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What’s going on with the AIDS epidemic?
Within just a few days’ time, three different news stories appeared, each seemingly presenting an entirely different epidemic. One spoke of gloom and doom, a disease reaching ever-greater heights. Another was cautiously optimistic, saying the epidemic was slowing. Yet another seemed to indicate a decline. Could all these be consistent? Indeed.
The key is understanding that with most fatal diseases, such as plague or typhus, infections and case diagnosis and death all come within a few days or weeks of each other. But with AIDS, there’s a huge time lag between each. Infections are followed an average of perhaps ten years later by a diagnosis with AIDS, followed on average about two years later by death.
The gloom and doom story, playing to headlines like AP’s "AIDS Leading Cause Of Death For Young Adults," declared that the disease has now become the leading killer of Americans between the ages of 25-44. This isn’t happy news, but neither is it as the federal Centers for Disease Control and Prevention (CDC) wants us to believe.
First, by picking out a specific age category, they are saying it isn’t the biggest killer in any other age category. So AP’s title is wrong, unless we insist on calling people between the ages of 20 and 24 something other than young adults.
Further, AIDS is the big fish in this very small pond. Very few Americans die of anything between the ages of 25-44. The second-leading killer during those years is accidents. Accidents would have still led, except that such deaths have been steadily declining over the last decade.
Most important, though, deaths represent the oldest part of the epidemic. Since the CDC data used 1993 deaths, we’re talking about infections that occurred on average in the early 1980s. This was before AIDS even had a name. There has long been evidence that the peak of AIDS infections in the major cities was during this time, so it was quite predictable that deaths would be peaking around now.
But what of actual AIDS cases? That was the second report. It found that cases have actually plummeted, from about 106,000 in 1993 to about 80,000 last year. Much of that, however, was due to the new case definition that began in January of last year. That definition increased the number of illnesses that, when accompanied by HIV infection, leads to an AIDS diagnosis. So doing, it caused a huge jump in reported AIDS cases last year. But that increase, accompanied by the predictable media horror stories, also drained off many cases that would have been diagnosed in later years. So the plummet this year is essentially the negative image of last year’s jump.
Using consistent definitions, AIDS cases would have increased by 3 percent, according to the CDC. This is essentially the same rate as last year, using a consistent definition, and the year before. In other words, the epidemic has been flat for three years.
All this happened despite our having been inundated with warnings that AIDS would just keep getting worse until someone invented an effective vaccine or we all had condoms welded onto our genitalia. Yet all epidemics, from plague to the pox, follow a curve which is steepest at first, then begins to level, then plateaus, and then begins to go down. AIDS could not have been any different.
Nonetheless, the AIDS doomsayers simply took a snapshot of the early part of the epidemic and extrapolated it forward. This allowed predictions of a disease would make the Black Death, to quote then-Health and Human Services Secretary Otis Bowin "seem pale by comparison." As late as two years ago, current HHS Secretary Donna Shalala said we might not have "any Americans left unless we’re prepared to confront the crisis of AIDS."
But the spin doctors are still at it, pointing out this year, as they do every year, that female and heterosexual cases are increasing the fastest. The statement is always true, and always irrelevant.
Prior to this year, female cases and heterosexual ones increased the fastest because they lag behind homosexual cases. This means they have always been on an earlier, steeper part of the upward incline. Even though their actual numbers were low, their rate of increase was high relative to other groups. Their rate of increase was slowing, but less rapidly than that of homosexuals and men in general.
Another factor in the growth of female cases in the last two years is that the new definition especially targets illnesses seen in women, including cervical cancer. Not too many male homosexuals get cancer of the cervix.
Drugs are only part of the reason for the declining epidemic.
Now, however, cases in all the categories are way down. So while female ones fell from more than 17,000 in 1993 to less than 15,000 last year, male cases fell even faster. While cases defined as heterosexual fell from almost 10 thousand in 1993 to 8,300 last year, homosexual ones fell faster. Thus female and heterosexual cases make up a larger slice of the pie, but the pie is so much smaller.
Now what about that infection data? These reports were released at the same time and place as the one on deaths, but naturally got much less media attention. It found rates of new infection among inner-city, predominantly black and Hispanic crack cocaine users, to be disturbingly high. But in the rest of the population, quite the opposite was true. The infection level among insurance applicants was just six-hundredths of a percent. Among women giving birth, by definition sexually active heterosexuals, it was 1.6 infections per thousand women. Meanwhile, infections among blood donors and military applicants are scraping along the bottom. As one would guess from the declining AIDS cases, infections among homosexuals and intravenous drug abusers are also declining.
Once again AIDS has thoroughly disappointed the doomsayers who have such a callous view of humanity that they believe the only way to make America care about its true victims is to lie and say we’re all going to get it.