Heterosexual AIDS

[brazil84]

@LinusK

In case it’s not clear, my position is it’s virtually impossible to get AIDS from ordinary, vaginal intercourse. When I used to tell people that, they’d look at me like I was a Moonie, or a space alien. Am I still wacko?

No, I don’t think you are a whacko. But it does seem likely that fear of AIDS has done a lot to prevent the spread of AIDS.

Why is Africa different from the US? That could be the subject of 100 debate threads. But Africa is different in a lot of ways.

[Cervaise]

Somewhat relevant older thread in which the ways cultural differences lead to different infection rates are discussed.

[susan]

Note the jump in “known deaths in the US” from AIDS between 1988 and 1989 - 4,855 in '88 to 14,544 in '89. Change in record keeping, or does the virus have some sort of 9 year life cycle?

I’m assuming that’s when CDC changed the criteria–before thayt, lots of women were dying with “HIV” but never meeting criteria for “AIDS.”

[MerryMagdalen]

@spoke-

One thing that always puzzled me was why AIDS seemed to be mostly a problem for homosexual men in the US, but seemed to be transmitted heterosexually in Africa.

In addition to what other people have said:

*Not all AIDS in Africa is spread by sex. There is a huge problem with reusing needles. In The Coming Plague, Laurie Garrett talks about a class of people called “injectionists”: when antibiotics came to Africa they were injection-only. So in some people’s minds, injection=good health, and there are people who will inject “medicine” into their “patients” for a variety of ills - including AIDS. And then those needles get reused on other people.

*Most men in Africa are not circumcised, and that may increase their ability to get AIDS through heterosexual sex. cite

[LinusK]

So you’re saying that if an attractive woman came up to you and told you that she’d sleep with you, but you should know that she had AIDS, you’d really do it?

There’s problems with your hypothetical, including the fact I’m married.

But if my wife was HIV+ (say, from a blood transfusion), I would still sleep with her.

So my answer is ‘yes’.

So all those people in Africa, all gay?

JThunder posted one of the problems with African AIDS statistics - AIDS is diagnosed differently Africa. Instead of an HIV test, the “Bangui definition” is used. So, for example, someone with diarrhea, weight loss, asthenia (a feeling of weakness), and a cough could be diagnosed with AIDS.

There are other issues that are particular to Africa, as well, including reusing needles, and the fact that ‘boring’ diseases, like diarrhea and tuberculosis, attract less foreign aid than sexy diseases, like AIDS.

The numbers ultimately boil down to an estimated 5,208 new infections in 2006 (in men) as a result of heterosexual intercourse. An estimated 18,000 new infections from male-male sexual contact and an estimate 5,000 new infections from intravenous drug use.

Part of the problem with the five thousand men who say they got HIV from women is the Magic Johnson effect - given a choice between admitting to being a junkie, or a ‘fag,’ many men are going to say they got it from a woman, instead. That’s particularly true if the men come from a culture that’s distrustful of authority, and disdainful of homosexuals.

I’m not challenging this, but it just sounds very odd. There is a clinic that tests for HIV, but denies all patients who are high risk? Who are they testing then? Nuns?

You could get tested, as long as you refrained from admitting to high-risk behavior.

Is it because they didn’t want to spend money on the state-madatory councilling?

Yes.

That sounds stupid too.

I agree. To me it was a good example of the law of unintended consequences. Somebody in the state legislature decided it would be a good idea for HIV+ people to get counseling, so they passed a law. The free clinic didn’t have the money to hire a bunch of counselors, so they stopped testing high-risk patients, instead.

LinusK–here’s a simple test: phone your old friend from college.

She as eventually tested, and she was negative.

HIV needs direct access to the bloodstream. It’s not enough to get it on your skin. That’s why needles make such an excellent transmission vector - they inject the virus directly into the blood.

Receptive anal intercourse is also a good transmission route, because it often (I’m told) causes tears inside the rectum.

Vaginal intercourse, on the other hand, doesn’t cause cuts or tears on either the penis or inside the vagina, under ordinary circumstances. Which is why it’s not a good way to transmit AIDS.

It’s possible the predicted explosion of heterosexual AIDS failed because heterosexuals were scared, and changed their behaviors. My own personal observation is that lots heterosexuals still have unsafe sex. And abortion data seems to bear that observation out. As of 2004, half of all pregnancies were still unintended - a total of 3.1 million unplanned pregnancies that year.

It would be a good thing to convince heterosexuals to have safer sex. But scaring them with AIDS is a poor way to go about it.

[MerryMagdalen]

LinusK one of the things you’re missing (which someone alluded to upthread) is there are major socioeconomic and cultural factors at work in Africa that make spreading AIDS there easier.

