VIRUSMYTH HOMEPAGE


MANUFACTURING THE AIDS SCARE
A Former AIDS Researcher Has Second Thoughts

By Michael Wright

2001


"AIDS is a gay disease"
-- Camille Paglia, Lesbian Author


On May 1, 1996, a rare and extraordinary event happened in the history of American journalism during the age of AIDS. One of the nation's most prestigious daily newspapers actually dared to attack officially-promoted beliefs about AIDS and HIV and to discuss the political motives underlying the campaign of fear orchestrated by the US Centers for Disease Control and its allies in the gay movement. The Wall Street Journal displayed on the front page the headline "AIDS Fight Is Skewed By Federal Campaign Exaggerating Risks."[1] Written by Amanda Bennet and Anita Sharpe, the lead paragraph stated that in the summer of 1987, federal health officials made the "fateful decision to bombard the public" with the "terrifying message" that "anyone could get AIDS."

The writers described this message as "highly misleading," and pointed out that the odds are 1,000 to one against a woman being infected by HIV during a single event of vaginal intercourse with an HIV-positive male partner. They also wrote:

...for most heterosexuals, the risk from a single act of sex was smaller than the risk of ever getting hit by lightning. In the U.S., the disease was, and remains, largely the scourge of gay men, intravenous drug users, their sex partners, and their newborn children.

The article described the creation of the CDC-sponsored "marketing campaign" to spread the belief in universality of risk for AIDS. The goal was to mobilize a high level of public support for government funding of various AIDS programs. Campaign planners believed that such support would be insufficient, so long as AIDS was seen as a disease primarily of gay men and injecting drug users. They found it necessary to incite mortal fear among all heterosexual Americans old enough to have sex. For assistance in planning this endeavor, the CDC retained the services of gay advertising agent Steve Rabin, senior vice president of Ogilvy & Mather.

The Journal writers observed that scientists and AIDS activists "knew that the government-nurtured fear of AIDS among upscale, non-drug-using heterosexuals was exaggerated," but "not everyone thought this was a bad thing. Indeed, many credited rampant fear with achieving pro-family goals that no amount of moralizing alone could have accomplished." They also reported a 1988 Gallup survey which found that 69% of Americans thought AIDS was likely to become an epidemic. This was an increase from 51% who thought so only a year earlier, before the scare campaign was launched.

The campaign was also effective in achieving substantially higher funding levels for government agencies involved with AIDS programs. The Journal, describing this as "a key desired effect," reported that federal funding for AIDS-related medical research "soared from $341 million in 1987 to $655 million in 1988, the year after the CDC's campaign began." For 1996, the figure stood at $1.65 billion. "Meanwhile, the CDC 's prevention dollars leapt from $136 million in 1987 to $304 million in 1988; $584 million was allocated for 1996." The National Research Council reported in 1993 that AIDS-related programs at that time constituted more than 40 percent of the CDC budget. [2]

The two leading causes of death in the United States are heart disease and cancer. In 1991, these two diseases accounted for 2.9 million deaths. By comparison, the official 1991 death count for AIDS was 29.5 thousand, and it was the ninth leading cause. There were about 98 times as many deaths from heart disease and cancer, yet AIDS received the largest amount of dollars for federally-funded medical research, prevention, and treatment programs during four of six years from 1991 through 1996. In fiscal year 1995 the National Institutes of Health (NIH) received 2.7 billion dollars for AIDS, compared to 2.4 billion for cancer and .8 billion for heart disease. [3]

On May 21, two letters were published to express the government's outrage at the Journal 's expose and to attempt a defense of the scare campaign. One was co-signed by CDC director David Satcher and Helene Gayle, director of the agency's Center for HIV, STD, and TB Prevention.[4] The other was signed by former Surgeon General C. Everett Koop.[5] Satcher and Gayle labeled "false" the Journal's report that the CDC had exaggerated the "danger posed by AIDS to the American public." Further, they denied that it was possible to predict in 1987 that there would be no massive US heterosexual epidemic in the ensuing years:

The story further suggests that it was possible in 1987 to predict with confidence the ultimate course of this nation's AIDS epidemic - predict it with such confidence, in fact, that one could dismiss as negligible the potential threat to tens of millions of Americans. What colossal irresponsibility that would have been, and yet your story suggests it would have been the proper course.

