AIDS And You Term Paper

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AIDS and YOU (May 1987)

By Martin H. Goodman MD

(this essay is in the public domain)


AIDS is a life and death issue. To have the AIDS disease

is at present a sentence of slow but inevitable death. I've

already lost one friend to AIDS. I may soon lose others. My own

sexual behavior and that of many of my friends has been

profoundly altered by it. In my part of the country, one man in

10 may already be carrying the AIDS virus. While the figures may

currently be less in much of the rest of the country, this is

changing rapidly. There currently is neither a cure, nor even an

effective treatment, and no vaccine either. But there are things

that have been PROVEN immensely effective in slowing the spread

of this hideously lethal disease. In this essay I hope to

present this information. History and Overview:

AIDS stands for Acquired Immune Defficiency Disease. It is

caused by a virus.

The disease originated somewhere in Africa about 20 years

ago. There it first appeared as a mysterious ailment afflicting

primarily heterosexuals of both sexes. It probably was spread

especially fast by primarily female prostitutes there. AIDS has

already become a crisis of STAGGERING proportions in parts of

Africa. In Zaire, it is estimated that over twenty percent of

the adults currently carry the virus. That figure is increasing.

And what occurred there will, if no cure is found, most likely

occur here among heterosexual folks.

AIDS was first seen as a disease of gay males in this

country. This was a result of the fact that gay males in this

culture in the days before AIDS had an average of 200 to 400 new

sexual contacts per year. This figure was much higher than

common practice among heterosexual (straight) men or women. In

addition, it turned out that rectal sex was a particularly

effective way to transmit the disease, and rectal sex is a

common practice among gay males. For these reasons, the disease

spread in the gay male population of this country immensely more

quickly than in other populations. It became to be thought of as

a "gay disease". Because the disease is spread primarily by

exposure of ones blood to infected blood or semen, I.V. drug

addicts who shared needles also soon were identified as an

affected group. As the AIDS epidemic began to affect

increasingly large fractions of those two populations (gay males

and IV drug abusers), many of the rest of this society looked on

smugly, for both populations tended to be despised by the

"mainstream" of society here.

But AIDS is also spread by heterosexual sex. In addition,

it is spread by blood transfusions. New born babies can acquire

the disease from infected mothers during pregnancy. Gradually

more and more "mainstream" folks got the disease. Most recently,

a member of congress died of the disease. Finally, even the

national news media began to join in the task of educating the

public to the notion that AIDS can affect everyone.

Basic medical research began to provide a few bits of

information, and some help. The virus causing the disease was

isolated and identified. The AIDS virus turned out to be a very

unusual sort of virus. Its genetic material was not DNA, but

RNA. When it infected human cells, it had its RNA direct the

synthesis of viral DNA. While RNA viruses are not that uncommon,

very few RNA viruses reproduce by setting up the flow of

information from RNA to DNA. Such reverse or "retro" flow of

information does not occur at all in any DNA virus or any other

living things. Hence, the virus was said to belong to the rare

group of virues called "Retro Viruses". Research provided the

means to test donated blood for the presence of the antibodies

to the virus, astronomically reducing the chance of ones getting

AIDS from a blood transfusion. This was one of the first real

breakthroughs. The same discoveries that allowed us to make our

blood bank blood supply far safer also allowed us to be able to

tell (in most cases) whether one has been exposed to the AIDS

virus using a simple blood test.

The Types of AIDS Infection:

When the AIDS virus gets into a person's body, the results

can be broken down into three general types of situations: AIDS

disease, ARC, and asymptomatic seropositive condition.

The AIDS disease is characterized by having one's immune

system devastated by the AIDS virus. One is said to have the

*disease* if one contracts particular varieties (Pneumocystis,

for example) of pneumonia, or one of several particular

varieties of otherwise rare cancers (Kaposi's Sarcoma, for

example). This *disease* is inevitably fatal. Death occurs often

after many weeks or months of expensive and painful hospital

care. Most folks with the disease can transmit it to others by

sexual contact or other exposure of an uninfected person's blood

to the blood or semen of the infected person.

