by Merle Hoffman

An ON THE ISSUES Exclusive Interview with an Introduction by Dr. Mathilde Krim,

Co-Chair American Foundation for AIDS Research (AmFAR)

There is no doubt that the number of cases of AIDS continues to increase sharply and that the proportion of such cases found beyond the boundaries of the so-called “high risk” groups – mainly homosexual males and I.V. drug users is also increasing. Women have been struck by this deadly disease. Although many women have contracted the infection predisposing them to AIDS through the sharing of hypodermic needles with infected drug abusers, a significant proportion have become infected through sexual intercourse. Because the incubation period preceding overt disease can be very long, on average as long as five or more years, even a monogamous relationship of several years with an apparently entirely healthy partner does not exclude the risk of infection and later disease. Asymptomatic carriers of the infection pose the greatest threat in the spread of AIDS. It is essential that all women learn what the “facts of AIDS” are. and learn how to protect themselves and their unborn children.

With that in mind, when On the Issues contacted me, 1 suggested they interview a woman physician who has done pioneering work on AIDS, both in research and with patients. She has. I believe, thoroughly informed views of the dangers of AIDS but she can also provide down-to-earth, practical advice on how it can be prevented. Because of the sensitive nature of her work, she prefers not to be identified. However, I think what she has to say is of major importance to everyone.

– Mathilde Krim

OTI: What was your first connection with AIDS?

MD: As an internist with a subspecialty in STDs; I began seeing immunologically unusual patients in 1980, and in 1981 I was one of the many people who first reported the new disease.

OTI: What are the characteristics of your female patients with AIDS?

MD: Well, that’s quite interesting. I had one patient in 1982 who had been a prostitute. She was a very intelligent woman, working as a prostitute three months of the year and attending college for the rest of the time. She realized that AIDS was related to sexual activity so she sent me six friends. Soon after. I got another prostitute referral from a physician, and had a total of eight women, three of whom were very abnormal, and one was the patient with AIDS. I’d been saying all along that we should be examining prostitutes, and fortunately, I was able to interest Dr. David Sencer (then Commissioner of the N.Y.C. Department of Health) who at that time, was studying women prostitutes for a new, resistant strain of gonorrhea. They (the Department of Health) were monitoring women in brothels. The health care worker went to the brothels where she took blood for syphilis testing and while she was doing it, asked the women if they would sign permission to see if they were immunologically normal and took another tube of blood. Unfortunately, they only gave me permission to get 1 Occs so I could never store enough to look at later on for the HTLV-III virus. But, we did look at it for the T cells, and two of the women were significantly immune depressed. I followed one for a year. She was very sick, she lost 35 pounds and had lymphadenopathy. She really looked like she was getting the disease. But a year later, she looked much better – she seemed a long way in getting over whatever she had.

OTI: It wasn’t AIDS?

MD: It was either ARC (AIDS Related Complex), from which we believe there can be a full recovery; or it was cytomegalovirus infection.

OTI: It seems most of the women you’ve seen have been prostitutes. Have you had other types of patients?

MD: Oh. yes. I had another woman who was a lovely, high-level professional with a couple of children. She married a man that she didn’t know was an I.V. drug user. She got AIDS from him.

OTI: Do most prostitutes get AIDS through sex or through drugs?

MD: 1 think most of those I saw got it from I.V. needle use, and they all – even the college student prostitute – had a boyfriend who was a drug user. She would shoot up with him once in a while and she shared his needle.

OTI: Do you think AIDS may end the so-called “sexual revolution”?

MD: No question about it. About one third of my practice is gay men and they have really curtailed their sexual activity. A lot of my patients (men and women) tell me that they are celibate. Everybody’s scared. Maybe more so then they have to be. but… A good rule of thumb is to use condoms.

OTI: The virus doesn’t pass through condoms?

MD: No. It can’t pass through, but if they break, you’re in trouble. The condom and spermicidal jelly together provide better protection. There is some evidence that the spermicidal jelly kills the virus.

OTI: Yes, we’ve heard that too. As a matter of fact, it seems that the virus, once it’s outside the human body, is fragile.

MD: Yes, fortunately it is very fragile. And it’s not even spread that easily sexually because the wives of hemophiliacs don’t always show the virus antibodies.

OTI: It has been reported that they have finally isolated the virus in women’s vaginal secretions. Why did it take them so long to do it?

MD: It’s very difficult to culture any virus in vaginal secretions because there are so many bacteria. So. you have to treat vaginal secretions with antibiotics and then look for the virus. It’s tricky. It has been done by passing it through tissue culture media several times.