The CDC officials admitted that in 1987, there were groups at "particularly high risk" for HIV infection. "But ," they added, "those at highest risk are neither readily distinguishable from the rest of the public nor hermetically sealed off from them." Former Surgeon General Koop echoed these sentiments. Declaring that he was going to "set the record straight," he claimed that in 1987, "we could not know who was or would be at risk for HIV infection." Although he acknowledged that the HIV virus had "made inroads in the gay community," he said there were "indications that it could spread to other groups."

In response to the letters from these officials, I undertook my own mission to "set the record straight" by presenting Journal readers with information from scientific publications and the CDC's own documents in print at the time the scare campaign was being constructed. Relying on information of this nature, I composed my own letter, which the Journal published on June 18.[6] Below is the complete text:

The May 21 Letters to the Editor from CDC officials and former Surgeon General C. Everett Koop continue to advance the CDC's campaign of distortion and exaggeration of HIV risk. CDC officials Satcher and Gayle suggest that in 1987 it was impossible to know that there was no risk of a US heterosexual HIV epidemic. They wrote that those at highest risk are not readily distinguishable from the rest of the public. Their statements are indefensible in view of numerous articles in scientific literature, as well as publications of their own agency.

In December 1987, the CDC issued a publication which specifically delineated groups at increased risk for HIV infection as follows: exclusively homosexual males, males with infrequent homosexual contact, injecting drug users, hemophiliacs, and other groups. The "other" classification included heterosexual partners of persons at high risk, heterosexuals born in Haiti and Central Africa, and blood transfusion recipients. These groups appear to be fairly 'distinguishable' from the rest of the public.

With the exception of women who might be the sexual partners of bisexual males who conceal their history of sex with men, it is easy for one to know whether he is a member of one of these groups identified at risk. Those members of the US population not belonging to any of the groups listed above were classified by the CDC as 'heterosexuals without specific identified risk.' The CDC estimated the size of this population to be 142 million. The agency estimated that the HIV infection rate in this group -- the vast majority of American adults and adolescents -- was 2 in 10,000 compared to 20 to 25 percent for homosexual males. Thus, for gay males the infection rate was 1000 times greater compared to heterosexuals outside of specific risk groups. (Source: CDC, Morbidity and Mortality Weekly Report, December 18, 1987, Vol 36/No. S-6, Table 14).

Further, in April 1988 CDC officials James Allen and James Curran published an article in which they cited several papers presented at the 1987 Third International AIDS Conference in Washington, DC. They also cited a publication by Nancy Padian, and thus indicated awareness of her expertise and reputation. (Source: American Journal of Public Health, April 1988, Vol 78/No 4, pages 381-386). How could they have overlooked her paper, presented at the 1987 conference, in which she demonstrated that the odds were 1000 to one against transmission of HIV in a single act of unprotected vaginal sex between an infected male and an uninfected female? (Source: Abstract THP.3-48:171, presented at the Third International AIDS Conference, Washington, DC, June 1987).

In a 1988 publication, researchers took information of this nature and demonstrated that the odds were 5 million to one against a new HIV infection taking place in a single act of unprotected vaginal sex between two people who are members of that massive population which the CDC recognized and labeled as "heterosexuals without specific identified risk." (Source: Journal of the American Medical Association, April 22/29, 1988, Vol. 259/No. 16, pages 2428-2432). Are we to believe that Koop and his associates at the CDC were not capable of figuring this out?

For brevity's sake I refrain from citing numerous other scientific articles demonstrating the extremely low risk of HIV transmission by means of vaginal sex. If CDC officials were unable to draw appropriate conclusions from the available evidence, they should be held to account for their incompetence. If they knew of this evidence (the more likely hypothesis), then they should be held to account for the extraordinarily dishonest, deceitful, and expensive scare campaign they have orchestrated.

