The Changing Face of AIDS : To Avoid Risk, You Need Facts


People have inadvertently been misled into thinking that AIDS won't happen to them unless they are gay or drug users. That may have been true of the first wave of AIDS, experts say, but we are now experiencing a second wave of HIV infections, transmitted through heterosexual contact.

"I have a whole lot of patients to prove it can happen," says Dr. Marki Knox, Santa Monica gynecologist. "These people are no different from you or me. They lead what anyone would consider low-risk, conventional lives. They just had bad luck that turned up in the form of a date. For most, it was a single sexual contact that got them infected."

Official statistics show that heterosexual contact is the most rapidly rising form of HIV transmission, says Dr. Jeffrey Laurence, director for AIDS research at New York Hospital/Cornell Medical Center and medical consultant to the American Foundation for AIDS Research.

And even those statistics from the Centers for Disease Control and Prevention show a misleadingly low number, Laurence says, because they are 10 years behind the times. It takes an average of eight to 11 years after infection for symptoms to show up, he says, so the CDC numbers reflect infections acquired a decade ago--when most people who now have AIDS were in their teens and 20s.

Experts say we need to be better informed about how the disease is transmitted so we can understand and avoid the risks. Here is what you should know:

* HIV infection is up to 98% preventable.

* Abstinence is the surest way to avoid AIDS.

* Monogamy is also safe--but only if both partners have tested negative for HIV and have avoided all sexual contact with others. Because it can take as long as six months after infection for the virus to show up in a blood test, experts recommend a second test six months after the first. If both partners test negative both times, they can feel safe with each other--if both remain monogamous.

* Oral sex is not safe. A moisture barrier such as a condom (for men) or a dental dam (for women) should be used. That's because men and women both release fluids during arousal and during sex. If a person is HIV-positive, there may be enough virus present in these fluids to infect the partner through the lining of the mouth, which often contains microscopic abrasions or ulcers.

* Most people don't know that these fluids are released during the early stages of arousal. These fluids may be so minimal as to be invisible--but the doctors say they can carry enough HIV to infect a partner. This pre-ejaculate (men) or cervical fluid (women) infects by entering through microscopic abrasions in the mouth, the vagina, the anus or the head of the penis.

It makes no difference where the virus enters, it can infect just the same. Says Laurence: "Some men with HIV figure as long as they don't ejaculate inside a person, they won't infect that person. But that is not true. The infected seminal fluid leaks during arousal, and it can cause HIV infection even if the man has pulled out before ejaculation, or if the man has put on a condom too late."

Women produce a cervical fluid during early arousal that can infect a man just as easily if she is HIV-positive.

* It's critical to talk with teen-agers. They know more about sex than their parents believe--and no, discussing sex with young teens doesn't mean you condone it. Experts say that in the age of AIDS, we must prepare children for the eventual sexual excursions so they can navigate safely.

Laurence says he and colleagues predict a "third wave" of HIV spread by teen-agers who have no idea they're infected to teen-agers who have no idea what adequate protection is.

If we don't inform them about oral sex and the dangerous fluids they may not know about, then "we're putting this whole AIDS problem on the backs of innocent kids," Laurence says.

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