To the Editor:
In a land teetering on the brink of hysteria over the present AIDS epidemic, Michael A. Fumento’s article, “AIDS: Are Heterosexuals at Risk?” [November 1987], stands as a cool voice of reason and probity amid the din of the generally bleak and apocalyptic AIDS stories with which we are almost daily bombarded. By exposing many of the misrepresentations, half-truths, and outright lies which have come to surround the disease (deceptions which the media are in no small measure responsible for perpetrating), Mr. Fumento does much to enhance our understanding of the reality of AIDS while at the same time allaying many of the groundless fears which are becoming increasingly prevalent within the nation’s heterosexual community.
One of the most important yet least asked questions in the AIDS debate is, why the deception? Further, why the seemingly concerted effort among gay and lesbian groups, scientists, public-health officials (including our own Surgeon General), condom manufacturers, and . . . the media to “‘democratize’ this plague”? I have long wondered in dismay at the push to make AIDS into an Everyman’s Disease, when the facts continue to prove otherwise.
As Mr. Fumento’s article makes convincingly clear, despite the wishful thinking of many persons in this country and throughout the world, AIDS has never been, nor is it now, a heterosexual disease which through some “fluke” emerged with a vengeance among the gay community. The primary risk groups are, as they have always been, homosexual males and intravenous (IV) drug users and their sexual partners. This is the reality of the disease, a reality determined by the nature of the virus and its bloodborne modes of transmission.
It is the duty of the aforementioned organizations, particularly the media, to inform the public of the reality of the present situation regarding AIDS, its transmission, and its primary risk groups. It is not their duty to whip the public into a frenzy of paranoia and distrust, which they have thus far succeeded wonderfully in doing, in order somehow to increase a sense of community social responsibility and compassion for the victims of this horrible disease. As Mr. Fumento remarks in closing: “Every dollar spent, every commercial made, every health warning released, that does not specify promiscuous anal intercourse and needle-sharing as the overwhelming risk factors in the transmission of AIDS is a lie, a waste of funds and energy, and a cruel diversion.”
Indeed, unless the present course of disinformation about AIDS is halted, there is the very real danger of a backlash of outrage by the heterosexual community against not only those messengers of doom who continued to predict a devastating heterosexual epidemic which never came to pass, but also, sadly, against the victims themselves. Mr. Fumento is to be congratulated for his moral and intellectual honesty in his treatment of the subject.
Thomas D. Gordon
Dania, Florida
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To the Editor:
Michael A. Fumento has written the first sensible article about the AIDS epidemic to appear in either the medical or the lay literature. My only disappointment is that he wrote the article I have been trying to write for the past year. I can claim to have written letters to the New York Times (never published) and the New York State Commissioner of Health (never acknowledged) in which I made the same point (i.e., the disease is transmitted mainly by anal intercourse and dirty needles, and that the targets of the “education” campaign were all wrong). I did receive an acknowledgment of the letter I wrote to Dr. Stephen Joseph, New York City Commissioner of Health, but he blithely dismissed my assertions and maintained that his department was “promoting effective preventive measures and [was] beginning to reach groups of particularly vulnerable segments of our population—women and young adults” (emphasis added). It is of great interest that in his reply to me he never mentioned anal intercourse, although that is what I wrote him about. He never even mentioned homosexual men.
Mr. Fumento does well to bring up the connection among hepatitis B and venereal diseases (now called sexually-transmitted diseases, STDs) and AIDS. The connection between hepatitis and homosexual (anal) intercourse was recognized many years before the first cases of AIDS were described. . . .
The extreme reluctance of public officials to face up to the real epidemiological problems of AIDS is testimony to the political power of homosexuals and their allies. When “Typhoid Mary” was spreading typhoid fever around New York City at the turn of the century, nobody talked about educating the public, confidentiality, and civil rights. The public-health officials simply quarantined her until she submitted to treatment.
Mr. Fumento may even have done the homosexual population a service. If the public can be convinced that the disease will not spread to them as long as they have no sexual contact with homosexuals or drug users, isolation measures may not prove necessary.
Finally, one must agree with his last paragraph. We must continue to help the hapless victims of this dread disease as best we can. . . .
Sherwood P. Miller, M.D.