Michael Wright
Scientific Social Research
Norman, Oklahoma

Numerous additional articles in health science journals are available to demolish the notion that there was ever a sound basis for creating generalized fear of AIDS among heterosexual Americans who do not engage in anal sex or use injecting recreational drugs. A study published in 1987 found that 45 of 65 females remained uninfected even after having each had more than 100 sexual events with HIV-positive males. This result was observed even though two-thirds of the women who remained HIV-negative did not use condoms.[7] A more recent Italian HIV study involving 343 women described as the "stable, monogamous partners of infected men" found that annually 93% of the women not using condoms still remained free of infection.[8] An American partner study published in 1991 reported that 80% of 307 female partners of HIV-positive men remained uninfected. The majority of participating couples had been monogamous since 1978.[9] Sixty percent of the females in this study reported no condom use.

Scare campaign dogma holds that sexually active women who are not monogamous are at greater HIV risk than those who have sex exclusively with one male. The evidence shows exactly the opposite. The median number of sexual partners for HIV-negative women in one study was four compared to 2.5 for infected women.[10] Writing in the Journal of the American Medical Association, Harold Lief pointed out that "women are more at risk from one infected partner than they are from multiple partners." [11] This is because the extremely low per-event transmission risk of HIV generally requires a large number of sexual contacts with an infected partner before a new infection takes place. Women who change sexual partners frequently are not at risk of stabilizing into a long-term relationship with an infected male.

If vaginal sex created significant risk of HIV transmission, one would expect a high infection rate among prostitutes, the most promiscuous of women. A study of Tel Aviv prostitutes found that all 128 female subjects who did not admit to drug abuse were uninfected.[12] It is extremely unlikely that a female engaging in vaginal sex with men outside of injecting drug use communities will ever be infected by HIV regardless of how many sexual partners she has. It is even less likely for a man to be infected by a woman. On a single event of unprotected vaginal sex with an HIV-positive female, the odds against a man being infected are about 8,000 to one.[13] In 1993 the New York City Department of Health reported that only 11 of the city's 37,436 cumulative AIDS cases were men whose infection was attributed to sex with a woman.[14]

In my Wall Street Journal letter I pointed out that the CDC published 2 in 10,000 (.0002) as the 1987 prevalence of HIV infection among heterosexuals without specific identified risk. By 1992 this had declined to .00015.[15] From 1985 through 1989, HIV seroprevalence among young adults in the US Army declined from about 1 in 2000 to 1 in 3400.[16] The higher HIV prevalence in the military reflects the fact that minority youth from inner city areas where injecting drug use is a factor account for a disproportionate share of Army recruits.

Credit for the Scare Campaign?

A reply to a commentary I wrote for the San Francisco Chronicle (May 24, 2000) was published by that newspaper on May 30, 2000. It was co-authored by Jay Levy, Nancy Padian, and Jeff Sheehy, all of the University of California at San Francisco. The authors argued that "HIV prevention programs" deserve the credit for "maintaining low infection rates among heterosexuals in this country." [17] This claim is so seriously flawed that its having been made by scholars of the stature of Padian and Levy, both of whom are UCSF faculty, calls into question their academic ethics. Given the content of her publications in scientific periodicals, it is difficult to believe Padian was sincere about what she wrote in the Chronicle.

In my May 24 commentary I discussed the population labeled "heterosexuals without specific identified risk" by the CDC and estimated by that agency to number 142 million in 1987.[18] I also cited a 1988 JAMA article estimating the odds against a new HIV infection taking place within this group to be 5 million to one.[19] The estimate published in JAMA relied upon Padian's 1987 conference paper concerning male-to-female infectivity.[20] With these kinds of odds, in 1988 how many annual new infections could have been predicted for this population, without the scare campaign?

For this I turn to the University of Chicago study of sexual behavior in the U.S. by Edward Laumann and colleagues.[21] From national survey data, Laumann reports a mean frequency of 6.4 sexual events per month for men and women, and says that 95% of most recent sexual events for men and 96% for women included vaginal intercourse.

