Conference quark::mennotes-v1

    When a woman has her period it is more likely that she will *transmit*
    HIV to her partner (if she's HIV+), not vice versa.

    Women or men who have any sort of STD, infection, rash, etc. are more
    susceptible to *acquiring* HIV if their partner is HIV+.

    STDs are a proven co-factor in the transmission (for men *and* women); 
    any rashes or infections which cause blisters or cause the person to 
    itch, scratch and break the skin *also* help the virus get into the 
    bloodstream.  Menstrual blood is still *blood* - which contains the 
    highest concentration of HIV in an infected person, and much higher 
    concentrations than semen or vaginal secretions (which can also transmit 
    the virus).

    A very informative (and recent - summer 1990) brochure can be found
    in Womannotes 733.1-.8 if people would like to read it or print it out.  
    Or if the mods don't mind I can re-post it here.  There's also a
    shorter one (I split it into 4 notes) that I found in the usenet a few
    weeks ago.
    
	cheers,
	deb

Deb,

Go ahead and post the brochure contents here, as long as such reproduction
is permitted by the copyright holder.

			Steve

I entered the brochure, "HIV INFECTION AND AIDS - What Everyone Should 
Know" in IKE22::WOMANNOTES (and elsewhere) with the disclaimer "posted 
without permission," which is acceptable in those files.

It is contained in WN 733.1-.9.  Chapters include:

	*  The Spectrum of HIV Infection
	*  HIV and its Transmission
	*  Protecting Yourself
	*  It's WHAT You Do, Not Who You Are
	*  The HIV Antibody Test
	*  Minorities, Friends, Women & Gay/Bisexual Men

Copies of this brochure can be requested from:

	American College Health Association
	1300 Piccard Drive, Suite 200
	Rockville, MD  20850
	(301) 963-1100

(I believe I have a couple extra if anyone wants to send me mail.)

Other sources of further information listed on the back of the brochure 
include:

   Contact your health service, sexual health program, peer sexuality
educators, lesbian/gay organizations, or health care provider.  Additional
information and support can be obtained from community-based AIDS service
organizations.  The following national hotline services are also available:

	Centers for Disease Control Hotline		1-800-342-AIDS
	Spanish-Language Hotline			1-800-344-SIDA
	Hotline Deaf and Hearing-Impaired People	1-800-243-7889
		Monday-Friday, 10am-10pm		TDD/TTY

   For more information about AIDS:

	AIDS ACTION Line				(617) 536-7733
	     Toll free (Massachusetts)			1-800-235-2331
	Latino AIDS Hotline				(617) 262-7248
	Bilingual AIDS Hotline				1-800-637-3776
	     (English/Spanish in Springfield)
	AIDS Project Worcester				(508) 755-3773
	Alternative Test Site Program (Mass.)		(617) 522-4090
    	   [free and anonymous testing]

I just called the American College Health Association to ask for permission to
post the brochure. They will get back to me around Weds or Thurs of next week.

	-- Charles

Sorry to be such a stickler, but just because other conference's moderators
have allowed violations of copyright law, that doesn't mean that I have to.
I don't have a problem with limited excerpts, but reprinting the whole
brochure without permission is clearly illegal.  I'd like to see the
information here, but only if it's done so legally.

					Steve

    If a woman has AIDS but her male partner does not then would he also
    gets AIDS too after having sex with her?
       a. No oral sex involved.
       b. Oral sex involved.
    
    From what I understand anal sex is a sure way to transmit AIDS, but
    supposing the man (the giver) does not have AIDS, would he be safe if
    his partner (the taker) has AIDS? What if both partners do not have
    AIDS then would it be ok?
    
    The reason anal sex is dangerous because of the tears, but when one
    goes to the bathroom and he/she has constipation, there will be tears
    when he/she tries hard.  He/she still can get sick,right?
    
    Sorry for those are silly questions, but I have to ask.

    "I'm not a doctor, but I watch the news and read Time Magazine."

    With my less-than-stellar credentials on the subject out of the
    way, and assuming that the questions in .6 are serious and not
    joking...

    Keep in mind that AIDS is caused by (or at least very strongly
    correlated with the presence of) a specific virus, which seems
    most readily transmitted with blood products. Don't get cause and
    effect confused.

 >     If a woman has AIDS but her male partner does not then would he also
 >     gets AIDS too after having sex with her?
 >        a. No oral sex involved.
 >        b. Oral sex involved.

    He certainly could. "Would" is a matter of statistics, but the
    chances are too high to play around with.
    
 >     From what I understand anal sex is a sure way to transmit AIDS, but
 >     supposing the man (the giver) does not have AIDS, would he be safe if
 >     his partner (the taker) has AIDS?

    He would *not* be safe ... he would be at a very high risk of
    acquiring the virus from "the taker". 

 >                                         What if both partners do not have
 >     AIDS then would it be ok?

    If neither carries the AIDS virus then there's no virus to
    transmit. Note that carrying the AIDS virus does not guarantee
    symptoms for a long time, so there's absolutely no sure way to
    know for certain that neither partner carries the virus. 

 >     The reason anal sex is dangerous because of the tears, but when one
 >     goes to the bathroom and he/she has constipation, there will be tears
 >     when he/she tries hard.  He/she still can get sick,right?

    Is this a serious question? AIDS is not caused by anal tears; it's
    caused by a virus which can be transmitted through blood products.
    An individual who doesn't carry the virus isn't going to somehow
    manufacture it by being constipated! There is nothing magical
    about "anal tears" and the virus - it can be transmitted through a
    cut finger, if the cut finger comes in contact with the virus.
    

>    transmit. Note that carrying the AIDS virus does not guarantee
>    symptoms for a long time, so there's absolutely no sure way to
>    know for certain that neither partner carries the virus. 
    
    This is something I keep hearing different things about:  it is my
    understanding that:
    
    - the HIV antibodies CAN be detected, about 3 months after infection.
      (I have heard different time frames too, but I think those people are
      confusing the amount of time that the SYMPTOMS take to appear -
      anywhere up to 10 years, right?)
    - While the presence of HIV does not guarantee the individual will
      suffer the symptoms referred to as AIDS, this individual is infected,
      as can transmit the infection to others
    - You can't have AIDS without HIV antibodies being present (i.e., if 
      tested negative for HIV anitbodies, and if you have abstained from
      unprotected intercourse in the last three months (since the last
      test) then you can be relatively sure that you are not infected.
     
    Please feel free to point out any errors or omissions...
    
    Dave
    

    
    > Note that carrying the AIDS virus does not guarantee
    >symptoms for a long time, so there's absolutely no sure way to
    >know for certain that neither partner carries the virus. 
    
    To agree with the previous note....
    My understanding is that if you have picked up HIV virus it is
    usually detectable through blood tests within 90 days of infection.
    
    The time that it takes for HIV to develop into AIDS (or not) is not well
    understood at the moment and, it seems, is highly variable.
    
    >Is this a serious question? AIDS is not caused by anal tears; it's
    >caused by a virus which can be transmitted through blood products.
    
    True - HIV virus is transmitted through blood/blood or blood/semen
    or blood/bodily fluids contact.
    
    However, as I understand it (and again, I'm no authority) the
    reason that anal intercourse is such an effective transmitter of
    HIV is that this activity is subjecting the very thin and delicate
    anal membranes to an activity for which they were not designed and
    microscopic tears in the membrane do occur as a result (and also
    as the result of constipation etc) as a matter of course. 
    These tears provide direct access to the bloodstream for semen deposited 
    in that area.
    
    So I think the comment about the tears is sort of correct.
    
    Unfortunately, the blinkered approach of many governing bodies
    that have laws stating that heterosexual anal intercourse is
    illegal makes it very difficult to assess the level of this
    activity in the heterosexual community.
    And it may well be far less prevalent in the gay male community
    than many people believe - it is not mandatory behaviour for gay men,
    so I've been told. This seems to be a common misconception.
    
    'gail
    
    

	re .8  Dave,
    
>    - the HIV antibodies CAN be detected, about 3 months after infection.
>      (I have heard different time frames too, but I think those people are
>      confusing the amount of time that the SYMPTOMS take to appear -
>      anywhere up to 10 years, right?)

	The *usual* time for enough HIV antibodies to build up to be 
    detectable on an HIV test is 3-6 months.  It is possible for it to 
    take longer or shorter periods of time.  [This is why it's pointless
    to take an HIV test the day after a rape, for example.]

>    - While the presence of HIV does not guarantee the individual will
>      suffer the symptoms referred to as AIDS, this individual is infected,
>      as can transmit the infection to others

	True.  The presence or absence of symptoms is irrelevant to the
    transmission.  Anyone HIV+ can transmit the virus--no matter how
    otherwise healthy they are, and regardless of whether they know they're
    HIV+ or not.

>    - You can't have AIDS without HIV antibodies being present (i.e., if 
>      tested negative for HIV anitbodies, and if you have abstained from
>      unprotected intercourse in the last three months (since the last
>      test) then you can be relatively sure that you are not infected.
     
	False.  There have been a very small number of cases of AIDS
    where the person did not test HIV+.  In fact, there's a small number
    of people who don't believe HIV causes AIDS at all.  Most of the
    experts are confident in the HIV-AIDS connection, though.

	Three months is too short a timeframe.  Before I would be
    "relatively certain" I would have 3 tests:  1 now, 1 in 6 months, and
    1 a year from now--obviously without having engaged in any remotely
    unsafe behaviors in the meantime.

	deb    

    
    P.S.  Yes, it can take up to 10 years for an HIV+ person to show
    symptoms.  This is where the research on co-factors is so important: It
    would be very helpful to know why some people become infected, develop
    symptoms and die with a couple of years, and others become infected and
    remain asymptomatic for years. Some (about 20% experts estimate) will 
    not develop AIDS at all; howver, some of those will develop ARC, which 
    can also be fatal.
    
    	deb

	re .11 Herb,

>    As i understand it, the only way to get aids is to participate is an
>    activity that results in intermingling of blood products.
>    If that IS the case, will somebody please verify that.
>    If that's the case and people are aware of it, then i feel that people
>    who participate in this discussion without acknowledging that are
>    disembling.

	No, that's not correct.  There needn't be "intermingling of blood
    products," but intermingling of blood with any of the following:  
    blood, semen or vaginal fluid.  The virus *has* to get into the 
    person's bloodstream somehow.

>    Can aids be transfered by the saliva of somebody who is HIV positive if
>    that person bites somebody viciously enough to draw blood?

	No.  There's not enough HIV concentrated in saliva to do any 
    damage whatsoever.  The highest concentrations of HIV are found in
    blood, semen and vaginal secretions.

>    in re The 3 or 4 people in Florida who contracted ais as a result of their
>    treatment by an AIDS infected dentist. 
>    Done anybody know how specifically they were contaminated by the dentist?
>    Is it assumed or known, that somehow he cut himself -or had an open
>    wound- and that blood from that wound mixed with an open wound on the
>    patient. 

	It has been proven that the dentist and his staff were lax in their
    sterilization procedures.  HIV can be transmitted by improperly
    sterilized instruments just as it can through sharing IV drug needles.
    The CDC believes that the instruments were used on an HIV+ patient,
    not sterilized properly, and re-used.  It's also possible that the
    dentist got HIV from a patient if he cut himself with one of the
    instruments.

>    Has anybody done some kind of a differential analysis to determine what
>    it was about these patients that caused THEM to contract the disease
>    and not all the others whom the infected destist presumably treated?
    