There is also a condition referred to as ARC ("Aids

Related Complex"). In this situation, one is infected with the

AIDS virus and one's immune system is compromised, but not so

much so that one gets the (ultimately lethal) cancers or

pneumonias of the AIDS disease. One tends to be plagued by

frequent colds, enlarged lymph nodes, and the like. This

condition can go on for years. One is likely to be able to

infect others if one has ARC. Unfortunately, all those with ARC

are currently felt to eventually progress to getting the full

blown AIDS disease.

There are, however, many folks who have NO obvious signs

of disease what so ever, but when their blood serum is tested

they show positive evidence of having been exposed to the virus.

This is on the basis of the fact that antibodies to the AIDS

virus are found in their blood. Such "asymptomatic but

seropositive" folks may or may not carry enough virus to be

infectious. Most sadly, though, current research and experience

with the disease would seem to indicate that EVENTUALLY nearly

all folks who are seropostive will develop the full blown AIDS

disease. There is one ray of hope here: It may in some cases

take up to 15 years or more between one's becoming seropositive

for the AIDS virus and one's developing the disease. Thus, all

those millions (soon to be tens and hundreds of millions) who

are now seropositive for AIDS are under a sentence of death, but

a sentence that may not be carried out for one or two decades in

a significan fraction of cases. Medical research holds the

possibility of commuting that sentence, or reversing it.

There is one other fact that needs to be mentioned here

because it is highly significant in determining recommendations

for safe sexual conduct which will be discussed below:

Currently, it is felt that after exposure to the virus, most

folks will turn seropositive for it (develop a positive blood

test for it) within four months. It is currently felt that if

you are sexually exposed to a person with AIDS and do not become

seropositive within six months after that exposure, you will

never become seropositive as a result of that exposure.

Just to confuse the issue a little, there are a few folks

whose blood shows NO antibodies to the virus, but from whom live

virus has been cultured. Thus, if one is seronegative, it is not

absolute proof one is not exposed to the virus. This category of

folks is very hard to test for, and currently felt to be quite

rare. Some even speculate that such folks may be rare examples

of those who are immune to the effects of the virus, but this

remains speculation. It is not known if such folks can also

transmit the virus.

Transmission of AIDS:

The AIDS virus is extremely fragile, and is killed by

exposure to mild detergents or to chlorox, among other things.

AIDS itself may be transmitted by actual virus particles, or by

the transmission of living human CELLS that contain AIDS viral

DNA already grafted onto the human DNA. Or both. Which of these

two mechanisms is the main one is not known as I write this

essay. But the fact remains that it is VERY hard to catch AIDS

unless one engages in certain specific activities.

What will NOT transmit AIDS?

Casual contact (shaking hands, hugging, sharing tools)

cannot transmit AIDS. Although live virus has been recovered

from saliva of AIDS patients, the techniques used to do this

involved concentrating the virus to extents many thousands of

times greater than occurs in normal human contact, such as

kissing (including "deep" or "French" kissing). Thus, there

remains no solid evidence that even "deep" kissing can transmit

AIDS. Similarly, there is no evidence that sharing food or

eating utensils with an AIDS patient can transmit the virus. The

same is true for transmission by sneezing or coughing. There just

is no current evidence that the disease can be transmitted that

way.The same may be true even for BITING,though here there may be

some increased (though still remote) chance of transmitting the


The above is very important. It means that there is NO

medical reason WHAT SO EVER to recommend that AIDS suffers or

AIDS antibody positive folks be quarrantined. Such

recommendations are motivated either by ignorance or by sinister

desires to set up concentration camps. Combined with the fact

that the disease is already well established in this country,

the above also means that there is no rational medical basis for

immigration laws preventing visits by AIDS suffers or antibody

positive persons.

The above also means that friends and family and coworkers

of AIDS patients and seropostive persons have nothing to fear

from such casual contact. There is no reason to not show your

love or concern for a friend with AIDS by embracing the person.

