Findings on ‘Silent’ AIDS Met With Shock and Uncertainty
Reports of the apparent fallibility of the standard AIDS test--to which millions of Americans have turned for reassurance that they are not infected with the deadly virus--shocked many around the country Thursday and brought new uncertainty to an already baffling epidemic.
Experts and others said they were stunned and disheartened by reports of a new UCLA study of gay men who had engaged in high-risk sex. The study found that nearly one-quarter had carried the virus for up to three years without showing up in the standard antibody test for acquired immune deficiency syndrome.
“I find this probably the most depressing piece of news in the last two years of this epidemic,” said Dr. Neil Schram, an AIDS specialist in Los Angeles. “The scope of the infection within the gay male community may be significantly higher than we are assuming.”
“It’s another incredibly discouraging piece of news,” said Torie Osborn, executive director of the Los Angeles Gay and Lesbian Community Services Center. “The battle is hard enough without fighting enemies you can’t test for.”
AIDS telephone hot lines rang off the hook from Los Angeles to New York City, but there was little agreement on the study’s implications. Some said it underscored the limited value of the standard test while others said it underscored the need for repeated testing.
There was also some skepticism toward the findings within the gay community and among specialists. Wary of the ever-changing quality of information about the deadly disease, some said they had learned to approach all such news with caution.
“One of the big issues for everyone is how much contradictory information (there is) and how many grim statistics and how many new ‘cures,’ ” said Ed Wolf, a 40-year-old gay man in San Francisco who tested negative three years ago.
“I try to take each piece of news and just witness it, and not take the ball and run with it,” he said. “It’s hard enough dealing with the day-to-day realities of how (it) affects all our lives, rather than go through the personal Rolodex (every time) and move things around.”
The study, published Thursday in the New England Journal of Medicine, involved 133 gay men who, according to the standard AIDS test, were not infected. But using more sophisticated tests, not widely available, the researchers found that 31 of the men were in fact infected with the virus.
The study involved only men with an unusually high risk of infection--men who had repeatedly engaged in unprotected anal intercourse. The “silent infection” rate is likely to be much lower among other groups and among people who practice safer sex, experts said.
Other studies of silent infection have reached different conclusions, some researchers noted. For example, the U.S. Centers for Disease Control found no convincing evidence of silent infections among heterosexual partners of people infected with the virus.
“We still have to see if this particular finding really can be extended to general populations,” said Dr. Martin Finn, medical director of Los Angeles County’s AIDS program office. Finn said it is impossible so far “to say what its total implication is.”
From New York City to Los Angeles, callers flooded AIDS telephone hot lines with questions about how to react to the news. Most of the calls came from people who had tested negative on the antibody test but suddenly found themselves doubting those results.
Standard Response
At the New York City Department of Health Services, operators emphasized the study’s limitations and the need for further research. It is not yet known, they said, whether people silently infected can spread the virus through sex.
But they also advised anxious callers to consider asking their physicians about receiving other tests, such as various immune-system tests. The tests used in the UCLA study are expensive, experimental and not yet available for widespread use.
At the Gay Men’s Health Crisis, a large AIDS service agency in New York City, hot line operators reiterated the importance of so-called safe sex--that is, the use of condoms during intercourse and the avoiding of any exchange of blood, semen and vaginal fluids.
“Safe sex means not engaging in any practices that could transmit the virus. Period,” said Jeff Levi, executive director of the National Gay and Lesbian Task Force. “And some of us did not have the same faith in (testing) technology that others did.”
Among gay men, the study brought a new and unsettling uncertainty.
Paul Causey, a 39-year-old gay man in San Francisco who has tested negative, said he was disturbed but not surprised by the findings. Similar but less dramatic findings have filtered out from other research projects over the last year.
May Be Retested
“We don’t know what the negative test means; this is just further proof of that,” said Causey, who is considering being retested. “It’s just another indicator, though emotionally it’s used for a lot more than that.”
Causey, who has participated in a support group for gay men who tested negative, predicted that some members of the group would “totally freak out.” He said many men feel guilt and confusion that they were somehow spared; they will now believe the test was simply wrong.
Men who have tested positive also expressed alarm.
“It’s an incredible thing to think about,” said Pierre Ludington, who is infected. “If they’re finding this many at this time, how many happened before this? How many will happen after this? What’s the next test that we are going to come up with?”
