Chicago Tribune (CT) - Sunday December 20, 1987
Jon Van, Science writer

They, the nation's most expert public health authorities, were brought together to plan defenses against a mysterious and lethal enemy, a microbe, the human immunodeficiency virus (HIV), which causes AIDS.

Because acquired immune deficiency syndrome is a sexually transmitted disease, they met here at the Kinsey Institute for Research in Sex, Gender and Reproduction. Human sexual practices have become the terrain of battle in what will be modern humanity's greatest challenge from an infection. The study of sexual practices, especially who does what to whom, where and how many times, has been regarded as of only marginal value to serious scholars. With the onset of AIDS, however, that view is giving way to a realization that the serious study of sexual practices is of paramount importance to public health.

Public health authorities say they are trying to fight this battle with intelligence left over from World War II-the studies published nearly 40 years ago by Alfred Kinsey and his colleagues-that remains the only comprehensive scientific picture of American sexual practices.

"It is a scandal," said Dr. Bruce Voeller, a physiologist and biochemist who is president of the Mariposa Education and Research Foundation of Topanga, Calif. "We should have been collecting data and updating the Kinsey work right along, but it hasn't been done. This lack of data really stymies us."

Dr. Michael Gottlieb, the Los Angeles physician who first discovered the virus, and Voeller, who gave the syndrome its name, called together about 70 experts from various fields to brainstorm and discuss new strategies for fighting AIDS.

Dr. June Reinisch, current director of the Kinsey Institute and the third convener of the meeting, also is upset that sex researchers have been left out of national planning to stem the epidemic.

"People accept the idea that it takes years of training to learn how to study bacteria and viruses," Reinisch said. "But they seem to think that because we all behave, anyone is qualified to study human behavior."

Along with physicians William Masters and Virginia Johnson of the Masters and Johnson Institute in St. Louis, Reinisch and Voeller have petitioned the President's AIDS Commission to begin consulting with them and other sex researchers to develop official strategies.

The Kinsey meeting was cosponsored by two federal agencies, the National Institute of Allergy and Infectious Diseases and the National Institute of Child Health and Human Development. But there was widespread frustration expressed that the nation's political leaders are afraid to do what's needed to address the crisis, especially in sex research.

"It's been unfashionable to fund behavioral research," said Dr. Gary Noble, director of the AIDS division of the federal Centers for Disease Control, "but now we've got to catch up. . . . The size of the bisexual population isn't well known. It's something we need a lot more information on. Their role in this epidemic is poorly understood. We also need better data on the size of the infected population."

Most sex research in recent decades has focused upon individual performance and response. What has passed for large-scale studies of sexual behavior often has been nothing more than a compilation of responses to questionnaires by readers of popular magazines.

Though such results may be interesting to readers, they aren't scientifically valid, Reinisch said, and they give almost no insight into practices among blacks and Hispanics, the two groups hardest hit as the virus spreads among heterosexuals.

AIDS first was diagnosed mostly among homosexuals in America's big coastal cities and was seen next among intravenous-drug users who are infected by using contaminated needles. Homosexual intercourse and drug use still are the two activities associated most with AIDS, but as the infection moves to heterosexuals, experts aren't sure how best to counteract it.

Even using terms such as "homosexual" and "heterosexual" may obscure the true situation. In Kinsey's original report, he found that 50 percent of American men never had any sexual experiences with males, and only 4 percent of American men had sex exclusively with other men all their lives. These are the pure heterosexual and homosexual males.

For the other 46 percent, there was a mix of sexual activity with males and females during the course of their lives.

Because infection in the United States is higher among homosexuals and lower among heterosexuals, the status of men who have practiced both types of behavior is likely to be crucial in determining the course of the epidemic.

One risk factor for homosexual men is having a large number of sexual partners. But Margaret Nichols, a Highland Park, N.J., AIDS counselor to women, said this doesn't hold for women who get the disease.

"Most women who are infected with HIV have one steady sex partner," Nichols said. "They have been in what they consider a stable relationship with one partner for years. These women don't consider themselves at risk."

Male partners may become infected from drug use or from having sex with males, activities the women don't even suspect their men are pursuing, Nichols said.

In New Jersey, 17 percent of AIDS patients are women, and in New York, it's 10 percent, Nichols said. While cases among homosexuals and drug users are doubling every 14 months in the East, cases linked to heterosexual contacts are doubling every 10 months, she said.

Public health officials have warned that prostitutes represent a major source of infection to heterosexuals, yet proof to support this is lacking.

Dr. Don DesJarlais of the New York State Department of Health said studies in New York City found that of 11,000 AIDS cases, 45 men claimed they were infected by prostitutes, but investigation found half of those had other risk factors for infection.

Fearing the economic peril of all sexually transmitted disease, New York prostitutes have long insisted that customers wear condoms, DesJarlais said.

New York studies indicate that prostitutes get AIDS at a rate 10 times greater than customers, he said.

Condoms aren't perfect, but they do appear to reduce greatly a person's chance of becoming infected or spreading the virus. Contaminated needles are the source of infection for most prostitutes, researchers have found. Experts agree that using condoms and spermicides to kill the virus is an excellent way of self-protection.

Preliminary studies show that homosexual men have changed sexual practices, reducing the numbers of partners and using condoms-enough so that spread of the infection in their community has dropped dramatically.

Still, many experts say it will be difficult to promote condom use among blacks and Hispanics. Even when advertisements for condoms are televised or published, they are most likely seen by white people who are their target audiences.

"White women are buying condoms, and they aren't the ones at high risk," Nichols said.

She said most minority males see condoms as an affront to their masculinity and even suggest use of condoms is a plot by the government to reduce the black population, she said. "For a black woman to suggest her sex partner wear a condom is a revolutionary act," Nichols said.

What is needed, the experts agree, is an understanding of how the virus spreads, combined with a knowledge of sexual practices in various subcultures, so health workers could give an accurate assessment of which practices hold the highest and lowest risk.

A great deal of such information relevant to male homosexuals has been learned. Oral sex, for example, holds a much lower risk than anal sex. But little is known about specific practices in many minority subcultures at highest risk.

"We have to have local workers surveying their communities to provide information about odds for infection," said Dr. Don Francis, on loan from the Centers for Disease Control to the California Health Department, where he is overseeing the AIDS program.

"If you tell people the risks, they will modify their behavior to protect themselves. . . .

"We should do it now. . . . When we get to the mid-1990s and more Americans have died of AIDS than died during World War II, the public will demand we do it. Those deaths are sure to happen because they're in the pipeline. Those people are already infected."

Dr. June Osborn, dean of the school of public health at the University of Michigan, noted that scientists don't even know how the virus is transmitted in human semen. The virus may be carried inside some white blood cells found in semen or in sperm. Knowing how the virus is transported could be important in stopping the spread, she said.

Men who have had vasectomies, for example, have low levels of white cells and no sperm in their semen. No studies have been done to determine if vasectomies reduce a person's ability to transmit the virus, but researchers agree it is a possibility worth studying.

William Masters, perhaps America's best known living sex researcher, told colleagues at the meeting that something as fundamental as the level of acidity within the body may be used to fight the virus. The female vagina normally is acidic enough to kill the virus, Masters said.

Semen contains buffering chemicals to neutralize the acid so sperm can survive. It may be that spermicides to counteract these buffers and keep the vagina acidic would provide a powerful weapon against AIDS infection from heterosexual intercourse, he suggested.

CAPTION: Photo: AIDS strategists (from left) Michael Gottlieb, June Reinisch and Bruce Voeller at the Kinsey Institute.

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