[1]. See, for example, Root-Bernstein, Robert, Rethinking AIDS: The Tragic Cost of Premature Consensus, New York: Free Press, 1993.
[2]. For general remarks on reductionist bias in biology, see, for example, Levins, Richard, Richard Lewontin, The dialectical biologist, Cambridge, MA: Harvard University Press, 1985. Many feminist critics of science have observed this bias, also. For example, Keller, Evelyn Fox, Reflections on gender and science, New Haven: Yale University Press, 1985.
[3]. An excellent discussion of this appears in chapter 3 of Adams, Jad. AIDS: The HIV Myth, St. Martin's: New York, 1989. See also, Root-Bernstein, Op.Cit.; Lauritsen, John, The AIDS War, New York: Asklepios, 1993.
[4]. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report,
[5]. The simple noteworthy fact is that people sometimes fail to report to their doctors their engagement in stigmatized activities, such as homosexual intercourse and injection of illegal drugs. Such underreporting is facilitated by a widespread prior belief by doctors and patients that AIDS is, in fact, being transmitted heterosexually in significant numbers. Hence patient reports of exclusively (non-stigmatized) heterosexual contact are an easily accepted evasion of unpleasant inquiries from doctors. However, more than just as a general sociological observation about people's reticence about stigmatized activities, the demographics of the reported heterosexual risk category indicate that misreporting is occuring. See Schüklenk, Udo, Juliet Ricther, David Mertz, "The Bioethics Tabloids: How Professional Ethicists Have Fallen for the Myth of Tertiarily Transmitted Heterosexual AIDS," Health Care Analysis 3(1), 1995; Mertz, David, Mary Ann Sushinsky, Udo Schüklenk "Women and AIDS: The Ethics of Exaggerated Harm," Unpublished manuscript.
[6]. Just how far cases declined is more difficult to say than one might expect. Unless the CDC changes its reporting procedures yet again, it will become easier to quantify the 1994 decline when later reports are issued. My own estimate is that the real decline was of the order of about 1/3. The actual reported numeric decline in the most recent report, between the period July 1992-June 1993 and that of July 1993-June 1994, was small: from 85,122 to 84,268 adult/adolescent cases (CDC, op. cit., Table 3). However, as discussed in the main text, January 1993 saw a significant change in the criteria for AIDS, which classified many more people as suffering from the syndrome. Since the earlier annual interval only contains six months under the expanded definition, it is not fully comparable to the later interval in direct numeric terms. Under the 1987 and pre-1987 definitions of AIDS, there was, in fact a decline in AIDS cases between July 1991-June 1992 and July 1992-June 1993 from 50,802 to 42,714, or a 16% decline (see Table 10, ibid). The reported figures by definition category for July 1993-June 1994 seem to be incomplete (although this is not indicated in the appropriate chart), but of the 40,946 cases classified by definition category for this first reporting interval fully under the 1993 expanded definition, 56% of cases fell under the expanded definition. Retroactive diagnosis of earlier cases, because of the inherently incomplete information on which they are based, show smaller percentages of cases which would have fallen under the 1993 expanded definition had it been in effect in earlier reporting periods.
[7]. CDC, op. cit., Table 10. See above, footnote .
[8]. Schüklenk, Udo, David Mertz, Juliet Richters, "The Bioethics Tabloids: How Professional Ethicists Have Fallen for the Myth of Tertiary Transmitted Heterosexual AIDS," Health Care Analysis 3:27-36, 1995. See p.29 for discussion of this. Also illustrative is De Vincenzi, Isabelle, "A Longitudinal Study of Human Immunodeficiency Virus Transmission by Heterosexual Partners," New England Journal of Medicine 331(6), August 11, 1994, which suggests that even heterosexual who have a known HIV seropositive status use condoms from inconsistently to not at all with their longterm partners who are known to be seronegative.
[9]. The arguments which can be made against testing of low-risk populations--or generally against treating HIV testing as a responsibility, rather than a choice--are several, and beyond the scope of this paper. At the least, it can be observed that the rate of false-positives probably exceeds the number of true positives for testing in low-risk populations and, further, that no non-toxic or effective therapy exists for AIDS treatment regardless of the accuracy of an antibody test.
[10]. In defense of moralizing over safe-sex, and sometimes of criminalizing "unsafe sex," the argument is often made that safe-sex advocates are concerned not about harm-to-self, but rather about harm-to-others. A general Millean distinction between these types of harm is assumed to be accepted on all sides; and I, in fact, endorse such a distinction myself. The question becomes one of whether engaging in unsafe sex presents a nose at which my right to swing my fist ends. I argue that there is something a bit absurd about thinking of unsafe sex in these terms of harm-to-others. One simply cannot engage in non-masturbatory sex alone, and hence any choice to engage in such acts--endangering or not--cannot be made without the involvement of another person. The moralizing safe-sex proponents seem categorically to remove sex thereby from the realm of personal autonomy. Further, given that universal awareness, or at least belief, of the danger of AIDS in sex (at least in the U.S. and other places where AIDS education has been widespread), it is implausible to maintain that by engaging in consensual unsafe sex I might expose another to a risk of which she is unaware or does not, in fact, deliberately choose. This mutual consent to mutal endangerment (which sex must be considered, quite regardless of any knowledge by one or both partners of serological status), is much like the choice one makes by engaging in a contact sport in which one chooses to risk a harm which, if inflicted, will come at the hands of another person (who has also chosen a similar risk). Ethicists and jurists have long recognized risks such as that of contact sports--absent conduct well outside the bounds normal to the activity--as covered by a civil-libertarian advocacy of rights to harm oneself, and legally as free of liability to the causal agent of one's harm. For much better elaboration of this discussion, see Schüklenk, Udo, "Rethinking Safe Sex, and (Mandatory) HIV-Antibody Test Campaigns: Some Doubts About the Role of 'Community Based' AIDS Organisations," Health Care Analysis 2(3), 1994; Mohr, Richard D., "AIDS, Gays, and State Coercion," Bioethics 1(1): 35-50, 1987; Illingworth, Patricia, Aids and the Good Society, London: Routledge, 1990.
[11]. See footnote . In particular, between the discussed intervals of July 1992-June 1993 and July 1993-June 1994, the decline in new AIDS cases among men who have sex with men was from 47,533 to 42,156. This includes those cases who have an additional injecting drug use risk, but the pattern is the same if they are excluded. As discussed in the mentioned footnote, this relatively small numeric decline represents a much larger numeric decline under a constant definition of AIDS, since the case-definition was greatly expanded during the latter interval.
[12]. Brandt, Allan M., No Magic Bullet: A Social History of Venereal Disease in the United States Since 1880, New York: Oxford University Press, 1985. See particularly, pp.12-17. The mentioned ten percent figure is by no means the highest estimate of syphlitic infection promoted in the early twentieth century, either. The assertion of Prince A. Morrow in 1911 is perhaps typical of estimates of venereal disease among social progressives, "[The] morbidity of venereal disease exceeds that of all other diseases combined." Brandt, p.13.
[13]. Brandt, Op.Cit.