my favorite t-shirts today, the
    bright yellow one with large black letters:
    
    		SOUNDS LIKE 
    		  BULLSHIT
    		   TO ME
    
    aq
    
    A thought:  I am, as always, impressed with Ann Broomhead's articulate and
    intelligent entry (the number of which I've forgotten).  Maybe I'll have 
    a new (more socially acceptable) t-shirt made:
    
    		SOUNDS
    	      NONSENSICAL
    		TO ME
    
    :)

    I'm not really sure what For the People is.  I gather it's some kind of
    magazine.  One of my colleagues gave me a photo-copy of the article.
    
    I agree that a lot of what was said is poop.  But I wouldn't put a lot
    of this past any AMA type organization.  Sorry for the cycnicism, but
    I've spent the past year watching almost my entire family (all my
    uncles, aunts and stepfather) die because they dutifully followed the
    dictates of their omnipotent, omniscient physicians (MD type). 
    Frankly, I wouldn't believe any MD if he told me water was wet and the
    sun rises in the east.
    
    Ron
    

    I copied it off and handed it to Harry last night, like the author he
    too has a string of medical degrees. I got asked why I keep bringing
    back drivel for him to read and it was compared to the great "Heroine
    cannot pass the placental barrier" fiasco (SMURF::DISCUSSION 23.*).

    He reckons that the poor man cannot get funds, not because he is
    exposing the "medical world closing ranks and covering up" but rather
    on the grounds that he has flipped his lid. 

    The whole thing seems to be designed to play on the American paranoia
    with its medical profession.

    Jamie.

    Nashville, TN--Belinda Mason, the only AIDS-infected member of the
    National Commission on AIDS and an outspoken critic of President
    Bush's AIDS research policy, died yesterday of pneumonia related to
    the disease.  She was 33.

    Ms. Mason, a Kentuckian who contracted the disease through a blood
    transfusion, had become a national symbol for AIDS sufferers, said
    Carisa Cunningham, a spokeswoman for the Washington-based AIDS
    Action Council.

    "She never tried to separate herself from every other person with
    AIDS who got it through drug use or sex activity," Cunningham said.

    Ms. Mason, of Utica, KY, a writer and the mother of two, was presi-
    dent of the National Association of People With AIDS when Bush
    appointed her in 1989 to the commission created by Congress to
    advise lawmakers and the president on AIDS issues.

    She was often critical of Bush's stance on AIDS, contending the
    administration treated the AIDS crisis as a moral issue instead of
    a public health issue.

    In an interview this summer, Ms. Mason, who was infected by a blood
    transfusion during the birth of her second child, said that Bush
    chose her for the commission because "I was perfect. I was Southern,
    I was white, I was articulate and I got AIDS in a nice way."

    The White House said in a statement that "the president is sad to
    hear of her death.  The president and Mrs. Bush send their sympathy
    to the family."

    She leaves her husband, Stephen Carden, a daughter, Polly, 8, and a
    son, Clayton, 4; her parents, and two brothers.

	--Boston Globe, 9/10/91

    Ms. Mason was a good friend of a friend of my
    husband's, Artie Ann Bates, a physician in 
    Blackey, Kentucky. I met Artie Ann for the 
    first time last year at Christmas, and she
    and I talked a lot about writing. (Artie Ann
    loves to write, as do I, and we exchanged
    publishing stories.) Anyway, Artie Ann
    talked to me a lot about Belinda, and what a 
    wonderful person she was. 
    
    Belinda was very active on the National
    Commission on AIDS, and Artie Ann was writing
    an article on her for a Kentucky medical journal.
    They cried a lot together when they wrote it.
    
    They had good reason.
    
    	june

            HIV in the Health Care Setting -- Questions and Answers

In recent months, the AIDS ACTION HOTLINE has received calls from the 
public concerned about the transmission of HIV in the health care setting.  
The following was prepared by the AIDS ACTION Committee and the AIDS Action 
Council in Washington, DC to help address those concerns.

    	 How many people have been infected with HIV by their dentist
    	 or surgeon?

