AIDS: Facts vs. Fiction
By John Dietrich, M.D.
When Magic Johnson announced he had the virus that causes AIDS, health clinic hotlines went crazy. After all, if a sports hero like Magic could get this disease, people assumed anybody could get it. But when Magic was named MVP at the NBA All-star game a few months later, a lot of people probably relaxed. After all, if an infected person could look so good and play so well, AIDS must not be all that bad.
So who's telling the truth about this frightening disease?
As a physician specializing in infectious diseases, I've treated hundreds of AIDS patients during the past 10 years of this epidemic. Based on that experience, I want you to know two things about it:
· You don't want to get this disease. It's a terrible, slow and sometimes excruciatingly painful way to die.
· You don't have to get it if you don't have it already.
Unraveling the mystery
The words "HIV" and "AIDS" are made from letters of phrases that describe them. The Human Immunodeficiency Virus leads to the Acquired ImmunoDeficiency Syndrome.
This may sound complicated, but it's actually pretty simple if you start from what you know about viral illnesses and then plug in what's different about HIV.
· Viruses are very small organisms that can cause diseases like colds and flu. HIV is so small that 5,000 HIVs would fit side on the diameter of the period at the end of this sentence.
· Your body's immune system is constantly alert for potentially harmful invaders (micro-organisms) trying to make you sick. HIV attacks the immune system, weakening its ability to protect you from certain diseases that healthy people don't usually get.
· White blood cells called T helper cells work with eater cells (macrophages), memory cells and other cells to recognize surface molecules (antigens) of invaders and immediately launch a counterattack. This is why you don't get diseases like chicken pox more than once. But HIV tricks these guardians of health by implanting material inside them, crippling them even while multiplying itself safely within them.
· Some viruses cause disease quickly. HIV infection, after causing an initial reaction in many cases from two to six weeks after exposure, may then cause no further symptoms for years. During all this time an infected but apparently very healthy person can infect others without even knowing he or she is sick!
This is the most treacherous characteristic of HIV — that millions of people will infect millions of others who will infect millions more, without anybody knowing for years that they have acquired a fatal disease. Although by the end of 1991 over 130,000 people had died of AIDS in the United States, an estimated two million others were infected — and infecting others.
· So far, about 65 percent of AIDS cases in the United States have been acquired through sex (60 percent homosexual; 5 percent heterosexual).
Homosexual practices more easily spread HIV because of multiple partners, anal intercourse, and the fact that homosexuals often have other sexually transmitted diseases
(STDs) causing skin sores, which make it easier for the HIV to enter the bloodstream.
Heterosexuals are at risk when they have sex with an HIV–infected partner, regardless of how the partner became infected. Transmission occurs both ways, male to female or female to male — and is more likely when either has STD–caused skin sores.
· From 12,000 to 15,000 recipients of transfusions acquired HIV between 1978 and 1985, before blood screening for HIV was developed. The infection rate from a single unit of tainted blood was nearly 100 percent. This demonstrates how potent this virus is and the most efficient mode of transmission — blood to blood. Most of these patients have now died.
· Another extremely efficient way to get infected is by sharing HIV–contaminated and unsterilized needles or syringes, as in intravenous drug use where blood is often drawn into the needle and syringe before the drug is injected. So far 50,000 of U.S. AIDS cases have occurred this way.
But sharing contaminated needles and syringes in other ways is also very dangerous; for instance, athletes injecting steroids, ear piercing, getting tattoos or participating in "blood brother" rituals. If you want to live past 30, stay away from these things.
Casual transmission doesn't happen
Although some microorganisms are spread in normal day-to-day activities, there is no proof that HIV is transmitted casually.
You can't get it from a toilet seat, or from restaurant silverware. There is no case where family members of AIDS patients have acquired HIV [except through sexual intercourse, unprotected healthcare, or child-
birth] even when household items and facilities were shared. If it doesn't happen there, it won't happen elsewhere.
So—there is no risk of infection from living in the same apartment, being in the same classroom or nursery, using public restrooms, hugging or touching, sitting in a waiting room with an AIDS patient, or even caring for one, except in a health care setting where some direct blood exposure has occurred.
You can't get it from mosquito bites, shaking hands, being coughed on or even from kissing (though deep kissing may not be absolutely safe).
So—the kind of ostracism that often occurs once it is known that a certain person is HIV–positive is based on fears that have no basis in medical science. This irrational fear must be overcome by anyone who wants to relate to AIDS patients with compassion and love.
—John E. Dietrich, M.D.
Who's at risk?
A lot of people think that no matter how the numbers or statistics sound, they'll be among the lucky few who escape. Teenagers and young adults are especially prone to this, which explains why so many of them take risks their parents would never consider.
I want you to take HIV as seriously as anything you've ever thought about. At the time, as a medical scientist, I am obligated to tell the truth: not everybody is at risk. But it's not a question of race, age, gender or even sexual orientation. It's mainly a matter of what you do or what you don't do that controls your risk of infection. Again, it's not complicated at all: HIV is spread in only three ways — through sex, exposure to blood and blood products, and from a mother to her baby.
· Health care workers (and rarely their patients) are at risk from blood–to–blood exposure. Needle sticks occur relatively frequently in a health care setting. If the patient is infected, the worker may acquire HIV. Five dental patients of one Florida dentist got HIV while he worked on their teeth. But no other medical or dental cases of transmission from health care worker to patient have been documented.
· In the U.S. about 3,000 babies have become HIV—infected through their infected mothers. This occurs before birth, during labor and delivery or through breast—feeding.
That's it! If you're not infected already, these are the only ways
you can become HIV—positive.
