Miami Herald - Sunday, July 15, 1990
Mike Wilson, Herald Staff Writer

It was the only time they ever had sex. The man, a recovering drug addict, gave the woman the AIDS virus.

"My mind wasn't on using condoms. All that went through my mind was that I wanted this guy," said the woman, a 42-year-old receptionist who lives in Miami. She asked that her name not be used.

"I just didn't figure he was infected."

A lot of people make the same dangerous assumption. Despite repeated warnings, despite 136,204 cases and 83,145 deaths documented to date, vast numbers of Americans still do not use condoms and spermicide to protect against the AIDS virus when they have sex.

Of course, we are not all at equal risk of getting AIDS. For example, because of the way the virus is transmitted, gay men still are far more likely to get the virus than heterosexual men. Women who have sex with intravenous drug users take a much bigger chance than those who don't.

But many people run some risk of getting AIDS through sex. (Those who have been tested and who maintain monogamous sexual relationships are excluded, of course.) Making a mistake is deadly, so it's a wonder that more people are not protecting themselves.

AIDS activists say there are as many reasons as there are cultures:

* Women -- the group becoming infected at the fastest rate -- fear men will reject them if they insist on condom use as a condition for sex.

* Among migrant farmworkers, it is feared that women will become promiscuous if they're urged to use condoms.

* Young gay men believe, erroneously, that the AIDS epidemic has run its course in older men and won't affect them.

* Teen-agers are too embarrassed to buy condoms or even to talk about sex with their partners.

* All groups say using condoms diminishes pleasure and adds a difficult, clumsy step to the mating dance.

* Perhaps the main reason people have unsafe sex -- the one cited by the 42-year-old receptionist -- is that they don't believe anything bad will happen to them.

"Human beings have a tendency toward apathy, and they have a tendency toward denial," says Juliette Love, director of Center One, Broward's AIDS help agency. "The mindset is, 'Well, it only happens to others and it's not going to happen to me.' "

Research presented at last month's International Conference on AIDS in San Francisco revealed that across the country, in gay bathhouses, singles clubs and high school hangouts, people are taking chances with the virus. Researchers dumped a truckload of statistics:

* A recent survey of the Peoria, Ill., chapter of Parents Without Partners revealed that only 17 percent of the men had used condoms and 22 percent of the women had had their partners use condoms in the previous year.

* A study of teen-age girls in Wastonville, Calif., found that, though they were sexually active, 30 percent of whites and 40 percent of Mexican-Americans had never had a partner who wore a condom.

* The percentage of gay and bisexual men using condoms increased from 32 in 1984 to 58 four years later, according to researchers at the University of California at San Francisco. But the researchers found that 19 percent "relapsed" into unsafe sex at least once. They also found that homosexuals younger than 30 were twice as likely as older gay men to have unprotected sex.

That it's happening at all seems incredible. The phrase "safe sex" has been trumpeted so loudly that it has worked its way into the national psyche. (The term now in vogue is "safer sex" because health educators agree no sex is completely safe.) The benefits of condom use have been stressed almost as strongly as the dangers of drugs. In San Francisco, ads promoting condom use have appeared at bus stops throughout the city. In high schools, AIDS educators preach the gospel of condom use, sometimes even unrolling condoms to show students what they look like.

How, then, can so many people be so reckless?

The answers are complex. One surprising study released in San Francisco showed that people who know how AIDS is transmitted are no more likely to use condoms than those who don't. In other words, people know they're taking a chance when they don't use a condom -- and they take the chance anyway.

"Condom use simply is unrelated to the level of HIV knowledge," said James Wells, who conducted the study for Project Hope, a Washington-based health policy agency.

Women -- who are 12 times more likely to get the virus from men than they are to give it to men -- have a particularly hard time putting their knowledge to work. A woman may want her lover to use a condom, but getting him to go along with it can be difficult.

Fear of the AIDS virus has added a vexing new set of rules to the dating game. Since the advent of the birth-control pill, men and women needed only to decide whether they liked each other before having sex. Nowadays they have to discuss the health implications of every coupling, and who wants to do that? Negotiating a major intercourse treaty is nobody's idea of foreplay.

Besides, suggesting that a man may be carrying a deadly disease does not exactly put him in the mood.

"By asking someone to wear a condom, you're basically saying, 'I don't trust you,' " says Cathy Lynch, executive director of a Dade AIDS help agency, Health Crisis Network.

Some women don't dare ask men to use condoms, Lynch says. Some women fear that men will get angry and hurt them. More often, they worry that their boyfriends will leave them for someone less demanding -- and less careful.

But women also have unsafe sex because, like men, they get excited and don't want to break the mood. Or because they don't like the feel or the rubbery smell of a condom. Or because they don't want to think their partner has the disease.

Susanna (real person, fake name) is a 36-year-old Miami publicist who says she has ended two relationships because men would not wear condoms. Even so . . .

"There have been times, I'll be perfectly frank with you, when I knew someone quite well, and I thought their past didn't present much of a risk, so we didn't use a condom," she says. Clearly, it wasn't a good idea: You can't tell if someone has the AIDS virus by looking.

Not everyone is so blase. Some women take extreme measures to avoid risk. Jennifer (another fake name), a 29-year-old health-care worker from Miami, says she separated from her live- in boyfriend three weeks ago. But that didn't end the relationship.

"We see each other as safe," she says, "so we keep going back to each other just for sex."

For women, the cost of unsafety is rising at a scary pace. About 10 percent of Americans diagnosed with AIDS are women, up from 6 percent in 1982. Thirty-one percent got it by having sex with men, according to the federal Centers for Disease Control in Atlanta.

