Miami Herald; Friday, November 15, 1991
Linda Roach Monroe and Elinor Burkett; Herald Staff Writers

About 1 in 10 Americans with HIV infection contracted it from the opposite sex, 100,000 men and women since 1985. Over that same period, the number of AIDS cases resulting from heterosexual sex has increased 12 times.

One in every 100 American men and 1 in every 600 American women is infected with the AIDS virus.

Only 12 percent of them know.

Only 12 percent can begin to get the medical attention they need to delay the onset of AIDS.

Only 12 percent can warn their sexual partners that they, too, are at risk.

Getting Americans to protect themselves requires talking about issues and situations that are morally reprehensible to some. But perpetuating ignorance about AIDS and how it is transmitted will only increase the death toll. To many, that also is immoral.

Here, then, is a guide to protecting yourself against the HIV virus.

HOW THE HIV VIRUS IS TRANSMITTED

It is not easy to contract the HIV virus. You can't get it by hugging or kissing an infected person. You can't pick it up from a toilet seat, a mosquito bite or an infected waiter. You can get it any of the following ways, listed in order from the most to the least likely:

* Sex: Anal intercourse is clearly the most dangerous possible sexual practice because it often tears the wall of the anus -- making it easy for virus in the semen to enter the bloodstream -- and because infected cells penetrate rectal walls relatively easily.

Vaginal intercourse might be marginally less risky. But it is a high-risk sexual activity -- especially for the woman. Women are much more easily infected than men in vaginal intercourse -- 17.5 times more easily, to be precise. Men are at higher than normal risk if their female partners have genital warts or are menstruating.

The dangers of oral sex continue to be argued. Many insist that if the person performing oral intercourse has no cuts in his or her mouth that the practice is safe as long as no semen is swallowed. They argue that swallowing vaginal fluids must be a very-low-risk practice because there has been virtually no sexual transmission of the virus between lesbians.

But 20 percent of infected gay men surveyed in San Francisco said they practiced only oral sex.

* Sharing needles: When you inject drugs -- steroids, cocaine, heroin -- and share your needle, you are passing on a little bit of your own blood. Or you're getting some of theirs. Never share a needle with another person. Period.

But if you do share a needle, clean it out with bleach between uses. This is done by filling the used syringe with bleach twice, then rinsing it twice with clear water.

* From contaminated blood: Testing of donated blood began in 1985, thus making blood transfusions relatively safe. However, since the virus can live in the body for up to a year without being detectable by routine testing, there is a 1-in-50,000 to 1-in-100,000 chance of infection from a blood transfusion.

The same problem of detection can make organ transplants, bone marrow transplants and artificial insemination slightly risky.

* In childbirth: HIV-positive women can pass the virus to their babies in utero, during childbirth or in their breast milk. Blood tests on newborns are not very accurate: Many test positive and later convert to negative. About one-third of the infants of infected mothers turn out to be HIV positive.

The risks of breastfeeding by HIV-positive women are still being debated, but most physicians recommend that infected mothers not breastfeed their children.

DANGEROUS ATTITUDES

"Oh, but I know my partner. He (or she) is a nice person."

"He (or she) is not the type to shoot up drugs."

"My boyfriend's 100 percent straight."

"We're monogamous."

"He (or she) is not a member of a high-risk group."

The facts:

Nice guys get infected. Lots of people have experimented with intravenous drugs. As many as 20 percent of American men say they have had sex with a man at least once. And who's to say he didn't have sex with an infected woman? In fact, who knows what he or she did before he ever met you -- and how frequently? There are no high-risk groups for AIDS. There are only high-risk behaviors. Gay men whose sexual activity is limited to mutual masturbation are at no risk of infection with HIV. Heterosexual women who have oral sex with straight men are. And the more sexual partners you have, the greater the danger.

PRACTICING SAFE SEX

Safe sex apart from long-term monogamy is mostly a myth.

Any type of sex with an HIV-negative person is safe. But in a time of what experts call serial monogamy, how can you be sure your partner is HIV negative?

Unless you began your current monogamous relationship before 1977, when you have sex with someone you're in effect having sex with every sexual partner that person has had in the last 10 years.

