A good many Americans no doubt thought that they had nothing to fear when the AIDS epidemic began its lethal spread across the nation. Even today the diagnosis of AIDS continues to be made quite disproportionately among male homosexuals (73%), blacks (25%) and drug addicts (17%). The AIDS virus, however, is neither sexist nor racist, and is quite amoral.
In Africa as many women as men are infected, and most of the spread is by heterosexual intercourse, with more than 30% of the general population of some cities already showing antibodies to the virus. Could this happen here? Of course it could--and it will unless we find some other way to stop the spread of infection than pious maunderings about "safe sex."
Since the beginning of the epidemic, the virus has been consistently underestimated by public health authorities.
Anal intercourse and blood mixing were said to be the only ways of spreading infection; they are not--rather, this was only the way in which the first American populations became infected with the virus. Heterosexual intercourse is now spreading the disease just as efficiently, possibly more so, and will eventually become the major route of contagion unless it turns out that "casual contact" can spread the virus when enough people are infected. This is a possibility that we simply cannot judge yet, though--and this cannot be overemphasized--we already know of casual contact that led to infection. (The British journal Lancet has reported the case of an elderly man who became impotent after a prostate operation. He was believed to have received AIDS from a blood transfusion; his wife had no other risk factors. Researchers say that she was infected, although the couple had no sexual contact other than kissing.)
Those who were infected earliest with the virus are now showing high rates of full-blown AIDS--up to about 40%. And there is no sign that the trend is decreasing. Those infected must be assumed to be infectious. Antibody production is a sign of infection, not merely exposure. It is the long latency between infection and disease that has obscured public perception of the threat posed by the AIDS virus and that has led to the overemphasis on members of the first risk groups.
During the Second International Conference on AIDS, held last month in Paris, Dr. James D. Curran, head of the AIDS task force at the U.S. Centers for Disease Control, made a public apology for underestimating the seriousness of the epidemic. Curran said that with prompt action two or three years ago, rather than wishful thinking, it would have been much easier to reduce the spread of infection.
Curran's apology pleased scientists who have long argued that AIDS is too deadly to allow the disease to spread further than can be avoided. But finding the right solution is difficult; the issue has become politicized since the perceived rights of a few were incorrectly believed to supersede the duty of the state to prevent the spread of the disease among its citizens.
Now California supporters of Lyndon H. LaRouche Jr. have managed to qualify an initiative for the November ballot that, if passed, would ban infected people from employment in restaurants and schools and might make testing and quarantining of those infected more likely. More initiatives of this sort will occur in other states unless the public can see clearly that public health authorities have come to grips with the AIDS epidemic.
But hasty, piecemeal legislation is dangerous in that it will probably be in-effective and unenforceable. States already have wide powers, including quarantine and detention, to deal with public health matters. Many more questions need to be answered, however, before such measures are applied ad hoc.
One thing that should be applauded is the Justice Department's opinion concerning discriminination toward AIDS victims. The opinion, written by Assistant Atty. Gen. Charles J. Cooper, separates the disabling affects of full-blown AIDS from the communicable nature of the virus. Thus, disabilities suffered by AIDS victims as a result of earlier infections with the AIDS virus are covered by Section 504 of the Rehabilitation Act of 1973, which bars discrimination against the handicapped. Those who are seropositive (infected with the virus) and, to a lesser extent, those classified as having AIDS-related complex are generally not disabled and thus not protected under Section 504. This has been interpreted to mean that employers can fire infected workers because they believe that those employees could be spreading the AIDS virus in the workplace.
Cooper believes that it was not the intent of Congress either to prevent an employer from using his own judgment in assessing the dangers of infection in the workplace or to preempt the wide statutory powers given to federal, state and local bodies for preventing the spread of disease. Thus his opinion is, as it should be, an interpretation of existing law, not a call for changes in social policy. An employer who fires a seropositive employee can still be made to justify his action, although the onus of proving that his presence is not a danger to the rest of his employer's work force has shifted toward the employee. Since we do not know how large the risk of infection by casual contact is, it would be premature to define it by statute.