The Prevention of Acquired Immunodeficiency Syndrome in The U.S.

(This is an Excerpt of a very EXTENSIVE and well documented report by

Donald P. Francis, MD, DSc, & James Chin, MD, MPH)

TRANSMISSION OF AIDS

"AIDS is one of the most viruent infectious agents ever encountered.

This virus, esitmated to kill up to half of those infected, has spread

to more than 1 million Americans. There is no safe and effective

treatment. Nor is there a vaccine.

AIDS has been isolated from fluids obtained from a variety of body

sites, including blood, semem, vaginal fluid, tears and saliva.

Epidomiologic studies have established that those fluids that provide

sufficent virus for transmission seem to be limited to blood, semen, and

vaginal secredtions. Presumably, the presence of lymphocytes in these

fluids increases the concentration of infectious virus and may be

important, or even essential, for transmission.

The exact risk of infection for a suspectible person having a single

sexual encounter with an infected partner is unknown. Yet there are

those who report having only one sexual encounter and have then

developed AIDS. In addition, a report from Australia that four of eight

women developed an infection after they were inseminated with semen from

an infected sperm donor, and a report of infection of a female

chimpanzee by intravaginal inoculation, suggest that a single encounter

with AIDS is sufficient in some situations to infect.

The major determinant of outcome of exposure appears to be the amount

of virus inoculated. Large inocula given in the form of transfused

blood almost universally result in infection.

A single episode of possible intrahousehold transmission between two

brothers has been reported.

Two out-of-hospital instances of AIDS transmission to individuals who

performed duties similar to hospital nurses.

PREVENTION OF TRANSMISSION

At the present time, there are no effective vaccines or

chemoprophylatic drugs for the prevention of AIDS infections. Likewise,

no effective treatment exists for AIDS infection once established.

Since there are no know animal or insect vectors and the virus is not

transmitted by the respiratory or fecal-oral route, prevention of AIDS

transmission must be directed at person-to-person spread via sexual,

blood-borne, and perinatal routes.

THERE IS NO RISK OF SEXUAL TRANSMISSION OF AIDS FOR THOSE WHO

PRACTICE SEXUAL ABSTINENCE. Furthermore, there is no risk of infection

if neither partner is infected. This would be the case for couples who

have been mutually monogamous since the introduction of AIDS in the

United States (presumably in the mid-1970's).

However, as with the use of condoms for pregnancy prevention,

failures can be expected, espically if the condoms are not used

consistently and continuously with all sexual partners.

Transmission among homosexual men appears to be due almost

exclusively to receptive anal intercourse. The prevalence of infection

in this group today is extermely high in most urban areas. Even with

profound decreases in the number of sexual partners, the risk of

infection in this community remains high because of the present high

chance that any single sexual partner is infectious.

Controversy has surrounded the issue of homosexual bathhouses. Any

setting that encourages unsafe sexual practices between individuals will

increase the transmission of AIDS. As such, those bathhouses that

encourage such practices adversly affect AIDS prevention.

The current risk of infection of a given heterosexual contact in the

United States is low, but infections and AIDS cases art certainly being

acquired by heterosexual contact. Logic would dictate that those

outside of mutually monogamous relationships who wish to minimize their

risk should limit their total number of partners and practice protective

sex all the the time.

Infection with this virus has potentially dire consequences;

therefore, sexual partners should carefully weigh the risks of

unprotected sexual encounters outside of mutually monogamous

relationships.

Prostitutes are a major source of infection in central Africa and

probably in some European countires.

INTRAVENOUS TRANSMISSION

The message for AIDS prevention is obvious: stop the use of IV drugs,

or, at a minimum, eliminate sharing of unsterilized injection

paraphernalia.

Intravenous drug abusers, if AIDS transmission persists, will likely

serve as a major entree of the virus into a segment of the heterosexual

community, most prominently in the urban poor communities.

The use of drugs in association with sexual practices is prevalent in

many communities, including the homosexual community.

OTHER DATA

Of surveys conducted 1985-1986, 72% of Homosexual men in STD clinics

in San Francisco are reported as having AIDS. 49% of Homosexual men in

San Francisco had AIDS, 59% of IV drug users surveyed in New York and

40% of the homosexuasls.

(For the sake of easier reading, AIDS was subsitiuted in-place of Human

immunodeficiency Virus (HIV) and inserted sub-headings)


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