A negative HIV-test result can lure you into a false sense of security. What's the date on that test result? And what has your partner done since then?

Since the test looks for antibodies to HIV -- which the body often doesn't produce until months after infection -- even a recent negative test can be misleading.

So don't take risks. Protect yourself. How?

It's not easy.

* Abstinence. It always works. *The next best option is monogamy with a person who also is committed to monogamy. If both of you are tested and turn out negative, practice scrupulously safe sex for a year. That means use condoms -- even if you're married. Get tested again, if you are both still negative -- and if you have 100 percent confidence that your partner will also remain monogamous, you can probably safely have sex without a condom.

*Finally, engage in sexual activities that do not involve intercourse or other exchanges of semen or vaginal secretions, such as sexual massage or mutual masturbation. This is what passes for safe sexual practice in the '90s. But remember, if you have cuts on your hands or torn cuticles, you should use latex gloves.

Sometimes it seems easier to jump into bed than to talk about wearing a condom. But embarrassment is a couple's worst enemy when it comes to protection from AIDS.

Sex educators advise a straightforward but firm approach, preferably before the couple has gotten beyond kisses and hugs. Writing in The Medical Aspects of Human Sexuality in 1987, Alan Grieco suggested these ways to counter typical arguments men have for preferring not to use a condom.

* "You're on the pill. I don't need a condom."

"I'd like to use it anyway. We'll both be protected from infections we may not realize we have."

* "I can't feel a thing when I wear a condom."

"Even if you lose some sensation, you'll still have plenty left."

* "I'll lose my erection by the time I stop and put it on."

"I'll help you put it on -- that'll help you stay aroused."

* "Just this once."

"Once is all it takes."

* "This is an insult! Do you think I'm some sort of disease-ridden gigolo?"

"I didn't say or imply that. I care for you, but in my opinion, it's best to use a condom."

* "I love you! Would I give you an infection?"

"Not intentionally. But many people don't know they're infected. That's why this is best for both of us."

Some AIDS educators compare using a condom to putting on your socks. It's a little more complicated than that, but not much.

First, unroll the condom enough so you can squeeze about a half-inch of the tip between two fingers. Holding this tip, unroll the condom further onto the top of the hard penis. This leaves a small airless reservoir at the tip that can fill with semen. Gently unroll the condom the rest of the way down the penis. If there is foreskin, it should be pulled fully back.

After ejaculation, the man should hold tightly to the condom's base and withdraw his penis from his partner while it is still erect.

Simple. But there are details to remember:

* Lubrication is important, especially in anal sex, because excessive friction during intercourse can cause a condom to break. If the partner's natural secretions don't seem adequate, use an artificial lubricant.

* But don't use baby oil, Vaseline, cooking oil, hand lotion or other oil-based substances because they weaken the condom. Instead, use a water-based lubricant such as K-Y jelly; labels of "personal lubricants" say whether they can be used safely with condoms.

* Use a different condom for every separate sexual act, even if climax has not been reached.

* Latex condoms are judged to be better at keeping infections from spreading than are lambskin condoms.

* Consider using a condom lubricated with nonoxynol-9, a sperm-killing substance that also kills the AIDS virus. Or you can place a small amount of the spermicide in the tip of the condom before putting it on.

* The newer the condom, the more reliable protection for you. Don't use one that has been kept crumpled in a wallet or baking in a car. * If the condom feels uncomfortably tight, there are large sizes available.

* If the condom does break, douching isn't the answer. Insert a spermicide containing nonoxynol-9.

Experts recommend using latex condoms, rather than those made of lamb skin, to provide the best protection against AIDS and other sexually transmitted diseases. But not all latex condoms are created equal, Consumer Reports concluded in March 1989. One popular brand, Trojan, ranked in the bottom half of the list of 32 acceptable condoms. Eight brands were found unacceptably likely to break: Sheik Non-Lubricated Plain End; Ramses Sensitol Lubricated; Saxon Ribbed Lubricated; Ramses Nuform; Mentor; Lifestyles Nuda; Lifestyles Extra Strength with Nonoxynol-9; and Lifestyles Nuda Plus.

