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.