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Education and Funds for AIDS

November 18, 1987

As a physician who occasionally treats patients with AIDS and who attempts to educate patients as to the potential risks of acquisition of the virus, I was alarmed by the recent statement of William Raspberry (Op-Ed Page, No. 2) that "it no longer threatens to 'break out' in any major way in the heterosexual community." This statement contradicts a comprehensive review of this subject published in the most recent issue of The New England Journal of Medicine.

Because the virus was introduced primarily into the male homosexual community, heterosexual cases have been relatively uncommon. Subsequently, heterosexual intravenous drug abusers and bisexuals have served as a "bridge" to the heterosexual community, producing an increasing number of heterosexually acquired cases. As the disease takes years to manifest itself, the rate of heterosexual transmission can only be estimated from the number of asymptomatic infections. These estimates, such as the overly optimistic ones discussed by Raspberry, are notoriously fraught with the risk of grave error. The fact is that no reliable statistics on this subject exist.

There are two aspects of the viral epidemic which suggest that the optimistic scenarios on the subject of heterosexual transmission may be incorrect. The first is that in Africa the disease has all of the earmarks of a classic sexually transmitted disease. Although there may prove to be substantial differences between the diseases on the two continents, the possibility remains that the epidemic in the U.S. may evolve to resemble that in Africa once a sufficient number of female cases develop.

Second, a recent screening of over 300,000 military recruits demonstrated that in areas of high prevalence (i.e., greater than 1% among recruits from New York City) the ratio of male to female cases is approaching one to one.

Even if Raspberry's optimistic scenario proves true, it will provide little solace for the victims who acquire the disease by heterosexual transmission.

DANIEL J. STONE, M.D.

Los Angeles

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