The Myth of Heterosexual AIDS.

Sex, Lies, and the Underclass

The Fifth Avenue offices of Forbes magazine don't usually attract militant demonstrators who carry placards and chant slogans. But then Forbes doesn't usually get swept up in a controversy over AIDS. It did in June, however, when the business magazine printed a favorable profile of a conservative writer and lawyer named Michael Fumento. Fumento, you see, believes that all the hype about AIDS is, well, hype. In fact, he thinks that the vast majority of Americans are more likely to meet Shirley MacLaine in a different life than to contract the deadly HIV-virus, and that the only reason the news hasn't gotten out is that a conspiracy of self-interested scientists, opportunitistic politicians, sensationalist journalists, conservative moralizers, and fearful homosexuals have manufactured the scare.

This does not make Fumento a popular guy.

To conservatives he is a turncoat. A former writer for The Washington Times, Fumento was plucked to serve as the resident right-ring AIDS consultant on the U.S. Commission on Civil Rights. But his condemnations of conservatives who were using the AIDS crisis to terrify America into monogamy lost him his favored-son status. Meanwhile, to many liberals and gays active in the fight against AIDS, Fumento is the Prince of Darkness, a man who would slash funds aimed at wiping out a virulent killer.

Soon after the June 26 demonstration, Malcolm Forbes himself printed a humble mea culpa, calling Fumento's views "asinine"; the apology was followed by a 13-point rebuttal to the article penned by protesters from the AIDS Coalition to Unleash Power.

And that was just in response to a profile of the guy. Imagine the fallout from Fumento's forthcoming 432-page book, The Myth of Heterosexual AIDS (*1), in which he painstakingly details his case that AIDS never really threatened anyone besides gays and intravenous drug users. Nor, according to Fumento, was there ever any reason to believe that it would threaten white, middle-class America--but that didn't stop a varied group of alarmists from creating the Big Lie. "Before it would run its course," writes Fumento, "this mythical epidemic would exact a severe price, to be sure--not in lives but in wasted resources, squandered credibility, and sheer terror."

After a graphic explanation of the mechanics of transmission of the AIDS virus, known as HIV, and of the statistical probability of infection, Fumento spends most of the book criticizing just about everyone you can think of for ignoring the facts. Fumento argues that the federal Centers for Disease Control's current estimates of 1 to 1.5 million infected Americans should be halved; that this exaggerated epidemic has already peaked; that the worst is over; and that by the mid 1990s, AIDS will be a relatively minor, albeit Horrible, health problem.

A lot is at stake. The public policy implication of all this is enormous: less money and manpower for AIDS. With 14 other diseases claiming more American lives, why, demands Fumento, should we be draining away our best research talent and millions of dollars for AIDS?

It's not hard to see why the thesis of The Myth of Heterosexual AIDS will be a litmus test of your commitment to treating this dread disease and of your compassion for those who have been felled by it.

But is it fair to paint Fumento as a frothing fanatic who's trying to underplay one of the modern era's greatest threats? Ultimately, no. Fumento is dead wrong about many things. But there's also a lot that he's right about--which may, unfortunately, be ignored in the political firestorm that's sure to erupt.

After all, the fearsome heterosexual "breakout," the specter of mounting corpses that monopolized magazine covers and kept yuppies in their own beds during 1986 and 1987, never did materialize. What's more, many of those who issued the most terrifying warnings--whether well-intentioned or not--should have known better.

Indeed, the nature of the homosexual epidemic was never a good model for heterosexual spread, as Fumento points out. The AIDS virus is transmitted through direct contact with infected blood (as when addicts share dirty needles or hospital patients get a tainted transfusion), or with semen or vaginal secretions during sexual intercourse. Few heterosexuals engage in once-common gay practices; in bars and bathhouses, men might have had a dozen sexual encounters a night, perhaps hundreds over the course of a year, thus increasing their exposure to HIV-infected individuals and their chances of infection. Yet even if heterosexuals were that promiscuous, the virus would still probably spread more rapidly among gays than straights since HIV is transmitted much more easily via anal intercourse than vaginal intercourse. Why? Because it is easier to rip the cellular membrane lining the urethra and rectum during intercourse than it is to tear the membrane lining the vagina; these rips then facilitate the entrance of the semen-borne AIDS virus into the partner's bloodstream. On top of that, studies show that female-to-male transmission is much rarer than male-to-female (just consider the mechanics). Fumento also competently explains why different cultural and health practices in Africa, such as reusing medical syringes, turned the epidemic there into a heterosexual one. Thus, Fumento concludes, "most heterosexuals will continue to have more to fear from bathtub drowning than from AIDS."

