The Examiner (San Francisco) - April 29, 2001
Fred Dodsworth

Fred Dodsworth: What have we learned in 20 years of the AIDS epidemic?

Dr. Marcus Conant: The answer seems to be nothing.

Q: Why?

A: As you go through epidemics, over and over again, you see the same patterns repeat themselves. And we've done that with AIDS.

The same thing we saw with epidemics of cholera and the epidemics of smallpox, every epidemic that we've seen, has played itself out with AIDS.

First you have people denying that it's really happening. You know: "It can't happen to us, we're straight." Sure enough, it did happen.

We had bigots like Jesse Helms saying, "If gay men would just quit doing what they do, this disease would go away." In Africa, people were doing what we assume Jesse Helms does and the disease not only didn't go away, we now have 30 percent of South Africa infected with HIV.

The denial happened as it happens with every epidemic, and it didn't protect us.

The next thing you see is scapegoating. It's someone else's fault. Someone else is doing it. For the great smallpox epidemic it was the Jews. "Jews were poisoning the wells."

No one asked: "Why are the Jews poisoning the wells, drinking the water and dying, too?"

Today it's gay men. "If they would just quit being who they are, this problem would just go away." Again it didn't work.

The next thing you see are inappropriate laws passed: "We're going to stop this by stopping people from traveling." That's what we did with smallpox.

Now we say no one who is HIV-positive can come into the United States, even for a meeting. That's why the international AIDS meeting hasn't been held in this country since 1990 and won't be held here again.

I believe the state of Indiana passed a law that you had to have an HIV test before you could marry. That was based on the antiquated notion that two people don't have sex until they are married. In fact, the relationship is usually consummated months to years before the marriage. Testing people for a sexually transmitted disease when they apply for a license to get married ...

Q: ... is like locking the barn after the horse gets out.

A: Precisely. We really haven't learned anything. Now the incidence of sexually transmitted diseases is going back up right here in San Francisco. For example, the instance of rectal gonorrhea is going up. There's only one way a man gets rectal gonorrhea. That tells you people are not practicing safe sex.

The prevention methods and messages that were effective 20 years ago aren't working. The thing that made them work wasn't knowledge, it was fear.

Now people aren't afraid of this disease. It doesn't command the same coverage in the press. The highly active retroviral therapy is very effective at keeping people alive. A young man does not go home and see his roommate dying on the sofa. Because we don't have that, people go back to what people like to do. They like to have sex.

Q: Sexual desire is in conflict with our cultural values.

A: Precisely. Why is that? It seems to me that religious institutions and politicians use the fear of sexually transmitted diseases and pregnancy as a way to control human behavior.

We're not devoting the energies that we need to to help young people have sex safely and not get pregnant and not catch a potentially fatal disease. We are 20 years into this epidemic. Why aren't we discussing this?

The instance of syphilis is going up. The instance of gonorrhea is going up. We have 37 sexually transmitted diseases and we never talk about that. Of those 37 diseases, at least seven can be fatal. Many of those are cancer. How many times have you heard the American Cancer Society talk about sexually transmitted diseases as one of the major ways people contract cancer?

Q: I've never heard that.

A: I haven't either. Why not?

Q: I think our society is terrified of sex.

A: Something that everyone does. Sex is an almost instinctual, hormonally driven impulse. The age when people contract sexually transmitted diseases, which is in their early 20s, the thing that is driving them at that point is not procreation, it's that they're horny. They just want to have sex.

On a daily basis I see patients coming in here with genital herpes. (They're) devastated that they have contracted a disease that 60 percent of the adult, sexually active population of San Francisco has. Yet we don't discuss it. We don't talk about how to prevent it, how to know if you've got it, what to do if you do get it.

Looking back at 20 years of the AIDS epidemic, what have we as a society learned that we can take forward and be useful to the people that come after us?

It seems to me that the only thing that has really worked for AIDS in the long term, what's really altered the course of the disease, is science. Not prayer sessions, not lectures, not sex education in the schools. The only thing that has really altered the course of this disease is that we've come up with drugs that prolong people's lives.

The only thing that's going to stop the AIDS epidemic is a vaccine. Nothing else is going to be effective.

If that's the case, what are we doing to develop surveillance systems and vaccines for all of the 37 sexually transmitted diseases? What's being done towards a syphilis vaccine? Precious little.

Q: We had the opportunity to eradicate syphilis for only $25 million just a few years ago. Congress refused to appropriate the money.

A: Precisely, because "nice people" don't get syphilis, according to Sen. Helms. According to Sen. Helms, nice people don't get anything (laughter), including the message, it seems.

If you look at the world, more kids have congenital syphilis in Uruguay than AIDS. Don't we as a culture, don't we as a country, owe it to the rest of society -- if for no other reason than our own well-being -- to come up with vaccines?

Q: Developing 37 vaccines is a Red Queen chase. Why not embrace a healthy, intelligent and responsible sexuality?

A: You're right. But changing the way people view something as primordial as sex? We fail at that.

Here in America we've been talking about cholesterol and low-fat diets for the last 20 years. Walk down the street. How many people are eating veggies and how many are walking into McDonald's? You cannot change basic instincts, what feels good.

Science is the only hope we have. With science, if you develop a vaccine for one of these diseases you do two things, hopefully you eradicate that disease and you develop the technology that is necessary for the next vaccine.

Many of these diseases are just knock-offs of each other. The discussion ought to be: How do we maximize vaccine development, not only for AIDS but for all of these other diseases as well?

Q: I've been told that the AIDS virus mutates fast enough that we'll never be able to develop a vaccine.

A: That's faith. They know the answer before they do the work. That's what faith is all about. Science is about trying, and when it doesn't work, trying to figure out why it doesn't work and do it again. The average kid who had high school science ought to be jumping up and down saying, "Wait a minute, that's not the way you think. You should try it and if it fails, try to answer why it failed."

Only when we begin to sort out what this virus is doing to defeat a vaccine can we ever stop this thing. That kind of thinking, even though it's been advocated by some of the top scientists in this country, is totally contrary to what science is all about.

On the Web: www.immunet.org/index.html

E-mail Fred Dodsworth at fdodsworth@sfexaminer.com

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