First, as I said, lack of healthcare infrastructure. The clinics may not always be able to do an ELISA test for every suspected case of AIDS, but with 40% seropositivity in some areas, people presenting with certain symptoms, who have also had sexual contacts presenting with same, are very likely to have HIV. Also, as I said above, healthcare supplies are abysmal in many areas - remember, Africa also has a huge amount of malaria. In children, malaria (and the sickle cell that sometimes prevents it) can cause anemic crisis in children. Needles and tubing are reused to help prevent kids from dying right now even though it may be dangerous in the long run. Clean needles are hard to find in general, and people outside standard healthcare structures reuse needles on hundreds of people, giving them traditional medicines.

Also, because of the wartorn nature of the continent right now, many men die. This forces women to live as prostitutes - they move in from the country to the city and make their money however they can. Men also come to the city during the week to work, and then go back to their wives on the weekends. Many procure the services of prostitutes.

Finally, there is the phenomenon of “dry sex” which is much more dangerous for both women and men, as it increases the number of microscopic tears in the vagina and on the penis, giving more chance for HIV to spread. Given that it seems that the cells under the foreskin seem to be more receptive to HIV, and given that most men in Southern and Eastern Africa are uncircumcised, they are more apt to catch the disease, even female to male.

Here is a bit about dry sex:

What he likes best is dry sex. In parts of sub-Saharan Africa, to please men, women sit in basins of bleach or saltwater or stuff astringent herbs, tobacco or fertilizer inside their vagina. The tissue of the lining swells up and natural lubricants dry out. The resulting dry sex is painful and dangerous for women. The drying agents suppress natural bacteria, and friction easily lacerates the tender walls of the vagina. Dry sex increases the risk of HIV infection for women, already two times as likely as men to contract the virus from a single encounter. The women, adds Chikoka, can charge more for dry sex, 50 or 60 rands ($6.46 to $7.75), enough to pay a child’s school fees or to eat for a week

Combine a large pool of seropositivity with a bunch of men more at risk for the disease due to being uncircumcised and patronising prostitutes regularly and a bunch of women more able to spread it due to being prostitutes and/or deliberately drying their vaginal canals (and leaving out the fact that the healthcare system is overwhelmed)…heterosexual AIDS is for real. Maybe not as much in the US, but it is very much for real.

Here is another article about dry sex, from the Lancet, in case Time is not considered scientific enough. And I understand that Africa is a huge continent, with many different cultural and sexual practices, and that not all people practice all things anywhere in the world. Africa for some of the reasons I’ve mentioned seems to have the “perfect storm” of heterosexual AIDS.

[WhyNot]

@LinusK

Vaginal intercourse, on the other hand, doesn’t cause cuts or tears on either the penis or inside the vagina, under ordinary circumstances. Which is why it’s not a good way to transmit AIDS.

I absolutely agree that it’s less likely to cause cuts or tears, and that it’s less likely to transmit AIDS than other riskier behaviors, but I don’t agree with the absolutist sounding “doesn’t” in this sentence. I’ve had some bad chafing and small cuts on my inner labia and in the vagina from boring old “ordinary” vanilla sex, especially if my partner has stamina, or if it’s a Sex Weekend with repeated bouts of intercourse within a short time frame. (Gawd, Sex Weekends are great, aren’t they? Until you go pee afterwards and the BURN! Well, that burn is urine making its way into dozens of microscopic tears and cuts. Maybe it’s a chick thing. Ask your wife.)

[LinusK]

@MerryMagdalen

LinusK one of the things you’re missing (which someone alluded to upthread) is there are major socioeconomic and cultural factors at work in Africa that make spreading AIDS there easier.

First, as I said, lack of healthcare infrastructure. The clinics may not always be able to do an ELISA test for every suspected case of AIDS, but with 40% seropositivity in some areas, people presenting with certain symptoms, who have also had sexual contacts presenting with same, are very likely to have HIV. Also, as I said above, healthcare supplies are abysmal in many areas - remember, Africa also has a huge amount of malaria. In children, malaria (and the sickle cell that sometimes prevents it) can cause anemic crisis in children. Needles and tubing are reused to help prevent kids from dying right now even though it may be dangerous in the long run. Clean needles are hard to find in general, and people outside standard healthcare structures reuse needles on hundreds of people, giving them traditional medicines.

Also, because of the wartorn nature of the continent right now, many men die. This forces women to live as prostitutes - they move in from the country to the city and make their money however they can. Men also come to the city during the week to work, and then go back to their wives on the weekends. Many procure the services of prostitutes.

Finally, there is the phenomenon of “dry sex” which is much more dangerous for both women and men, as it increases the number of microscopic tears in the vagina and on the penis, giving more chance for HIV to spread. Given that it seems that the cells under the foreskin seem to be more receptive to HIV, and given that most men in Southern and Eastern Africa are uncircumcised, they are more apt to catch the disease, even female to male.