Here are the top-rated condoms, those with a projected maximum failure rate of 1.5 percent.

* Gold Circle Coin

* Lifestyles Extra Strength Lubricated

* Saxon Wet Lubricated

* Ramses Non-Lubricated Reservoir End

* Sheik Non-Lubricated Reservoir End

* Excita Extra

* Kimono

* Sheik Elite

FOR COPIES OF THIS REPORT

Details on obtaining copies of this special report are available from TeleHerald, The Miami Herald's free news and information service. In Dade, the number is 373-4636; in Broward, 527-4636; in Spanish, 373-1111. The lines are open 24 hours a day, seven days a week, but you must call from a touch-tone phone. For information, enter the daily access code -- 37 -- then press 2437 (AIDS) to hear the appropriate recording.

ANATOMY OF THE HIV INFECTION

The human immunodeficiency virus, the virus believed to be the primary cause of AIDS, enters your blood system and attacks the immune system. Its most important target is a type of white blood cell called a T4 cell, without which your immune system essentially falls apart.

Most infected people have no idea when they contracted the virus since it usually gives no sign of its presence, often for years. Some people develop flu-like symptoms -- fever, achiness and swollen glands -- immediately after initial infection, but the symptoms usually disappear rapidly.

For the first few weeks or months after infection, the virus would not be detected by current HIV tests. Those tests look for antibodies produced by the body to combat the HIV. During this "window period," the body isn't producing those antibodies. Test results, then, will be negative.

HIV infection doesn't simply turn into AIDS one day. In fact, physicians are increasingly uncomfortable with the distinction between infection and AIDS, preferring to call both HIV-spectrum disease. The active phase of the disease -- what the public calls AIDS -- occurs when the virus has damaged the immune system so badly that the person falls ill with one of two dozen ailments, among them: pneumocystis carinii pneumonia, toxoplasmosis, Kaposi's sarcoma, cytomegalovirus and tuberculosis.

Early symptoms of AIDS, other than the onset of one of these diseases, may include extreme tiredness, chronically swollen glands, weight loss, night sweats, a white coating on the tongue and throat and, in women, chronic yeast infections that won't go away even with medication.

The median survival time for a person with AIDS is less than two years.

ORAL SEX

Is there any way to enjoy oral sex without worrying about HIV? Not unless you like the taste of latex. The AIDS virus is in semen and vaginal secretions, experts say. The risk would be highest if you have inflamed gums or a mouth sore that would make it easier for the virus to enter your bloodstream, or if the woman is menstruating.

Some experts advise using a condom. A square of latex called a dental dam is marketed as a female equivalent for oral sex. But no one is really sure how much protection

A WORD TO TEENS (AND PARENTS)

When you're 15 and the whole world is in your future, it's hard to think about how the easy sexual pleasures of youth could kill you.

But, remember, Magic Johnson was just 19 when he slam-dunked his way onto a professional basketball tour that gave him so many opportunities for easy pleasures.

Teen-agers today face more pressures than did their parents. Fitting in isn't just a matter of how you dress or wear your hair, but whether you've "done it" yet.

The federal government estimates that the average American girl loses her virginity at 16. For boys, it's 15.

The problem is that early sexual experience increases the chances of getting a serious sexually transmitted disease, from herpes to genital warts to AIDS. And research also shows that, if you have any sexual disease, even a minor one, it will be easier for the AIDS virus to infect you if you encounter it in another sexual contact.

So, being informed and responsible about your sexuality is a matter of protecting your own health. Abstinence really is the best way to avoid AIDS. But you still need to be informed about safe sex -- because it's sometimes easier to believe in a rule than to live by it.

One final word about drugs and alcohol, which, in a way, are part of the same issue.

Let's be honest. Once you get drunk or high, your judgment isn't great. Sure, you plan not to have a one-night stand or, at the least, intend to use a condom. But too much partying tends to lead to unplanned vacations from safe sex.

