Is The Virus Enough?
It appears, but not with total certainty, that the virus called Human T-cell Lymphotrophic Virus-3 (HTLV-3) is the essential ingredient in developing Acquired Immune Deficiency Syndrome (AIDS). There has been considerable press coverage of AIDS and HTLV-III in Denver during the past few weeks. Unfortunately much of this information has been grossly inaccurate. To try to correct the many misconceptions about AIDS that the straight community has is a monumental task, particularly when many of these misconceptions are reinforced by shoddy journalism and poorly researched T.V. news coverage. The first responsibility we have as gay people around the AIDS issue is to get the facts right ourselves. It is important to realize that AIDS is not a gay disease despite what we might hear from the straight media in this town. Confusion was created and harm done recently when the results of a research project conducted at Denver Metro Health in spring of 1984 were presented inaccurately by the Denver Post in their February 28, 1985 issue.
First of all, there has not been any recent "upsurge" in the number of cases here. The problem is very real in Denver but the number of new PWA's (persons with AIDS) has been very consistent for some time and is expected to remain so (about one new case per week.) This is tragic enough but hysterical headlines misrepresenting the actual state of affairs creates undue anxiety.
Exposure to HTLV-III in the Denver gay male community is significant. In April and May of 1984 a random sampling of gay men coming into the V.D. clinic at Denver Metro Health were tested for antibodies to the HTLV-III. There were 123 men in the sample and of this number 60 (49%) tested positive for antibody - not for virus. This does not mean that these 60 men have AIDS. What it does mean is that they have all had an exposure to HTLV-III significant enough to result in the production of antibodies. It is not an indicator that the virus is present currently. It does not mean that these men will develop AIDS. Many AIDS researchers speculate that 5% to 10% of those testing positive for antibodies will go on to develop AIDS. This is horrible enough, but screaming that "50% of Denver's homosexuals are infected with AIDS" is alarmist and inaccurate.
As a community grappling with this nightmare it is important to realize that the men tested at Denver Metro Health represent a biased sampling. They were clients of the V.D. clinic. In San Francisco a recent random survey of the gay male community, not a sample of men going to a V.D. clinic, showed a 37% positive rate. The previous percentage of antibody positivity for San Francisco gay men was based on a sample of V.D. clinic clients and showed a 64% positive rate. It is therefore logical to assume that if a study of a broad cross section of Denver's gay male community were done that the percent positive for antibody would be significantly lower than the 49% found from the V.D. clinic sample. If the rate of positivity for the Denver community paralleled that of the San Francisco community we could speculate that the percent positive for antibodies would be 28% and not 49%. That would be good news and bad news. The bad news being that approximately 1 out of 4 of us have been exposed and the good news is that 3 out of 4 of us have not been exposed to HTLV-III. Remember that exposure significant enough to result in the production of antibodies does not mean that AIDS is inevitable.
The bottom line on all this is that it is very important that gay men take good care of themselves these days. Unless you are in a mutually monogamous relationship safe sex should be a high priority in taking good care of yourself.
In addition to safe sex measures another important area for gay men to consider in protecting themselves from AIDS is the possible role co-factors may play in the development of this disease. I am writing this from the point of view that infection with HTLV-III is necessary to develop AIDS, but that other co-factors facilitate and perhaps even make possible the development of full blown AIDS. This is a rather confusing concept but a very important one especially for those of us who have been, or will be, exposed to the virus. Many people knowledgeable about AIDS "believe that though infection with the virus is essential other assaults must also be occurring that are damaging to the immune system and facilitate the virus creating havoc and destroying one's immune system beyond repair. What follows here is a list of possible co-factors.
1) Once is not enough. Perhaps repeated exposure to HTLV-III is needed for some persons to develop AIDS although many feel that a single exposure can be sufficient. Intimate sexual contact in which body fluids are exchanged seems to be a rather efficient way of transmitting the virus. This risk factor can be dealt with by reducing the number of different sexual partners and practicing safe sex techniques. Some AIDS experts believe that HTLV-III may be a very unstable virus that changes rapidly. Thus, even if you were able to develop an immunity to one virus that immunity might very well not protect you from a slightly different form (mutation) of the virus. It is also possible that you cannot develop an immunity against this virus at all.
2) High Risk Sexual Practices. Certain sexual practices seem to carry a greater risk of transmitting this virus. This could be related to the concept of "viral load". Any germ that is going to make us sick must get into the body in sufficient numbers to overcome our natural defenses. As mentioned above, it is not known if a single exposure is sufficient to deliver an adequate "viral load". Certain sexual practices may facilitate the delivery of an adequate load. In a study first reported in Lancet, an English medical i (Sept. 1984) research by James J. Goedert et al. showed a strong correlation between certain sexual practices and testing positive for HTLV-III antibody. Being fucked or fisted correlated highly with being positive as did the number of sexual partners (i.e. the greater the number the greater the chance for testing positive.) The men in this study were followed .for a period of two years. Lifestyle, health conditions, immune responses and the presence of HTLV-III antibodies were examined on a regular basis. Interestingly the more a person related being the inserter in fucking the less correlation there was to exposure to HTLV-III. Before we all run out and become tops, however, think about the conscientious use of good quality rubbers.
3) Viral Infections. Repeated viral infections are also felt to be detrimental to the immune system. Hepatitis-B comes quickly to mind. To have a hepatitis, from any of the various viruses that can cause it, is not good for the immune system. An effective vaccine now exists to protect you from Hepatitis-B. Find out if you need this vaccine and get it if you do.
4) Poppers. The issue of poppers has been very controversial. Early on they were a prime suspect as the cause of AIDS. This, however, has been ruled out. More recent studies indicate inhaled nitrates may be damaging to the immune system and thus a co-factor. In the Sept./Oct 1984 issue of Pharmocotherapy a strong editorial warned against any popper use, at least for the time being. A team of researchers at M.D. Anderson in Houston has hypothesized that poppers do play a key role in the development of Kaposi sarcoma. This cancer, though not unique to gay men with AIDS, is disproportionately found in that risk group. One particulatly disturbing finding was that white blood cell function was significantly impaired even 24 hours after exposure to the chemicals found in poppers. More conclusive studies are currently under way. The best advice right now is don't use poppers at all.
5) Drug Abuse. Obviously the abuse of any drug, including alcohol, is not good for the body and can either directly or indirectly be harmful to the immune system. In relation to AIDS the most risky form of drug abuse remains I.V. injection when shared needles are used.
6) Poor Health Habits. Eating a balanced diet, vitamin supplements where appropriate, exercise, and getting enough rest are all important to good health. A lifestyle assessment with your health care advisor or provider is certainly appropriate.
7) Parasite Infections. Intestinal parasite infections are common in many sexually active gay men. Oral/anal contact (rimming) is felt to be a major mode of transmission for parasites. Chronic parasite infections do not contribute to an overall state of good health. Discussing with your health care provider whether or not you are a likely candidate for parasitic infections is advisable. The symptoms can be very benign and indicative of many other problems.
If researchers knowledgeable about AIDS are correct and only a small percentage of those infected with the virus will develop the deadly syndrome, then it is reasonable to believe that there are co-factors playing a role in who get AIDS and who does not. It is these co-factors that will hopefully be identified in the several long range AIDS studies now being conducted. Let's not wait on the research, however, but instead take a pro-active role in affecting our own health status and identify those elements in our lives which may be draining our immune systems and change some of our habits. The overriding component in the AIDS crisis has been our sense of powerlessness. We need not be passive victims! In fact, our own individual behavior may play a much more decisive role in whether we come down with Alps than anything the medical world will ever be able to do for us.