	I don't know what sort of "differential analysis" you mean.  If it
    was indeed a case of haphazard sterilization, that would explain it.
    BTW, CNN recently had a segment on dentists/doctors and HIV, and what
    patients should look for and be aware of.  I just caught the tail end
    of it, but it seemed like pretty basic common sense things.

	deb

	Oh, sorry for the 'notes collisions'...I'm setting host today and
    the response is V E R Y slow!  Grr...

    In re a couple of issues raised with this comment from my .7 ...

 >     > Note that carrying the AIDS virus does not guarantee
 >     >symptoms for a long time, so there's absolutely no sure way to
 >     >know for certain that neither partner carries the virus. 
 >     
 >     To agree with the previous note....
 >     My understanding is that if you have picked up HIV virus it is
 >     usually detectable through blood tests within 90 days of infection.

    I used the term "for certain" deliberately. You can have degrees
    of confidence of non-infection based on a blood test following a
    period of abstinence with no other risky activities, but knowing
    for "certain" somebody is AIDS-free is (as far as I know) nigh on
    impossible.

    An in RE my "is this a serious question" point in .7 - that was
    addressing the apparent question of whether you can get AIDS
    simply by being constipated. If you can, sales of broccoli and
    celery should skyrocket.

    
    
    If it takes approx. 90 days for HIV+ to be detectable. Will any blood
    donated within this 90 day period, from a potentially HIV+ person, also
    be potentially HIV+ ?
    
    Gillian

Re: .17

Absolutely.  Which is why the Red Cross is getting even more picky about
wbo should NOT donate blood.  I donated last week, and they are now asking
some very explicit questions about personal behavior intended to screen out
those who are at risk for having HIV.

There was also a recent case in the news about an organ donor who did not
test positive for HIV at the time of death, but apparently had it and
several of the organ recipients contracted AIDS.

				Steve

    What does that mean one has HIV and not AIDS?  I thought once you have
    the virus then you have AIDS.  If having HIV but not AIDS then does it
    mean that your body is able to control or destroy the virus somehow?
    If a person has HIV but not AIDS does that mean that because he/she is
    healthy so his/her immune system able to fight off the virus?
    
    Scientists now identify the virus (HIV), but how come they cannot
    develop any drugs to kill them?

HIV is the virus, AIDS is the collection of symptoms caused by HIV.  You can
be a carrier of HIV and not have any of the symptoms of AIDS.  It is not
known what prevents some HIV carries from developing AIDS.

As for killing the virus, viruses are very difficult to kill, as in some
sense they are not "alive".  At present, treatments which disable the virus
are also injurious to the patient.

		Steve

    
    
    My information tells me Herb is right on the money here.  I have
    friends who have lived a long, long time with AIDS -- even years an
    years.  But each of them also knows that they are living on borrowed
    time.
    

Re: .22

I don't think so.  I have read that 50% of the people who are HIV positive
never develop the AIDS symptoms.  I agree that once AIDS develops, it is
essentially 100% fatal.  There are many illnesses for which someone may
be a carrier but not ever develop the illness themselves, though they can
pass it on to others.

				Steve

    I'm not a Dr. I have a masters degree in  .... Science
    
    I would like to try to answer some questions raised here.
    
    AIDS (Acquired Immuno Deficiency Syndrome) is the physical
    manifestation resulting from HIV infection.  Essentially, HIV
    destroys the immune system and diseases that normally can't even get at
    you attack.  Common and uncommon diseases eventually kill you because
    you cannot fight them off.
    
    An infected person might not test positive for years, yet, during the
    entire time, is capable of transmitting the infection.  There may be a
    few long term survivors at this time, but, HIV+ DOES indeed mean a
    death sentence of probably long duration.  The only hope is that a cure
    will be discovered before the other diseases destroy you.
    
    A virus is, by many definitions, not alive.  It is basically a protein
    capsule containing genetic material.  It is usually smaller than almost
    anything else "alive".  The way it "lives is to attach to a cell and
    inject the genetic material.  This material takes over the function of
    the cell and makes the cell produce new copies of the virus.  When all
    of the cell is used up, the cell membrane ruptures releasing the virus
    to infect new cells.  If you have a cold (which is another virus they
    have not found a cure for) this rupture happens in the throat and you
    get a sore throat.  The reason viruses are so hard to kill is that they
    are protected by the cell they are infecting while they are active and
    when they are between cells, they are inactive and relatively inert. 
    The way we kill most bacteria is to poison them, viruses, being
    inactive when they are outside the host cell, are damned hard to poison
    without killing the host.  The beauty of the HIV strategy (if you are a
    virus) is that it infects the very cells that normally hunt down and
    destroy virus particles.  
    
    If you think about it long enough, you'll never watch another thriller,
    reality is infinitely more frightening.
    
    Hope this helps some.
    jimc

Keep in mind that the numbers of folks diagnosed as HIV positive but
asymptomatic is rather low, due to the relative scarcity of HIV testing
of the general population.  There are families where the mother has HIV
and passed it on to her children, some of the kids develop AIDS, the
mother doesn't - yet, anyway.  It may develop later.  There's not enough
information.

				Steve

	re .16  Herb,

    % of women-to-women transmission:  extremely rare - less than 1%.

    % of female-to-male transmission:  I'll check tonight and see if
    I have that info available.  It's definitely higher than the
    previous instance, but I don't want to trust my memory on the %.

    RE the last paragraph:  Good for you, not to "bet [anyone's] life
    on it"!  Position doesn't make any difference at all, so that myth
    can be ruled out.  It's true that male-to-female transmission is
    easier than female-to-male, but it happens, and it's being 
    identified a lot more of late.  One of the recent PBS specials had
    a man who was away in the service who found out his wife had AIDS
    when he got to the morgue and she had a tag in big red letters
    saying "AIDS."  He got tested and he was HIV+ too.

	re .19  Nguyen,

    I am truly astonished that intelligent business people in 1991 still
    think that HIV=AIDS.  If you send me your mail stop I'll be glad to
    send you the brochure mentioned in .1.
    
    RE the virus:  There are lots of viruses and diseases that scientists 
    can't "kill" yet, including the common cold and flu.  HIV happens to
    be a retrovirus, which is a particularly difficult class of beastie
    to pin down and eradicate.

	re .21  Herb,

    As I said in .12 (I think), not all people who've been identified as
    HIV+ in the past 10 years have developed AIDS.  It is believed that
    some 20% will not develop AIDS (characterized by the presence of one
    or both of: PCP - pneumonia, or KS - cancer); some of those 20% will
    however develop ARC (AIDS-Related Complex) which may have very
    severe - and sometimes fatal - manifestations.  Some people are still
    walking around asymptomatic after 10 years of being HIV+.  This is
    why research into co-factors is so important - it would be fantastic
    if scientists could find a way to keep HIV+ people *asymptomatic*
    until a cure is found.  Is AIDS an "automatic death sentence"?
    Right now, sooner or later: yes.  Is HIV?  No.  That's the difference,
    and why early intervention *before* a person develops AIDS is so
    crucial.

    And as Steve said, whether a person is HIV+ (with or without symptoms),
    or has ARC or AIDS - the person is *still* able to transmit the virus
    to others via blood transfusions, organ donations, needle sharing, or 
    sex (with any combination of genders).

	more later, I hope,
	deb

Re: .26

> Keep in mind that the numbers of folks diagnosed as HIV positive but
> asymptomatic is rather low, due to the relative scarcity of HIV testing
> of the general population.

I'm not quite sure what you're trying to say here Steve. Are you commenting
on the number of asymptomatic HIV+ individuals relative to those with symptoms?
If so, I believe you're mistaken, it was my impression that there are many
more asymptomatic HIV+ individuals than with symptoms. If you were commenting
on the number of asymptomatic HIV+ indviduals relative to the total population,
then, yes, I believe that's true, but I don't understand how it's relevant, the
total number of people who test HIV+ are relatively low, symptomatic or not.

In any case, I know many more people who are HIV+ and asymptomatic than those
who have symptoms, and some of the symptoms (lowered T-cell count) are fairly
subtle.

	-- Charles

    re .28
    
    Hmm, good point.  It is currently estimated that there are 1 - 1.5
    million HIV+ people in the US - most of whom are unaware of their HIV
    status.  The worldwide estimate is 10 million HIV+.
    
    	deb

	Okay Herb, back to your female-to-male transmission question.
    According to the latest CDC report I have (March 1991, which is
    rather old I'm afraid):

	Total AIDS cases reported to CDC 	171,876
		Adolescent/Adults = 168,913
		Children < 13 yo =    2,963

	Men account for 152,108 reported adult/adolescent cases, or about 
    88%.  Heterosexual sex (with IV drug users, blood transfusion 
    recipient, female born in "Pattern-II" country, HIV+ female with risk 
    not specified, etc.) as the mode of HIV transmission acounts for 3,657
    or 2% of the total US cases reported to the CDC.

	This compares to 5,534 (33%) of the 16,805 (10% of total) females 
    who report the mode of transmission as heterosexual sex (with any of the 
    above categories, plus hemophiliac males - <1% and bi males - 3%).  
    HIV transmission by heterosexual contact has increased rapidly in
    recent years.

	There's also another category: "Other/undetermined."  According to 
    the CDC, this refers to people whose mode of exposure to HIV is unknown, 
    including: patients under investigation; patients who died, were lost to 
    follow-up, or refused interview; and patients whose mode of exposure to 
    HIV remains undetermined after the investigation.  It also includes 3 
    health-care workers who seroconverted to HIV and developed AIDS after 
    occupational exposure to HIV-infected blood.  There were 5,010 (3%) 
    males and 1,027 (7%) females in this category as of March.

	In the 13-19 year old category, heterosexual sex is listed as
    13% of the reported cases (670 total), and in the 20-24 year old age 
    bracket, it's 10% (of the 7,097)--not broken out by male/female.  While
    the actual numbers are small, women and children/adolescents are the
    fastest increasing categories, and heterosexual contact is the *only*
    increasing mode of transmission on the CDC reports.  All other modes--
    homosexual contact, IV drug use, blood transfusions, etc.--have been 
    decreasing.
    
	Please note these CDC figures are for the US only and reflect
    only those diagnosed cases of AIDS (characterized by PCP or KS) which
    have been reported to the CDC; worldwide numbers and percentages are 
    drastically different (but I don't have a WHO report, sorry).  Also,
    it is estimated that 45% of women who die of AIDS do *not* fit the
    CDC's definition of AIDS--instead of PCP or KS many HIV+ women develop
    gynecological cancers which the CDC hasn't gotten around to putting
    on the list of official AIDS manifestations (and many of which are
    not as easily recognizable as KS skin lesions or a case of pneumocistis
    pneumonia).

	Hope this helps.  I have a concise report somewhere in a
    currently-inaccessible archived notesfile.  If I can get to it, or 
    find more current stats, I'll enter them.

	deb

    
    If a mother can pass the HIV virus to an infant while breast feeding, I
    wonder if the same holds true for the mothers partner, should they wish
    to participate in the same activity?
    
    Steve

    What about AZT? Is it's function to bolster the immune system? How does
    it work? What other drugs are there, on-line or in the approval stream?

    Charles and Steve,
    
    Since HIV can have a lengthy dormancy and since the epidemic is on an
    rapid increase, you would expect there to be many more HIV+ people than
    AIDS symptomatic people.  It proves nothing.  What you want to know is
    how many HIV+ people are still asymptomatic after X years.  I believe
    the figure is very low for X > 5.  
    