How to keep your risk zero
Want to forget all about HIV? Here's how: Don't have sex before marriage. If you marry, stay faithful to an uninfected partner. Don't inject drugs and avoid other activities that bring an infected person's blood, semen or vaginal fluids into your body. That's all it takes!
Staying uninfected sounds simple enough, so why is this disease spreading?
· The sexual revolution lives on, whispering that sex is okay between consenting partners as long as nobody is hurt.
Fact: Your very first experience with sex can kill you if your partner is infected. And how will you know that person isn't infected? You can't, because if he or she has been sexually active before you, it is possible he or she is infected without even knowing it . . . or lying, to take advantage of you.
· Adolescents believe that "everybody is doing it," and waiting until marriage is weird or abnormal.
Fact: The majority of high schoolers are not doing it. They're waiting, even if they're not boasting about it because they don't want to be laughed at. You can wait, too. Self-control is self–protection.
· For years "sex education" programs have promoted "safe sex," especially sex using a condom (rubber). Certain high—profile public figures have supported this, including Magic Johnson during the frenzy of press coverage immediately following his initial announcement.
· Fact: There is no such thing as "safe sex," which explains why the term "safer sex" is being used more by people who believe that emphasizing abstinence is unrealistic.
Condoms have a proven track record of failure — as high as 20 percent among teens trying to prevent pregnancy. HIV is 30 times smaller than the width of a human sperm cell. All it takes is a tiny hole in that latex, or a tear, or possibly slippage—and you could be on your way to the grave.
If you've been placed at risk
1. See your doctor, and be totally honest about it.
2. Get tested.
3. If uninfected, stay that way.
4. If you can't seem to control your behavior in relation to
sex or IV drugs, get help:
from your physician.
from a counselor.
friends and family.
from your pastor.
If you are infected
1. Protect others; don't spread it.
2. If you've exposed others, you have a moral obligation
to tell them, so they can get tested, seek treatment and
keep from passing HIV on to somebody else.
3. Pursue knowledgeable medical treatment immediately,
because new drugs are making this disease more manageable.
—John E. Dietrich, M.D.
· When adolescents or young adults hear the words "abstinence" or "monogamy," they think "not having sex very often," and "only" with a steady companion, as long as the relationship lasts."
Fact: Abstinence means waiting until marriage for sex. Monogamy means faithfulness to one partner for life. Yet even if you have already lost your virginity, you can recommit yourself to abstaining. If you are fortunate enough not to have already contracted HIV, saving yourself for marriage could be the wisest, healthiest decision you will ever make.
From HIV infection to AIDS
Just in case you're still not convinced to take AIDS seriously, I want to be crystal clear about what you can expect if you become HIV–positive.
A few weeks after getting infected, you'll probably think you have the flu or even mononucleosis. Even if you see a doctor during this time, the real cause of your symptoms may not be diagnosed. After these flu-like symptoms resolve, you'll gradually regain your strength as the virus becomes dormant, probably for years. But whether you feel normal or awful, you'll still be able to infect others.
Your immune system will continue to fight off infections, strongly at first, less effectively later on. If your HIV status is recognized early enough, there are therapies available and under development that can attack the virus itself. However, there is no cure.
At some point, you'll begin having other symptoms; specifically, persistent low- fever (along with night sweats) , diarrhea, increased fatigue, unexplained weight loss (more than a pound a week, not due to dieting) , enlarged lymph nodes and difficulty swallowing, persistent dry cough and shortness of breath, sores, rashes or purplish spots on your skin, and headaches.
What's happening is that your immune system has been weakened to the point where it begins to lose its ability to fight off those invaders I mentioned earlier. Infections now seize the opportunity (that's why they're called "opportunistic") to grow unimpeded in most parts of your body.
Once the number of T-helper cells drops below 200, your body will no longer be able to defend itself properly, especially against certain pneumonias, cancers and infection of the brain, which causes an Alzheimer's-like dementia. You have now crossed the official line between HIV infection and AIDS.
When this stage is reached, medicines can fight the infections and malignancies, winning skirmishes as you fight for life. But your system will gradually crumble before the never-ending attack, and eventually you will lose the war and die.
The faces of AIDS
If there's anything I want to plant firmly in in your mind, it's that AIDS is no joke. It's horrible and dehumanizing. I've seen a lot of people die from different illnesses.
Believe me, AIDS is by far the worst.
When you see people go from the pinnacle of physical fitness and beauty to a hollow-cheeked shadow of their former self, oblivious to their surroundings because their brain no longer functions properly, isolated from their friends and families and feared by their society . . . you can come to only one conclusion, as I have. Before it's over, AIDS may well become the worst plague in the history of humanity.
In the summer of 1991, I found a small envelope on my desk, tucked away amidst the journals and charts. "Dr. Dietrich," its weakly scrawled script said, "Thank you for all you did for me in my hour of need. May God Bless, Robert."
This little note really brightened an especially hectic day. Robert had been through the wringer that spring, hospitalized for two grueling months when he was pushed to ther brink of death by germs relentlessly stalking his defenseless body. At one point Robert had fevers to 105 degrees, drenching sweats that soaked his bed each night, and a lung infection that forced us to use a ventilator (breathing machine) just to keep him alive. I just about gave up hope he would pull through.
But he did, at least long enough to write me that note. Sadly, five months later, AIDS got him. When he died, Robert weighed about 90 pounds. He was literally a skeleton of his former self.
For me, Robert's face stands out among many desperate faces of AIDS patients I've treated. My hope and prayer is that you will never acquire this disease. If you choose wisely and responsibly, there's no reason you should.
John E. Dietrich, M.D.
John E. Dietrich is a board-certified infectious disease specialist, and co-author of the book:
The AIDS Epidemic: Balancing Compassion & Justice (Multnomah; Portland, Ore; 1990)