The paradoxical skinny on sex
The science of AIDS and HIV-related behavior is paradoxical and enigmatic. How can someone be HIV-antibody positive for a decade or more and never develop AIDS? Why do people who have died of AIDS appear not to have HIV in their bodies? Why does HIV not behave like other sexually transmitted pathogens? How can one individual have thousands of high-risk sexual encounters with an HIV-positive person and never become HIV infected or develop AIDS and why is it that another individual can have a single sexual encounter and acquire HIV?
It was my curiosity about the specifics of sexual transmission that plunged me into this series of stories on AIDS. My effort to understand sexual transmission and statistics represents the circling enigmas and paradoxes found within this scientific religion. In this article I want to share with you information I found on my journey.
Two years ago I read a local article that said more women were dying of AIDS, more than men, the percentage said. The article also said there was a large percentage increase of Oregon women contracting HIV heterosexually. I was alarmed. I also read national articles proclaiming AIDS in Africa was increasing by the tens of millions and that it was all heterosexually transmitted. Women prostitutes were allegedly responsible for transmitting HIV to many different men, each of whom then took HIV home to infect their wives, who then infected their babies. I was even more alarmed and curious as to how women could transmit HIV to men sexually, by the tens of millions. I thought I would gather information about a story on women and AIDS, with the classic journalism formula of profiling some local women and organizations and then stretch the issues out to show global and national trends.
My first stop was a visit with Thomas Bruner, the executive director of the Cascade AIDS Project (CAP). I asked him about sexual transmission and what's new in Oregon.
"Absolutely women can give HIV to men!" he said with enthusiastic conviction. "How exactly?" I asked. "If a man has cuts and lacerations on his penis it can happen," he said, adding that it was uncommon. Huh, I thought. If it's uncommon, how can African women be spreading HIV by the millions? This method of bumping sores or harboring cuts seemed similar to woman-to woman transmission, I thought. It seemed a contradiction since ALL health agencies and experts say woman-to woman transmission is nil, since it is common knowledge we (the author is a lesbian) are God's Chosen Ones, using the logic of the Religious Right.
I asked more specific transmission questions and Bruner repeated the two-pronged party line several times throughout our conversation: "I think everyone contracts HIV the same way: Through unprotected sex and sharing needles." He said AIDS is a fatal disease that is not gender-specific. He went on to emphasize that we need to stop looking at the epidemic in broad, all-encompassing categories like white gay men. I thought that category sounded pretty specific and that it's a category needing attention since about 87 percent of Oregon AIDS cases are white gay men.
He discouraged me from writing a story about local women with AIDS and instead had three other developed story ideas for me. Although CAP's media packet and citywide billboards were filled with the faces of white women and heterosexual families, I was shocked to learn CAP had no staff or programs for women. Bruner gave me the names and numbers for two women in the prevention department who act as CAP's women and AIDS contacts.
I first called Sonali Balajee and asked her about the number of Oregon women who had HIV or AIDS. She didn't know the numbers and encouraged me to contact the Women's Intercommunity AIDS Resource, a very small Portland nonprofit that is specifically for women. I said I will do that, but I would still like the numbers from her. She referred me to the other CAP woman contact, Allison Goldstein. Ms. Goldstein also did not know the specific numbers of the "changing epidemic" and told me to look at the websites of the Centers for Disease Control and Prevention and the Oregon Health Department. I said I'll do that, but since CAP keeps talking about the "changing epidemic," I thought CAP could give me some statistics showing that. I called back several times. At one point she said she had her staff working on it and then said CAP was busy moving. I left more messages and finally she didn't return my last call asking if there was someone else at CAP who might be able to answer my questions.
My next stop was Mark Loveless, the head AIDS/HIV epidemiologist for the Oregon Health Division. He said epidemiology would say receptive penile-anal sex would constitute the highest risk of HIV transmission and coming up second and third would be penile-vaginal intercourse and oral sex.
It still seemed vague to me. I was curious about the direction HIV was going in the vaginal and oral sex categories. I asked: 'When you say vaginal intercourse, does that mean men are getting it from women's vaginas, or men are giving it to women through their vaginas? And the same questions for oral sex, with the added variables of who is giving or receiving oral sex?"
Dr. Loveless appeared angry and curtly said "Again! I would have to do some significant research on good studies about women getting HIV!" (Dr. Loveless said prior to this question he was going to have to "do some significant research!" when I asked him about how much money the state of Oregon spends on AIDS, hence, "Again!") I asked Dr. Loveless if he could refer me to any good studies about sexual transmission, and he said: "How could we do that! How could we study that?! How could we study of efficiency of male-to female or female-to male transmission?!" I was shocked, he was the expert, and didn't know what to say.
Oregon's head AIDS/HIV statistician said percentages are very misleading figures if they are very low and depending on what's in the numerator and denominator. That clarified some confusion.
When I looked at the Oregon Health Division's (OHD) Surveillance Report for 1990, I found 36 Oregon women had AIDS. In 1999's report, the most recent annual report, I found there were 24 women AIDS cases in Oregon. I was shocked again. By reading The Oregonian and CAP's material, I thought the epidemic was huge among women, instead I find AIDS cases have actually decreased in Oregon by one-third!