    						- Vick
    

Re: .28, .29, .33

The key word in my note was "diagnosed".  By this, I mean people who were
tested and found positive for HIV, even though they were asymptomatic.  I
say this because the general population isn't being tested for HIV, and
there would be a tendency for those with symptoms to be tested, while
those without wouldn't bother.  In no way was I suggesting that there
were not indeed a lot of asymptomatic HIV carriers out there, I was only
saying that there isn't enough data to really know for sure.  The estimates
Deb cites are just that, estimates.  It could indeed be far more pervasive
than we thought, and a lot of people could be in for an unpleasant surprise.

				Steve

    in re .31
    
    Steve,
    
    One would presume only if her partner consumed a significant amount
    of milk (assuming that HIV does pass through mother's milk, Deb?).
    If a woman is not lactating then there is no medium to pass the HIV
    virus in the case of oral/breast contact.
    
    Bonnie

    jimc,
    
    Thanks for your informative .25...  However, one phrase leapt out at
    me, and I was surprised it was not challenged in the last 10 replies:
    
>    An infected person might not test positive for years, yet, during the
                                  ====
>    entire time, is capable of transmitting the infection. 
                                      
    I read this to mean that, even if you HAD a blood test, and it was HIV
    negative, you could still have it, be a carrier, and transmit to others...  
                                                                   
    Is this true???   Or did you mean to say that people can exist without
    AIDS/ARC symptoms showing up for years, and still be carriers?  (I
    hope)
    
    If this is true, why all the talk about HIV showing up between 3-6-9 
    months??    (And therefore blood tests that are negative after that 
    amount of time since unprotected sex is a pretty good indication that 
    you are HIV-free)
    
    Or do you mean that, in very rare exceptions, individuals have
    displayed AIDS/ARC related symptoms, without testing HIV+??
    
    If its true that even testing won't help, then is the only truly safe
    unprotected sex between two non-needle using, transfusion-free
    virgins??  (I hope not! :-)
    
    Dave 

    re .31  Steve J,
    
    Theoretically, yes it's possible.  No cases of such transmission have
    been reported in the last 10 years though.
    
    re .32  Hoyt,
    
    I don't have time now to enter AZT and drug info, but I'll try to get
    to that later if no one beats me to it.  In the meantime, could you
    (and the other people - I forget who you are) please do me a favor?
    I'd really appreciate it if during this discussion we could avoid terms
    such as "AIDS victim" and "AIDS carrier" which - despite any innocuous
    intentions - only serve to alienate and aggravate those who are
    sensitive to HIV/AIDS issues (not to mention people--friends,
    relatives, coworkers, etc.--with HIV/AIDS).  Thanks.
    
    	deb

    Sorry (really!) about apparently inappropriate expression "HIV
    carrier." I don't see what could be offensive about it; it means that
    such a person carries the virus, hardly an indictment of their
    character. But injury is in the eye/ear of the beholder. What
    expression WOULD be suitable? "Person who has tested positively for the
    HIV virus" is pretty neutral, I hope, but clumsy for everyday use.
    Does "HIV bearer" have unfortunate connotations? "HIV infected?"
    
    Re tests not being foolproof: As I understand it, the HIV test locates
    HIV antibodies, which are not produced by the body for 6-12 months
    after infection. So, to be safe, have your love-object tested, then
    wait 12 months before engaging in intimacy. This might revive
    romance!

    >I'd really appreciate it if during this discussion we could avoid terms
    >such as "AIDS victim" and "AIDS carrier" which - despite any innocuous
    >intentions - only serve to alienate and aggravate those who are
    >sensitive to HIV/AIDS issues (not to mention people--friends,
    >relatives, coworkers, etc.--with HIV/AIDS).  Thanks.
    
    I'd like to second Hoyt's question:  if the terms above are
    inappropriate, then what do we use?  
    
    					andrew

> I'd like to second Hoyt's question:  if the terms above are
> inappropriate, then what do we use?  

HIV positive, or person with AIDS, whichever is more appropriate.

	or "Bill" or "Seth" or "Nancy."

	:-(

	-- Charles

    Yes, I see what you're saying -- 
    
    But I asked myself: would I say "cancer victim?" and I said "yes."  
    Or "hepatitis B carrier" -- same answer.  I see these terms as
    "clinical" rather than unfeeling.
    
    Am I being unfeeling?  I don't know -- I don't mean to be.
    
    					andrew

    re last few:
    
    Commonly used (and not cumbersome) terms include:
    
    HIV+
    HIV- 
    PWA (person with AIDS)
    PLWA (person living with AIDS)
    PWHIV (person with HIV)
    PWARC (person with ARC)
    
    Thanks for your understanding, gentlemen.  Despite volumes of
    explanations, most people don't grasp the significance of different
    terminology...unless one happens to have an incurable thingie
    themselves.
    
    	deb

    re .38  Hoyt,
    
    Rule #1 of safer sex:  Treat *all* of your new/unknown sex partners as
    if s/he were HIV+.  Use condoms.  Don't ASSume that just because the
    person is a successful lawyer or star athlete that they are HIV-.
    
    People should take responsibility for their own sexual behavior; if you
    value your life, protect yourself.  If your sex partner doesn't value
    his/her life - or yours - and refuses to use a condom, well...that's
    your game of Russian roulette.  It only takes one mistake...
    
    	deb

	re drugs,

	In the past 10 years, one drug--Zidovudine (AZT)--an antiviral-- 
    has been approved by the FDA for the treatment of AIDS.  Other drugs 
    which are still being tested in clinical trials include ddI, ddC, 
    CD4, and Peptide-T, which have less harmful side-effects than AZT.
    They're only available as experimental treatments to people who meet
    strict entrance criteria (you have to be sick enough, but not too 
    sick).  Also there's AP (aerosolized pentamidine), which taken
    regularly can prevent the PCP pneumonia which takes the lives of
    many PWAs.

	Some people can't tolerate AZT at all because of its extreme
    toxicity and severe side-effects; most people can only tolerate it 
    for a limited time - a year or two.  AZT has been shown to delay the 
    symptoms of AIDS but it does not stop it.  AZT interfers with the 
    RNA-to-DNA copying by essentially becoming a fake DNA molecule which the 
    HIV virus is attracted to.  Pregnant women with AIDS are not allowed to
    take AZT at all because it might damage the unborn fetus (although
    women were never included in the AZT trials so it's not really known
    what effect(s) it has on women).

	Early testing when a person thinks s/he has been at risk is 
    important because the treatments we have available today work best on
    relatively healthy immune systems.  If treatments are begun early--
    before the immune system is destroyed and opportunistic infections
    take over--symptoms can be delayed and the person can live a longer,
    healthier life.

	None of these is or ever will be a cure, however.  Finding a cure
    is so difficult because HIV is a retrovirus; it's hard to tell the
    infected cells from uninfected ones when the virus isn't replicating.
    Killing all of the types of cells the virus infects (helper T cells,
    macrophages, or types of central nervous system or brain cells) would
    kill the patient.

	But a cure in the sense of clearing hte body of all trace of HIV
    may not be necessary.  People with HIV infection could lead almost
    normal lives if treatments could be found that would prevent the
    appearance of any symptoms.  If the virus did not replicate, there
    wouldn't be any damage to the immune system and no symptoms would
    appear.  It's even possible that the person would not even be
    infectious.  (In the past, people with diseases like tuberculosis
    have taken drugs that prevented the appearance of symptoms and also
    kept them from passing the pathogen on to others.)  Since people with
    HIV would have to take such drugs for the rest of their lives, non-
    toxic drugs taken by mouth would be the most feasible.

	There are 7 vaccines currently  under development and study.
    Some of these it is hoped will allow a person to neutralize an HIV
    infection; others are designed to prevent the HIV virus from
    replicating once the person is infected.

	(Some material creatively swiped from "Infection, Your Immune
    System and AIDS" by the Enterprise for Education in association with
    the Massachusetts Medical Society, 1990.)

	deb

    a couple (more like three and a half) years ago, there was a very
    informative, frank television broadcast on AIDS... late night stuff,
    educators, medical folks, and a wide audience participation.
    
    I learned there that transmission of the HIV from mother's milk is
    extremely unlikely, just as it is unlikely to be transmitted through
    saliva.
    
    tony
    (who hopes the rules haven't changed since then)
    

    Some condoms do not provide AIDS protection.  Unfortunately, I don't
    know how to tell which ones do.  Fortunately, I'm not in the market
    right now.  Can anyone provide guidelines for those who might be?
    
    					- Vick

 They've gotta be latex, not natural lambskin...

    re .45  Tony,
    
    Methinks that's what I said in .37.  8-)
    
    re the 6-letter-C-word-that-can't-be-mentioned-on-teevee:
    
    Yup - only latex condoms are effective in preventing the transmission
    of HIV (and other STDs); natural skinned ones have a lot of holes which
    are too small for semen to get through, but allow lots of other
    undesirables to get through.  Some condoms also contain Nonoxynol-9, a
    spermicide which has been shown to kill the HIV virus.  There are all
    sorts of new ones on the market: ribbed, smooth, heavy-duty,
    lubricated, colored, flavored, glow-in-the-dark...
    
    Condoms are extremely effective when used properly (from start to
    finish, and unrolled all the way up).  Breakage is very rare, and 
    usually caused by damage to the latex: being too old (condoms should be 
    thrown out after 1 year even if the package hasn't been opened), being 
    damaged by heat (never keep condoms in your wallet or pocket for long 
    periods of time), or being punctured (i.e. er...biting).
    
    	deb

>    Some condoms also contain Nonoxynol-9, a
>    spermicide which has been shown to kill the HIV virus.  
    
    I was rather surprised to find more than one partner that STRONGLY
    insisted that the ONLY condom they would find to be acceptable would be
    a latex condom that contained Nonoxynol-9...
    
    I was also surprised to learn that they were carried around in the
    woman's pocketbook - which, IMO, is an EXCELLENT (no, required) idea
    for any sexually active woman...
    
>    damaged by heat (never keep condoms in your wallet or pocket for long 
    
    Does anybody know if the glove compartment is also not a good place for
    storage??
    
    Thanks,
    
    Dave

A glove compartment on a sunny day can reach temperatures well in excess
of 100 degrees F.   

			Steve

    Is this a marketing opportunity? How about a device which tests
    condoms, e.g. a dildo with an integrated pump: slide on the condom, do
    a few pumps, and the condom fills with air or shows a hole. Or would
    this be an instance of the Heizenburg uncertainty principle: the act of
    testing renders a safe condom unsafe?!

    Along the same lines: what are the chances of getting a home HIV test?
    You put a drop of blood on a piece of paper and it turns red in the
    presence of HIV?! Put it in the vending machines at pick-up joints?! It
    becomes part of the mating ritual: "Yo, babe, shall we do the Nelson
    test together, and proceed to a night of exquisite rootin' for taters?"

Re: .51

There really isn't a need for that.  The general statement is that only
condoms made from latex provide protection against disease; those made
of other materials provide protection against pregnancy only.  Indeed, the
maker of Trojan brand condoms was recently ordered by the FDA to recall
packages of lambskin condoms which did not properly bear the warning to
this effect.

See also note 324.

		Steve

    Commercially they are tested to see if an electrical charge passes
    through.  At least in the one plant that I've seen.
    
    ed

    more on condoms:
    
	From what I've seen, out of the zillions of packages of condoms
    at the drugstores, only a few contain Nonoxynol-9 (so far, anyway).
    I'd say that the added protection is a smart choice.

