AIDS: Bad Advice
The difficulty of striking an appropriate balance between prudence and panic in containing the AIDS pandemic was well illustrated this week with the release of a book by two noted researchers in the field of sexuality. They have sounded an alarm concerning the spread of the disease through the heterosexual population that suggests dangers that are far greater than any identified by most public-health officials or those already engaged in research.
Dr. William H. Masters and Virginia E. Johnson have been joined by Dr. Robert C. Kolodny in preparing the new report, “CRISIS: Heterosexual Behavior in the Age of AIDS.” Together they argue that “the AIDS virus is running rampant in the heterosexual community” and that “the odds are that the rate of spread among heterosexuals will now begin to escalate at a frightening pace.” The only protection, they argue, is abstinence, monogamous relationships or the testing of sexual partners over long periods to be sure that there is no infection before engaging in sexual intercourse.
Their conclusions contrast most conspicuously with the views of Dr. Robert E. Gould, clinical professor of psychiatry, obstetrics and gynecology at New York Medical College, published in the January issue of Cosmopolitan magazine. He argued that women “in all probability” will not be infected, even in a relationship with an infected man, “unless you engage in anal sex or there is an open lesion in the vagina when you are having vaginal intercourse.”
The Masters-Johnson-Kolodny book at least has the virtue of focusing the attention of the nation on the risks of the deadly disease beyond the homosexual and intravenous-drug populations, in which more than 90% of the AIDS cases in the United States have been reported. The three are right in emphasizing that there is no such thing as safe sex outside a monogamous relationship, and in underscoring what can be done to make promiscuous sex safer.
But they are not persuasive when they charge “benevolent deception” by those who are already engaged in the efforts to control the disease. The Centers for Disease Control have been extraordinarily successful in tracking and projecting the spread of the disease. On the basis of their own study of 848 persons, the authors assert that “authorities are greatly underestimating the number of people infected” and that “experts generally are gravely underestimating the degree to which the AIDS virus has spread into the heterosexual community.” But they offer no scientific base for their own projections that they mask with such words as “quite likely” and “probably.” Gould also dismisses the work of the public-health professionals when he argues that “there is almost no danger of contracting AIDS through ordinary sexual intercourse.”
There is a disservice in understatement as well as in exaggeration. That is why both the article by Gould and the Masters-Johnson-Kolodny book have drawn sharp criticism from leading public-health officials. Their diverse challenges to the efforts to control the spread of AIDS can only confuse the public and make the campaign to contain the disease more difficult. Gould invites complacency and promiscuity-as-usual. Masters-Johnson-Kolodny raise the risk of wasteful diversions of funds by suggesting unproved risks and proposing the counterproductive remedy of massive mandatory testing.
Masters-Johnson-Kolodny are, like most researchers who are engaged in this terrible problem, surprised at the resistance to behavior modifications of people at risk. Gould has encouraged that resistance. Yet there is widespread evidence that, even among the highest-risk populations, many continue to engage in the most dangerous activities, like anal sexual intercourse, and to ignore the limited but important protection that condoms provide in vaginal sexual intercourse. Perhaps Johnson and Masters had hoped to shock the population into adopting safer sexual practices with their awesome figures. But their failure to substantiate their claims is as likely to cloud efforts to control the disease as is Gould’s reckless encouragement to deny the risks.