Indeed, there appears still to be NO rational basis for

excluding AIDS suffers from food preparation activity. Even if

an AIDS suffer cuts his or her finger and bleeds into the salad

or soup, most of the cells and virus will die, in most cases,

before the food is consumed. In addition, it is extremely

difficult to get successfully attacked by AIDS via stuff you


AIDS cannot be transmitted by the act of GIVING blood to a

blood bank. All equipment used for such blood donation is

sterile, and is used just once, and then discarded.

How is AIDS transmitted?

Sexual activity is one of the primary ways AIDS is

transmitted. AIDS is transmitted particulary by the transmission

of blood or semen of an infected person into contact with the

blood of an uninfected person. Sex involving penetration of the

penis into either the vagina of a woman or the rectum of either

a woman or a man has a very high risk of transmitting the

disease. It is felt to be about four times MORE likely for an

infected male to transmit AIDS to an uninfected woman in the

course of vaginal sex than it is likely for an infected woman to

transmit AIDS to an uninfected male. This probably relates to

the greater area of moist tissue in a woman's vagina, and to the

relative liklihood of microscopic tears to occur in that tissue

during sex. But the bottom line is that AIDS can be transmitted

in EITHER direction in the case of heterosexual sex.

Transmission among lesbians (homosexual females) is rare.

Oral sex is an extremely common form of sexual activity

among both gay and straight folks. Such activity involves

contact of infected semen or vaginal secretions with the mouth,

esophagus (the tube that connects the mouth with the stomach)

and the stomach. AIDS virus and infected cells most certainly

cannot survive the acid environment of the stomach. Yet, it is

still felt that there is a chance of catching the disease by

having oral sex with an infected person. The chance is probably

a lot smaller than in the case of vaginal or rectal sex, but is

still felt to be significant.

As mentioned above, AIDS is also transmitted among

intravenous drug users by the sharing of needles. Self righteous

attitudes by the political "leaders" of this country at local,

state, and national levels have repeatedly prevented the very

rational approach of providing free access to sterile

intravenous equipment for IV drug users. This measure, when

taken promptly in Amsterdam, was proven to greatly and

SIGNIFICANTLY slow the spread of the virus in that population.

The best that rational medical workers have succeeded in doing

here in San Francisco is distribute educational leaflets and

cartoons to the I.V. drug abusing population instructing them in

the necessity of their rinsing their "works" with chlorox before

reusing the same needle in another person. Note that even if you

don't care what happens to I.V. drug abusers, the increase in the

number of folks carrying the virus ultimately endangers ALL

living persons. Thus, the issue is NOT what you morally think of

I.V. drug addicts, but one of what is the most rational way to

slow the spread of AIDS in all populations.

Testing of donated blood for AIDS has massivly reduced the

chance of catching AIDS from blood transfusions. But a very

small risk still remains. To further reduce that risk, efforts

have been made to use "autotransfusions" in cases of "elective

surgery" (surgery that can be planned months in advance).

Autotransfusion involves the patient storing their own blood a

couple of weeks prior to their own surgery, to be used during

the surgery if needed. Similary, setting up donations of blood

from friends and family known to be antibody negative and at low

risk for AIDS prior to schedualed surgery further can decrease

the already small risks from transfusion.

AIDS and SEX: What are the rational options?

The "sexual revolution" of the 1960's has been stopped

dead in its tracks by the AIDS epidemic. The danger of

contracting AIDS is so real now that it has massively affected

the behavior of both gay and straight folks who formerly had

elected to lead an active sexual life that included numerous new

sexual contacts.


The safest option regarding AIDS and sex is total

abstinence from all sexual contact. For those who prefer to

indulge in sexual contact, this is often far too great a

sacrifice. But it IS an option to be considered.

Safe Sex

For those who wish to have sexual contact with folks on a

relatively casual basis, there have been devised rules for "safe

sex". These rules are very strict, and will be found quite

objectionable by most of us who have previously enjoyed

unrestricted sex. But to violate these rules is to risk

unusually horrible death. Once one gets used to them, tho, the

rule for "safe sex" do allow for quite acceptable sexual

enjoyment in most cases.