    	The only drawback is that it (N-9) can create a rather
    funny-tasting condom.  However, you can achieve the same results by
    using plain latex condoms with a lubricant containing N-9.  Again,
    most lubes don't have N-9 in them (KY doesn't, for example), and
    most of the ones that do are found in the "feminine products"
    section of the drugstore, *not* next to the condoms (at least here
    in Mass.).  %-\

    	re home HIV tests:
    
    	I doubt we'll be seeing that for a looong time...Probably not
    unless they develop an HIV test for urine (highly unlikely, because 
    even in  HIV+ people, urine contains such miniscule amounts of HIV 
    that it's really difficult to detect...which is also why even though
    urine, saliva, sweat and tears are technically "body fluids" they
    present no danger in transmitting HIV).
    
	deb (who will try to keep it coming)  ;^)

    Spermidical pessaries are produced (at least in the UK, anyway) which
    are intended for use with non-spermicidal condoms. They are also
    excellent lubricants.

    
    Yes - and some of the gels that you can use with diaphragms etc
    also contain N-9 and can be used with a condom as lubricant or
    whatever......
    And they taste OK too.
    
    I had read that, to be effective as a potential HIV-stopper, the
    product needs to contain *at least 5% N-9*.
    
    Can anyone confirm this?
    
    Certainly most UK products that list N-9 as an ingredient are
    below this %.
    
    'gail

 Maybe it's just me, but condom taste is pretty low on my list of criteria...

    Flavors! Killer idea! Root beer. Anise. How about liqueurs? How about
    diet condoms, only 1 calorie! How about diet supplement condoms, 100%
    of the RDA for 12 sex-related nutrients? Jinseng condoms. Kosher. Wow.

    
    Someone's just brought out a range of pre-mixed cocktails which come
    in test tubes called....
    	
    
    
     .....Testi-Coolz
    
    No kidding.
    Do you have them in the USA? Come to think of it, you probably had
    them first...

> Maybe it's just me, but condom taste is pretty low on my list of criteria...
    
    It can matter if you try to continue anything oral (for EITHER party)
    after taking the condom off...   
    
    OK, now for a real serious question...   Male and female, having
    unprotected intercourse.  I know that the male can infect the female
    through semen.  Is there any other way, through normal intercourse,
    assuming no cuts on the male, that HIV can be transferred?  In other
    words, if the male does not climax, and there are no open wounds, what
    kind of risk are we talking here (i.e., are there any other methods
    other than seminal transfer, if there is no blood transfer??)
                            
    And now for something I can't figure out:  how does the female infect
    the male??  I can only assume that the virus travels up the vas
    deferens (again, I'm assuming this occurs during (male) orgasm), but 
    my question once again is: what risk is there if the male does not 
    climax?  (I.e, does the virus travel in the absence of seminal fluid...)
    
    (Please pardon my biological ignorance, but I'm sure I'm not alone in
    wanting to know the mechanical details of transfer...  and this has
    been the best forum I've found for getting the 'real story'...)
    
    Thanks,
    
    Dave

    I think it's fairly common for a couple of drops of pre-orgasmic fluid
    (whether it contains sperm or not, I dunno) to be present, so even if
    the man doesn't "climax", there's still a liquid medium which could
    carry STDs.

    First of all, I'd like to say that all of you guys are terrific!  You 
    really ask great questions--practical and intelligent.
    
    re .61 Dave and .62 Hoyt,
    
    The answer about how females can infect males is...mucus membranes. 
    Every time a man and woman have intercourse (even without climax)
    the  mucus membranes of the urethra and vagina come into contact with
    each other.  So even if there aren't any cuts, sores, etc. the virus
    can be transmitted between partners.  This is how a lot of STDs are 
    transmitted.
    
    HIV infects white blood cells.  The walls of the vagina constantly
    produce a fluid that contains white blood cells.  During sexual arousal
    and intercourse, these fluids are secreted in greater quantities.  When
    a woman has her period (and even a day or two afterwards) the vagina
    also contains menstrual blood.  Through these fluids, the virus can
    pass from an infected woman to a man during vaginal intercourse.  The
    chance of transmission is greatly increased if the man has an open
    sore--such as often results from some other STDs.
    
    As to the risk...it's considered "risky" in all AIDS/HIV brochures to
    have intercourse of any kind without a condom.  In a draft of an
    upcoming brochure,the author lists 25 activities on a continuum from 
    riskiest (sharing needles, piercing or cutting tools) to completely safe 
    (talking dirty, phone sex, fantasy).   Being informed about various
    risks is important so each person can make an informed choice. 
    Obviously celibacy is a guarantee that you won't become infected by any
    sexual contact, but one shouldn't feel that one *has* to eliminate sex
    out of fear of HIV.  Knowing the facts, communicating with your
    partners, and making rational choices are the key ingredients.
    
    As a side note, the "rational choices" part is the reason that HIV/AIDS
    brochures discourage use of drugs and alcohol...when one is high or
    drunk we  may not use our better judgement, and mistakes can happen.
    
    The list of activities is as follows (#18-25 are considered to be
    completely safe).  I hope this isn't too sexually explicit for this
    conference...it's hard to talk about STDs without talking about sex...
    
    #1	Sharing needles, piercing or cutting tools
    #2	Unprotected anal intercourse
    #3	Unprotected vaginal intercourse 
    #4	Getting urine or feces in mouth, vagina, anus
    #5	Unprotected oral sex on a mensturating woman
    #6	Unprotected oral sex on a man with ejaculation 
    #7	Unprotected oral-anal contact
    #8	Unprotected fisting or finger-f***ing
    #9	Unprotected oral sex on a man without ejaculation 
    #10	Unprotected oral sex on a non-menstruating woman 
    #11	Sharing uncovered sex toys
    #12	Anal intercourse with a condom
    #13	Vaginal intercourse with a condom
    #14	Oral sex on a man using a condom
    #15	Oral sex on a woman using a condom
    #16	Oral-anal contact using a latex barrier
    #17	Fisting or finger-f****ing using a glove
    #18	Petting, manual-genital contact
    #19	Deep (French) kissing
    #20	Spanking,whipping that does not break the skin
    #21	Bondage and discipline play
    #22	Masturbation (alone or with a partner)
    #23	Hugging, kissing, touching
    #24	Massage
    #25	Talking dirty, phone sex, fantasy
    
    Hope this helps,
    
    	deb

    Thanks for the list. Boy, is my sex life tame. Re #10 and #15 -- how
    does one protect during cunnilingus? I can't see where the condom fits.

    
    You can use dental dams Hoyt. They're kind of thin rubber squares
    designed to help dentists isolate a tooth they're working on -
    now available in different colours and flavours in enlightened
    establishments (so I've heard.....)
    
    Usful for protecting with any "risky" oral contact.
    'gail

>    The answer about how females can infect males is...mucus membranes. 
    
    OK, thanks a lot Deb...  Just one last thing - does this work the other
    way, too??   (I.e, unprotected intercourse without climax may still
    infect the female, but the risk is substantially greater with climax,
    right?  Looks that way, from your list...)
    
    Also...   how is oral sex WITH a condom dangerous?  (not to mention
    how is it pleasurable :-)
    
    Thanks for the great scoop - I'm sure many people appreciate this info.
    
    Dave
    

    > Also...   how is oral sex WITH a condom dangerous?
    
    My guess is 1) if it's not latex and 2) if it breaks.
    

    Well, it also seems possible that some fluids from the outside of the
    condom would come into contact with mucous membranes in the mouth.
    
    ed

	For the most part, it isn't the condoms that fail, it's the
    people using them...

	The safest choice in condoms (for preventing pregnancy *and*
    sexually transmitted diseases) is a latex one with a tip (or
    reservoir), pre-lubricated (it's less likely to tear), and pre-
    treated with Nonoxynol-9 spermicide.  (or you can add lubricant and
    spermicide to a plain latex condom.)

	Condom basics:

    *	Never re-use a condom.  (Sounds silly, but some people do!)

    *	Don't use the condom if the plastic envelope has been broken.
	Open the package carefully so you don't tear the latex with your
	teeth or fingernails.  Don't test it by stretching it out or
	inflating it; the manufacturer has already tested it.  You may
	damage it this way.  If the condom is sticky or brittle, throw
	it away; the rubber has deteriorated from age or heat.  Never
	keep condoms around for more than one year.  Never expose them
	to heat such as in your pocket, wallet or glove compartment for
	long periods of time (one evening is okay, but no longer).

    *	Put on the condom as soon as the penis is erect.  Pre-cum 
	may contain the HIV virus.

    *	Don't pull the condom tight against the tip of the penis; leave
	about 1/2 inch to hold the semen; otherwise the condom may leak
	or burst upon ejaculation.  Pinch the air out of the tip, then
	roll it all the way over, down to the hair.  (Trapped air bubbles
	can make the condom break.)  Don't try to *pull* it on; if it
	doesn't unroll easily, you've got it on upside down (the roll
	should be on the outside).

    *	Don't lubricate the condom, penis or vaginal area with saliva
	or with any product that contains oil (including cooking oil,
	Vaseline, mineral oil, baby oil, hand lotions, massage oils,
	cold cream).  Any of these products (except saliva, which may
	contain small amounts of HIV) made tiny holes in latex during
	laboratory tests...holes that might allow the virus to pass
	through the latex.

  	Most condoms today are pre-lubricated.  If you want to add more
	lubricant, use K-Y Jelly, Ortho Jelly, or even better, a 
	spermicidal jelly containing nonoxynol-9.  They do *not* make
	holes in condoms.  They're usually found in the feminine 
	products section of stores.  Place a *SMALL* dab in the tip
	before putting it on; *don't* use too much or the condom will
	come off.  The *outside* can be lubricated as much as you want.

    *	Condoms come in sizes; if one brand slips off too easily, try
	one advertising a "snugger fit."

    *	Hold onto the rim of the condom during withdrawal so that a)
	the penis doesn't slip out and b) semen doesn't spill on your
	partner.  Withdraw before the penis becomes limp.

    *	After removal, tie the condom in a knot and check it for tears
	before throwing it away.  If there are tears, immediately 
	insert foam containing nonoxynol-9.

    *	Immediately afterwards, both partners shold wash off any semen
	or vaginal fluids with soap and water.

	Oral sex...

	Several long-term studies of groups of couples in which one
    was HIV+ have not revealed any HIV transmission by mouth-to-
    genital contact.  One case has been reported (as of a year ago) where 
    a man seems to have acquired the virus from an infected woman through 
    oral sex.  (Although they didn't state which person was HIV+ - the 
    giver or receiver of oral sex. The *receiver's* risk is very *very* 
    small; the *giver's* risk is higher.)

	Ingesting semen is dangerous (mucous membranes in the mouth, and
    the possibility of sores or bleeding gums - even tiny bleeding after
    brushing or flossing teeth).

	RE the % of nonoxynol-9 needed to be effective:  I'll try to
    remember to do some 'market research' next time I go to the store.
    I thought it was 2%, but I'll double-check to be sure.

	deb

    
    Re: .70
    
    >*   After removal, tie the condom in a knot and check it for tears
    >        before throwing it away.  If there are tears, immediately
    >        insert foam containing nonoxynol-9.
    
    Insert foam where, in the vagina?
    
    Also from previous notes/brochures etc. it has been stated that you
    cannot get the HIV virus from toilets. Does this also apply to a toilet
    used by a menstrating woman? Seems there may be a fair amount of blood
    around at these times.
    
    Steve

    I thought standard practice with condoms was "condoms and foam" -- you
    used the nonoxynol-9 stuff in all events, in case the condom failed. It
    takes about fifteen seconds.
    
    - Hoyt

    > Does this also apply to a toilet
    > used by a menstrating woman? Seems there may be a fair amount of blood
    > around at these times.
    