How many monthly events of vaginal sex take place in the U.S.? Since such an event requires two persons, for estimation purposes the population should be reduced from 142 to 71 million.

Monthly events = approx. 6.4 x 71 million = 454 million

Monthly infections = 454 divided by 5 = 91

Annual new infections = 12 x 91 = 1092

Thus, without the scare campaign one could predict that annually less than 1/1000th of one percent of the U.S. heterosexual population outside of specific risk groups would be infected. That's hardly a raging epidemic. In contrast, since the "HIV prevention" programs began, in 1995 it was estimated that annually from the late 1980s there have been 10,000 new infections among practicing homosexual or bisexual males, who are only about 2 1/2 percent of the population. The public monies wasted for the fraudulent heterosexual scare campaign would have been much better spent in support of medically underserved populations and research for combating top killers such as diabetes and heart disease.

The CDC/Gay Alliance: Denying Risk of Anal Sex

An enormous volume of published scientific evidence demonstrates that anal intercourse is overwhelmingly the most common route by which HIV is transmitted sexually among homosexual men. [22-27] A CDC study published in 1987 found that, for gay men, receptive anal intercourse and number of partners were the best predictors of HIV positivity.[28] The following year, CDC officials James Curran and James Allen informed the medical community that "receptive anal intercourse has been the specific sexual practice to be repeatedly implicated as increasing the risk of HIV infection" in homosexual men.[29]

Likewise, numerous studies have demonstrated that women who have sex with HIV-positive men are at far greater risk if they engage in anal intercourse. Nancy Padian's partner study done in the mid-1980s found that, for females in long-term relationships with infected men, those having anal intercourse were 2.3 times more likely to acquire infection than those who had vaginal sex only.[30] This does not mean that anal transmission risk on a per-contact basis is only 2.3 times greater than vaginal. It means that women in the study who engaged in any anal intercourse were 2.3 times more likely to become infected than those who did not.

From a later study of a similar nature she reported that 30% of the women who had any anal sex became infected compared to 14% of those who did not.[31] A 1988 article in the Journal of the American Medical Association advised physicians that patients should be told to avoid anal intercourse.[32] The following year the same publication cautioned that HIV is transmitted by "a particular form of sexual behavior, anal intercourse."[33]

CDC brochures being produced in the mid-1980s, before the heterosexual scare campaign was manufactured, emphasized the hazards of anal sex. An October 1986 pamphlet entitled "Gay and Bisexual Men and AIDS" was printed bearing the emblems of both the American Red Cross and the US Public Health Service.[34] Gay and bisexual men were explicitly advised to avoid anal intercourse because of the risk of "injury or rips in tissue." Another 1986 Public Health Service item, a booklet from the National Institute of Mental Health, gave the same advice.[35] A 1987 pamphlet of the American College Health Association stated that anal intercourse is "especially risky."[36] According to the Hastings Center Report, advice of this nature was not warmly greeted by the gay community:[37]

Gay groups have strongly criticized these guidelines, because their global character seems to imply that the main sexual activities of gay men are, by definition, risky. Discouraging anal intercourse, sex with strangers, or almost any sexual activity that is stimulating with those suspected of being exposed to the HIV virus, does seem unrealistic.

It was "unrealistic" only because it presented a barrier to the CDC/ gay alliance which later materialized for the purpose of misleading the heterosexual public. On behalf of this partnership, the official brochures were later changed to leave the false impression that anal and vaginal sex were equally risky and that condoms should be used for both types of encounters. This highly misleading message - reversing the earlier appropriate advice against anal sex - was implemented in order to avoid offending the gay activist community and to create inflated fear of vaginal sex among heterosexuals.

