As a physician in rural Wisconsin I
have seen only one case of AIDS but I pondered about how to do my part in
prevention. My breakthrough in thinking
came when the president of the US said early in the epidemic, “I don’t see why
people worry about getting AIDS. All
they have to do is wait until they are married.” It was obvious that this advice was incomplete for most of
us. A new question for my interviews
occurred to me: “Are you medically married?” This always stirs up some
discussion including the phrase “because the bugs don’t care about the paper
work.” Even old folks listen when I tell then that everybody knows somebody who
is at risk so please be my
representative and educate them.
Red-blooded physicians have no reluctance to try to influence the health
of people they will never meet. Here is
the advice for those who are not “medically married” and who do not “shoot
drugs.” When establishing a new
relationship, no matter how promising, treat it as a one night stand for two to
three months and always use protection.
Then, after this duration of a committed, exclusive relationship you
both get tested and have a “mortgage burning ceremony” to get rid of the rest
of the excess rubber goods.
For those who do “shoot drugs” the
advice is more difficult because it must also suffice for the time before they
stop using drugs. Un-sterile injection
equipment that has been used by an infected individual is a major route for
AIDS to get to the general population by way of non drug- using sexual
partners. In most if not all of Europe
sterile equipment is available to drug users to help prevent this spread of
AIDS but not in the USA. Annals of
Internal Medicine recently publicized a summary of jurisdictions in the US
where physicians may legally dispense prescriptions for sterile equipment; this
is almost the entire country, including Wisconsin. Drug addicts may be on a waiting list for treatment for many
months and should know of this option.
The actual treatment of drug addiction is permitted in the US only in
special licensed clinics, hence the long waits.
AIDS, the acronym for acquired
immunodeficiency syndrome, was probably a disease of chimpanzees in west
central Africa for centuries and crossed the species barrier to humans many
years before taking off in the human population by heterosexual contact. The initial human cases almost surely
occurred in butchers of “bush meat.” Stored human blood specimens from various
research projects of the past are being tested for AIDS. The earliest positive specimen was from the
Congo from 1959. Seventy percent of all
infected humans live in Africa with about twenty five percent of the population
infected in Uganda and South Africa.
This means a mortality in 10 years greater than that of the Black Death
in the middle ages in Europe.
Senegal on the Atlantic coast of
Africa, Uganda in Central Africa, and Thailand have had remarkable success in
controlling the spread of the disease.
In Senegal, the government mounted a public education campaign early in
the worldwide epidemic, and the incidence did not rise above two percent and is
now falling. In Uganda, the education
effort came late but has reduced the incidence in less than 20 year olds and in
those attending antenatal clinics, from twenty eight percent in 1991 to five
percent in 1998. Thailand persuaded sex
workers to use condoms, reducing the carrier rate in 21-year-old military
recruits from four percent in 1993 to less than two percent in 1999. Thailand’s example is spreading to nearby
countries.
Currently in the US the most rapid
increase in HIV positives (positive blood test without overt disease) is in the
general population, not in homosexuals or IV drug users as was the case
initially. Treatment for AIDS seems to
be too expensive except for those in the developed world. However, the availability of some treatment
motivates at risk people to be tested thus enhancing efforts at
prevention. Treatment preserves
apparent health for a decade or so. No
cure or vaccine is in immediate prospect.
AIDS is a public health problem.
Regarding it as a strictly moral matter will result in much misery for
innocents.
See also: Public Health, PublicCosts, and
Public Benefits under Economics and politics.
John
A. Frantz, M.D
August
14, 2000
Food does not need gender separations
John A. Frantz, M.D
The Monroe Times
Nate Klassy at city hall recently asked me what I
thought of an article in the Reader’s
Digest for July 2001 about five foods men need most and five foods women need
most to enhance
their health and gender-specific characteristics. My first
thought was that the Reader’s Digest was hard up for copy. A more
interesting interpretation is
that they got it backwards: women should eat the foods for men to make them more aggressive so they
run for office and we have better
government, and the men
should eat the foods
for women to make them
less aggressive so we
can have fewer
wars. Urban legends
either way you
slice it.
most
needed foods.