    There are five known cases of people apparently infected by a dentist 
during dental procedures.  All were patients of the same dentist.  There 
are no known cases of patients infected by a surgeon during surgery.

    	 How do we know there are not others?

    We don't.  We do know that a number of studies--including that of a 
Johns Hopkins surgeon with HIV (Journal of the American Medical 
Association, July 1990)--have followed thousands of patients of doctors 
with HIV, and have turned up no related infections.  In addition, in the 
year since the Florida case appeared, a number of physicians with HIV have 
informed their patients of their illness.  As a result, thousands of 
patients have been tested, and no infections have turned up.

    	 How was HIV transmitted to those five people from their dentist?

    Dr. Harld Jaffe, Deputy Director of Science at the federal Centers for 
Disease Control offered two theories: one, that the dentist injured himself 
while working and infected each of the patients with his own blood while 
performing invasive procedures; or two, that the dentist contaminated his 
instruments with the blood of an infected patient or with his own blood, 
and then used those instruments on other patients without cleaning them 
properly.

    	 Which is the most likely?

    Because five patients of the same dentist have been infected with HIV, 
the evidence seems to indicate it was the instruments, rather than the 
dentist himself, that infected the patients.  It is extremely unlikely that 
five accidents took place in one office.  Neither the dentist nor the 
patients remembered any accident which drew the dentist's blood.  There is 
also evidence--the testimony of the dentist's own staff--that his equipment 
was not always properly sterilized, and that he reused equipment meant to 
be used only once.

    	 Does it matter?

    It does.  If the explanation is bad infection control practice, then 
the solution is different than if the explanation was something less 
controllable like unavoidable accidents.  Bad infection control practices 
can be addressed by better training in and enforcement of infection control 
procedures.  Moreover, bad infection control means that HIV could be 
transmitted from patient to patient--through contaminated equipment--thus 
making a focus on the health care worker irrational and perhaps even 
dangerous.

    	 Who is in charge of making policy on this issue?

    The Centers for Disease Control (CDC) is charged with setting guide- 
lines on HIV for health care workers and is generally acknowledged as the 
country's leading public health agency on disease control.  In February, 
1991, CDC held a public meeting in which nearly 100 medical and public 
health experts participated.  With two or three exceptions, all favored 
greater infection control and opposed mandatory testing of health care 
workers.

    	 What policy did the CDC finally recommend?

    In July, 1991, the CDC released new guidelines for preventing the 
transmission of HIV and the Hepatitis B Virus (HBV) to patients during 
exposure-prone invasive procedures.  These guidelines rejected mandatory 
testing of health care workers for hepatitus B and HIV antibody, and 
instead called for strict adherence to universal infection control 
procedures.  The CDC also recommended that health care workers infected 
with HBV or HIV could continue to perform invasive proedures *not 
identified as exposure-prone*, provided they practiced recommended surgical 
or dental technique and complied with universal precautions.

    	 What were the CDC recommendations concerning exposure-prone
    	 invasive procedures?

    The CDC called upon medical, surgical, and dental organizations to 
identify those procedures which are exposure-prone (those where there is an 
increased likelihood of health care workers cutting or injuring themselves, 
allowing their blood to contact a patient's blood, mucous membranes, or any 
other tissue under the skin).  It recommended that health care workers who 
perform exposure-prone procedures be tested for the HIV antibody.  For 
those who test positive, the CDC recommended they voluntarily refrain from 
such procedures until they have sought counsel from an expert review panel 
which will determine under what circunstances, if any, they may continue to 
perform them.

    	 How high is the risk of transmission in the medical setting?

    The risk of any person contracting HIV from any surgeon anywhere in the 
country performing any procedure has been calculated at one in 1,538,461, 
or .65 per million procedures.  Some have questioned whether the risk is 
even smaller than .65 per million, since the only known case of 
transmission has resulted in a cluster of cases, and no other random 
occurrences have been documented.

    	 How does this compare to other risks assumed by patients during
    	 surgery?

    Other risks with equally severe consequences are much, much higher.  
For example: the risk of death from anaesthesia is 100 per million; the 
risk of death due to penicillin anaphylaxis is 20 per million; and the risk 
of wound infection (which can be fatal) is 147,000 per million.