Of course, women who have sex with drug users and bisexual men still are more likely to become infected than other women. But again, every woman runs some risk.

For heterosexual men, the reasons for having unsafe sex are somewhat less complicated. To start with, they have less to worry about. Getting the AIDS virus means getting tainted body fluids in your bloodstream. Unless a man has a lesion on his genitals, it is unlikely he will get the virus through sex with a woman. Possible, but unlikely.

But the main reason men have unsafe sex is that it doesn't feel as good as intercourse au naturel. You know the saying: Wearing a condom during sex is like washing your feet with your socks on.

John (again, the name is made up), a 30-year-old drug counselor, couldn't agree more. A year ago, he met a woman and, on their second date, had sex with her without first putting on a condom. He wanted to do it, he says, and he didn't want anything to get in the way.

Now John is dating a woman who insists that he wear a condom. He isn't crazy about it, but he says he cares for the woman and knows it's the right thing to do. "We're talking about life and death here, you know?"

John and his girlfriend are unusual -- they talked about sex before they jumped into bed. Often, that doesn't happen. Some men don't have safe -- make that safer -- sex because that would mean actually having to discuss the subject first. Men want sex, but a lot of them don't want to, you know, talk about it.

Dr. Manuel Laureano-Vega, who directs the League Against AIDS, which serves Hispanics and Haitians in Dade, says many of his Hispanic clients avoid the subject simply because talking about sex is not part of their culture.

The silence fosters many myths: Some poor, uneducated men, including migrant farmworkers, think their wives will become promiscuous if they're encouraged to use condoms, he says.

Hispanics often are most comfortable getting the message not from a peer, but from a clergyman, doctor or other community leader, Laureano-Vega says. He says he always addresses clients with the respectful usted instead of the familiar tu. That way, the message doesn't sound condescending.

"In Spanish, it's necessary to use that flexibility if you want to get your point across," he says.

The League Against AIDS goes out of its way to promote condom use. To reach Haitian women, for example, workers visit beauty parlors around Miami. The women seem to feel more comfortable discussing sex when men aren't around, Laureano-Vega says.

Teen-agers tend to be uncomfortable regardless of the setting. Perhaps more than any other group, teens shun condoms because they don't want to talk about them. It's a paradox: Many kids are mature enough physically to have sex, but few are grown-up enough emotionally to discuss it.

"To admit that you're ready to have sex is taboo, especially for girls, but also for guys," says Debbie Crawford, who works with teen-agers through the Comprehensive AIDS Program in West Palm Beach.

(Which is not to suggest teens are uninterested in the subject. When teen-agers are asked to name the best ways to avoid contracting AIDS, they almost never think to mention abstaining from sex, Crawford says. She always has to bring it up.)

Compounding the problem is that teen-agers think they're immortal, Crawford says. Teens have unsafe sex for the same reason many of them drive too fast: They think nothing bad will ever happen to them.

In the early '80s, homosexual men felt the same way, and it killed a lot of them. But when it became clear that using condoms helped prevent the spread of AIDS, many gay men started using them. The bad news from the AIDS conference is that some have quit doing so, and some never started in the first place. Gay men run a particularly high risk because, during anal sex, tainted semen is passed directly into ruptured blood vessels.

Gay men in South Florida say that, instead of using condoms, gays often ask one another if they have the AIDS virus. That's dangerous. It can take six months for HIV antibodies to appear, so it is possible for someone with the virus to test negative.

"People really should stop talking about test results and start being safe," says George, a 33-year-old gay man who lives in Miami. He asked that his last name be withheld. "But they do not want to deal with it."

Perhaps most disturbing is that young gay men think the epidemic is over.

"There is a whole new generation of sexually active young men who may not have been reached during the intensive and quite successful education efforts," AIDS activist Mervyn F. Silverman said in San Francisco. The San Francisco AIDS Foundation and the American Foundation for AIDS Research are planning a nationwide advertising campaign to reach them.

Most AIDS activists say the best way to teach people about sex is to be open and honest about it. People should not only be told to use condoms but also where to get them and how to use them, the activists say.

But merely educating people may not be enough. The study conducted by Project Hope showed that people were more likely to use condoms if they not only knew about AIDS but also feared it.

"My data may indicate that, to change people's behavior, you have to create a fear of AIDS," researcher Wells says. "I think the jury is still out on what is the best way to manipulate that fear."

Maybe it wouldn't be a good idea to devise an ad campaign saying, "Use a Condom -- Or Else." Then again, given the meanness of the disease, maybe it would.

* Of the more than 10,000 American women who have AIDS, 31 percent got it by having sex with men.

* A study of unmarried adults showed that only 17 percent of men and 22 percent of women had used condoms in the previous year.

* Less than half the sexually active teen-age girls in one study said they had ever used a condom. Teen-agers often are too embarrassed to buy condoms or even to talk about sex with their partners.

* Gay men younger than 30 are twice as likely to have unsafe sex as those older than 30.

FOR INFORMATION

To find out more about AIDS and sex, contact these agencies:

* Dade: Health Crisis Network, 634-4636, from 8:30 a.m. to 5 p.m. weekdays, or the League Against AIDS, 576-1000, 9 a.m. to 5 p.m.

* Broward: Center One, 485-7090, 9 a.m. to 7 p.m. weekdays.

* Palm Beach: Comprehensive AIDS Program, (407) 845-4400, 8:30 a.m. to 5 p.m. weekdays.
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