Fumento goes on to explain why fears were inflamed, and to name names. What results is a merciless--though often legitimate--indictment of the purveyors of panic. He exposes lazy scientists who published their findings but neglected to conduct follow-up studies that would have explained inconsistencies in the data, and he criticizes researchers who spoke about information outside their area of expertise (though where does that leave Fumento, an erstwhile lawyer?). He trots out embarrassing statements from such figures as U.S. Health and Human Services Secretary Otis Bowen, about how AIDS could make the Black Death "pale by comparison"--statements that they later tried to squirm out of. And he notes that any large and sudden increase in funding is "begging for boondoggles," a phenomenon that is as true for medical research as it is for defense contractors. Fumento suggests that some in the research establishment just wanted to continue milking the lavish budget and media attention. But there were others (probably more than Fumento would grant) who, along with gay groups, came to the unhappy realization that exaggerating the threat to middle-class heterosexuals was the only way to capture Washington's attention.

Bennett's vice squad

And conservatives? "In the AIDS epidemic, some conservatives believe they have found a shiny weapon with which to recapture their vision of a better world--one where homosexuality is pushed back into the closet... where chastity, monogamy, and sexual morality are revered." Consider the AIDS Prevention Institute, chaired by Pat Boone, which prints a newsletter admonishing "Save sex for marriage," or the home videos that warn against deep kissing. Some right-wingers even tried to popularize the vicious lie that HIV could be casually transmitted. It's frightening to contemplate how many of these crusaders held high positions in the Reagan White House, where they pushed their moral agenda and helped waste millions by championing useless policies like premarital testing. Education officials filed material on AIDS and changing sexual mores under the telling heading "VICE (Perversion/AIDS)." And Education Secretary William Bennett's booklet on "AIDS and the Education of our Children" focused on chastity almost to the exclusion of drug use. (Bennett, of course, is now President George Bush's drug czar.)

Then there's the media, which promoted the panic without verifying the facts. "Like perpetual motion machines, the articles fed upon fear, and used it to breed still more fear." Like the Atlantic, which printed a hysterical warning about heterosexual breakout loaded with statistical errors, later nominated for a National Magazine Award. Or Newsweek, which deserves particular censure for publishing the irresponsible doomsday projections of sex therapists Masters and Johnson. Hollywood and TV fare even worse. "The typical profile of a victim of heterosexual AIDS transmission was... a white, upwardly mobile woman who was infected after a one-night stand with a man who later proved to be a bisexual.... One couldn't possibly guess that, in fact, the profile of the typical non-IV [drug-abusing] heterosexual AIDS victim was a lower-class black or Hispanic woman whose regular sex partner was an IV drug user. White heterosexuals at the time of the media blitz on heterosexual AIDS (late 1986 to mid-1987) made up only about one-half of one percent of AIDS cases." Fumento is right to point out that this disproportionate focus on white, middle-class heterosexuals has helped contribute to the dearth of public health education targeted specifically at minorities--the group now most at risk.

Back to Bacchus

But Fumento has trouble distinguishing between a political conspiracy and mistaken assumptions that may have seemed reasonable at the time. Figuring out the scope of a new phenomenon isn't quite so easy without the benefit of 20-20 hindsight. With a real-life heterosexual epidemic in Africa as an example, the potential for a similar disaster here didn't always seem so outlandish. Nor is everyone involved a self-interested scoundrel, an ideological Machiavelli, or a journalistic Joe Isuzu. Whenever the media presents details that sit uncomfortably with Fumento, he suggests that they might just be lying. After all, says Fumento, Janet Cook, the Pulitzer-Prize-winning Washington Post reporter, once made up a story about an eight-year-old drug user. The implication is that journalists writing about AIDS might be doing the same thing. But does the example of Roy Cohn mean that all lawyers--like Fumento--are not to be trusted? Nor is it true for staff writers that "the faster one cranks out the words, the higher the pay scale." And it doesn't necessarily apply to freelancers either.

Ultimately, what Fumento is wrong about will overshadow what he's right about. And he's most certainly wrong to insist that heterosexual AIDS doesn't exist as long as white, middle-clas suburbia is free from it. In fact, AIDS is alive and well and growing at a terrifying pace among heterosexuals--only they're poor and black or Hispanic.