    Maybe my reaction (offended!) is a little PMS-enhanced  ;-)  but I hope
    this question doesn't indicate an assumption that there's gushing and
    splattering going on by menstruating women.  We're pretty adept at
    containment and disposal procedures, and we do clean up after
    ourselves.... and even if there were a drop on the seat, my
    understanding is that HIV survives only a matter of seconds when
    exposed to air (corroboration, anyone?).
    
    Leslie

Re: .74

I think the question was serious, probably born out of a rather serious lack of
knowledge most men have about the way a woman's body works.

				Steve

    re .72  Steve,
    
    Your first question:  yes
    Your second question: no  
    
    As Leslie said, we women generally do not flood all over a toilet seat;
    and we  wipe away any accidental drips.  In any event, even HIV+ blood
    on unbroken skin is harmless - it has to get *into* your bloodstream
    somehow.  There are lots of things one can acquire from toilet seats,
    but HIV isn't one of them.
    
    re .73  Hoyt,
    
    N-9 stuff can come in contraceptive foam  and lubricating jelly forms
    (and maybe others?).  Variety, ya know!
    
    re .74  Leslie,
    
    When doctors say HIV is "a fragile virus" they mean it does not survive
    long when exposed to air, and therefore can't be 'caught' like a cold
    by coughing or sneezing.
    
    However, if the virus is present in a person's blood, and that blood is
    spilled, it can survive...up to 1 week on a dry surface, and 2+ weeks
    if it is kept moist.  This is why teeny droplets of blood left in an IV
    needle, on a piercing or tattoo tool, or on a non-sterilzed surgical
    instrument can infect other people.  They don't have to be re-used
    within nanoseconds.  But the blood *does* have to make its way *into*
    another person in order to infect them; blood spilled on your unbroken
    skin will not infect you.
    
    Precautions:  Assume that blood spilled in public places is HIV+ and
    don't touch it without rubber gloves.  To clean a blood spill when the
    HIV status is + or unknown, wash it with disinfectant (wearing gloves) 
    - most household ones will do, including bleach (1 part bleach with 9 
    parts water),alcohol, hydrogen peroxide, or Lysol.  The virus can also 
    be killed by heating the blood to 56 degrees C for 10 minutes.  (Not 
    exactly a practical solution, however.)
    
    Oh, another thing about risk and transmission...Just because you have
    unprotected sex with an HIV+ person once or get stuck with a needle
    containing HIV+ blood, it does *not* guarantee that you'll get
    infected.  The *quantity* has a lot to do with it.  For example,
    transfusing an entire pint of HIV+ blood would pretty definitely result
    in transmitting the virus; but the number of health care workers who've
    been stuck with HIV+ needles and became infected is less than 1%.  That
    is also why I call unsafe sex a game of "Russian Roulette" - you may
    get away with it once, or twice, or ten times - you never know.  We do
    know that some people have been infected after only one instance; we
    also know that IV drug needle sharing is *the* most efficient means of
    transmission (directly from blood to blood).
    
    	deb

    Deb (since you appear to be the most knowledgeable here)
    
    Has anyone EVER done a real study of possible means of transmision by
    insects. Your previous note on how long HIV virus can remain outside
    the body adds to my suspicion of misquitos, deer flies, horse flies,
    etc. I don't see much difference in a misquito and a needle. If it were
    not possible, I would think that the givmt would be studying misquitos
    as to why not.
    
    I know that they clain that it cannot happen. I also know that our
    givmt isn't always totally honest. I also know what peoples reaction
    would be to news like this; quarantine of HIV/AIDS persons, swamps, a
    thing of the past, DDT, Malathion (sp)  spraying etc. Who could argue
    against these things?
    
    Steve

    Steve
    
    There is a particular pattern evident in the case of insect born
    diseases. To put it simply, all people in the area are at equal 
    risk of catching the disease. Epidemiologists have shown that
    HIV infections do not follow this pattern, i.e. people in low
    risk categories, children and old people are not infected in
    the same percentages as people in high risk categories. When
    they are in the vast majority of the cases a link to HIV blood 
    can be proven. Were HIV to be passed by insects there would be
    large numbers of people who were HIV positive that could not be
    shown to have been infected by any known HIV positive source.
    
    Further, there is a great deal of difference between a mosquito
    and a needle. The mosquito sucks blood into it's stomach where
    it is digested. Digestive fluids are quite capable of destroying
    viruses. There are only a limited number of diseases that are
    passed by mosquitos. These are the result of organisms that have
    specifically evolved to survive in the mosquito's digestive system.
    (The malarial organism, for example, grows in the mosquito's 
    salavary glands.) Mosquitos do not pass chicken pox, or colds,
    or mumps, or syphillis, or pnuemonia, inspite of the fact that
    they bite people with these diseases. The reason is, of course, that
    the organisms can't survive in the mosquito.
    
    Science news, over a year ago, reported on experiments where mosquitos
    bit HIV infected individuals and were then examined. The HIV virus
    did not survive in the mosquitos.
    
    Bonnie

    .76 and .78 especially - important info, and well stated.
    
    Leslie

    
    ref: .74
    
    Yes it was a serious question, thanks for your serious answer.
    
    Probably a lack of knowledge or maybe my SO is particularly heavy.....
    
    Steve

    I've just recalled an article that I believe was in Newsweek more
    than a year ago.
    
    There is a very poor community in Florida where the incidence of
    mosquitos and mosquito borne diseases is high and where there
    is a large drug addicted community. A disease control organisation
    studied the area, specifically to check for mosquito transmission
    of HIV. They found that the incidence of HIV in children and the
    very old to be inconsistent with any insect vector. i.e. it was
    quite low and explainable by identifiable exposure to HIV. Had
    HIV been transmitted by mosquitos the incidence of infection would
    have been much closer to that found among addicts who shared needles,
    and individuals who practiced unprotected sex.
    
    Bonnie

    Re: .81
    
    That's Belle Glade, Florida.
    
    		Steve

    Thankyou
    
    Bonnie

    And if I recall, Belle Glade has a thriving commerce in prostitution,
    which, in conjunction with the drug use, contributes to the unusually
    high incidence of AIDS among the adult population there.  It has
    been the subject of a number of studies.
    
    			Steve

    
    I used to have a very coherent statement about mosquitos - if I can
    find it tonight I'll post it.
    
    Anyway, it is definitive that one can NOT acquire HIV from mosquitos.
    
    	deb

    RE Bonnie:
    
    OK Mosquitos may kill the virus in their stomachs, although they might
    still have it on the outside of their needle. I do understand what you are
    saying about the pattern of infection in normally unaffected groups.
    
    How about other insects; deer files, horse flies, etc that don't
    necessarily take your blood into their stomach? Their cutting/biting
    devices? The evidence you cite about the FL study does seem to somewhat
    circumstancial.
    
    Steve
    
    BTW: This is my biggest concern/fear about HIV/AIDS. That the givmt
    will withhold something like this for fear (political etc) real or
    imagined of the publics reaction. I am sure we all have our favorite
    givmt not telling/coverup story; Watergate, Iran-contra, 1960 election
    Pearl Harbor, etc.

    Steve,
    
    all I know is that I've read in Science News or in news magazines
    that insect testing and epidemological studies show that insects
    cannot be a vector for HIV.
    
    you have to realize that viruses are quite host specific. if they
    do not have the right type of cell to invade they cannot replicate
    and grow.
    
    HIV is specific to the human immune cells. one problem that scientists
    have had with trying to develop vaccines in cures is the problem with
    getting the virus to grow out side of a human body.
    
    and biting insects do indeed bite for food or for production of egg
    yolk (the female mosquito) so any blood they take in would go 
    into their stomachs. as Deb has pointed out - it takes a certain
    volume of HIV infected blood or body fluids to infect someone. my
    educated guess is that even were you biten by a horse fly that
    had just bitten an HIV infected person the amount of blood transfered
    to you from the fly would be miniscule. further, biting insects bite
    when they are hungry or need blood for egg yolks, so they would not
    be likely to make two blood meals in close succession.
    
    Bonnie

Steve, while I too have a healthy concern for governmental misinformation
and withholding of information, I don't think the government controls all
the news about AIDS.  They liked to pretend it wasn't even a problem for
several years, after all.  While they are currently funding much of the
research, it is being carried out by labs which are not required to clear
their findings with the government first; independent labs and universities
don't submit to prior censorship of their scientific results.  They wouldn't
accept funding that came with such strings attached.  So in this case, while
I don't trust government as far as I can throw it, I'm not worried that they
are squelching research information.  They can't.

DougO

    
> I'm not worried that they are squelching research information.  They can't. 
    
    I'd really, really love to believe this.
    
    I take your point DougO - it would be *very* difficult to squelch
    all the various institutions that are researching.
    
    But I still fear that, if something scary/expensive/horrific enough
    were to emerge we would NOT BE TOLD. 
    I not only don't trust the government - I guess I should admit that
    I am actively paranoid about most of them (yours and mine included).
    
    Their agenda is more important to them than my life - anytime.
    
    'gail
    

    Scientific American in the September issue reported on positive
    results in preliminary trials on an AIDS vaccine. It is given
    to people already infected with HIV. The individuals treated all
    showed a degree of recovery of their immune systems.
    
    

        RE mosquitos/insects:

    I can't find my concise, coherent reference - sorry.  The bottom line 
    is NO, they can't transmit the HIV virus, for a number of reasons...

    1.	The *quantity*--There was a study done in 1988 (reported in
	_Science_ magazine) where they figured out (or made very
	educated guesses) the number of virus particles in an HIV+
	person's blood and what fraction of a ml of blood a mosquito
	sucks up.  The conclusion was that it would take at least
	1,000 bites for one mosquito to get one virus particle from
	an HIV+ person.

    2.	Epidemiological evidence--IF insects could transmit the virus,
	then the pattern of disease in insect-prone areas would match
	the pattern of people who get bitten by insects (like the pattern
	of malaria infection, for example).  Therefore, there would be a
	lot of HIV infection among small children, older people, and
	people living near stagnant water.  But this isn't the case.  The
	pattern of HIV infection in insect-infested areas is the same as
	elsewhere: people who are sexually active and people who share
	needles.

    3.  Methods of insect transmission--There are two ways insects can
	transmit diseases: mechanically and biologically.  This is a long
	story, but the short version is that mosquitos (unlike flies)
	are very neat creatures. They insert a tube for drawing blood, and
    	by the time they're ready for another meal (even if they've been
	interrupted quickly) any viruses from the first one are stored in
	their midgut.  In biological transmission, the pathogen *must*
  	complete a portion of its life within a carrier (which malaria does,
	for example).  The HIV virus does *not* replicate or develop in the 
	mosquito; once inside the virus quickly dies.  There have been many 
	studies done since 1986 showing that HIV-infected blood fed to 
	mosquitos and other arthropods does NOT live to be passed on and 
	there is no biological transmission cycle of HIV in blood-feeding 
	arthropods, which ingest the virus as part of their blood meal.

    4.	In the past 10 years there has been no case of transmission by
	insect; there is NO scientific evidence to support further reseach
	in this area (much to the chagrin of many entomologists, I'm sure).
  	BOTH epidemiological data in developing countries AND laboratory
	data from insect cell replication experiments totally *rule out*
	insects as playing any role in HIV transmission.

	-- info creatively swiped from a variety of sources

	deb

	Well, I did a quickie check at the pharmacy yesterday afternoon
    (quick because I was having eye problems and was anxious to get home
    in my semi-blind condition)...