The May 1996 Wall Street Journal article noted that the CDC chose a gay ad agent to assist in the planning of its HIV scare campaign. This was done because CDC strategists realized that they needed the involvement of the gay AIDS activist community in its political stagecraft for terrorizing heterosexual America in order to build support for the spending campaign in search of AIDS treatments. It is well known that anal sex is one of the favorite practices among gay males. In order to maintain the CDC/gay alliance, it was necessary to adopt the pretense that anal sex with a condom was safe. Further, the CDC adopted the strategy of creating sexual fear specifically among heterosexual women. To provide females with the scientifically defensible view - that they would be virtually free from sexual risk by avoiding anal intercourse and sexual relationships with injecting drug users - would have undermined this goal.

Changing the Party Line to Promote Heterosexual Fear

Before the CDC's success in achieving wide implementation of the heterosexual scare campaign, the content of newspaper articles inspired by public health officials minimized alarm. A New York Times News Service article about AIDS appeared in early 1988 and stated that "evidence grows ever stronger that the much-feared explosive invasion of the general population is not occurring, and never will." [38] Dr. Otis R. Bowen, Secretary of Health and Human Services, reassured the public that no "explosion into the heterosexual population" was expected. A 1987 New York Times headline read "Anxiety Allayed on Heterosexual AIDS." [39] The article quoted several "AIDS experts" including CDC official Harold Jaffe, who said that no explosive growth of the AIDS epidemic was occurring among heterosexuals. Nonetheless, he took "very seriously" the possibility of a heterosexual epidemic. Others quoted in this article were less alarmed:

Many other national AIDS experts have also concluded from health statistics that explosive spread of the virus among heterosexuals seems highly unlikely, although the reasons for that remain speculative.

Dr. B. Frank Polk, an AIDS epidemiologist at the Johns Hopkins School of Hygiene and Public Health in Baltimore, said in an interview here that 'a number of scientific leaders in AIDS have overstated the risk in the absence of data.'

In addition to discouraging anal sex, another feature of early AIDS information prepared for heterosexual consumption was the advice to avoid having sex with members of specifically-identified risk groups, such as bisexual males and injecting drug users. A 1985 booklet from the Oklahoma Health Department listed the following groups who were considered at risk of AIDS: (1) gay or bisexual men, (2) injecting drug users (IDUs), and (3) heterosexuals having sexual contact with AIDS patients or with members of other risk groups.[40] A 1987 New York Times article was published on the front page and highlighted the spread of HIV among injecting drug users.[41] CDC official Jaffe told the Times that "the great majority" of those infected with HIV, "are either members of a high-risk group or had sex with a member of a high-risk group."[39]

Heterosexuals reading advice inspired by U.S. health officials before the manufacture of the elevated fear campaign would likely have been led to a course of action involving the avoidance of three activities: (1) anal sex, (2) sharing needles for injecting drugs, and (3) sexual contact with IDUs or bisexual males. For agency leaders who desired increased government AIDS spending, allowing this state of mind to exist among mainstream Americans was detrimental. It did not arouse sufficient fear, and most Americans would suffer no inconvenience by accommodating themselves to it. The main problem was that it did not give the typical American, who is neither gay nor an IDU, a personal interest in the dream for a "miracle drug" cure.

The change in the official message was dramatically announced in 1988, when the Public Health Service mailed to every US household its brochure entitled "What You Should Know About AIDS." [43] The main message of this politically-manicured publication was that "AIDS affects us all." Nowhere did the document advise against anal sex, nor against having sex with members of specific risk groups. On one page it advised that "the safest way" to avoid AIDS is to avoid promiscuous sex and illegal drugs. On the preceding page it told teens to avoid sex altogether. Nowhere did it remind the public that gay and bisexual males are at increased risk. The pamphlet stated: "You can get AIDS from one sexual experience." It did not inform heterosexual Americans of how infinitesimally low the chance of HIV infection is for those not having sex with members of specific risk groups earlier identified in official literature.

From the 1988 pamphlet, an uninformed reader would receive the misleading impression that (1) gays and straights are equally at risk, and (2) there is no substantial risk reduction associated with avoiding anal intercourse and sex with members of specific risk groups.