Blood, sex and money, we want drama and when we convert low numbers to percentages, they dramatically become big. With ALL AIDS cases in the denominator, in 1990 women made up 4 percent of all AIDS cases and in 1999 women jumped up to 11 percent, thereby showing a 7 percent increase! The change is due to the fact AIDS cases and deaths among white gay men have flattened out. The heterosexual woman increase that CAP and other organizations are fond of talking about is from 13 Oregon women with AIDS in 1990 to 14 women in 1999. Again, the 13 women in 1990 made up 36 percent of all AIDS cases among women and the 14 women in 1999 made up 58 percent, showing a 22 percent increase. Mainstream media do nothing but regurgitate misleading statistics that are fed them by AIDS organizations and health officials to continue private and public alarm and funding. Another big jump in women's numbers occurred in the mid-90s when the definition of AIDS changed (for the third time) to include cervical cancer.
The scientific study of sex
Next I went to the vast library of Oregon Health Science University and found what Dr. Loveless thought impossible: Hundreds of studies dryly and perversely detailing the efficiency of male-to female, female-to male, male-to male and female-to female HIV sexual transmission! The study of gay male sex was by far the most popular since that is where most HIV infection is purported to be, and far, far fewer heterosexual transmission studies were available, by comparison.
I found that although sexual transmission is studied and studied and studied, doctors do not like to come to clear conclusions. They like to say things like "male-to female transmission is eight to ten times more likely than female-to male transmission," which would be dandy if they said what female-to male transmission is, but they do not, because it is so small it is statistically impossible to calculate, they say. Another dizzying circle. I have seen over and over again the statistic that male-to female infectivity per contact is 0.0009, which means the likelihood of transmission is once every 9,000 sexual contacts. Yet I also saw the figure once per 1,000 sexual contacts for male-to female transmission and once per 8,000 contacts for female-to male transmission several times. Take your pick.
To contract HIV once every 1,000 to 9,000 contacts is really different from any other sexually transmitted disease, like syphilis or gonorrhea, for example. It takes on average only two or three unprotected sexual contacts to infect most people with most sexually transmitted diseases. And except for HIV, sexually transmitted diseases affect people in a pretty gender-balanced way. For instance, syphilis infects at a ratio of 60 percent female to 40 percent male, whereas the ratio for HIV infection is purported to be 10 percent female to 90 percent male in the US.
Studies often detail the "rugged vagina, fragile anus" idea to explain HIV transmission because studies have concluded the number one risk factor that is independent of all risk factors is receptive penile-anal intercourse with HIV antibody positive semen. Anal sex is risky, they say, because it is almost like shooting drugs. Semen goes directly into the bloodstream because the anal canal is thin, easily torn and quick to absorb liquids. The vagina is tougher and not as friendly to HIV. The vagina is elastic and is designed to stretch, lubricate, deal with punctures and be discerning about what it lets in. Also, the acidity of the vagina inactivates HIV, thereby making vaginal secretions not very contagious. Semen, on the other hand, has high pH levels and makes a favorable environment for HIV.
This makes sense, but statistically more heterosexuals engage in anal sex than gay men, so why are heterosexual women not affected to the same degree? Sexual behavior studies say more than 10 percent of heterosexuals engage in anal sex, and 10 percent of American heterosexuals far out number all gay men.
Many doctors and studies have questioned how present HIV is in semen. The first study to demonstrate the presence of HIV antibodies in semen was done by the doctor who co-discovered HIV, Dr. Robert Gallo. He found HIV in some semen and not in others and where he could find HIV, it was in extremely low amounts and transient. Another anomaly is that if semen is loaded with HIV, as the generalized message dictates, why has there not been significant infection via artificial insemination? Artificial insemination should be the gold standard of proof for heterosexual infectivity since semen is shot directly onto the cervix.In conventional terms, this would be a very high-risk activity, yet of the 80,000 women in this country who are artificially inseminated per year, only two have become HIV positive and no case of infant AIDS exists from this method.
Mothers are said to transmit HIV to their fetuses, but mothers give everything to their child (just ask any mother!) including her immune system.Babies pick-up Mom's HIV antibodies through the placenta but within the course of six months they shed it. Babies ride on Mom's immune system (and catch everything Mom has) until they build their own immune systems. The HIV test tests for HIV antibodies -- if mom tests positive so will baby because baby has the same antibodies -- if you test within the first six months. Most of the statistics we see about women and their HIV antibody positive babies are from intravenous drug using moms at public hospitals that test the babies right away.
I am two years along my journey and still I am swimming and circling through the puzzle of HIV and AIDS. These sexual transmission issues bring into question the true contagiousness of the HIV retrovirus and again we ponder if resources are being used properly. Maybe CAP could share some of its $3+ million budget on chlamydia, for example, which newly infected 6,200 Oregonians in 1999, compared to 260 new infections of HIV for the same year. But government-funded health care isn't really interested in prevention anyway.
This is part three of a five-part Portland Alliance series. Kim Stephenson is a freelance writer.
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