OTI: If the virus is in vaginal secretions, why is it that the spread doesn’t seem to be as great from women to men?

MD: Some think there are 48 cases of men in this country now who got the disease through sexual activity with women. (Editors Note: The number has increased since this interview.)

OTI: We are told that there’s no evidence that AIDS spreads among family members unless they are engaged in sexual intercourse. But, on the other hand, we’re being told the virus can incubate up to 10 years and of course, none of these families have been studied that long.

MD: Yes, but fortunately you don’t have to study the family that long. You can do the blood test and that tells you whether or not they have developed antibodies because they’ve been exposed. So, thankfully, the mystery is really out of it. We really do know a lot more about the epidemiology of this disease because of the blood test. And we can say for certain now that family members of people with AIDS do not get the disease. And health care workers don’t get the disease just from handling patients.

OTI: A case was reported which indicates that AIDS may be spread between lesbians.

There was a case of a lesbian couple, one of whom had been an I.V. drug user, developed AIDS and died. Her lover was the primary care giver and now has ARC. She never used drugs. The question is whether this had come through care giving or if there is some way of sexually transmitting AIDS between lesbians.

MD: The fact is. that even though there is potential that AIDS may be transmitted from saliva, it would be very difficult to do and we have no proven cases that AIDS has been transmitted that way. Now, this lesbian case you mentioned may be the first one. but there are no known cases where people only got it from kissing and there are 29.000 cases already of known AIDS. Of course, the women may have shared sexual aids such as dildos.

OTI: For something as horrible as AIDS, the virus seems awfully difficult to transmit. By the constant doubling of the number of victims, you’d think AIDS would be much more infectious, much easier to transmit casually …

MD: You can’t confuse seriousness with infectivity. AIDS is sexually transmitted. And even then, as I’ve said, the wives of hemophiliacs show evidence of exposure to the virus 60 percent of the time. They are having, I assume, regular sex with their husbands and yet they all don’t show exposure. So, either it’s because they are using barrier contraceptives or because the disease is not that easy to transmit. It is transmitted sexually and in blood products but it’s not transmitted casually.

OTI: What about children with AIDS going to school? If there is a potential danger that it could be spread more casually than we now know, couldn’t cities be hit with law suits for “murder”? Have you heard of that?

MD: That’s what they’re all talking about, that the City of New York could not afford a law suit for this if any other child got it. However, the advantage of being intelligent is that we can learn from what has happened before. All the families of children with AIDS have been studied by the New York City Department of Health. None of the sibs who are older or who are not blood related to children with AIDS have shown seropositivity. The same with the foster parents who are taking care of these children – they are all sero-negative. We’re talking about the foster mothers not the natural mother, because the natural mothers are how the children got the disease in the first place. They got it in utero.

OTI: Also, there are children who contracted AIDS through transfusions before the testing for the virus was available.

MD: Yes, like the boy in Kokomo. Indiana. What a terrible thing. Those people tried to keep this boy out of school so that he couldn’t even have the company of his friends and his peers while he is this sick. I think those parents are terrible. I saw pictures of them walking with signs that say “Parents Against AIDS”. That’s fine. Be against AIDS, it’s important to be against AIDS. But, it’s not good to keep a boy from school and from his friends. 1 met with a group of parents from New Jersey who were trying to keep a brother of an AIDS victim from going to school. The boy was sero-negative for the virus. One of the mothers said to me, “But you know who these children are, you know who their mother was … she was a prostitute.” So, therefore, the children have no rights and should be segregated from society. They have forgotten the Golden Rule and that the child could have been their child and could have had a transfusion and contracted the disease that way.

We really should be worried about our children, especially the teenagers. One day one of their friends is going to say. “Hey, try this stuff, it’s gonna make you feel great” and “Here, look, I’m gonna give it to myself and now you take the syringe and you use it”. Because this kid doesn’t want to lose face in front of his peers, he takes this bloody syringe and faces the danger of giving himself AIDS. And. some teenagers have poor judgment. They’ll do anything that their friends tell them.

OTI: Kids are at risk of contacting AIDS sexually because most of them don’t use contraceptives. We see it every day at Choices; young girls who come in without a thought about what they were getting themselves into. It’s sad.

MD: What I’m seeing now are the kids who have used I.V. needles. I have a patient, a lovely young woman brought up in a middle class family. Somehow she got on drugs and now that she finally pulls her life together, gets married, has a child with this disease. For her there was no second chance.