Candid Gay Comments

Occasionally gay spokesmen writing for periodicals not intended for mainstream audiences will candidly admit to the political nature of the campaign to spread fear within the general public. In a Village Voice article, writer Robert Massa stated bluntly that "AIDS is a gay disease." [43] In the same paragraph he admitted that AIDS activists have argued forcefully that AIDS is not a gay disease, because this line was seen as "the best way to rally resources." So long as the dream of a miracle cure remains unrealized, many gay activists will blame "homophobia" and the government for their illnesses. Massa continues:

Homophobia has escalated the epidemic, driving people at risk away from health care, crippling the self-esteem needed to practice safer sex, fueling the hysteria that contorts public-health policy, allowing the government to sit back and watch us die.

Gay AIDS patient Michael Callen once disclosed that he had been asked not to talk about the fact that some AIDS patients "seem to have survived full-blown AIDS for 5 or more years." He added, "It's bad for fund-raising, we're told... " [44]

Any information tending to calm public fear of AIDS is bad for fund-raising. In February 1995, The New York Times published a CDC finding that only about one fourth of the estimated 40,000 new HIV infections in the US the earlier year were among gay men. [45] The remaining three quarters, mostly residents of inner city minority populations, were counted as either IDUs or sexual partners of IDUs. The reduced impact among gay men was not seen as altogether good news among gays employed by the AIDS industry.

"It's a real dilemma," said Stephen Soba, communications director for the Gay Men's Health Crisis. The Times reported a fear among others that if AIDS education becomes connected to the task of drug abuse prevention, then people outside the inner cities will "falsely feel that they are not at risk."

In 1994 The Advocate reported that many AIDS activists were "worried and angered" by a University of Chicago study which stated that AIDS is likely to be confined to gay men and intravenous drug users. "There are no impregnable walls that can contain a sexually transmissible disease, and no American should be put at risk by false assumptions of immunity," said Daniel Bross of the AIDS Action Council, based in Washington, DC. [46]

Not typical as a spokesman from the gay world is lesbian Camille Paglia, who told the Harvard Gay & Lesbian Review that she celebrates the fact that gay men have pushed "the freedom of the sex impulse" to its limit. On the other hand, she bluntly states that "AIDS is a gay disease," and expresses no sympathy for the gays' political demand that society should bear the consequences of their self-indulgent behavior by paying the cost of drug development:[47]

Stop whining! Stop saying 'I'm a victim; Ronald Reagan should have gotten me out of this.' Look, you've destroyed yourself... .Live free and die, I say! But stop whining.

Another gay writer who stands in stark contrast to the orthodoxies of AIDS activism is New York resident Richard Berkowitz, who denies neither the health hazards of anal sex nor the reality that heterosexual sex is insignificant as an HIV risk. In 1993 he pointed out that "a grand total of 17 out of more than 30,000 cases of AIDS" in New York City were "men who claim their only risk factor is sex with a woman." [48] He says that the delusions spread about AIDS have cost thousands of lives, undermined effective safe sex education, and misdirected billions of dollars "into a wrong, useless, and wasted direction." Similar views have been expressed by Arthur Leonard, writing in the gay publication New York Native:[49]

However much we may be enchanted by the 'party line' about heterosexual transmission that has finally focused the attention of the media, the public, and the government on AIDS, heterosexual men are, next to lesbians, probably the least threatened by AIDS as a sexually transmitted disease. The 'party line' ... may do more harm than good by deflecting attention from groups who need the most help.

Recommendations

With the exception of those providing social services, non-toxic treatments, and hospice care to the medically indigent, federal AIDS programs should be defunded, and public officials who are responsible for developing the deception associated with them should be held accountable. For prevention of the diseases suffered by those who have been called "AIDS" patients, future educational messages need to contain only these simple warnings:

1. avoid anal sex;
2. avoid recreational drugs;
3. avoid being the sexual partner of a recreational drug user.

Putting aside momentarily the question of whether HIV causes "AIDS," it is clear that:

1. almost 100% of U.S. patients diagnosed with this syndrome have engaged in at least one of the three behaviors listed above;

2. the overwhelming majority of Americans who have avoided these three behaviors have not suffered the severe immunesuppression associated with the AIDS diagnosis.

