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The AIDS epidemic has peaked — and not everyone wants you to know about it. Especially not the media, which have taken recent CDC reports to proclaim yet again that AIDS is exploding, especially among heterosexuals. To quote CNN:
The number of new AIDS cases in the United States grew even faster than anticipated last year. The Centers for Disease Control and Prevention had expected a 75 percent increase partially because of a new expanded definition of the disease. New AIDS cases actually jumped 111 percent last year because of a sharp increase in infections among heterosexuals. . . . AIDS resulting from heterosexual contact in 1993 rose 130 percent .
Meanwhile, NBC Nightly News reported that "a broader definition of AIDS, [and] a sharp increase in infections among heterosexuals, more than doubled the number of new cases." Time said, "The number of new AIDS cases surged unexpectedly last year, more than doubling, owing to a jump in infections among heterosexuals."
Newsweek jumped in to proclaim that "heterosexual AIDS is no myth," and talk-show host Vicki Lawrence told her audience that 170,000 teenagers had been diagnosed with AIDS in 1991 and 1992. (The actual number was 318.)
Far from a "jump" caused by heterosexual infections, the entire increase in the CDC’s findings was due to the expanded definition. By the old definition of AIDS, there was a 2 percent decrease in new AIDS cases last year. This is long-awaited news and a monumental relief, but most of the press virtually ignored it: Lawrence Altman in the New York Times allowed it part of a sentence on the 107th line of his story.
The CDC findings appeared in two articles in the agency’s official Morbidity and Mortality Weekly Report. The first, by John Ward, chief of the surveillance branch, division of HIV/AIDS at the CDC, described the effects of the new case definition. The second, by Pat Fleming, chief of reporting and analysis in the CDC’s AIDS division, begins with this sentence, "From 1991 through 1992, persons with [AIDS] who were infected with human immunodeficiency virus (HIV) through heterosexual transmission accounted for the largest proportionate increase in reported AIDS cases in the United States."
Note the dates: "1991 through 1992." The new case definition only applied to 1993 cases. Like the horror movie mad scientist who combined man and beast to create a monster, the media spliced the two sets of data together to come up with the latest heterosexual AIDS scare.
Taking each set of data separately, we see that this latest alarm is just as groundless as the ones sounded every year since 1987. While it’s true that heterosexual cases did jump 130 percent in 1993, a table in Ward’s article shows clearly that the intravenous drug abuser category increased by 136 percent. The largest percentage increase was in the hemophiliac category, which shot up 189 percent.
But headlines like "AIDS Spreading Fastest Among Hemophiliacs" not only don’t sell newspapers, they knock down the notion that the heterosexual increase, large as it appears to be, can be attributed to a "sharp increase in infections." That’s because hemophiliac infections ceased altogether after 1985, when their clotting factor began to be heat-treated for blood transfusions. If the hemophiliac cases could jump 189 percent with no infections in the past seven years, then clearly the heterosexual jump also has no connection to new infections.
So what’s the explanation? Despite the New York Times’s flat-out assertion that "the new definition does not affect the rate of increase by heterosexual transmission," the CDC data showed that it changed everything. For one thing, the expanded definition added a test whereby persons whose T-cells fall below a certain number are considered to have AIDS. (T-cells are white blood cells that protect the body from infection; generally speaking, the fewer one has the more susceptible one is to deadly infections.) The result is that cases that wouldn’t have been diagnosed until 1994 or 1995 were diagnosed in 1993.
Moreover, the definition added three new indicator diseases that, when accompanied by HIV, will prompt an AIDS diagnosis. The new diseases — pulmonary tuberculosis, recurrent pneumonia, and invasive cervical cancer — are found much more often in non-homosexuals than in homosexuals, just as Kaposi’s sarcoma is found almost exclusively in homosexuals.
Cervical cancer, of course, is strictly a disease of women. The T-cell test has also disproportionately expanded non-homosexual cases because the original indicator diseases tended to be matched to the course of disease in homosexuals, whereas the T-cell depletion affects all AIDS victims.
This, in turn, could be used to help determine what chemicals cause cancer.
Will Eskimos soon be the largest racial/ethnic group in Houston? Stay tuned!
Pat Fleming’s assertion that heterosexuals accounted for the largest proportionate increase in new infections during 1991-1992 is another failed effort to portray the old and well-explained as something new and mysterious. The heterosexual transmission category has always been the fastest-growing, for two simple reasons. First, it’s mathematically easier to grow the fastest, in percentage terms, from a low baseline. In other words, if the Eskimo and Mexican populations of Houston in 1992 were two and 50,000 respectively, and in 1993 two more Eskimos moved to town along with 10,000 more Mexicans, the Eskimo increase would be 100 percent while the Mexican increase would be only 20 percent. No one would point to these data as indicating that Houston would shortly be swamped with Eskimos.
The other reason heterosexual cases comprise a larger proportion of the epidemic is that all epidemics, from bubonic plague to smallpox to polio, follow a bell-shaped curve whereby the epidemic’s rate of increase is fastest early on, then it progresses at a slower and slower rate until it peaks and cases actually start to decline. Since heterosexual cases lag by a couple of years behind homosexual and intravenous drug abuser cases, they are further down on the upside of that slope.
Indeed, by 1992, homosexual cases were already sliding down the right side of the bell curve. Thus, even if heterosexual transmission cases had been exactly the same number as the year before — or even slightly less — as a percentage of the epidemic their share would still have grown.
Prior to the new definition, the trend toward a peaking of heterosexual cases was quite clear. In the early 1980s, heterosexual cases increased by over 100 percent per year. But by 1990, heterosexual cases had increased only 39 percent over the previous year, by 1991 21 percent, and by 1992 only 17 percent. Suddenly there’s a 130 percent jump in heterosexual cases.