Merrick, New York
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To the Editor:
Congratulations on Michael A. Fumento’s article, a lucid, factual assessment. One can no longer expect unbiased information from the Surgeon General, a decent man, who, however, prefers crusades to enlightenment. Meanwhile, the authorities have failed to do two helpful things in their power: (1) decriminalizing the sale of unused needles (forbidding the sale without prescription induces addicts to become AIDS victims as well by reusing needles) and (2) punishing severely, and thereby possibly deterring, infected persons who expose others to infection. Such persons certainly deserve punishment.
Our courts seem to regard spreading AIDS as a civil right. They insist, for instance, that infected hemophiliac children—who by definition bleed easily and copiously—go to school with uninfected children. The Surgeon General is concerned with telling schoolchildren that anal intercourse is no more risky than normal intercourse. Homosexuals are not to be offended at the expense of truth. The issue has become politicized. This can only aggravate and prolong the epidemic.
Ernest Van Den Haag
Fordham University
New York City
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To the Editor:
In his otherwise sensible and enlightening article about some of the dubious statistics spun out of the AIDS crisis, Michael A. Fumento, alas, passes along a few himself. He quotes a 1981 study to the effect that AIDS victims at age thirty-five had an average of 61 sexual partners a year and projects that to a total of 1,098 partners since age seventeen. The extrapolation is debatable: while most men’s sex drive is strongest in youth, lack of nerve and lack of opportunity tend to limit the frequency of their activity until they get a little older, so the true totals were almost certainly smaller. Moreover, was there absolutely no overlap between each year’s 61 partners and the previous year’s? Mr. Fumento does not say, and I do not know how the researchers could tell—or the survey subjects themselves, for that matter. For one thing, frankly, if you are that promiscuous, you may not even realize you have been with someone before.
The really spurious assertion, however, is the one that follows: “If each partner was equally promiscuous, the size of the pool of partners and partners-once-removed comes to a staggering 1,205,604.” Sure. But that is not 1,205,604 different people; it is the same much smaller pool of contacts counted over and over. After all, if two AIDS victims living in the same city frequented the same bars and bathhouses to achieve their liaisons, it stands to reason that many of their partners—to say nothing of partners-once-removed—will have been the same. And that is exactly what AIDS researchers have found.
To be sure, none of this invalidates Mr. Fumento’s salient central point: that sexually-transmitted AIDS remains primarily a disease of the homosexual community and is chiefly a result of a few particular practices preferred by homosexuals.
William A. Henry III
Plainfield, New Jersey
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To the Editor:
COMMENTARY is to be praised for Michael A. Fumento’s article on the surprising lack of evidence of the spread of AIDS among heterosexuals.
The actual facts seem to be typified by the case of Elizabeth Prophet. She was a San Francisco prostitute and drug user who had been documented as having AIDS by 1977, perhaps earlier. She continued to work on the streets until her death in May 1987.
The first heterosexual cases of AIDS in San Francisco may be dated to about November 1984, when two cases were found. By March 1987, this had grown to 14, seven men and seven women. None of these can be traced to Prophet or to any other prostitute. Since the rule of thumb is that about half the cases will show symptoms within three to five years after infection, we should by now be able to get a fair picture of how many people Prophet infected. The present data suggest either none or very close to none.
As of November 7, 1986, in the entire U.S., 75 males and 381 females were reported to have been heterosexually infected here. . . .
No doubt AIDS still has some surprises left in store for us. But on the basis of present data, it must be said that women may become victims, but they are not much of a hazard as transmitters, except in the case of pregnancy. . . .
Bruce Tyler
Sacramento, California
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To the Editor:
Michael A. Fumento’s article demonstrates intellectual excellence, a compelling sense of social responsibility, and the uncommon courage to make a public statement that runs hard against the dominant views concerning the etiology and epidemiology of AIDS. Reflecting extensive research and thoughtful exposition, Mr. Fumento’s . . . article is both timely and welcome. . . . It enable[s] us to direct our attention to issues that are crucial to understanding the etiology of homosexuality which, paradoxically, have gone largely undiscussed.