    	Wow!  There are a zillion different things: foams, jellies, sponges,
    suppositories...all with N-9 in them.  Regular foams/jellies have 2%,
    the "extra strength" Gynol-II lube has 3%.  Some products are made by
    the condom folks (like Ramses, for example).  However, these products
    are sold in the "feminine products" section, while I found the condoms
    a few aisles over - next to the tobacco and "men's stuff" products.  I
    only saw a couple brands of condoms containing N-9, but it says so
    right on the package (and is slightly more expensive).

	deb

    We can hardly trust government. After all, those so-called public
    servants are primarily drawn from penal institutions, dope rings, and
    smut operations. Rather we should place our trust in private
    enterprise, e.g. the pharmaceutical companies would NEVER suppress a
    effective drug merely because they are reaping unbelievable profits
    from stop-gap measures like AZT.

    Geez, Hoyt, little paranoid there, buddy??  I mean, I'm for a
    minimalist government as much as the next guy, but I'd hardly seriously
    say stuff like:
    
>    After all, those so-called public servants are primarily drawn from 
>    penal institutions, dope rings, and smut operations.
    
    Whatsamatta, lose a race for public office once?  :-)
    
    Dave
    

'gail, as I said, I don't trust government.  If they could suppress information
I have no doubt that some misguided idiots would try.  But I think there are too
many activists, reporters, angry patients, and ethical researchers working on it
independently, for any attempt at a coverup to succeed.  I hope I'm not wrong.

DougO

    Hoyt, it's worse than that. These so-called "private enterprises" (note
    that these words are derived from the LATIN language and thus are a
    product of the MASSIVE influx of ILLEGAL aliens which is destroying
    this great nation) are often simply FRONTS for the international,
    perhaps even INTERGALACTIC (but I say too much), conspiracy which also
    puts KNOWN CRIMINALS at the head of our government.
    
    Ray
    
    P.S. - I'd expect drug companies could make more profit from a cure
    than from AZT, unless it turns out to be nutmeg or something.

    Thanks for all the good info Deb. I still haven't heard back from the
    pamphlet folks. I'll give them another call.
    
    For what it's worth, there are a number of personal lubricants on the
    market today that contain Nonoxynol-9. They are usually carried in
    "adult" stores and, in my opinion, are light years better than K-Y and
    kin.
    
    For the person who asked where the foam goes if a condom breaks, the
    foam or jelly goes wherever the condom was, though I'd simply wash with
    warm soapy water whatever the condom was on. (That's not just being
    cute. If you use a condom on your sex toys - and you should - if the
    condom breaks, you should wash the toy. Better yet, never NEVER share
    toys.)
    
    Play safely out there.
    
    	-- Charles

    
    Thanks Charles - I've got the 8 notes (chopped up to be in readable
    chunks) extracted and ready.
    
    I don't recommend K-Y to people because it doesn't contain N-9, and I
    was keeping to products readily available in any drug store.  (Here in
    the 'burbs we don't have "adult" anythings anyway.)  But you're right,
    they do carry a lot of things you won't find in your local CVS.  8-o
    
    	deb

    A r-o sent me mail asking the following questions, and said it was 
    okay to post my answers to them in the file:

From .76:

>In any event, even HIV+ blood on unbroken skin is harmless - it has to get 
>*into* your bloodstream somehow.  There are lots of things one can acquire from 
>toilet seats, but HIV isn't one of them.
  
>This is why teeny droplets of blood left in an IV
>needle, on a piercing or tattoo tool, or on a non-sterilzed surgical
>instrument can infect other people.  They don't have to be re-used
>within nanoseconds.  But the blood *does* have to make its way *into*
>another person in order to infect them; blood spilled on your unbroken
>skin will not infect you.
    
>    Precautions:  Assume that blood spilled in public places is HIV+ and
>    don't touch it without rubber gloves. 

^These previous paragraphs seem to contradict the last paragraph.  You basically 
^say that you can't contract HIV through contact with blood unless the skin is 
^broken.  In the last paragraph, you state that it should not be touched without 
^rubber gloves (or should this be qualified with "if your skin is broken"?).

    It's a *precaution*; just like treating all new/unknown sex partners
    as though they are HIV+ or not eating half-eaten candy bars you find
    on the sidewalk or washing your hands after you go to the bathroom.  
    If you know the person whose blood it is (like your wife or your 2-year 
    old nephew), that's different.
    
>    Oh, another thing about risk and transmission...Just because you have
>    unprotected sex with an HIV+ person once or get stuck with a needle
>    containing HIV+ blood, it does *not* guarantee that you'll get
>    infected.  The *quantity* has a lot to do with it.

^If quantity matters, who is the minute amounts of blood in a drug user's needle 
^enough to infect another drug user?

    Why?  Because it's injected directly into the bloodstream - over and 
    over again.  Blood from an accidental needle stick may or may not go 
    directly into the bloodstream.  Transfusing a pint of infected blood 
    has an 89-100% probability of transmitting the virus.  Less than 1% 
    of the health care workers accidentally stuck with hypodermic needles 
    have developed infections.  With IV drug users, it is customary to 
    draw blood back into the syringe to make sure the needle is in a vein. 
    If the needle is then used again on another person without being 
    cleaned, the first person's blood remains in the syringe and will be 
    injected into the next person. Even though the dose of infected blood 
    is relatively small, it is *repeated*, because IV drug use is habitual.

    Remember that people don't always become infected every time they 
    are exposed to a pathogen - some people are more susceptible because
    of their general health or hereditary factors.  Today almost all HIV
    transmission by blood is due to IV drug abuse.  Research done in 1987
    showed that of the reported AIDS cases, 65% of those in women, 69% in
    heterosexual men, and 73% in children infected at birth, were due to
    IV drug abuse or sexual contact with an IV drug abuser.

    For most diseases, the efficiency of transmission isn't known well 
    enough to put exact numbers on it.  But studies of the transmission 
    of gonorrhea found that *on average* an uninfected man who has a 
    single sexual contact with an infected woman has about a 1 in 5 chance 
    of becoming infected; an uninfected woman who has a single sexual 
    contact with a man infected with gonorrhea has about a 1 in 2 chance.  
    With HIV, it is known that 1) the receptive partner is at higher risk 
    than the insertive partner (although transmission is possible either
    way), and 2) the chance of transmission is greater if either partner 
    already has an STD, sores, cuts or rashes.

From .91

>    1.  The *quantity*--There was a study done in 1988 (reported in
>        _Science_ magazine) where they figured out (or made very
>        educated guesses) the number of virus particles in an HIV+
>        person's blood and what fraction of a ml of blood a mosquito
>        sucks up.  The conclusion was that it would take at least
>        1,000 bites for one mosquito to get one virus particle from
>        an HIV+ person.

^I cannot believe that there is more than 1,000 mosquito bites worth of residual 
^blood in a drug user's needle!

    I believe this was answered earlier.  If not, let me know (this is
    getting rather long).

	deb    

re .95
>'gail, as I said, I don't trust government.  If they could suppress information
>I have no doubt that some misguided idiots would try.  But I think there are too
>many activists, reporters, angry patients, and ethical researchers working on it
>independently, for any attempt at a coverup to succeed.  I hope I'm not wrong.


  There is a book called something like "Everything Your Doctor Won't
  Tell You".  I've seen it at B.Dalton recently and it discusses among
  other things a cure that was discovered for cancer in the late '50s,
  but was squelched by government because of the extreme economic
  consequences it would have had on the health care industry.

  While I would not put it past our government to cover up cures for
  certain illnesses,  I find it difficult to believe that the government
  would cover up a cure for AIDS because this disease is an economic
  liability versus the positive effect other diseases have had on our
  economy.

.101> ...the positive effect other diseases have had on our economy.

I may be totally missing the point, but, how in the name of all that is
holy, could a disease have a "positive effect" on one's economy?

Bubba

    There have been a few cases where mothers have become infected
    after giving birth, and their babies also have become infected.
    It is thought that the virus was probably transmitted in the
    mother's milk, even though breastfeeding is not considered to be
    an efficient way of transmitting HIV.  Here in the US, a mother
    who has reason to think she may be infected can prevent 
    transmission by buying sterile formulas at the supermarket.  In
    other parts of the world this is not always possible.  The World
    Health Organization considers breast feeding to be a "slight
    chance" of transmission.

    If I find anything more conclusive, I'll post it.

	deb

I did read the article, and went back to find the earlier discussion in this
note on the subject.  Both agreed that there were known cases of HIV
transmission through breast feeding.  The article said that most medical
authorities discouraged breast feeding by HIV-positive mothers for this
reason.

				Steve

    
    re .107  Steve,
    
    In Pattern-II countries WHO (World Health Organization) does not
    discourage women from breastfeeding infants because of a) the slight
    chance of transmission, and b) lack of alternative nutrition for
    infants.
    
    	deb

	Hello,

	I recently received a mail-shot from American Express trying
	to sell me life assurance.  What interested me was the list
	of exclusions.  Amid the usual exclusions: suicide, act of war, 
	civil rebellion etc was "any AIDS related illness".  
	
	Is this normal for assurance policies?  I certainly don't think 
	it is fair.  If you are not HIV+ at the time that you take out
	the policy, then they should have no right (IMHO) to exclude
	AIDS related illnesses.  

	Has anyone else come across this?  Are there laws to prevent
	insurance companies doing this in the States?  (I'm in the UK).
	If there isn't, what is to prevent an insurance company putting
	in an exclusion clause along the lines of "anyone who dies on
	a week-day"

	Cheers,

	Alan	

Re: .109

There are no laws against it.  Many insurance companies will nowadays insist
on an HIV test before writing new policies, in an attempt to weed out people
who know they are HIV positive already.  The policy is likely to be a bad
deal anyway, even without that limitation.  Shop around.

				Steve

>	I recently received a mail-shot from American Express trying
>	to sell me life assurance.  What interested me was the list
                        ^^^^^^^^^

    You mean life *Insurance* right? I'd be a lot more interested in
    assurance than insurance. :-)

    		Alfred

	Re: .111

	Different usage this side of the pond!  I looked it up in my dictionary
	and it seems to be a 'Chiefly British' term...you insure your property
	but you assure your life.  I agree it does look a bit funny, a bit like
	a protection racket.

	Re: .110

	BTW I'm not even looking for life assurance, it was just a mail shot
	I happened to look at before consigning it to the bin.  My concern is
	that they put on an exclusion clause without justification.  If they
	insisted on the test and then excluded AIDS on the basis of the
	results, that I could understand.  

	Here in Britain we normal get the question  "Have you ever been refered 
	for a blood test in connection with a sexually transmitted desease?".
	I don't know what happens if you answer YES, but I'd guess they'd
	either increase your premiums or refuse cover altogether.

	My question arises because this is the first time that I've ever seen 
	a catch-all exclusion for a specific illness.  I'm just wondering if 
	this has become the norm, and if we can look forward to other catch-all's
	such as heart-desease etc.

	Alan   

    No, the term "assurance" is technically correct. You "insure" against
    an event so that if it happens you will be in the same situation as if
    it had not. You can insure against your child breaking a neighbour's
    window but you cannot insure against death. Even AmEx cannot sell you
    that.
    
    As another nit, what you can insure (or assure) is entirely up to the
    company to decide on as a business risk unless there is a specific law
    to the contrary. There has been insurance against clouds ruining a
    country fair or preventing a satellite launch. There has even been
    insurance against a particular party winning an election. The only real
    difference between insurance and gambling is that with gambling the
    person paying the money expects to better off if the unlikely event
    happens. A calculation of odds that includes any known or available
    information on AIDS is not only legal (in many countries) but is just
    common sense for the insurer (or betting office).

Re: .114

It makes little sense to refer to an American English dictionary for
a British usage question.  And I think that further discussion of this
aspect of the note is inappropriate here.