And one more final word -- about condoms:

The more positive an attitude you have about condoms, the more likely you are to use them. Studies have shown that the sexually active teen-agers who use condoms do so because they make sex possible on the spur of the moment, because they are easy to use and because they involve sharing the responsibility for birth control.

In other words, if one of the reasons for having sex is that it makes you feel grown-up, there's nothing more grown-up than using a condom.

TO TEST OR NOT TO TEST

Even five years ago, few AIDS service organizations encouraged Americans to be tested.

"What for?" they asked in a world where there was no treatment and where discrimination against the infected seemed to be growing.

While discrimination continues -- in housing, jobs and insurance -- treatments now slow the progression of HIV disease to AIDS. AZT and DDI are approved for containing the spread of the virus throughout the body. A number of drugs are available to prevent -- or treat -- specific diseases that used to kill people with AIDS.

Furthermore, how can you inform your sexual partners if you don't know if you are infected? How can you plan a pregnancy?

So testing is a good idea. And don't assume that because you've had blood tested for other reasons -- a hospitalization, pregnancy, an infection -- that you were tested for HIV. In Florida, under most circumstances, you cannot be tested without your permission.

What's the down side of testing?

It's scary. But it isn't much different from any other blood test. Someone draws blood from your arm and sends it off to a lab. Results return in about two weeks.

In Florida, you will be counseled before and after you are tested. If you turn up positive, don't panic. Dozens of agencies, programs and support groups will help you through the emotional shock and guide you to appropriate medical care.

The other down side, according to AIDS service agencies, is the likelihood that a positive test will make it hard to get medical or life insurance. They recommend that you be tested anonymously to avoid this possibility.

All AIDS testing is confidential -- like other medical records, the results cannot be released by a doctor or hospital unless you give written permission -- but that is not the same as anonymous, which means that the testing agency doesn't know your name.

Some physicians will test you anonymously, charging you an average of $70. You can be tested anonymously for $10 to $35 at one of the following locations:

DADE

Dade County Public Health Unit (2 locations):

* 1350 NW 14th St., Miami Monday-Friday, 8 a.m to 4 p.m.

* 615 Collins Ave., Miami Beach Monday through Friday, 8 a.m. to 4 p.m.

Appointments for either location: 325-1234

University of Miami: Elliot Building 1800 NW 10th Ave. 547-3832

By appointment.

BROWARD

Broward County Public Health Unit: 2421 SW Sixth Ave.

Fort Lauderdale Call 467-4893 for an appointment.

Planned Parenthood 263 N. University Dr.

Pembroke Pines Call 963-9889 for times.

They will offer free testing on Dec. 3.

MONROE

Monroe County Public Health Unit AIDS Prevention Center 513 Whitehead St.

Key West 292-6701 Monday through Friday, 8 a.m. to 4:30 p.m.

PALM BEACH

Palm Beach County Public Health Unit: For anonymous testing, Call (407) 840-4591 for appointment, 8 a.m. to 5 p.m. Cost is $20. Locations:

* 110 N. F St., Lake Worth

* 225 S. Congress Ave., Delray Beach

* 851 Avenue P, Riviera Beach

* 6405 Indiantown Rd., Jupiter

* 3701 Broadway, West Palm Beach

Confidential testing is at three county sexually transmitted disease clinics: 3701 Broadway, West Palm Beach, (407) 845-4407; 345 S. Congress Ave., Delray Beach, (407) 274-3100; and 38754 State Road

Celebrities and others concerned about AIDS will gather at the Omni International Hotel Saturday night to raise money to support research on the disease at the University of Miami's Jackson Memorial Hospital.

Called Another Night to Remember for AIDS, the $150-a-person event will feature a show of fantastic masquerade costumes from around the world. Rotary Club member Dushan "Dude" Angius of Los Altos, Calif., will be given ANTRA's AIDS Awareness Award for his creation of the film The Los Altos Story.

The event is being sponsored this year by the Brazilian consulate. Additional information is available from its two key organizers, Arthur Metz, 374-3343, and Sonia Najman, 945-5074.

80, Belle Glade, (407) 996-1600.

CAPTION: PHOTO Hand holding a CONDOM

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Always watch for outdated information. This article first appeared in 1991. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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