Here is a bit about dry sex:

Combine a large pool of seropositivity with a bunch of men more at risk for the disease due to being uncircumcised and patronising prostitutes regularly and a bunch of women more able to spread it due to being prostitutes and/or deliberately drying their vaginal canals (and leaving out the fact that the healthcare system is overwhelmed)…heterosexual AIDS is for real. Maybe not as much in the US, but it is very much for real.

Here is another article about dry sex, from the Lancet, in case Time is not considered scientific enough. And I understand that Africa is a huge continent, with many different cultural and sexual practices, and that not all people practice all things anywhere in the world. Africa for some of the reasons I’ve mentioned seems to have the “perfect storm” of heterosexual AIDS.

There’s also female circumcision, or mutilation:

There are three main types of circumcision:

* The removal of the tip of the clitoris;
* Total removal of the clitoris and surrounding labia;
* The removal of the clitoris and labia and the sewing up of the vagina, leaving only a small opening for urine and menstrual blood - a process known as infibulation.

So drastic is the mutilation involved in the latter operation that young brides have to be cut open to allow penetration on their wedding night and are customarily sewn up afterwards.

BBC

And systematic, violent rape:

It had been no secret that nearly all sides in the Congo’s complex civil war resorted to systematic rape among civilian populations, and estimates were as high as a quarter million victims of sexual assault during the four-year-long conflict. But once fighting died down, victims began coming out of the jungles and forests and their condition was worse than anyone had imagined. Thousands of women had been raped so brutally that they had fistulas. They wandered into hospitals soaked in their own urine and feces, rendered incontinent by their injuries…

Ordinary rapes, even violent ones, do not usually cause fistulas, although it’s not medically impossible. Doctors in eastern Congo say they have seen cases that resulted from gang rapes where large numbers of militiamen repeatedly forced themselves on the victim. But more often the damage is caused by the deliberate introduction of objects into the victim’s vagina when the rape itself is over. The objects might be sticks or pipes. Or gun barrels. In many cases the attackers shoot the victim in the vagina at point-blank range after they have finished raping her. “Often they’ll do this carefully to make sure the woman does not die,” says Dr. Denis Mukwege, medical director of Panzi Hospital. “The perpetrators are trying to make the damage as bad as they can, to use it as a kind of weapon of war, a kind of terrorism.”

Newsweek

[LinusK]

@WhyNot

I absolutely agree that it’s less likely to cause cuts or tears, and that it’s less likely to transmit AIDS than other riskier behaviors, but I don’t agree with the absolutist sounding “doesn’t” in this sentence.

Well, the CDC says about 8000 women contract HIV through sex with men.

An unknown number of them may have gotten it from anal sex - the CDC, so far as I know, doesn’t track that information. Some of them may have also had another risk factor - like illegal IV drug use - but were unwilling to admit it to the CDC.

But in a population of 300 million, even 8000 is a small number.

You’re right, though, that cuts or wounds inside the vagina would increase the risk of transmission, assuming your partner was HIV+.

[saoirse]

@JThunder

Colorectal cancer claims a lot more deaths – over 57,000 per year, which means that its mortality rate is more than twice that of AIDS. It’s also a lot harder to prevent than HIV infection. Still, we don’t hear any clamor about a “colorectal cancer crisis.” Lung and breast cancer have even higher death tolls. Those are just specific varieties of cancer, mind you; the total death toll from cancer blows that of AIDS away.

While that’s true, it’s not the only test you would use to prioritize funding. Compare the number of cancer deaths each year from 1978-1998 to AIDS deaths over the same period.

[Tastes_of_Chocolate]

@LinusK

In case it’s not clear, my position is it’s virtually impossible to get AIDS from ordinary, vaginal intercourse. When I used to tell people that, they’d look at me like I was a Moonie, or a space alien. Am I still wacko?

A month ago, I stood in front of a table containing biographies of about a dozen kids in Tanzania, who had lost their parents to AIDS and need help with education. I know the people behind this drive. I’ve known them for 25 years. These are real cases.

From Tanzania’s official website.

HIV infection is unevenly distributed across geographic area, gender, age, groups and social economic classes in the country. The percentage of the population infected by HIV ranges from less than three percent across most of the country to more than 44.4 percent in certain sub populations. The epidemic has struck more the most economically active group of adults, those aged 15-45.

The youth and the women have been the most affected groups because of economic, social-cultural, biological and anatomical reasons. Hence, poverty, which reflects the country’s economy, is an important determinant. Mobile population groups have also been categorised as vulnerable to HIV infection as their occupation forces them into high-risk sexual behaviour. The mobile population groups include commercial sex workers, petty traders, migrant workers, military personnel and long distance truck drivers.