    	 The risk of HIV infection by one's dentist or surgeon may be
    	 small, but it could happen.  Given that the consequence is so
    	 great, shouldn't more be done to protect patients?

    Yes.  While it is not possible to guarantee a risk-free environment, it 
is possible to make the medical setting even safer from HIV transmission 
through better training of personnel, stricter enforcement of universal 
precautions, and the use of safer equipment, such as retractable needles 
and flexible scalpels.

    	 What more should be done?

    We concur with the CDC recommendations for stricter monitoring and 
enforcement of infection control procedures.  The CDC, the National 
Institute of Occupational Safety and health, the Occupational Safety and 
Health Administration, and the Food and Drug Administration must also 
actively pursue the approval and marketing of safer technology such as 
flexible scalpels and retractable needles--which can help prevent exposure 
from patient to practitioner and vice versa.
    Professional associations and licensing boards should train their 
members in infection control procedures and implement professional 
standards.  In Massachusetts, legislation has been filed that calls for 
mandatory training and continuing education on HIV for all licensed or 
registered health providers.  The AIDS Omnibus Bill, House 963, could 
represent an important step forward in guaranteeing that our health care 
providers are informed about the most effective and up-to-date infection 
control procedures.

    	 Shouldn't dentists and doctors already be taking basic pre-
    	 cautionary measures which include cleaning equipment?

    Yes.  "Universal precautions," formulated by CDC in 1987 call for the 
use of gowns, masks, and goves, sterilization of equipment, and the 
disposal of used syringes and needles in special containers.  Those 
measures are intended to prevent the spread not only of HIV but of other 
blood borne infections as well.  When universal precautions are strictly 
followed, it is unlikely that infection can occur.  It appears from 
available evidence that the breach of these universal precautions caused 
the infections in Florida--and the lack of other cases seems to demonstrate 
the effectiveness of universal precautions in preventing transmission.

    	 Why not just keep people with HIV out of the medical setting?

    It is not the safest approach.  Because of the three-to-six-month 
"window" between the time a person becomes infected with HIV and when HIV 
antibodies are dectable by a blood test, there will always be health care 
practitioners with HIV providing care to patients.  It is much safer to 
ensure that everyone is using good infection control procedures--to protect 
against the transmission of HIV and hepatitis B, and to protect against 
patient-to-patient transmission through contaminated equipment.
    In addition, it's just not practical.  To bar practitioners with HIV 
from the medical setting means, first of all, testing them, since most 
people with HIV don't know they have it.  For such a program to be useful, 
health care personnel would have to be tested every day--especially in 
emergency room settings where practitioners are repeatedly exposed to the 
possibility of HIV transmission.  Proponents of a universal, mandatory 
testing policy have not yet answered questions about how such a testing 
program could be structured and paid for.  The CDC concluded that the low 
level of risk does not support the diversion of resources that would be 
required to implement mandatory testing programs.

    	 Aren't you more concerned about the rights of health care workers
    	 than about patients' health?

    As AIDS advocates, we are most concerned about stemming the spread of 
HIV in our society.  The transmission of HIV in the health care setting can 
best be prevented by stricter enforcement of universal precautions.  We are 
also concerned that policies which needlessly drive health care workers out 
of their professions will damage patient care, especially in large urban 
settings where the epidemic is already placing a heavy burden on the 
hospitals.
    
    	 How would restrictions harm patient care?

    Restrictions would create a dis-incentive for medical professionals to 
perform exposure-prone procedures or to work in those states where the 
epidemic has hit the hardest.  Health care workers would constantly be 
worried about the potential loss of their careers and patient care would 
suffer.  This would affect all patients.  Restrictions would also have a 
disproportionate impact on the health care of people with AIDS or those 
perceived to be at risk of HIV.

    -- w/o permission from AAC _Update_, Vol 6, No. 7, Fall 1991

    Thank you for entering that, Deb.
    
    E Grace

    
    It was pointed out in another conference that while there were 147,000
    wound infections out of one million, that they did not indicate exactly
    how many fatalities there were out of those 147,000 infections.
    
    	deb