The AIDS Breakout


San Jose, California. -- Anybody can get AIDS, but not everybody does: The rise in heterosexual transmission of the AIDS virus is strongly linked to drug abuse, according to the federal Centers for Disease Control and Prevention.

For years, AIDS activists warned that the disease was an equal-opportunity killer that someday would "break out" of the gay community to terrorize heterosexuals. AIDS is out of the gay ghetto -- but not out of the drug ghetto. Drug abusers accounted for nearly three out of four new HIV infections in 1994, reports the New York Times, citing the as-yet unpublished federal study.

It's not news that intravenous drug abusers pass the infection by sharing dirty needles. The news is the role of crack cocaine, which fuels reckless promiscuity. In particular, women trade sex for drugs or drug money, exposing themselves to dozens of sexual partners, some of whom are going to be IV-drug abusers.

As many as half the women infected heterosexually may be crack addicts; abuse of other drugs and alcohol also is linked to infection. Not surprisingly, addicts are not reliable practitioners of safe sex, and they are likely to have other sexual infections that can ease the transmission of the AIDS virus.

Drug-related transmission has changed the face of the AIDS epidemic. Ten years ago, about half of new infections were related to gay sex, a quarter to sharing dirty needles. Now those ratios have been halved for gay men, doubled for needle-sharing drug abusers. Heterosexual transmission has more than doubled: Typically, needle-sharing men infect women, who may pass the disease on to their babies.

Michael Fumento was pilloried for writing "The Myth of Heterosexual AIDS," but he was right. Heterosexuals who are shielded from the drug epidemic are largely shielded from the AIDS epidemic. That doesn't mean there's zero risk for drug-free heterosexuals. It doesn't mean that drug-free promiscuity is a good idea. It does, however, mean that AIDS prevention campaigns have wasted a lot of money trying to scare low-risk heterosexuals, while doing little to inform inner-city residents about the high risk of heterosexual sex with drug users.

Focusing on high-risk people risks worsening the AIDS stigma: Gay men and drug abusers are not the most popular groups in society; the predominance of blacks and Hispanics in the drug-related AIDS group doesn't help either. But marketing AIDS as an all-American disease hasn't stopped the epidemic. The discriminatory nature of AIDS is an uncomfortable truth. That beats a dangerous lie.

The importance of drug abuse in spreading AIDS underscores the desperate need for needle-exchange programs. Another uncomfortable truth -- at least for drug warriors -- is that giving addicts clean needles in exchange for dirty ones is an effective way to slow the spread of AIDS.

A large study in New York, where about half of IV addicts are infected with the AIDS virus, found giving clean syringes (and Clorox, condoms and counseling) halved the infection rate. According to the American Foundation for AIDS Research, there was no evidence of increased drug use. In other studies, needle exchange decreased drug use by connecting addicts to drug treatment.

As a result, two Centers for Disease Control reports, leaked earlier this month, recommend federal funding of needle exchanges. The reports had to be leaked because the Clinton administration was too afraid of looking "soft on drugs" to let public-health officials report their conclusions.

Preventing AIDS infection in IV abusers will protect their future sexual partners and their babies. Attacking the crack factor in AIDS transmission is harder. It requires more drug-treatment options, especially residential programs for women and their children. It costs money. Success isn't guaranteed.

The alternative is grim: Let them die.

Joanne Jacobs is a columnist for the San Jose Mercury News.

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