Foremost among them, as Warren Gadpaille has shown (“Research Into the Physiology of Maleness and Femaleness,” Archives of General Psychiatry, March 1972), is that heterosexuality is established in fetal life among biologically normal individuals (the vast preponderance, including homosexuals). No evidence exists demonstrating that homosexuality (or other deviant sexual behaviors) is inherited. Indeed, mere common sense suggests that homosexuality is not inherited from heterosexual parents. Nor is it learned behavior—from whom did the first homosexual learn to be homosexual, and Why? And it is least of all chosen (an “orientation”), for the painful costs of peer rejection and ridicule during pre-adolescent and later years vastly outweigh the benefits of being homosexual. . . .
There is, however, ample evidence from Bieber, Ovesey, Socarides, and others unequivocally showing that homosexuality is a psychopathology. . . . Furthermore, . . . homosexuality can be—and has been—cured in those who want to change, are young enough to be able to respond to therapy, and whose therapists understand and know how to treat the underlying psychodynamics of this psycho-sexual pathology, as some do not.
The overriding issue about human sexuality today, therefore, is not the AIDS epidemic, as perilous as it is, but the prevention of homosexuality through sound parental behavior supported by the media and popular culture, emphasizing the paramount value of marriage and family. . . . These fundamental human states are infinitely more preferable than a life of sexual promiscuity, a disturbingly high rate of sexually-transmitted diseases and alcoholism, and much inner unhappiness. The pervasiveness of these afflictions among homosexuals prompts the question of why those suffering from them remain homosexual—if homosexuality is a result of choice.
Edward M. Levine
Evanston, Illinois
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To the Editor:
It was with great dismay and surprise that I read Michael A. Fumento’s article, “AIDS: Are Heterosexuals at Risk?” . . .
To say, as Mr. Fumento does, that “the supposed spread of AIDS into the general population illustrate[s] the old saying about lies, damn lies, and statistics” is a meaningless cliché
Mr. Fumento tries very hard to convince us that the heterosexual spread of AIDS is nothing to be concerned about. He cites specific articles—many of which would appear to have been irresponsibly planted in the medical literature—to justify his preconceived supposition. But he totally ignores articles by Dr. Margaret Fischl of Miami, who has a large clinic of heterosexuals, and who has demonstrated that unprotected sexual relations between one who is infected and one uninfected result in an 80-percent spread of the virus within two years. He also ignores the recent study by Baltimore’s Health Director, reported in the AMA News in October 1987, which shows that 40 percent of patients with a positive Human Immunodeficiency Virus (HIV) test going through the Sexually Transmitted Disease Clinic have no risk factors and are therefore to be considered as cases of heterosexual spread of the virus.
There are references in the article to Randy Shilts’s book, And the Band Played On, but Mr. Fumento neglects to quote from that part of the book where Shilts states that in New York City in 1985, of heterosexually active males with no other risk factors, 3 percent carry the virus.
Mr. Fumento is able to write off the epidemic in Africa with suggestions that the causes are contaminated needles, scarification, and blood transfusions and to conclude that the devastating epidemic in Africa is not a result of the heterosexual spread of the disease.
America today faces the greatest threat that we have ever encountered. But the enemy is within our society, not outside it. The enemy is not the virus itself, for if we started using standard public-health techniques we could bring this epidemic under control. The enemy consists of those irresponsible people who seem intent upon keeping us from using responsible public-health techniques: testing, public-health follow-up and education for those infected, and the use of the force of law against irresponsible people who are intentionally spreading a deadly disease. For some reason some people seem to be intent upon confusing the American people and keeping them asleep until it is too late.
I regret to say that this article fits into the category of “. . . lies, damn lies, and statistics.”
Stanley K. Monteith, M.D.
Chairman, Mid-Coast AIDS Resource Center
Santa Cruz, California
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Michael A. Fumento writes:
Both Thomas D. Gordon and Sherwood P. Miller speak of a backlash against homosexuals, resulting from the “disinformation” that AIDS is spreading to the heterosexual community. There is no doubt that this is a real phenomenon: according to a report by the National Gay Task Force, among anti-homosexual acts committed in 1986, “Reference to AIDS was made by the perpetrators in 14 percent . . . of the total number of incidents, including 5 percent of physical assaults.”
