‘Magic Bullets’ and Deadly Taboos : What We Don’t Want to Know of Sexual Behavior May Kill Us
Tom Hayden (D-Santa Monica) is the chairman of the Assembly subcommittee on higher education. He recently held six months of hearings on the University of California’s role in combating AIDS. The nation’s battle against acquired immune deficiency syndrome appears to be gaining momentum. There is a kinder, gentler attitude in the White House. The federal AIDS budget is $1.23 billion. Research funding has increased tenfold since the early 1980s, and thousands of articles on AIDS appeared in scholarly journals last year alone.
But is the effort pointed in the right direction? Is there light at the end of the tunnel?
The official war on AIDS has an eerie resemblance to the war on cancer of the 1970s. In that era, the Nixon Administration launched a $5-billion effort to eradicate cancer through research. A decade later, while there were significant advances in treatments, no “magic bullet” cure was discovered. Our toxic life style was not curbed. Cancer has remained the symptomatic disease of the petrochemical and tobacco advertising age.
With AIDS, the saga is similar. At the University of California, which receives nearly 20% of federal dollars allocated for AIDS research and treats one-third of the AIDS patients in the state, there is the same goal of finding a “magic bullet.” Yet experts say there is no cure and no vaccine in sight. New drug treatments that offer hope of delaying the progression of the disease are slow in reaching the market and every effort must be made to speed their availability. But the only effective strategy for containing the spread of AIDS--education aimed at behavioral change--receives the least research attention.
Of the $29 million that the UC task force on AIDS has awarded in grants since 1983, 14.3% has gone to behavioral research on high-risk groups, mostly in the past year. Of the 1989-90 grants, only 8 of 90 are prevention-oriented. Only 2%--a scant $24 million--of the federal budget is devoted to similar purposes. These priorities are beginning to change, but slowly.
Little is more sacred than public belief in scientific cures and nothing is more urgent to the estimated 300,000 Californians infected with human immunodeficiency virus (HIV). Viral diseases such as polio have been cured or controlled in previous decades. UC research on viral behavior may contribute eventually to an AIDS cure. The drug pentamidine, which is effective against pneumonia in AIDS patients, can be taken through an aerosol spray that was developed largely by UC clinical research.
Yet behavioral change remains the only sure means of prevention. The rate of infection among white, gay males in San Francisco has dropped from an 18% rate of increase annually to less than 2% as the community has adjusted its life style.
But our cultural aversion to knowing about sexual behavior hinders our very ability to predict the extent and spread of AIDS. Our estimates of the numbers infected with HIV are based on Kinsey studies of homosexual encounters from over 40 years ago. Similarly, there is a lack of current information about the numbers of heterosexuals practicing non-monogamous sex.
The federal government is hung up over whether to contract for a new survey that the Chronicle of Higher Education has called the “first truly representative poll” into American sexual behavior. Though endorsed by the President’s Commission on AIDS, the research project was criticized by U.S. budget director Richard Darman for asking “inappropriate questions” and by know-nothing, right-wing lobbyists who argue that anal intercourse will be legitimized if we survey how many Americans engage in it!
Serious research would not only track the sexual behavior of Americans on a regular basis, it also would urgently seek to understand ways to reverse the mentalities that spread AIDS and pierce the ignorance affecting policy makers.
Among the factors that need further examination:
--A surprising number of American teen-agers are becoming infected with the AIDS virus during early adolescence. In addition, only 27% of sexually active college students use condoms and 33% never do. How can the “illusion of immortality” so basic to youth be altered?
--Racial minorities are experiencing a rising rate of infection, yet there is little or no research on effective prevention strategies for a variety of subcultures ranging from Caribbean blacks to Chicanos to Filipino-Americans. Instead, minorities tend to be lumped together--when they are studied at all.
--Bisexual men play an important role in the transmission of HIV, yet are difficult to reach with prevention information since they may not participate in educational programs of the gay community.
--Intravenous drug users, while not yet as widely infected here as in New York, are clearly at the center of the next wave of AIDS. Yet little is known about the culture of needle-sharers who during the past three years have shifted from heroin to cocaine use (although some significant research money is now being spent on the subject of IV drug users).
The search for a cure and effective treatment must continue. In the meantime, the AIDS epidemic can only be contained by education. But a public education strategy that depends on rational “safe sex” awareness modeled after the organized, highly educated and resourceful gay community makes little sense for the disadvantaged, the young, the uneducated or those drawn by impulse into high-risk behaviors. We need to investigate the taboo, the secret and the self-destructive in ourselves if we are to have any chance of conquering or channeling those impulses away from their fatal expression in AIDS.
