Heterosexual Transmission of HIV

The Myth of the "Gay Disease"

Because of rampant misinformation since the dawn of the AIDS era, andbecause of the importance of the AIDS crisis within the homosexualactivist community, the dangerous myth still circulates that this is a"gay disease." At the time of this writing, HIV has been on the publicradar for almost two decades. And yet there remains, in many circles,the misconception that this disease is unique to the gay community, thatit is an exclusive concern thereof, and even that it is somehow intendedas a divinely-conceived punishment for the alleged sins of same-sexromance.

And yet to discover the fallacies of this viewpoint, any number ofscientifically proven facts may be consulted. Even semantically, theanswer is in the name of the virus; HIV stands for HumanImmunodeficiency Virus, and the key word is "human." Without regard forsexual orientation, race, or any other socially divisive factors, thetarget of HIV is the human immune system, and any human exposed to thevirus, or engaged in high-risk activities without proper precautions, issusceptible.

The myth that this is a "gay problem" may derive partially from thefact that anal sex is the highest-risk sexual contact, with regard tothe spread of HIV, and that mainstream America has traditionallyimagined the homosexual lifestyle to consist of anonymous, unprotectedanal penetrations behind dumpsters and in public parks at night. Inreality, unprotected anal sex is the highest-risk activity because ofthe absence of natural lubrication. The friction of penile thrustinginto the anus greatly increases the chance that skin will be broken andthere will be an exchange of body fluids. It is as agreeable anenvironment for viral transmission if the anus in question happens tobelong to a female.

An Exchange of Body Fluids

For this is what causes HIV, which causes AIDS - it is wrought by anexchange of body fluids. Regardless of sexual preference, whether youare a drag performer in the East Village or a Republican senator, youare at risk for HIV transmission if you have anal, vaginal or oral sexwith a person already infected by HIV; if you share a needle or syringewith a person already infected by HIV; or if you are exposed tocontaminated blood or blood products. The virus can also be spreadthrough maternal fetal transmission, wherein a mother infected with HIVpasses the virus to her child, either before, during or after birth.

If a mother is HIV positive, breast feeding is an extremely dangerousmeans of transmission to her child. This is one example of a means ofHIV transmission that is clearly the by-product of heterosexualrelations - lactation and breastfeeding are related to "straight" sex ina far truer and more exclusive sense than anal penetration is related togay sex, and yet the misapprehensions persist.

Perhaps they can be attributed partially to the fact that in theearly days of AIDS activism, it was the gay community that respondedwith the most vigor; the earliest efforts to get AIDS acknowledged as amajor health crisis, and the first significant appeals for federalsupport toward research and treatment were championed by the leaders ofthe "gay movement" in America. But in fact, this speaks more to theongoing refusal of our nation's white, heterosexual, male mainstream toaccept themselves as a part of this problem.

In the global sense, misconceptions about AIDS as a gay disease canalso be attributed to the American-centric view of the world thatprevails in the United States. While in unschooled circles in thiscountry, it may be possible to believe that people with HIV aregenerally gay, all one has to do is remove America from the equation todiscover that AIDS worldwide is overwhelmingly claiming the lives ofheterosexuals. Worldwide, more than 80 percent of all adult HIVinfections have resulted from heterosexual intercourse.

At Home and Abroad

Some further statistical truths, from the Centers for Disease Controland Prevention:

As of the end of 2001, an estimated 40 million people worldwide -37.2 million adults and 2.7 million children younger than 15 years -were living with HIV/AIDS. More than 70 percent of these people (28.1million) live in Sub-Saharan Africa; another 15 percent (6.1 million)live in South and Southeast Asia.

Worldwide, approximately one in every 100 adults aged 15 to 49 isHIV-infected. In Sub-Saharan Africa, about 8.4 percent of all adults inthis age group are HIV-infected. In 16 African countries, the prevalenceof HIV infection among adults aged 15 to 49 exceeds 10 percent.Approximately 48 percent of adults living with HIV/AIDS worldwide arewomen. An estimated 5 million new HIV infections occurred worldwideduring 2001; that is, about 14,000 infections each day. More than 95percent of these new infections occurred in developing countries.

In 2001, approximately 6,000 young people aged 15 to 24 becameinfected with HIV every day - that is, about five every minute. In 2001alone, HIV/AIDS-associated illnesses caused the deaths of approximately3 million people worldwide, including an estimated 580,000 childrenyounger than 15 years.

In the United States, where there is a relatively high awareness ofthe importance of safer sex - higher than in, say, Sub-Saharan Africa,where there is virtually no healthcare system encouraging protectiveindividual initiative -- an estimated 800,000 to 900,000 U.S. residentsare living with HIV infection. Of these, about one-third are unaware oftheir infection.

Approximately 40,000 new HIV infections occur each year in the UnitedStates, about 70 percent among men and 30 percent among women. Of thesenewly infected people, half are younger than 25 years of age.

Of new infections among men in the United States, approximately 60percent of men were infected through homosexual sex, 25 percent throughinjection drug use, and 15 percent through heterosexual sex. Of newinfections among women in the United States, approximately 75 percent ofwomen were infected through heterosexual sex and 25 percent throughinjection drug use.