For those who wish to indulge in pentration of the vagina

or rectum by a penis: The penis MUST be sheathed in a condom or

"rubber". This must be done "religiously", and NO exceptions are

allowed. A condom must be used by a man even when he is

receiving oral sex. Cunnilingus (oral stimulation of a womans

gentitals by the mouth of a lover) is NOT considerd to be safe

sex. Safe sex includes mutual masturbation, and the stimultion

of one genitals by another's hand (provided there are no cuts in

the skin on that hand). But manual stimulation of another's

genitals is NOT safe if one has cuts on one's hands, unless one

is wearing a glove.

Note that even when one is conscientiously following the

recommendations for safe sex, accidents can happen. Condoms can

break. One may have small cuts or tears in ones skin that one is

unaware of. Thus, following rules for "safe sex" does NOT

guarantee that one will not get AIDS. It does, however, greatly

reduce the chances. There are many examples of sexaully active

couples where one member has AIDS disease and the other remains

seronegative even after many months of safe sex with the

diseased person. It is particularly encouraging to note that,

due to education programs among San Francisco gay males, the

incidence of new cases of AIDS infection among that high risk

group has dropped massively. Between practice of safe sex and a

significant reduction in the number of casual sexual contacts,

the spread of AIDS is being massively slowed in that group.

Similar responsible action MUST be taken by straight folks to

further slow the spread of AIDS, to give our researchers time to

find the means to fight it.


For those who would have sexual activity, the safest

approach in this age of AIDS is monogamous sex. Specifically,

both parties in a couple must commit themselves to not having

sex with anyone else. At that time they should take AIDS

antibody tests. If the tests are negative for both, they must

practice safe sex until both members of the couple have been

greater than six months since sexual contact with anyone else.

At that time the AIDS blood test is repeated. If both tests

remain negative six months after one's last sexual contact with

any other party, current feeling is that it is now safe to have

"unprotected" sex. Note that this approach is recommended

especially for those who wish to have children, to prevent the

chance of having a child be born infected with AIDS, getting it

from an infected mother. Note also that this approach can be

used by groups of three or more people, but it must be adhered

to VERY strictly.

What to AVOID:

Unscrupulous folks have begun to sell the idea that one

should pay to take an AIDS antibody test, then carry an ID card

that certifies one as AIDS antibody negative, as a ticket to

being acceptable in a singles bar. This is criminal greed and

stupidity. First, one can turn antibody positive at any time.

Even WEEKLY testing will not pick this change up soon enough to

prevent folks certified as "negative" from turning positive

between tests. Much worse, such cards are either directly or

implicitly promoted as a SUBSTITUTE for "safe sex" practices.

This can only hasten the spread of the disease.

If you want to learn your antibody status, be sure to do

so ANONYMOUSLY. Do NOT get the test done by any agency that

requires your real name, address, or any other identifying

information. Fortunately, in San Francisco, there is a public

place to get AIDS antibody testing where you may identify

yourself only as a number. Tho that place has a three month long

waiting list for testing, there are other private clinics where

one may have the test done for cash, and may leave any false

name one wishes. The reason I suggest this is that currently

there are some very inappropriate reactions by government and

business to folks known to be antibody positive. Protect

yourself from such potential persection by preventing your

antibody status from being a matter of record. That information

is for you, your lover(s), and (if need be) your physician. And

for NO one else.

There currently is NO treatment for AIDS (this includes

AZT) that shows significant promise.

In Conclusion:

It is my own strongly held view, and that of the medical

and research community world wide, that the AIDS epidemic is a

serious problem, with the potential to become the worst plague

this species has ever known. This is SERIOUS business. VASTLY

greater sums should be spent on searching for treatments and

vaccines. On the other hand, we feel strongly that this is

"merely" a disease, not an act by a supernatural power. And

while it does not seem likely we will find either a cure or a

vaccine in the forseeable future, it may be that truly effective

treatments that can indefinitely prolong the life of AIDS

victims may be found in the next few years. When science and

technology do finally fully conquer AIDS, we can go back to

deciding what sort and how much sex to have with who ever we

choose on the basis of our own personal choice, and not by the

coercion of a speck of proteins and RNA. May that time come

soon. In the mean time, we must all do what we can to slow the

spread of this killer. This article is intended to help

accomplish that. Please circulate it as widely as possible.


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