Not incidentally, this same reasoning also applies to female AIDS cases. Because their numbers are small and because female cases lag behind male ones, female cases have always been increasing more rapidly than male ones. This doesn’t stop the media from announcing each and every year, however, that this year women’s cases are increasing faster than men’s. Indeed, it is common to see this presented, as the Washington Post’s Boyce Rensberger did last year in a front-page story, in such a way as to make it seem that women now have a greater chance of getting the disease than men.
A graphic example of the attempt
to make women an
equal opportunity disease.
Rensberger wrote: "Last week the [CDC] reported that American women of all ages were coming down with AIDS four times as fast as men." What the CDC actually said was that the rate of increase among women was four times greater, the reason being that the rate of increase among men had dropped to almost nothing. But male cases continued to come in at a rate eight times that of female cases.
Did reporters deliberately confuse the two sets of data released by the CDC? Pat Fleming told me that she had fielded over a hundred media phone calls since her article was released. Since she freely acknowledged that the two sets of data were incompatible, there’s no reason to believe she would have misled reporters. (Lawrence Altman at the New York Times would not return my calls.)
Interestingly, a Nexis search conducted two weeks after the Fleming report’s release turned up not a single dissenting reference to the latest heterosexual AIDS myth. By contrast, after a National Research Council (NRC) report last year said AIDS would remain a disease of "marginalized" minorities, the media were filled with critical responses. In its determination to democratize this disease, the press gives little play to its increasing racial and ethnic ghettoization — even within the heterosexual cohort. Charges of racism and homophobia flew.
But the NRC was right: Of the 1993 heterosexual contact diagnoses, 78 percent were in black and Hispanic males and 74 percent in black and Hispanic females, even though these groups together comprise only about 20 percent of the population.
If the CDC’s new definition has the fingerprints of AIDS activists all over it, that shouldn’t surprise: they’d be the first to take credit. As one ACT-UP pamphlet notes, "ACT-UP and many public health professionals realized that [the-then] definition was too narrow and pressured the CDC to change it." It continues: "Under activist pressure, CDC announced a proposed expansion of the AIDS definition in the summer of 1991."
The Associated Press recognized the activists’ influence in this headline two years ago: "CDC Bows to Activists; Adds New Diseases to Proposed AIDS Definition." As the A.P. story noted, "Activists welcomed the proposal, saying it would mean diagnoses for thousands of HIV-infected women and drug users." It was just a matter of time before the new definition pressed for in 1991 became reality in 1993.
It is also no coincidence that the new definition and its expansion of the heterosexual categories took effect the year that AIDS diagnoses would have otherwise leveled off. Indeed, the latest statistics reveal that the government’s projections of an AIDS epidemic increasing on into the late 1990s — along with all the projections of the other AIDS doomsayers — have proved hopelessly wrong. More than that, there was never any reason to think they would be right, as I observed fully five years ago in the May 1989 The American Spectator.
Dr. Joel Hay
That article challenged the then-current estimate of HIV infection of one to 1.5 million, citing a large body of infection data and the failure of full-blown AIDS cases to manifest as quickly as would be needed to justify such a number. I proffered instead a lower figure of 500,000-800,000 calculated by Dr. Joel Hay, now of the University of Southern California. For his efforts, Hay was derided by AIDS projectionists at the CDC and elsewhere.
But lo! the next year the CDC did lower its estimate to one million. Yet even that number was too high: last December, authors of the first nationwide survey of AIDS infections estimated that 550,000 Americans were infected. While saying that they thought the figure might be a bit low, the CDC did grant that its one million estimate was too high. As CDC official Dr. Scott Holmberg explained, "Because more than 200,000 people have died of AIDS, we would expect that the current prevalence is below one million." Indeed, the word is out, reported by Lawrence Altman himself, that the CDC is about to lower its official estimate to 800,000. At a glance, Holmberg’s explanation makes sense. The problem is, it ignores the impact of the purported new infections that the CDC says are coming in at a rate of 40,000 a year, slightly higher than the highest number of AIDS deaths in any year. By Holmberg’s reckoning, the one million figure should actually have been increasing, not plummeting.
In 1988 the CDC extended its projected caseload figure to the end of 1993, predicting 450,000 cases by then. The press went wild over the figure, upping it sometimes to half a million. The editor of the Washington Post’s Health magazine declared, "No one is questioning the projection that about 450,000 Americans will be diagnosed with AIDS by 1993." But Hay and I and others did question it. Indeed, I cited the CDC’s own data indicating that since it appeared that HIV infections peaked around 1991 and 1992 in major cities, the epidemic would peak about ten years later, since lag time from infection to full-blown disease averages about ten years. Now we find that at the end of 1993, even including the new case definition, the CDC projection was too high by about 90,000 cases. Without the new case definition, it would have been too high by fully 50 percent.
My 1989 article also anticipated that the CDC would start talking less and less about its projections "unless CDC keeps expanding the definition of AIDS to catch earlier and earlier stages of HIV infection." And so it did, casting the best news of the epidemic as an utter disaster. Americans have been effectively prevented from learning that in the same year in which the Clinton administration increased AIDS spending by 28 percent — cutting the budget of most every other disease except breast cancer — AIDS cases fell by 2 percent. (The president’s proposed budget for next year again favors justs these two diseases.)
AIDS remains a horrible disease with no hope of cure on the horizon. A declining epidemic by no means indicates that it is about to end any time soon. Nonetheless, an AIDS campaign that emphasizes heterosexual contact can no more succeed than can a breast cancer detection campaign that singles out men or a prostate cancer program that focuses on men under 30. AIDS prevention efforts can succeed only if the public is told who is at greatest risk, who is at least risk, and what those at greatest risk can do to reduce their peril.