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There can be few people living in Britain now who have not heard of AIDS. Many of you have probably reached almost saturation point with advice. information and conflicting Opinion about the relative risks of acquiring the condition. and while much ofthe media coverage recently has been helpful. some has also been alarming and some alarmist. fuelling intolerance and prejudice. It is difficult to work out how worried we should be. We asked Dr Alexander MacMillan ofthe Royal Infirmary. Edinburgh this question. He deals with AIDS sufferers. mainly homosexuals and intravenous drug users. but also has had many enquiries from worried members of the public who in his words ‘perceive that they‘ve been at risk’. His response to the question was: ‘They shouldn‘t be scared. They should be aware that the virus exists. Though the present risk oftransmission through heterosexual contact is very low. both hetero— and homosexuals should wear a condom for casual sex.‘

He points out that one of the main reasons for the present campaign of information and caution is concern that there is no guarantee that the virus will continue to behave in the same way as it has until now. While in the West. the virus has been slow to spread amongst heterosexuals. in Central Africa this has not been the case. It is then difficult to give I categoric reassurance to people. His advice to the general population (that is those not in so-called ‘high-risk‘ groups) however is not to worry. Given the low numbers of HIV-infected people (‘carriers‘) among the ‘low—risk‘ heterosexual population (that is people who have had no sexual contact with homosexual or bisexual men. intravenous drug users or haemophiliacs) the risk at present is extremely low for most people.

The following points. checked over for us by Dr MacMillan. may be helpful. 1. You cannot catch AIDS. AIDS (Acquired Immune Deficiency Syndrome) is a pattern ofdiseases that develop in some (not all) people as a result of their body‘s immune system being damaged by a virus known as HIV (Human Immunodeficiency Virus). The virus is what is passed on. So far. not all people who become infected by the virus , who are refered to as ‘carriers‘. develop AIDS. 2. The HIV virus works by

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As International Aids Day approaches, we recap on the medical advice.

weakening the body‘s immune system ofdefence against disease. It inserts its genes into the genes ofthe white ‘1“ blood cells. Ifthese cells become active the virus is able to multiply. so infecting more cells and damaging their ability to defend the body against disease. This makes it possible for rare forms of disease to take a hold in the body.

3. In infected persons the virus can be found in all body fluids. But it is only reckoned strong enough to be transmissable in genital secretions and blood. It is therefore transmitted when infected blood is taken into the bloodstream through injection or transfusion or when genital secretions containing the virus get into the blood during sexual intercourse. Wearing a condom lessens this risk considerably. Anal sexual intercourse is particularly risky because the membranes in the rectum are quite delicate and easily ruptured. facilitating the passage of semen into the bloodstream.

4. Because of the nature of transmission ofthe virus. certain groups are more at risk than others. Intravenous drug users. ifthey share needles and other ‘equipment‘. with an infected person. because the virus then passes straight into the bloodstream; haemophiliacs. though becoming less at risk because of increasingly vigilent screening of blood; homosexuals because anal intercourse is particularly risky and because some of them have a particularly high number of partners. It is not a ‘gay disease‘. The nature of transmission of the virus makes it more likely to affect homosexual men.

5. At present the majority ofpeoplc who have developed AIDS remains among these ‘high risk' groups. There is the possibility that the virus will find its way into a broader section of the population through bisexual and heterosexual contact. Because there is a time lapse of several months between being infected with the virus and it showing up in the antibody test, and a possible further time lapse ofseveral

years before (if) a virus—infected person develops AIDS. it is difficult to assess the number of ‘carriers’ at any given time. It is this grey area of unquantifiables that gives rise to concern. For this reason it is advocated that ifyou are in one of the so-called ‘high risk‘ groups. you adopt measures to avoid contracting the virus or passing it on to others: not sharing drugs ‘equipmcnt‘. restricting the number ofsexual partners (ofeithcr sex) and following ‘safe sex‘ guidelines (see below). Repeated exposure to the virus is thought to be more dangerous than one exposure.

Any couple embarking on ‘casual‘ sex are probably best advised to protect each other by using a condom and avoiding any blood—drawing activities. Naturally views differ as to what constitutues ‘casual sex’! Should we be worried about any new sexual encounter. be it long-term, briefor for one night only? How can we ever assess if and when either partner may have come into contact with the virus over the recent past? Clearly it is impossible to give categoric answers to these questions the best course lies in open and frank discussion with one another. and in using a condom

5. For both heterosexual and homosexual partners Safe sex is reckoned to bezkissing. mutual masturbation, body rubbing. massage and unshared sex toys. Low risk sex: oral sex (ifyour mouth and lips are healthy), anal/vaginal sex using a condom. High risk sex: anal/vaginal sex without using a condom, sharing sex toys which have genital secretions/blood on them.

7. The virus is very fragile. It cannot exist for long in the open air. You cannot 'catch‘ it from the air. from ustensils. from sharing cups, mugs. etc. You cannot contract it from normal contact with an infected person (hugging. hand-shaking) or by eating food prepared by them. You cannot be infected in swimming pools (no matter who has swum in them). You cannot catch it at the dentist (dentists are required by law to sterilise their equipment between

patients) nor when giving blood. You cannot catch it during mouth-to-mouth resuscitation. There is no evidence of anyone ever having caught it from kissing: while the virus maybe present in all bodily fluids it is diluted and made ineffective by the natural antiseptic qualities ofsaliva. It is not possible to catch it through sneezes. coughs or bodily contact other than sexual with an infected person. It is however inadvisable to share razors or toothbrushes. It is not easy to catch the virus. 8. If you are worried you can ask to have a test. The test will not tell you you have AIDS. It tells you whether HIV antibodies are present in your bloodstream (hence the term ‘Antibody positive‘). It cannot be completely conclusive because of the time lapse between becoming infected and the virus showing up. Because of this you are advised to wait several months between ‘high—risk’ sexual contact and having the test. If you want a test you should go to genito—urinary department ofa hospital, not to the blood transfusion unit. You Will not automatically be given one. you will first be counselled about your concern. 9. Two current issues ofdebate are the questions ofwhethcr infected individuals should be isolated from the general community and whether the general population should be screened. Clearly this is a matter of opinion. The common sense answer to both questions would appear to be no. Isolation of infected individuals only makes sense when they have an easily contagious disease. The reverse applies to HIV virus carriers. The HIV virus is not contagious. it is infectious. and is only spread through specific forms ofclose contact. It would therefore seem pointless, inhumane and an infringement of civil rights to isolate HIV infected individuals from the community. Screening the entire population for the virus would be an almost prohibitively costly exercise and largely unnecessary. Because of the time lapse involved in the virus‘s development. it would also be inconclusive. 10. The nature of the transmission of the HIV virus has sadly made it a prime opportunity for various forms of prejudice and intolerance to reassert themselves. If the appearance 0“ AIDS encouraged more sexual openness and understanding. rather than the reverse, that would at least be something positive.

The List 20 March 2 April 41