For those who choose to defy these educational messages and consequently develop disease, the obligation of government to support research in search of treatments should be no more or no less than the effort provided on behalf of victims of other behavior-related diseases.

As I argued in the San Francisco Chronicle , it is scientifically nonsensical to search for the cause or causes of "AIDS." Research should instead be directed towards the question of what are the causes of severe immunesuppression, and such research should not be encumbered by biases favoring viral hypotheses.

Finally, I recommend that an appropriate Congressional committee conduct a thorough and critical inquiry into the history of the AIDS program in the US, and that scientists, writers, and scholars dissenting from the orthodox viewpoint be invited to testify.

Michael P. Wright
PO Box 204
Norman, Oklahoma 73070
405/329-6688
mpwright9@aol.com

Notes

1. Amanda Bennett and Anita Sharpe, "AIDS Fight Is Skewed By Federal Campaign Exaggerating Risks," The Wall Street Journal, May 1, 1996
2. National Research Council, The Social Impact of AIDS in the United States (Washington, DC: National Academy Press, 1993): 24.

3. Judith A. Johnson, "AIDS and Other Diseases: Selected Federal Spending and Mortality Statistics," CRS Report for Congress (Congressional Research Service, The Library of Congress) March 9, 1995

4. David Satcher and Helene Gayle, "The Democratization of AIDS [letter], The Wall Street Journal (May 21, 1996)

5. C. Everett Koop, "The Democratization of AIDS [letter], The Wall Street Journal (May 21, 1996)

6. Michael Wright, "CDC 's Deceitful HIV Scare Campaign [letter]," The Wall Street Journal (June 18, 1996)

7. Nancy Padian, "Male-to-Female Transmission of Human Immunodeficiency Virus," Journal of the American Medical Association, 258, no. 6 (1987): 789.

8. Alberto Saracco, "Man-To-Woman Sexual Transmission of HIV: Longitudinal Study of 343 Steady Partners of Infected Men," Journal of Acquired Immune Deficiency Syndrome, 6, no. 5 (1993): 497.

9. Nancy Padian, Stephen Shiboski, Nicholas Jewell, "Female-to-Male Transmission of Human Immunodeficiency Virus," Journal of the American Medical Association, 266, no. 12 (1991): 1665.

10. See note 7.

11. Harold Lief, "Sexology," Journal of the American Medical Association, 261, no. 19 (1989): 2889.

12. Baruch Modan, "Prevalence of HIV Antibodies in Transsexual and Female Prostitutes," American Journal of Public Health 82, no. 4 (1992): 590.

13. Nancy Padian et al., "Heterosexual Transmission of Human Immunodeficiency Virus (HIV) in Northern California: Results from a Ten-Year Study."American Journal of Epidemiology 146, no. 4 (1997): 350-57.

14. Pauline Thomas, "Trends in the First Ten Years of AIDS in New York City," American Journal of Epidemiology, 137, no. 2 (1993): 124.

15. Centers for Disease Control, National Serosurveillance Summary, Volume 3 (1992) HIV/NCID/11-93/036: 36.

16. John McNeil, et al. "Trends of HIV Seroconversion Among Young Adults in the US Army, 1985 to 1989," Journal of the American Medical Association, 265, no.13 (April 3, 1991): 1710.

17. Jay Levy, Nancy Padian, and Jeff Sheehy, "Proven Connection - HIV Causes AIDS; Differences between U.S. and African Epidemic Don't Disprove Cause of Both," San Francisco Chronicle, May 30, 2000, p. A25.

18. CDC, Morbidity and Mortality Weekly Report, December 18, 1987, 36, no. S-6, Table 14.

19. Norman Hearst and Steven Hulley, "Preventing the Heterosexual Spread of AIDS: Are We Giving Our Patients the Best Advice?" Journal of the American Medical Association, 259, no. 16 (1988): 2428-2432.

20. Abstract THP.3-48:171, presented at the Third International AIDS Conference, Washington, DC, June 1987

21. Edward O. Laumann et al., The Social Organization of Sexuality: Sexual Practices in the United States (Chicago: University of Chicago Press, 1994), p. 98.