From Unicef
Esimated number of orphaned children, 0-17years of, due to AIDS: 1.1 million

And from UNADS (Joint United Nations Programme on HIV/AIDS)

AN estimated 1.4million (1.3 million-1.6million) adults and children were living with HIV in the United Republic of Tanzania at the end of 2005

These are numbers from just on country. It is NOT virtually impossible to get AIDS from ordinary, vaginal intercourse. It is tragically possible.

[pendgwen]

While studying immunology this afternoon I learned that there are 2 variants of HIV. HIV-1 is the predominant variant. HIV-2 is found mainly in Africa and is more readily transmitted heterosexually than HIV-1. So this apparently contributes to the perfect storm of heterosexual AIDS transmission in Africa.

[JThunder]

@saoirse

While that’s true, it’s not the only test you would use to prioritize funding. Compare the number of cancer deaths each year from 1978-1998 to AIDS deaths over the same period.

I’m not sure what your point is. I already pointed out that colorectal cancer alone kills more people per year than AIDS does, and that both lung and breast cancer kill even more. Why would “the number of cancer deaths each year from 1978-1998 to AIDS deaths over the same period” be a more significant metric? If anything, I’d point out that those figures are outdated, and that the more recent statistics are more relevant.

Besides, I wasn’t talking about funding – at least, not specifically. I was talking about the claim that AIDS should be declared a crisis due to the number of deaths that it produces. Why is there no similar demand that colorectal cancer be considered a crisis, even though it is much harder to prevent? Even though it kills more than twice as many people per year?

[WhyNot]

@JThunder

Why is there no similar demand that colorectal cancer be considered a crisis, even though it is much harder to prevent? Even though it kills more than twice as many people per year?

Who says there isn’t? There are over 8 million google hits for the phrase cancer crisis.

And, as mentioned previously upthread somewhere, the very fact that HIV is so preventable means that dollars, time and energy spent to prevent it actually do more good than they would addressing an illness which is difficult to prevent.

[saoirse]

@JThunder

Besides, I wasn’t talking about funding – at least, not specifically. I was talking about the claim that AIDS should be declared a crisis due to the number of deaths that it produces.

That’s a claim that no one is making but you, though.

[JThunder]

[

@WhyNot

Who says there isn’t? There are over 8 million google hits for the phrase cancer crisis.

Look closely at the first three pages of those Google hits. Almost invariably, those hits refer to a worldwide cancer crisis or a crisis outside the USA (especially in Africa and various developing countries). Others refer to personal cancer crises, which are obviously a different matter. In contrast, your post was talking about a crisis within the USA population alone. I don’t think we can use those Google hits to conclude that there’s any widespread clamor to consider colorectal cancer – or even cancer in general – to be a “crisis” within the USA.

Heck, just listen to the media. AIDS gets vastly more attention, even though cancer claims many times more lives. As I said, I’m not trying to diminish the tragedy of AIDS, but it’s unfor

And, as mentioned previously upthread somewhere, the very fact that HIV is so preventable means that dollars, time and energy spent to prevent it actually do more good than they would addressing an illness which is difficult to prevent.

I don’t think that logically follows, but even if it did, it’s not the point I was addressing. Nowhere did I say that we need to reduce funding for curative AIDS research or maintain funding for its prevention. I’m merely pointing out that we are quick to declare it a crisis, even though there are diseases that claim many more lives and gather far less attention. As far as I’m concerned, the question of funding is a separate issue altogether.

[JThunder]

@saoirse

That’s a claim that no one is making but you, though.

Absolutely true. In fact, I specifically quoted post #17, which said,

“… still think that over half a million people dead over 20 years from AIDS in the US counts as a ‘crisis’, even if it could have been worse.”
To say that I’m the one making this claim is simply and absolutely inaccurate.

[bbs2k]

Hello?

[saoirse]

@JThunder

Absolutely true. In fact, I specifically quoted post #17, which said,

“… still think that over half a million people dead over 20 years from AIDS in the US counts as a ‘crisis’, even if it could have been worse.”
To say that I’m the one making this claim is simply and absolutely inaccurate.

Well then I was wrong about that. I would simply offer that 500,000 people dying from a communicable disease with a seven-years incubation period constitutes a crisis.

[JThunder]

@saoirse

Well then I was wrong about that. I would simply offer that 500,000 people dying from a communicable disease with a seven-years incubation period constitutes a crisis.

For my part, I’ll say that the line between “crisis” and “non-crisis” is a fuzzy boundary – and that this label is often applied emotionally, rather than objectively. In evaluating whether any particular disease constitutes a crisis, it makes sense to consider (a) ease of transmissibility, (b) ease of prevention, and (c) how the death toll of this affliction compars to those of diseases that have traditionally merited the label of crisis or not. This is especially true when it comes to politically loaded issues, as emotional fervor often obscures sound judgment.