				Steve

    
    
    I think I saw the same segment Herb, but was still in sleep mode.  I
    think the point they were trying to make is that it is more difficult
    for a man to "catch" HIV from an infected woman than it is for a woman
    to "catch" HIV from an infected man, what with the woman being the
    "receptive partner" and all.
    
    	   GJD

    I assume they were talking about heterosexual men and heterosexual
    women.  If they were saying 20% of HIV+ women contracted it from
    heterosexual partners and only 1% of HIV+ men (including gays) contracted 
    it from heterosexual partners, then the statistic seems a little bogus.
    
    						- Vick

    I guess I saw the TV too guys and gals. Seems to me that AIDS is more
    infectues than we have been told it was or at least what the GAY
    comunity is trying to tell us. AS IN! How does a doctor, who IS not
    having an affair with his client transmit AIDS? Shit! If all that was
    in her mouth was his fingers then WE ARE ALL IN DEEP TROUBLES!! 

    
    
    It hasn't yet been determined how the dentist in Florida (or if the
    dentist in Florida) transmitted HIV to his patients.  There are those
    who believe that his biggest error was in not conforming to the
    standard equipment sterilization procedures.  The liklihood of
    blood-to-blood contact between dentist and patient is very minimal, but
    DOES happen.  AIMHI::RAUH, your notes are alarmist in nature.  It is
    well established and accepted that casual contact (likes fingers in
    mouths) will NOT transmit HIV.

    Reported in the Wall Street Journal
    
    From the CDC 
    
    	1 in 100 estimated to be HIV +
    
    	350,000 estimated to have died by 1993
    
    	May become the 5th leading cause of death of US women by years
    	end
    
    

    re : .126
    
    Seems to me like mother nature must be a man !  It may seem ridiculous
    to say this, but it seems unfair that women, who are far more likely
    to be monogomous, are more at risk of contracting the disease than a
    philandering male.
    
    
    Jerome.

    
    Strikes me that the arguments around who is "responsible" for
    safe sex work out, in practice, very much like responsibility for
    pregnancy....
    
    In practice, women take birth control precautions in the vast
    majority of cases seemingly because 1) they are the ones who would
    get pregnant and 2) they have a wider range of options at their
    disposal. I know very few men who have bothered to ask about
    contraception before jumping into bed - they just assume that
    I look after myself.
    
    Consequently, with AIDS, although it is true that men can catch
    it from a female partner it is widely known that the risk is
    far greater in the other direction.
    She who is at risk will take the trouble to protect herself.
    
    So, to answer herb's question, I reckon that the real action 
    will be taken by the receptors choosing not to receive.
    
    'gail

            HIV in the Health Care Setting -- Questions and Answers

In recent months, the AIDS ACTION HOTLINE has received calls from the 
public concerned about the transmission of HIV in the health care setting.  
The following was prepared by the AIDS ACTION Committee and the AIDS Action 
Council in Washington, DC to help address those concerns.

    	 How many people have been infected with HIV by their dentist
    	 or surgeon?

    There are five known cases of people apparently infected by a dentist 
during dental procedures.  All were patients of the same dentist.  There 
are no known cases of patients infected by a surgeon during surgery.

    	 How do we know there are not others?

    We don't.  We do know that a number of studies--including that of a 
Johns Hopkins surgeon with HIV (Journal of the American Medical 
Association, July 1990)--have followed thousands of patients of doctors 
with HIV, and have turned up no related infections.  In addition, in the 
year since the Florida case appeared, a number of physicians with HIV have 
informed their patients of their illness.  As a result, thousands of 
patients have been tested, and no infections have turned up.

    	 How was HIV transmitted to those five people from their dentist?

    Dr. Harld Jaffe, Deputy Director of Science at the federal Centers for 
Disease Control offered two theories: one, that the dentist injured himself 
while working and infected each of the patients with his own blood while 
performing invasive procedures; or two, that the dentist contaminated his 
instruments with the blood of an infected patient or with his own blood, 
and then used those instruments on other patients without cleaning them 
properly.

    	 Which is the most likely?

    Because five patients of the same dentist have been infected with HIV, 
the evidence seems to indicate it was the instruments, rather than the 
dentist himself, that infected the patients.  It is extremely unlikely that 
five accidents took place in one office.  Neither the dentist nor the 
patients remembered any accident which drew the dentist's blood.  There is 
also evidence--the testimony of the dentist's own staff--that his equipment 
was not always properly sterilized, and that he reused equipment meant to 
be used only once.

    	 Does it matter?

    It does.  If the explanation is bad infection control practice, then 
the solution is different than if the explanation was something less 
controllable like unavoidable accidents.  Bad infection control practices 
can be addressed by better training in and enforcement of infection control 
procedures.  Moreover, bad infection control means that HIV could be 
transmitted from patient to patient--through contaminated equipment--thus 
making a focus on the health care worker irrational and perhaps even 
dangerous.

    	 Who is in charge of making policy on this issue?

    The Centers for Disease Control (CDC) is charged with setting guide- 
lines on HIV for health care workers and is generally acknowledged as the 
country's leading public health agency on disease control.  In February, 
1991, CDC held a public meeting in which nearly 100 medical and public 
health experts participated.  With two or three exceptions, all favored 
greater infection control and opposed mandatory testing of health care 
workers.

    	 What policy did the CDC finally recommend?

    In July, 1991, the CDC released new guidelines for preventing the 
transmission of HIV and the Hepatitis B Virus (HBV) to patients during 
exposure-prone invasive procedures.  These guidelines rejected mandatory 
testing of health care workers for hepatitus B and HIV antibody, and 
instead called for strict adherence to universal infection control 
procedures.  The CDC also recommended that health care workers infected 
with HBV or HIV could continue to perform invasive proedures *not 
identified as exposure-prone*, provided they practiced recommended surgical 
or dental technique and complied with universal precautions.

    	 What were the CDC recommendations concerning exposure-prone
    	 invasive procedures?

    The CDC called upon medical, surgical, and dental organizations to 
identify those procedures which are exposure-prone (those where there is an 
increased likelihood of health care workers cutting or injuring themselves, 
allowing their blood to contact a patient's blood, mucous membranes, or any 
other tissue under the skin).  It recommended that health care workers who 
perform exposure-prone procedures be tested for the HIV antibody.  For 
those who test positive, the CDC recommended they voluntarily refrain from 
such procedures until they have sought counsel from an expert review panel 
which will determine under what circunstances, if any, they may continue to 
perform them.

    	 How high is the risk of transmission in the medical setting?

    The risk of any person contracting HIV from any surgeon anywhere in the 
country performing any procedure has been calculated at one in 1,538,461, 
or .65 per million procedures.  Some have questioned whether the risk is 
even smaller than .65 per million, since the only known case of 
transmission has resulted in a cluster of cases, and no other random 
occurrences have been documented.

    	 How does this compare to other risks assumed by patients during
    	 surgery?

    Other risks with equally severe consequences are much, much higher.  
For example: the risk of death from anaesthesia is 100 per million; the 
risk of death due to penicillin anaphylaxis is 20 per million; and the risk 
of wound infection (which can be fatal) is 147,000 per million.

    	 The risk of HIV infection by one's dentist or surgeon may be
    	 small, but it could happen.  Given that the consequence is so
    	 great, shouldn't more be done to protect patients?

    Yes.  While it is not possible to guarantee a risk-free environment, it 
is possible to make the medical setting even safer from HIV transmission 
through better training of personnel, stricter enforcement of universal 
precautions, and the use of safer equipment, such as retractable needles 
and flexible scalpels.

    	 What more should be done?

    We concur with the CDC recommendations for stricter monitoring and 
enforcement of infection control procedures.  The CDC, the National 
Institute of Occupational Safety and health, the Occupational Safety and 
Health Administration, and the Food and Drug Administration must also 
actively pursue the approval and marketing of safer technology such as 
flexible scalpels and retractable needles--which can help prevent exposure 
from patient to practitioner and vice versa.
    Professional associations and licensing boards should train their 
members in infection control procedures and implement professional 
standards.  In Massachusetts, legislation has been filed that calls for 
mandatory training and continuing education on HIV for all licensed or 
registered health providers.  The AIDS Omnibus Bill, House 963, could 
represent an important step forward in guaranteeing that our health care 
providers are informed about the most effective and up-to-date infection 
control procedures.

    	 Shouldn't dentists and doctors already be taking basic pre-
    	 cautionary measures which include cleaning equipment?

    Yes.  "Universal precautions," formulated by CDC in 1987 call for the 
use of gowns, masks, and goves, sterilization of equipment, and the 
disposal of used syringes and needles in special containers.  Those 
measures are intended to prevent the spread not only of HIV but of other 
blood borne infections as well.  When universal precautions are strictly 
followed, it is unlikely that infection can occur.  It appears from 
available evidence that the breach of these universal precautions caused 
the infections in Florida--and the lack of other cases seems to demonstrate 
the effectiveness of universal precautions in preventing transmission.

    	 Why not just keep people with HIV out of the medical setting?

    It is not the safest approach.  Because of the three-to-six-month 
"window" between the time a person becomes infected with HIV and when HIV 
antibodies are dectable by a blood test, there will always be health care 
practitioners with HIV providing care to patients.  It is much safer to 
ensure that everyone is using good infection control procedures--to protect 
against the transmission of HIV and hepatitis B, and to protect against 
patient-to-patient transmission through contaminated equipment.
    In addition, it's just not practical.  To bar practitioners with HIV 
from the medical setting means, first of all, testing them, since most 
people with HIV don't know they have it.  For such a program to be useful, 
health care personnel would have to be tested every day--especially in 
emergency room settings where practitioners are repeatedly exposed to the 
possibility of HIV transmission.  Proponents of a universal, mandatory 
testing policy have not yet answered questions about how such a testing 
program could be structured and paid for.  The CDC concluded that the low 
level of risk does not support the diversion of resources that would be 
required to implement mandatory testing programs.

    	 Aren't you more concerned about the rights of health care workers
    	 than about patients' health?

    As AIDS advocates, we are most concerned about stemming the spread of 
HIV in our society.  The transmission of HIV in the health care setting can 
best be prevented by stricter enforcement of universal precautions.  We are 
also concerned that policies which needlessly drive health care workers out 
of their professions will damage patient care, especially in large urban 
settings where the epidemic is already placing a heavy burden on the 
hospitals.
    
    	 How would restrictions harm patient care?

    Restrictions would create a dis-incentive for medical professionals to 
perform exposure-prone procedures or to work in those states where the 
epidemic has hit the hardest.  Health care workers would constantly be 
worried about the potential loss of their careers and patient care would 
suffer.  This would affect all patients.  Restrictions would also have a 
disproportionate impact on the health care of people with AIDS or those 
perceived to be at risk of HIV.

    -- w/o permission from AAC _Update_, Vol 6, No. 7, Fall 1991

    RE .130
    
>    Other risks with equally severe consequences are much, much higher.  
>For example: the risk of death from anaesthesia is 100 per million; the 
>risk of death due to penicillin anaphylaxis is 20 per million; and the risk 
>of wound infection (which can be fatal) is 147,000 per million.
    
    To clarify, 147,000 per million get wound infections, a few die. Probably
    not useful as the other comparisons are for death.
    
    Steve

    re .131
    
    Good point, Steve.  They should have indicated how many of the 147,000
    infections were actually fatal.
    
    	deb

    The one that is REALLY significant is how many persons this year will
    be struck by lighting; something like 152 out of 240-250 million in the
    US. This is useful in putting the AIDs/doctor thingie inperspective.
    
