AIDS Alarm Bell

Perry Ellis, a fashion designer, dies at the age of 46, and the cause of death is announced as encephalitis. No one mentions AIDS--for fear that the knowledge that a designer was gay will harm future sales of his line of clothing.

This is no isolated case. In the last few years many relatively young, single men have died premature deaths. Some of them were prominent in the arts or other fields, and their deaths were noted in obituary articles, which listed cancer or pneumonia as the cause--if they said anything at all.

No one can blame the individuals or their families in these circumstances. The patient has suffered through a terrible illness that ended in an early death, and the families are understandably reluctant to make a public declaration of homosexuality on top of it. In fact, in deference to the sensibilities of AIDS patients and their families, at least some private physicians are not reporting all of the cases that they see. The Centers for Disease Control estimates that 20% of AIDS cases go unreported.

But this reticence has a social cost. The general public remains unaware of the full extent of the AIDS epidemic, blunting the sense of urgency and the political consensus needed to insist that the government do more to find a way to stop it. As of last week, the Centers for Disease Control had listed 21,726 cases of acquired immune deficiency syndrome, of whom 11,815 have died.

The actual figures are higher, perhaps much higher. Besides underreporting by doctors, there is also undercounting by the Centers for Disease Control itself, whose definition of reportable AIDS is narrower than the actual clinical cases that occur. Some patients die of so-called AIDS-related complex--or ARC--which is AIDS without one of the opportunistic diseases that the CDC requires. In truth, these are also AIDS deaths. The CDC estimates that there may be 8 to 10 cases of ARC for every case of AIDS, but the agency says that its "tighter" definition ensures uniformity of reporting throughout the country.

Any way you count it, the AIDS epidemic is spreading at an accelerating rate. "We have been unable to control the spread of infection in the homosexual population," said Lewis H. Kuller, professor of epidemiology at the University of Pittsburgh. "The mortality and morbidity of AIDS continue to increase."

Until a few months ago about 60 new cases a month were occurring in Los Angeles County. Since March, however, there have been more than 100 new cases a month. Nationally, the Public Health Service predicts that as the disease spreads beyond New York and California--its primary locations so far--it will cause 179,000 deaths by 1991, and will be more common among heterosexuals than it has been.

In the absence of a vaccine or any effective treatment, the only way to combat AIDS remains public education about the sexual practices and intravenous drug use that spread the disease. For every case of AIDS so far, there may be 100 cases of infection, mostly in people who don't know that they are infected and who may be transmitting it to others.

Stopping AIDS requires changing private behavior that is driven by deep biological urges--behavior that has enormous personal and social consequences. The government needs to spend whatever it takes to drive the message home to everyone in a high-risk group for AIDS: Behavior must be changed. This is a matter of life and death.

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