VIRUSMYTH HOMEPAGE
BIOGRAPHY
Gordon T. Stewart
Gordon Stewart is Emeritus Professor of Public Health at the University
of Glasgow, and a physicianconsultant in epidemiology and preventive
medicine. In a professional career of over 50 years in the UK and elsewhere,
he has specialised mainly in the control of infections, with increasing
emphasis upon the importance of behavioural, social and environmental conditions
as prime factors in disease control. He was one of the first physicians
to recognise the dangers to personal and public health of the sudden increase
in drug addiction, sexual freedom and unfamiliar infections which began
in the 1960's. He designed programmes for investigation and control of
some of these problems in the USA and UK. The WHO asked him to continue
this work when he retired in 1983. This led to an intense involvement in
the epidemiological investigation of AIDS, on which he has written reports
for the WHO, medical, nursing and economic journals, and the Press. He
has participated in many radio and television programmes internationally.
Stewart would be the first to agree that his view of the causation of
AIDS is controversial. In 1987, he challenged the view that AIDS would
cause a pandemic by heterosexual transmission in the general populations
of the USA and Europe. Mathematical projections which he prepared then
have now been shown to be accurate to within 10% of registration data.
Although various strains of HIV can infect males and females almost equally
by sexual and congenital transmission and accidentally by transfusion,
AIDS is a complex disorder which seldom if ever develops unless there is
concomitant riskbehaviour in the form of repeated anal intercourse
with changes of partners, intoxication by addictive drugs, other sexuallytransmissible
infections or some rare conditions causing loss of immunity. In many parts
ofthe third world, including notably subSaharan Africa, the pattern
of transmission appears to be different. But there is an absence of reliable
data and an immense overlap between AIDS and other lifethreatening
diseases and deprivations which makes accurate assessment in these regions
difficult or impossible.
In Stewart's view, present policies for the control of AIDS in the UK
are erroneous and unbalanced because the medical emphasis is upon elimination
of HIV by vaccination or chemotherapy whereas, in the USA and Europe at
least, the epidemiological evidence shows unequivocally that AIDS is attributable
in the first place to behaviour which places individuals and sometimes
entire communities at high risk of all sexuallytransmissible and many
other infections of the urogenital organs, lungs, mouth and bowel.
So long as this continues, so long will AIDS persist in risk groups even
if drugs better than those at present in use, and a vaccine, are discovered.
The emphasis for primary prevention must therefore be on elucidation, matteroffact
explanation and discouragement of risk behaviour and of circumstances leading
to it from puberty onward. For secondary prevention in early cases, treatment
may be effective if and only if it is accompanied by a cessation
of risk behaviour. For the tragic suffering in late cases, as in so many
other wasting diseases, it would seem that there is at present little more
to offer than symptomatic relief with care and compassion. But this should
never mask the fact, especially in the third world, that AIDS is a complex
disease which can be ameliorated by early recognition and treatment of
collateral and recurrent infections like the other sexuallytransmissible
infections, tuberculosis, malaria, diarrhoeas, dehydration and malnutrition
which have been endemic for centuries before 1985 when AIDS was first recognised
in a coastal city in Africa, four years after its first appearance in the
USA.*
VIRUSMYTH HOMEPAGE