OTI: It must be very difficult for you to have to tell some of these people that they are really doomed.

MD: Well, I never thought I would be in this position. I didn’t go into oncology because I didn’t want to deal with so many dying patients and here I am, dealing not only with dying patients but many of them young women with children. I did a project studying women in a drug treatment program – women who really want to get their lives together, who are going into therapy or are in therapy, using Methadone. trying to be drug free, and now they have this to contend with.

OTI: Is there any chance for survival … are the odds looking better?

MD: No. Well, not everybody who gets the virus comes down with the disease. We’ve been looking at it since the 70s. We have blood specimens stored, so these people have been followed until 1985. According to the study, one-tenth to one-quarter of those who were exposed will get the disease.

OTI: If somebody has ARC, can they spread the infection?

MD: Oh, yes. People are probably much more contagious before they develop symptoms of the disease so that unfortunately the carrier state consists of people who feel well and don’t know that they have this problem.

OTI: Would you suggest that any woman who has had multiple sex partners be tested for the AIDS virus?

MD: No. The odds of a woman being exposed to it are still very minute.

OTI: I know a young woman who is highly intelligent and careful but who has had maybe five or six sex partners in the past couple of years. She is sure that one was shooting drugs. I thought it might be a good idea if she was tested.

MD: I think that it is a good idea. If she was sleeping with somebody who was shooting drugs that certainly increases the chances… I’ve seen many women who are hysterical because they discovered their boyfriends were bi-sexual. And you know, we will test them.

OTI: They should be tested?

MD: Well, not necessarily should. If they can’t live with the uncertainty.

OTI: Also, they could infect other people.

MD: Right. I recommend that all homosexual men get tested, but anonymously. They have to be able to trust their doctor and not have the results made public or in any public data bank. I think it’s important for everyone to know what their state is. If they are negative, they can keep it negative. If they are positive, they have to inform their sex partners and use protection for themselves and the other person.

OTI: When you have to tell somebody that they have AIDS, do you talk to partners, too?

MD: By the time somebody has AIDS, they’re sick. And they know it. And usually with ARC also, they’re suspicious. But. when they’re just positive for the virus, no I don’t tell their partners, that’s not my business. But I certainly inform them that they should tell their partners. With any sexually transmitted diseases, I have given people lectures about having to inform their partners that they have to be treated. We used to think venereal warts was a pretty benign condition and now we find it is probably related to carcinoma of the cervix. So, that’s not such a benign condition anymore.

OTI: What are the most important things women should know about AIDS?

MD: I think women have to know that this is a sexually transmitted disease and transmitted in blood products. Certainly, using needles with cocaine, using heroin, is really a risky thing to do. Sharing a needle with anybody is suicidal and worse than suicidal because this is not a clean way to die – it’s just an awful way to die. And they have to know that AIDS like any other sexually transmitted disease can be prevented by the combined use of condoms and spermicidal jelly. Gone are the days where it was “your pad or mine toots, and we’ll get to know each other better later”. In fact, I had a nurse who used to say that we should have a needlepoint banner made for the waiting room saying “No condoms. No sex!”

OTI: I think that’s a wonderful idea. If you can sell it to the teenagers and even younger set. Have you heard about the new condom that’s supposedly slip proof? They are packaging it for women to buy … pretty pink containers.

MD: Sociologically, women have always been afraid to ask men to wear condoms. But, I did a little poll among workers in a sexually-transmitted disease clinic and every one of those women made men wear condoms.

OTI: I’m not surprised. Before we wind down – what percentage of babies born to mothers with the virus will have the disease?

MD: Very early data is showing that if a woman is positive for the virus, she probably has a 50-50 chance of having a baby with the disease. This is just one of the most awful pieces of information to come out of this because those are very high odds of having a child who will sicken and die.

OTI: William F. Buckley thinks that all AIDS carriers or high-risk people should be identified by tattoos on arms for drug users and buttocks for homosexuals to warn potential lovers. He also believes that people with AIDS should be sterilized because the virus is transmitted to the unborn. Just a comment?

MD: It seems to me that when heterosexual people get so upset with homosexuals for having spread this disease, what they are really saying is that they are angry with homosexuals for fucking around – because now they can’t do the same thing themselves!

Merle Hoffman is publisher/editor-in-chief of On The Issues magazine and founder/president of both Choices Women’s Medical Center, Inc., and Choices Mental Health Center.