    Steve

    Hello,
    
    	The town where I am living in south of France VENCE, is twinned with a
    german town LAHNSTEIN. Both european towns have been working together
    for 12 years with a cooperation program with OUAHIGOUYA our twinned
    town in BURKINA FASO (AFRICA - SAHEL).
    
    	We are now renovating the HOSPITAL and worked on the AIDS problem
    which is really a continental plague for AFRICA.
    
    	For the majority of other deseases big campaigns of vaccination have
    been organized in AFRICA.
    
    	My question is the following,
    
    	Suppose you vaccinate someone against diphtheria, cholera .... who
    is HIV+, what will happen ?
    
    	a HIV+ body is supposed to be more fragile to fight against the
    virus, when you vaccinate you innocule a part of a virus to make the
    body reacting and creating its own imminulogy against this virus.
    	As the body is fragile, don't you think that a vaccination could be
    dangerous and consequently accelerate the evolution of the HIV+ body
    towards AIDS or give the desease you wanted to vaccinate against ?
    
    	I have not found people able to give me a clear answer to this
    question, does anyone have an idea?
    
    	Thank you!
    
    	THIERRY

    re .134  Thierry,
    
    I'll have to look this up later and see what I can find, but I would
    think that an asymptomatic HIV+ person with a high T-cell count would
    be able to be vaccinated without adverse effects.  A person with AIDS
    or ARC, who has a very low T-cell count (and virtually no immune
    system) would, I believe, be better off without introducing new
    pathogens that it can't fight off.
    
    I'll see what I can find this weekend.
    
    	deb

Re. 634.134

		It depends on the type of vaccine.  Some vaccines are composed
	of weakened microorganisms while others contain only fragments of micro-
	organisms.  I wouldn,t think there would be any problem with vaccines
	composed of biological fragments as one cannot become infected by these,
	however there could be some danger using those containing functional but
	weakened agents.

							Jim

    
    
    	Well according to my doctor here in France innoculating someone
    HIV+ could be fatal. 
     	As background I recently bought an old house with garden and
    needed new anti tetanos vacine since the old had run out. I am in
    what is considered a high risk group and my doctor knows this. He
    is also president of the french gay doctors association so he keeps
    well informed about AIDs issues. Until I took the test he refused
    to prescribe the vaccine.
    	However as -1 said it might depend on what disease the vaccine
    is for.
    		Geof.
    

    	At 6:00 PM this evening Los Angeles Laker basketball star Ervin
    "Magic" Johnson will announce his retirement at age 32. He has tested
    positive for AIDS.
    	All Boston radio and TV stations are trying to confirm....
    
    	Now maybe AIDS will be taken seriously.
    
    Ken

    
    what makes you think its not already being taken seriously?
    
    maybe one should ask what you mean by "taking it seriously"...

    	Let's just say that until the right buttons are pushed, problems
    are not considered problems by the population as a whole. With a famous
    and virile young athlete with tens of millions of fans worldwide, tens
    of millions of dollars in corporate endorsements and an extremely high
    visibility factor, it will create a pressure unlike what has been felt
    prviously. 
    	Look what happened after the announcement. Front page headlines
    that Magic has HIV. If it was Joe Smith down the street, would the
    headlines be there? Some congressman from Illinois jumped up to the
    podium and called it a national tragedy and that the gov't has to start
    becoming more involved. If it had been Joe Smith down the street, would
    have the congressman been so inclined?
    	Many people took AIDS seriously after the first 10 people
    died....others believed it to be something that could only affect the
    people they had nothing to do with....Gays, IV druggies. They even
    pooh-poohed tainted blood because they don't believe it will happen to
    them.......tick, tick, tick........Now there will be a different focus 
    and I expect to see great strides made in the treatment of AIDS and I
    expect to see a vaccine within 3-5 years. All to be driven by the NBA
    in the beginning and then the NFL and major league baseball. 
    
    	That's what I mean by seriously.   

    Teenagers in particular, have not yet taken AIDS seriously.  To them
    it's somebody else's disease.  Teenagers are very sexually active
    these days and most sexually active teenagers have not started 
    practicing safe sex.  It's scary.
    						- Vick

    I don't believe there are many diseases that teenagers take seriously.
    AIDS and others STDs, and problems due to smoking, drugs, alcohol
    are only examples.
    
    And if we make inroads on the collective teen consciousness this year, we
    get to do it all over again next year for a whole new crop...
    
    ed

just a minor nit...

Johnson tested positive for the HIV virus. He does not have AIDS.

todd///

    True -- that's because AIDS isn't a disease -- it's a syndrome.
    
    When his immune system weakens sufficiently, then organisms that a
    healthy person would easily overcome will threaten his life, and
    eventually kill him. But: the crucial event has already occured;
    the stage is set.
    
    					andrew

    
    No Andrew, it's because HIV n.e. AIDS.  10-20% of HIV+ people will never
    develop AIDS; some will develop ARC; some willjust remain HIV+ for [we
    don't know how long yet...so far, the longest documented is being HIV+
    for 10 years without developing AIDS or ARC].
    
    The news media, various notesfiles, and my mail inbox are great
    indicators as to the level of ignorance that is still widespread in the
    general public.  According to the CDC, heterosexual sexual transmission
    is the *only* category that has steadily *increased* in the past
    several years.  Why?  Denial, ignorance, and the fact that many
    entities (government, media, etc.) have treated HIV as a moral issue,
    not a medical one.  Few people cared when it was just a bunch of gays
    and IV drug users; now it's someone "normal" who didn't get it through
    "tainted blood" and the whole country sits up and takes notice that
    "holy cow--it could happen to me through my 'normal' sexual practices."
    The fact that women are about 20 times more likely to get it from men
    than the other way around does not mean that men have nothing to worry
    about.
    
    All I can say is,it's about time.  I feel very badly not only for a
    great athlete like Johnson, but for all the "nobodys" who've been
    living with HIV and getting the shaft because they're not someone
    famous, and therefore not worthy enough to make headlines and have
    people listen to them.  Johnson showed a lot of class in his
    announcement; I hope he'll be able to reach people with his safer sex
    messages (like teenagers and minorities) who really need to hear them.
    I think he'll be a great 'ambassador,' and I hope he'll be spreading
    his messages for a long time.
    

    
    what shaft are the ones with aids getting? 
    
    what shaft are they getting that terminal cancer patients
    don't get? 
    
    what shaft are they getting that other communicable
    disease carriers aren't getting?
    
    what shaft are they getting that anyone else with an uninsurable 
    health risk aren't getting?
    
    other than the occaisional (and reprehensible) fundamentalist calldown of 
    the wrath of G*d on them, what is this shaft that you say they are getting ?
    
    are insurers supposed to make an exception for these cases only, which
    they do not make for weak hearts, aneurisms, other health risks..?
    are they supposed to just suspend their financial duties because this
    particular condition has exceptionally powerful lobbyists?
    
    

    I apologize if these have been asked already.
    
    1. How long between the time a person is infected with HIV until it
       shows up on a blood test?
    
    2. When a person is infected with HIV is it actively attacking the
       immune system of that person, or does the virus remain dormant until
       something triggers it to attack?
    
    
    Thanks,
    Brian
    

    According to Dr Anthony (?)Fauci (sp), head of AIDS research at
    National Institue of Health(?) or head of AIDS department Communicable
    Diseases Center Atlanta(?) 99% of cases have shown up within a year,
    90% (?) within 6 mos.
    
    			herb

    re .147
    
    1.  Between two weeks and a year...usually; the average is 3-6 months.
        Rarely (as Herb said) it can be over a year.
    
    2.  The little HIV buggers start going to work right away; a person is
        communcable with HIV even before s/he builds up enough antibodies
        to show up on an HIV test.  It depends ona person's overall health
        and immune system (as well as cofactors*, which are under study) how
        long they can fight off the HIV invaders.
    
    * Cofactors: It's been determined that stress, smoking, alcohol and drugs 
      (especially cocaine) damage the immune system.  Other cofactors under
      study include: the effects (positive or negative) of sunlight, exercise,
      diet, hereditary factors, person's history of illnesses.
    
    	deb

Four stages of HIV disease:

1)  The Acute Infection
2)  The Stage of Hidden Struggle
3)  Transition to Severe Immunosuppression
4)  Final Stage: Opportunistic Infections

1)  The Acute Infection

	A few days to a few weeks after becoming infected with HIV, some
    people develop symptoms like those of flue or infectious mononu-
    cleosis; fatigue, headaches, fever, and sweating.  Sometimes a rash
    appears on the torso.  This illness lasts for one to three weeks,
    and then goes away.  During this period, the immune system is
    responding inthe way you have learned.  Helper T cells are activated;
    B cells differentiate to make plasma cells, and the plasma cells
    produce antibodies against HIV.

	Because these symptoms are so similar to those of ordinary flue
    and are often very mild--or even nonexistent--people who have just
    been infected with HIV cannot tell whether they are infected.
    Neither can their friends or anyone else.  But the immune system is
    responding to the presence of the virus.  From two to twelve weeks
    after becoming infected, a person's blood will usually* contain 
    antibodies to the virus, a sign of infection.  A blood test is the
    only way a person can learn whether he or she is infected, since
    recognizable symptoms may not develop for years.  Doctors suspect
    that a person is very infectious during the acute infectious stage,
    particularly before antibodies appear.

	-- "Infection, Your Immune System and AIDS", 1990 from the
	    Massachusetts Medical Society

    * Please note the word "usually"...this is a variable depending on
    the person's health, immune system, etc.  It has been proven that
    it can take several months to build up enough antibodies to register
    positive on an HIV test.  Plus, there are a few baffling cases where
    a person consistently tests negative until they develop opportunistic
    infections (Stage 4).

    I would like to have someone figure out something statistically;
    
    How many people would you have to had relations with before you have
    about a 100% chance of infection with the current rates of infection:
    
    I realise that there are different tranmission rates for M-F, F-M, 
    M-M, F-F etc. There are also different rates of infected persons; M, F,
    etc
    
    Say 1 in 100 partners had the HIV virus
    Say 1 in 1000 partners had the HIV virus
    Say 1 in 10000 partners had the HIV virus
    
    I think it would be quite eye opening. How many would it take?
    
    Can anyone figure this out? Did the CDC do this? Deb?
    
    Steve

    Since the question is statistical in nature you should define "about a
    100%" more closely.  Do you want 90%? 95%? 99%?  I reckon it's not
    hard to cm up with an answer.  Now, where was that book?
    
    ed

    Ed, stats was NEVER one of my strong suits. Give me/us what you can
    come up with. 90-99% would be fine if that is what the stats answer
    yields.
    
    	Looking forward to your stats.
    
    Steve

    Ok, I guess I really have to find the book.  And I just unearthed
    my copy of Robert's Rules, too.
    
    ed

    re .151  Steve,
    
    Sorry, I can't help you...Nothing I've read (by CDC or anyone else) has
    gone into that.  In fact, as I mentioned in a previous note here, they
    haven't ascertained any absolute risk %'s...only that F-F is the
    lowest, and that receptive partners are more at risk than insertive
    partners.  (A recent study indicated that the receptive partner's risk
    is 17x that of the insertive partner, but...one study does not a 
    *conclusion* make.)
    

    
    More focus has been put on AIDS recently with first the announcement
    last weekend that Freddie Mercury of Queen was suffering from AIDS, 
    and then his death from pneumonia brought on by AIDS on Sunday.
    
    Queen announced yesterday that they will re-release "Bohemian Rhapsody"
    on December 9th in tribute to Freddie with all proceeds to go to the 
    Terence Higgins Trust (for AIDS).  Let's hope the money does some good.
    
    Sam