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Denial of heterosexual risk of AIDS

Many have tried to play down the heterosexual problem as a non-issue for white men and women, especially in wealthy nations. This is remarkably short-sighted and inaccurate. Heterosexual acts are now the commonest cause of new infections in countries like the UK - mainly infected in other nations.  You can't place a ring of steel around a country and hope.  What happens in one nations affects others.  What hits Burundi also affects Rwanda. Infections travel.  You can have a great health campaign but if the epidemic is out of control elsewhere, watch out.

It is clear that heterosexual spread in the US or Europe is far slower than in many developing countries. While viral variation could be the reason, with more virulent strains in some places (see Chapter 2) or some genetic susceptibility (see Chapter 5), the overwhelming evidence is that untreated sex diseases such as gonorrhoea and chancroid facilitate spread by damaging the protective surface of the genitalia.  Differences in the numbers of sexual partners between wealthy and poorer nations are not enough to explain the much slower rates of HIV spread.

The AIDS epidemic world-wide is still in its very earliest stages. And with no vaccine or cure on the horizon, this is an epidemic that threatens our future.  But even if a drug was found tomorrow that is as effective against HIV as antibiotics against TB and syphilis, we have to remember that despite these effective treatments, available for fifty years, we have the largest global epidemics of both illnesses today.  In other words, even a cheap and widely available cure will not mean the end of AIDS.  And effective vaccines are a long way off, despite media hype.

Many churches are experiencing phenomenal growth in different parts of the world. Millions of young people are becoming Christians each year. Often there are spectacular conversions resulting in radical changes in lifestyle. Heroin addicts throw away their needles. Marriages are rebuilt. The results are often permanent---but so is the previous infection. AIDS will damage churches physically, emotionally, psychologically and spiritually---unless they are prepared.

At a conference for church leaders, I met a man who had been a heroin addict before his conversion four or five years ago. He is now leading a church. This kind of success story is happening in many different nations. Some of these people will develop AIDS.

So what do we do? How can we prevent the disease? How can we cure it? How can we cope with it? The rest of this book addresses these four questions. But is AIDS really so different from any other disease, or is it just the mass hysteria and panic associated with it?

AIDS is certainly unusual or unique in two respects. First, I do not know of any other illness today where people are beaten up, killed or denied basic medical care just because they happen to have a particular diagnosis.

Secondly, I do not know of any other illness which has so generated political debates, pressures, campaigning and aggressive activism. Some companies are now saying it is hard to conduct normal medical research in the area of HIV or AIDS because the political pressures are so great that they threaten to overwhelm and interfere at every level. They are certainly under huge pressures to give away their ownership of any AIDS therapies they create, and that means investors get worried and less money is available for AIDS research, especially into vaccines.  One day I hope we will have a vaccine that works, but whoever makes it  will face irresistible demands to give it all away "to save the world".

Discrimination, prejudice and fear are seen every day in many countries. It is true that some activism has been driven by members of the gay community in developed countries, rather than by drug users, heterosexuals or those with haemophilia, or by those in the poorest nations---a fact which becomes very obvious at the larger international AIDS conferences.

Indeed global AIDS events are often split by two conflicting interests:  first by gay HIV activists who have a particular agenda, and second by far less well organised and less well resourced representatives of the vast majority of people with HIV who live in the poorest nations.

AIDS has also attracted the eccentric and the bizarre. I was recently sent literature from an organisation claiming that the US government made HIV as part of a deliberate plot to reduce the world population by 75%. The Mafia and the CIA are said to be deeply involved. Equally bizarre are some of the `cures', including eating earth and drinking vinegar, or high-cost preparations with no proven value.  Other minorities try to persuade people that HIV is harmless and does not even cause AIDS (see Chapter 5 Questions People Ask).

Yet in another sense there is nothing special about AIDS. It is just the latest in a long series of epidemics spread by sex. Sleeping around has always carried risks to health. Now it can be lethal.