Ernest van den Haag advocates decriminalizing the sale of needles to reduce needle-sharing by addicts. Some may rightly flinch at the thought of providing people with instruments enabling them to engage in illegal and immoral acts, but it must be conceded that education in the form of pamphlets, posters, and lectures has had and will continue to have a limited effect on so heedless a population as this. Local public-health officials I have spoken to in the cities hardest hit by AIDS unanimously support the issuing of free needles, or of bleach with which to clean used ones. New York, however, the state with the highest number of IV-drug-user AIDS cases, and consequently the highest number of IV-drug-related heterosexual-transmission cases, refuses to issue clean needles (this, mind you, is the same state that came close to mandating instruction in the use of condoms in fourth-grade classrooms).
More methadone programs for drug abusers would also be valuable, although it should be noted that methadone is only effective against one injectable drug, heroin. Amazingly, the chief of drug-dependency treatment at the New York Veterans Administration Medical Center has publicly sneered at needle distribution and increased methadone programs on the grounds that neither addresses the problem of heterosexual AIDS transmission.
Whatever the merits of William A. Henry Ill’s theory concerning the frequency of homosexual activity, the figures I presented were not mine but those of Dr. Harold Jaffe, chief epidemiologist at the Centers for Disease Control (CDC), as given in the August 1983 Annals of Internal Medicine. From the wording of the article, it would appear that the extrapolation was made on the basis of the total number of partners divided by years of sexual activity, although, logically, it would seem more useful to inquire into year-by-year contacts and extrapolate from those. At any rate, when dealing with numbers this high, surely the figures given by individual patients are nothing but educated guesses. (The overlap factor is a point I thought too obvious to belabor.) Whatever the exact numbers, a highly promiscuous individual having sex with other highly promiscuous individuals creates an enormous disease pool. No wonder that in 1981 one doctor (quoted in Randy Shilts’s book) said, “I[f] something new gets loose here, we’re going to have hell to pay.”
Stanley K. Monteith asserts that my article “fits into the category of . . . lies, damn lies, and statistics,” yet he does not contest a single statistic. The Fischl study he alludes to was presented at the Third International Conference on AIDS and was in fact a subset of a larger study of 45 couples. I referred to the general study in my article, in citing evidence indicating a correlation between HIV seroconversion (testing positive for HIV) and infection with other STDs.
One problem with Dr. Monteith’s use of the Fischl study is that it was so small: only 17 participants (the other 28 out of the 45 couples included those who used condoms, abstained from sex, or were seropositive at the beginning of the study). The smaller the survey sample, the more likely there is to be distortion in results. Other small studies have had completely different results: one Arkansas study, for example, found no evidence of seroconversion among eight steady heterosexual partners of seropositive individuals; another study, in England, found no seroconversions out of 14. But whatever the variance among small surveys, those with a greater number of participants invariably show lower infection rates than those in the Fischl study.
Another salient characteristic of the Fischl cohort is that all of the initially seropositive partners had either AIDS or AIDS-related complex. There is a growing body of evidence that end-stage AIDS victims are more contagious than asymptomatic HIV carriers. For epidemiological purposes, therefore, our concern should focus on these asymptomatic carriers and their partners, since they are the ones who are going to be making most of the sexual contacts, rather than on those whose sex drive is already reduced by illness and whose manifestations of disease are likely to frighten away sexual partners.
Some of the seroconversions in the Fischl study may also have resulted not from intercourse but from needle-sharing, as evidenced by the fact that 63 percent of the partners of IV-drug users (including those Dr. Fischl listed as prostitutes) tested positive for HIV as opposed to only 44 percent of the others. In other studies, partners of seropositive IV-drug users have shown a significantly higher seroconversion rate than partners of hemophiliacs, transfusion recipients, or bisexuals. Some epidemiologists, such as the CDC’s Alexander D. Langmuir, believe that many individuals who claim that their only high-risk activity has been sexual intercourse with an IV-drug user are in fact sharing needles with those partners.
For all these reasons, Dr. Fischl’s study cannot be cited as the definitive study of the heterosexual transmission of AIDS. Nor has anyone come up with any partner study to refute Dr. Nancy Padian’s finding (cited in my article) that on average it takes more than 1,000 contacts for a man to infect a woman heterosexually. To the extent, then, that heterosexual transmission is a problem, casual sex is not the culprit; heterosexual transmission is altogether too inefficient to sustain a widespread heterosexual AIDS epidemic in this country.
