SCIENCE / MEDICINE : Americans Young and Old Play With Fire in the Age of AIDS
The much-touted reversal in the 1980s of the sexual revolution of the ‘60s and early ‘70s does not seem to have materialized.
Today AIDS is slowly spreading among heterosexuals, and other sexually transmitted diseases--gonorrhea, syphilis, chlamydia, herpes and papilloma virus, to name a few--have become major public health problems. Yet researchers are finding that heterosexual habits are changing slowly, if at all. And that means increased risk.
Something quite different is true of male homosexual habits. In the early 1980s as the bad news about a strange and deadly immune system disease began to make headlines, gay men responded with major changes in their behavior. In San Francisco, for example, America’s tragic center for the first onslaught of AIDS, rates of seropositivity for the virus among gays shot from 1% in 1978 to 65% in 1984. But in the mid-1980s it leveled off.
Why? Because the gay community slowed the epidemic almost to a standstill, by reducing their number of partners, using condoms, indulging less in anal sex, and staying away from bathhouses that encouraged casual promiscuity. The tragedy was that because they were hit first, these men were not aware of the threat soon enough and the result has been devastating mortality.
But what will be the excuse for the rest of us? It appears there isn’t one.
Take a study published in the New England Journal of Medicine in March, comparing the sexual habits of college women in 1989 with those of their counterparts in 1975 and 1986. Most in 1989 were aware of and worried about the threat of sexually transmitted diseases. Yet the proportion who were sexually active was the same in all three years (about 87%) as was the proportion who admitted to having more than one partner in the previous year (about 40%). The percentage who engaged in anal intercourse at least occasionally (roughly 8% to 10%) also did not change significantly.
Given that people are going to be sexually active from their youth, and that many are going to have multiple partners, what precautions are they taking? The encouraging news from this study was in the area of condom use: regular use climbed from 12% in 1975 to 21% in 1986 and then to 41% in 1989. This is an improvement, but it still leaves almost 60% of women unprotected. In addition, many of those who do use condoms report that they don’t always use them.
Other recent studies suggest that men and women frequently lie to their sex partners about their sexual history, including whether or not they have ever been infected with a sexually transmited disease and that promiscuity has not decreased appreciably in the last decade.
All these studies so far have been of adults, more or less. Studies of teen-agers are more unsettling. Half have begun sexual intercourse by age 16. Two-thirds of teen-age girls use no or ineffective contraception; only 15% use condoms. Bacteria such as chlamydia and the organism that causes gonorrhea are carried by small but significant minorities of teen-agers--including some who have no symptoms. And AIDS is beginning to make its way through their ranks, probably beginning with infected intravenous-drug abusers.
Needless to say, teen-agers can be expected to be about the last people to change their sex habits in the face of health threats--threats that must seem to them as remote as mortality itself.
For people of any age, not to respond to such threats is playing with fire. True, AIDS in America remains largely confined to select populations. But this need not and almost certainly will not last much longer.
Herpes, gonorrhea, chlamydia, syphilis and human papilloma virus--one probable cause of cervical cancer--are already carried by substantial minorities of heterosexuals, including asymptomatic ones. People who are sexually active, have multiple partners and lie or conceal the truth, while failing to use condoms, are a gift to these microorganisms. This, to these organisms, is a major ecological opportunity; they won’t let it pass by.
Meanwhile, certain recalcitrant and very ignorant politicians are standing squarely in the way of our getting the knowledge we need of America’s sex habits. A primary example is Rep. William E. Dannemeyer (R-Fullerton), who has publicly ridiculed efforts by the National Institutes of Health to begin a major new scientific survey of sexual behavior patterns, comparable to the Kinsey surveys of the 1940s.
Such a survey is crucial to our understanding of how AIDS and other sexually transmitted diseases will spread through our population in the future. Opponents of such research will bear a heavy burden of responsibility for excess illness and death that might have been prevented if we only knew more.