22. Kirk Elifson, Jacqueline Boles, and Mike Sweat, "Risk Factors Associated with HIV Infection among Male Prostitutes," American Journal of Public Health, 83, no.1 (1993): 82. 23. Andrew Moss, et al., "Risk Factors for AIDS and HIV Seropositivity in Homosexual Men," American Journal of Epidemiology, 125, no. 6 (1987): 1045.

24. Randall Coates, et al., "Risk Factors for HIV Infection in Male Sexual Contacts of Men with AIDS or an AIDS-Related Condition," American Journal of Epidemiology, 128, no. 4 (1988): 732.

25. Lawrence Kingsley, et al. "Risk Factors for Seroconversion to Human Immunodeficiency Virus Among Male Homosexuals," The Lancet (Feb. 14,1987): 347.

26. Warren Winkelstein, "Sexual Practices and Risk of Infection by the Human Immunodeficiency Virus," Journal of the American Medical Association, 257, no. 3 (1987): 321.

27. George Seage, Kenneth Mayer, and C. Robert Horsburgh, "Risk of Human Immunodeficiency Virus Infection from Unprotected Receptive Anal Intercourse Increases with Decline in Immunologic Status of Infected Partners," American Journal of Epidemiology, 137, no. 8 (1993): 900.

28. William Darrow, "Risk Factors for Human Immunodeficiency Virus (HIV) Infections in Homosexual Men," American Journal of Public Health, 77, no. 4 (1987): 482.

29. James Allen and James Curran, "Prevention of AIDS and HIV Infection: Needs and Priorities for Epidemiologic Research," American Journal of Public Health, 78, no. 4 (1988): 381.

30. See note 7.

31. Nancy Padian, Stephen Shiboski, and Nicholas Jewell, "Heterosexual Transmission of HIV," [letter] Journal of the American Medical Association, 267, no. 14 (1992): 1918.

32. See note 19.

33. See note 11.

34. American Red Cross and US Public Health Service, Gay and Bisexual Men and AIDS [pamphlet] October 1986.

35. National Institute of Mental Health, Coping With AIDS: Psychological and Social Considerations in Helping People with HTLV-III Infection [booklet], Publication No. (ADM) 85-1432 (1986).

36. American College Health Association, AIDS: What Everyone Should Know [pamphlet], (Rockville, Maryland: ACHA, 1987)

37. Dan Beauchamp, "Morality and the Health of the Body Politic," Hastings Center Report (December 1986): 31.

38. Philip Boffey (New York Times News Service), "Spread of Virus May Be Moderating," The Norman Transcript, February 14, 1988, p. 28.

39. Lawrence Altman, "Anxiety Allayed on Heterosexual AIDS," New York Times (June 5, 1987), p. 11.

40. Oklahoma State Department of Health, "AIDS Update" (November 1, 1985).

41. Lawrence Altman, "Spread of AIDS Virus Is Unabated Among Intravenous Drug Takers," New York Times (June 4, 1987), p. 1.

42. Centers for Disease Control, "What You Should Know About AIDS" [brochure] (US Public Health Service: 1988).

43. Robert Massa, "All That We Can't Be," The Village Voice (May 18, 1993), p. 18.

44. Michael Callen, "Are You Now, or Have You Ever Been?" PWA Coalition Newsline (January 1989), p. 34.

45. Gina Kolata, "New Picture of Who Will Get AIDS Is Crammed With Addicts," The New York Times (February 28, 1995), p. B6.

46. John Gallagher, "10% Reality or Myth?" The Advocate (November 15, 1994), p. 24.

47. Camille Paglia, interviewed by Michael Hattersley, "I am a Celebrator of Decadence," The Harvard Gay & Lesbian Review, 5, no. 2 (Spring 1998): 12.

48. Richard Berkowitz, "The Truth Sucks," NY Press (June 2-8, 1993)

49. Arthur Leonard, "On the Need for a Realistic View of the Epidemic," New York Native (July 20, 1987), p. 22


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