Dr. Monteith chides me for ignoring a Baltimore study, which is currently being used by a Washington, D.C. area blood-testing clinic to terrify heterosexuals into shelling out their money for needless tests; well, this study happens to have come out after my article appeared, but it should be ignored anyway. Once again, of the various studies performed throughout the country, Dr. Monteith has chosen the most alarming: the percentage of allegedly heterosexually-transmitted HIV-positive cases in Baltimore was several times higher than that found in any other study in any other city. But the study is anomalous in another important respect as well: there were no interviews of tested individuals, or reinterviews of those who tested seropositive. This is significant because of the aforementioned tendency of seropositives and AIDS victims to claim that they have been infected through heterosexual activity or blood transfusions rather than admitting to homosexuality or IV-drug use.
For example, the El Paso County, Colorado, Health Department interviewed 20 seropositive servicemen, of whom 15 originally claimed no high-risk activity. After reinterrogation, all but three admitted either to homosexual acts or IV-drug use. Again, according to Rand Stoneburner, director of AIDS research for the New York City Department of Health, 60 percent of that city’s AIDS victims who originally claim contact with prostitutes as their only high-risk exposure later admit either to taking part in homosexual acts or to IV-drug use.
Would those in the Baltimore study lie even when guaranteed anonymity? Certainly. According to federal officials, plans to do survey testing around the country have bogged down because up to one-third of those contacted say they do not trust the government’s guarantee of anonymity.
The fallaciousness of the Baltimore study is further attested by Baltimore’s present AIDS statistics: as of November 30, 1987, of 331 total cases, only 11 (3.3 percent) could be attributed to heterosexual activity. There is of course a lag between seroconversion and the development of AIDS (although, as I pointed out in my article, this is not as significant as many would like us to think), but it is ludicrous to suppose that in a city where only 3 percent of the AIDS cases are heterosexually transmitted, 40 percent of all HIV carriers got the virus through heterosexual activity.
Whatever his intent, Dr. Monteith appears to concede my point about how the AIDS epidemic in Africa differs from ours. Let me just point out that a new study in Africa indicates that uncircumcised men may have nine and one-half times greater chance of acquiring HIV than circumcised men. Since the great majority of American men of sexually active years have been circumcised, while the reverse is true in many tribes in Africa, this could be yet another factor differentiating the two cases.
According to Dr. Stoneburner, the study referred to in Randy Shilts’s book and cited here by Dr. Monteith suffers from the same methodological flaw as the Baltimore study; that is, it was a self-administered questionnaire. Dr. Stoneburner says the doctor who administered the study has since changed his methodology. In any event, I would refer readers to a later study, ongoing since December 1986: as of June 30, 1987, of 440 men tested at an STD clinic in New York City, five (or a little over 1 percent) claimed no other risk than sexual contact with IV-drug users. Two also claimed no risk factors at all, but one is suspected of having had homosexual relations and the other of abusing injected drugs. This New York STD study, which was presented as an abstract at the Third International Conference on AIDS, concludes: “In the city with the largest number of heterosexual AIDS patients in the United States, these preliminary results suggest a low prevalence of HIV infection among sexually active heterosexual adults who are not [IV-drug users].” That just about says it all.
Thus, as data continue to accumulate, those who have been predicting a breakout of AIDS into the heterosexual community look ever more wrong. At the close of 1987, the official CDC AIDS figure for heterosexuals was holding firm at a hair below 4 percent. (As I pointed out in my article, this figure is itself inflated by the CDC’s arbitrary inclusion of Haitians and Africans in the heterosexual category; without these groups, the figure would be 2 percent.) Even Surgeon General Koop, quietly and slowly, has switched his position.
Still, in the month my article appeared, the federal government spent $4.6 million for an anti-AIDS campaign that did not mention that homosexuals are at higher risk. With federal, state, and local governments continuing to pour tens of millions of dollars into further “AIDS-doesn’t-discriminate” campaigns, this is clearly one myth that is going to die hard.
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