AIDS Risk Likely to Stay Highest Among Gay Men

A substantial increase in AIDS in the heterosexual population is “inevitable,” but the greatest risk of the deadly disease is likely to remain among homosexual men, intravenous drug users and their steady sexual partners, according to the federal government’s top AIDS experts.

“The ‘straight’ community doesn’t perceive the risk to be as high--and it’s not,” said Dr. James Curran, chief of the AIDS task force for the federal Centers for Disease Control.

But, he added: “It doesn’t mean the heterosexual risk is nil. It’s just lower. It may always be lower. But it will increase from where it is now. Further heterosexual transmission is inevitable. The numbers are likely to increase in all groups.”

Even though the total number of heterosexual AIDS cases is rising, federal health officials, in a series of interviews this week, played down public perceptions that heterosexuals eventually will be as vulnerable to the fatal disease as known high-risk groups are now. Outside the United States, particularly in central Africa, the disease primarily afflicts heterosexuals.

“It is unlikely that other groups will catch up and transmit the virus as fast as gay men, because there are so few people infected in the heterosexual community,” Curran said. “It’s not going to spread like wildfire. It’s going to spread like it’s been spreading. But I don’t find that consoling.”

Dr. James Mason, acting assistant secretary of health and director of the CDC, said that researchers have found very few cases in which women are believed to have transmitted the disease to men, another factor that may inhibit the spread of AIDS among heterosexuals.

“We are looking at that very carefully because we are concerned with the central Africa experience,” he said. “I have asked local public health officials over and over again: ‘Do you have a case you positively know spread from a woman to a man from intimate relationships?’ I don’t get many ‘yes’ answers. There is no question this disease spreads from men to women. The question is: How frequently does it spread from women to men? If it has difficulty spreading from women to men, that will have some chilling effect on the spread of the disease.”

High-Risk Group

In addition, public health officials believe that increases of AIDS among heterosexuals are likely to appear first in lower socioeconomic areas, largely because of heterosexual contacts with intravenous drug users or prostitutes and the lack of stable sexual relationships.

Belle Glade, Fla., for example, with high poverty and a large number of intravenous drug users, has the greatest total of AIDS cases among those who are not in any known risk group: 20%, compared to less than 5% for the rest of the nation, according to the CDC. The majority of cases there are heterosexual.

“That is the closest you can get to the African situation,” said Dr. Walter Dowdle, director of the CDC’s Center for Infectious Diseases. “We shouldn’t think that what’s happening in Africa is going to happen here. We don’t necessarily have the same frequency of sexual contact they do elsewhere.

“My bet would be it’s not going to explode into the general population,” he added. “It’s inevitable that it will spread there, but I don’t see an explosion.”

AIDS, or acquired immune deficiency syndrome, destroys the body’s immune system, leaving its victims vulnerable to otherwise rare infections. Evidence indicates that it is transmitted through the exchange of bodily fluids, primarily through sexual relations or the exchange of unsterilized needles, and not through casual contact. Also, pregnant women who are infected can transmit the disease to their unborn children.

Although the cause of AIDS has been identified as a virus known as HTLV-III, there is no known cure, nor has there been an instance in which lost immunity has been regained.

In April, a blood-screening test that detects AIDS antibodies was instituted by the nation’s blood banks to halt the spread of the disease to those who receive transfusions and to hemophiliacs who receive blood products.

Although AIDS cases are still expected to appear within those groups during the next several years because of the disease’s long incubation period, the test is expected to prevent further infections through this route of transmission.

12,408 Known Cases

As of Monday, there had been a total of 12,408 cases of AIDS, with 6,212 deaths. Of these cases, 8,980 were among homosexual or bisexual males; 2,097 were among intravenous drug users; 261 were among hemophiliacs or were transfusion-related; 122 were among heterosexuals with known contact with an infected person or with someone in a high-risk group, 149 were among children and 799 were not among any known high-risk groups. The figures include 803 cases among women.

New York state and California have the highest numbers of cases, 4,433 and 2,833 respectively, followed by Florida, with 866. The CDC expects the cases to rise to an estimated 34,000 by the end of 1986.

“There are many unknowns with this disease, but it isn’t a mystery disease,” Mason said. “Most cases are due to an exchange of bodily fluids, or blood. If we could stop (intravenous) drug abusing, we could stop a significant amount of transmission. If we could stop the exchange of bodily fluids among members of the homosexual or bisexual community, we could stop this epidemic in its tracks.”

Yet Curran said that, although such behavior changes already have “unquestionably made a difference over what it would have been,” it does not mean that the numbers of people contracting AIDS have declined, “because the risk is greater.”

He added: “A gay man who has casual sex in 1985 has a greater risk of getting AIDS than he did in 1980--because more people are infected. Even though behavior has changed, it doesn’t mean the risk is lower. It’s higher.”