Sex diseases are common (STDs). Over 30 million in the US are estimated to have genital herpes. Some 56 million, or 20% of all US adults, are estimated to be carrying an STD at any time.  50% of all adults in Mumbai India are carrying an STD. Worldwide there are an estimated 250 million new STD infections each year. With ordinary STDs the damage is usually more obvious, immediate and less serious than with HIV.

More than 300 years ago a plague broke out in Europe and spread across the Western world. Vast numbers died. Early symptoms were mild, the second stage made people very ill, and half of those who developed the third stage died, many with brain damage. It was a terrible disease, and it was spread by sex. It was named `syphilis'.

Syphilis only stopped being a major threat with the discovery of penicillin at the end of World War II. During the war, United States army recruits were warned that, after Hitler, syphilis was Public Enemy Number One. A famous US Army war poster was of a prostitute walking with Hitler on one arm and the Japanese Emperor on the other. The caption read: `VD (venereal disease) worst of the three.' Syphilis has not gone away; we are in the middle of a major heterosexual explosion of cases which often produce few or no symptoms and are untreated for a long period.

Gonorrhoea also became a curable sexual disease with penicillin---until the recent advent of penicillin-resistant strains which are now spreading rapidly across the globe and becoming harder and harder to treat. There is an unprecedented epidemic of genital herpes. Highly infectious, appallingly painful blisters prevent sex. There is no cure and it can cause problems throughout a person's life. There is also a big increase in cancer of the neck of the womb (cervix), some of which is associated with a virus infection and is due to sleeping with multiple partners.

There is also the heart-rending problem of infertility. Have you ever wondered about the huge test-tube baby programme in many wealthy nations?  The major part of the workload is people with badly damaged and scarred fallopian tubes---the thin delicate tubes which guide the egg from the ovary to the womb. The cause is an infection called pelvic inflammatory disease (PID), which can be caused by a tiny organism called chlamydia. There is no treatment that can undo the damage of pelvic inflammatory disease. One in ten women develop it after being infected with chlamydia, gonorrhoea, or some other infections. It causes aches and pains that are chronically disabling, and it gradually causes the reproductive organs to stick together.

Then came a new disease---AIDS---that many people think has been around in Africa, the US and Europe for decades before recognition in the late 1980s Wherever it started, it spread slowly at first, undetected, and then explosively among men, women and young children. It was only detected as it hit the medical technology of the United States, was misdiagnosed as an American gay curiosity, and only traced to its probable roots some two or three years later.

The difference between HIV-related diseases and other sexual epidemics is that HIV can infect you for years before you know it, and by the time you do it has spread to infect possibly hundreds of others.  The long "silent" delay between infection and death is why HIV is so dangerous - not the fact that it kills.  

The other difference is that once you develop full-blown AIDS---which can take many years---you face almost certain death, unless you die of something else in the meantime. As I say, there is no cure and no vaccine, nor is either anywhere in sight. There are many misleading reports but no good results, many very expensive and toxic treatments that help prolong life but no way to rid the body of infection.  However, some of these treatments can protect those who have recently been exposed, particularly the unborn or small babies.

A rapidly-spreading, silent killer which is difficult to detect, infectious and lethal causes panic. Radiation disasters are similar: you cannot hear, see, feel, or touch the enemy, nor feel the damage it is doing until too late---sometimes not for years. No wonder the Chernobyl nuclear reactor disaster in Russia caused such terrible pandemonium: false rumours, false scares, false cures, false hopes abounded. AIDS is the same today.

If a man had sex with a work colleague and three weeks later was dead, and that was repeated across the country, the impact would be dramatic. You would not need any health campaign because the coffins would be the campaign. But with HIV and AIDS the enormous time lag produces a credibility problem: the only people who really understand what is likely to hit us are the mathematicians. An invisible terror can be ignored.

If we have to wait tanother en years to see exactly what is happening, we will be too late.