Intravenous drug use was in effect the needle through which HIV was primarily injected into the heterosexual community. The deadly virus spread from arm to arm; the mostly poor and minority addicts passed it to their wives and lovers, and they, in turn, passed it to their unborn children. Worse yet, AIDS has more recently been given a booster shot from crack, the drug that is ravaging poor communities from New York City to Portland, Oregon. Crack seems to trigger sexual binges that would make a latter-day Bacchus blush--binges that rival the activities in the gay bathhouses of the 1970s. This sexual explosion within a closed circle of people, many of whom may be infected, increases the probability that someone will pick up the virus through heterosexual intercourse. An explosion of syphilis--which produces open sores and facilitates the spread of the AIDS virus--has accompanied the spread of crack houses. Crack smokers may also go on to shoot heroin, thereby exposing themselves to infection from the heroin-abusing population.

If the drug-addicted population is finite and isolated, then AIDS may just run through it, kill off most of the members, and then burn itself out. A horrifying enough scenario. But crack use appears to be spreading to many poor urban pockets throughout the nation. The 1988 National Household Survey on Drug Abuse, the most comprehensive analysis of Americans's daily drug habits, found that the number of cocaine and crack addicts increased sharply even though casual use was on the decline.

If you want to look into one possible vision of the epidemic's future, go to the south Bronx. One in 22 young mothers in some areas tests positive for the AIDS virus; so does about one in 40 infants.

While Fumento entitles a chapter "The Agony of the Underclass," he spends less than two pages on crack. He notes the frightening crack-AIDS nexus and the billowing rise in syphilis, but he doesn't use this new information to talk about the epidemic's future, only to show how AIDS is draining resources from syphilis prevention. And even that conclusion is contradicted by Fumento's own admission that "as word got out on AIDS, non-AIDS [sexually transmitted disease] rates among homosexuals began to plummet." Fumento acknowledges the spread among minorities but treats it almost in passing.

But is he right that the total number of cases will be halved? Well, most drug-related cases haven't shown up in the official statistics yet since so far there is about a seven-and-a-half year lag between the time someone is infected and the time he or she develops AIDS. Add another year or two between diagnosis and the time the case is reported to the Centers for Disease Control--perhaps even longer since many down-and-out drug users have poor access to health care. Still others will never be included in the official statistics because they do not fit the CDC-approved case definition of AIDS or because they died before they could be tested for the virus. In New York City, for instance, health officials say that the epidemic among drug users is underestimated by well over 100 percent.

Yet Fumento pretty much ignores these cases and uses the official body count to conclude that AIDS is eating up far too much funding. Indeed, he charges the CDC with distorting the official estimates by broadening its definition of AIDS and thus enlarging the caseload--even though the new definition is clearly more accurate. And he complains that the AIDS budget nearly matches and may soon surge past cancer's, although the latter disease causes far more deaths. But cancer has been researched for decades at a cost of billions. AIDS research--which will have applications to other fields--was largely ignored by the federal government until 1987; the virus wasn't even discovered until 1984. Nor does Fumento take into account that extra seed money is needed in the early years for basic research. Fumento makes even less sense when he points out that AIDS research expenditures equal about 4.5 percent of cancer patient costs but are 230 percent greater than AIDS patient costs. So what? The vast majority of AIDS patients won't swamp the health care system until years down the road--as even Fumento would acknowledge. And cancer isn't contagious.

The real myth is that America doesn't have to panic because white America isn' at risk. Thus, the book will not only be controversial; it may also be dangerous. It advances a cause that could mean abandoning hundreds of thousands to a painful death. And that would be true even if AIDS cases were to stop their unabated climb upwards today and level off.

Homosexuals and researchers saw how AIDS went ignored when it was perceived as a "gay disease." Only once the fear-mongering that Fumento documents convinced mainstream America that it was at risk, did the federal funds begin to flow. Persuading the public that the virus trains its deadly fury on drug users (a despised group) and minorities (a neglected and often powerless one), may now shut off the spigot.

Does the threat to these groups justify wholesale panic? Fumento emphatically says it does not. He may be right. Exaggerating the danger can diffuse scarce resources and be used to justify extreme measures like quarantines and forced testing.

But Fumento fails to explore the more crucial question of how one mobilizes the government in the face of a serious health threat that doesn't endanger middle-class, heterosexual whites. Instead, Fumento is guilty of a tactic he condemns: To make his point, he seriously underplays the heterosexual epidemic that continues to devastate Hispanic and black America. You just need to look at the SRO crowds in New York City hospitals, the growing number of homeless people with AIDS, or an HIV-positive infant to know that the real danger is still complacency.

(*1) The Myth of Heterosexual AIDS. Michael Fumento. New Republic Books, $22.95.

Patricia Cohen is editor of "Current," Newsday's new Sunday opinion section.