The Increasing Incidence of HIV Amongst Heterosexuals

Meanwhile, transmission of HIV throughheterosexual intercourse is unmistakably on the rise. According to TheJournal of the American Medical Women's Association, the rate of HIVinfection through vaginal intercourse of teenage girls alone rose bynearly 117% between 1994 and 1998. This can undoubtedly be attributed tothe fact that public campaigns to increase awareness of safer sex,including education in regard to the use of condoms and other safetymeasures, have not been sufficiently directed toward the young femaledemographic - in part because of the lingering impression, on a nationalscale, that HIV is predominantly the concern of gay men.

However, these statistics are cited not in an attempt to shift theemphasis of misconception from gay men to adolescent heterosexual women.Men can become infected with HIV when they have unprotected sexualintercourse with a woman carrying the virus, most probably via exposureto secretions or menstrual blood in the vagina. During heterosexualintercourse, the man's urethral lining may be exposed to infected fluidthat enters through the urethra (the opening and tube in the penisthrough which urine and semen flow). Another way that a man may becomeinfected is through an open sore, cut, or minor abrasion on the penis,which could facilitate viral transmission. Conversely, researchers atUCSF have estimated that the odds of an HIV-positive male infecting afemale partner, in an unprotected sexual encounter, is about 9 in10,000. The chances are lower for female-to-male infections. Females areabout eight times more likely than males to become infected by theirHIV-positive partners.

The Sexy Condom

Ultimately, it is vital that heterosexuals not see themselves asbeing at low risk for HIV infection if they are engaging in unprotectedsex of any kind. There is a pervasive mentality in the heterosexualworld that although HIV infection is always possible in the academicsense, it is virtually impossible that a specific unprotected sexualencounter will lead to it. Often, there is the misconception that if oneknows the person one is having sex with, there is no chance that thatperson could be HIV positive. The facts, of course, speakdifferently.

The condom has been the most visible symbol of the fight againstAIDS, and its use is immeasurably important. There remains, among bothgay and straight people, the attitude that the use of a condom decreasessexual pleasure by limiting physical sensation, and that the act ofdonning a prophylactic is an unwelcome interruption in the delicatedance of sexual seduction.

No effective education refutes this entirely. Obviously, if sexualintercourse were a completely risk-free activity, it would be wonderfulto leap headlong into passion without having to introduce barriers, orraise the subject of the threat of infection in any way. However, thisis simply not the way things are, and to behave as though it is is torecklessly endanger not only one's own health, but the health of one'spartner.

Central to condom education initiatives has always been the conceitthat the application of a condom can be incorporated into foreplay, andthis is certainly true. When a heterosexual man puts on a condom, heshould see this not as an embarrassing concession to the dangers of animperfect world, but as an opportunity to show his partner that he ispreparing his penis for entry into her body. It can be an excitingprelude to penetration.

At the same time, if this is contrary to one's individual style, acondom can also be put on subtly. A man who understands condoms andknows how to use them properly can sheathe himself in a few seconds, andthe activity needn't disrupt sexual momentum to any detriment. Men notused to condoms should practice using them alone, so as to perfect theirtechnique, allowing the reservoir tip to sag slightly so as to receivehis semen and lower the chances of condom rupture. Also, though,practicing with condoms independently can increase a man's ability toput one on easily and smoothly. Putting on a condom is much more likelyto ruin the mood if a man seems to be fumbling; if he knows what he'sdoing he comes across as not only more responsible, but more in control,more the virtuoso of his own sexuality - in short, it can be sexy.

While condoms undeniably do decrease penile sensitivity, this must beseen as part of modern sex; it is an essential concession to reality.And no sexually proficient man can credibly claim that the lessenedsensation of protected sex is significant enough to threaten the statusof intercourse as a profound pleasure.

It should also be taken into account that there are as many varietiesof condoms as can be imagined. While materials other than latex are notthought to be as effective in the prevention of infection, within thatscope an infinite array of shapes, sizes, textures, and thicknesses areavailable. Condoms specifically designed and marketed to increasesensation are available, and in many cases they are noticeably thinnerand less threatening to sensitivity than standard condoms.

Let us imagine that a man and a woman, two strangers, have met at abar and find themselves irresistibly locked in the overwhelming bind ofinstant sexual attraction. Throughout the course of flirtatiousconversation - the delectable strategizing that occurs when neitherparty has yet stated sexual want directly, but it is as understood asthe presence of the sky overhead - they wind up leaving the bar andheading toward an apartment, a hotel room, or a secluded urban alleywayto consummate their urgent desire for one another. If one of them makesmention of a condom, whether it is a stop somewhere to purchase some, ora simple inquiry as to whether they are in either's possession, thisshould be seen as the pulse-intensifying moment when they look at eachother with the triumph of admission. When a condom is suggested, itmeans that they are going to have each other.

Of note, condoms have proven effective not only in reducing the riskof HIV infection - not to mention unintended pregnancy - but also asbarriers against other sexually transmitted diseases. Herpes, syphilis,gonorrhea, hepatitis B and chlamydia all increase the risk of HIVinfection; someone infected with one sexually transmitted disease isautomatically at higher risk for HIV transmission, as the body's defensemechanisms are altered in circumstances of STD infection.

The Future

It is vital to the future of AIDS - which is to say, the continuedand increased federal support of HIV research, and the necessaryincrease in attention to the pursuit of an HIV vaccine - that thedisease is understood as a worldwide human crisis. Its statistics revealinteresting and useful data with regard to incidence, but nobody isimmune; regardless of race, age, sexual orientation, or any otherfactor, those who engage in high-risk activities without precautionarymeasures are dramatically increasing their chances of becominginfected.

While nobody should see himself or herself as someone who needn'tworry about HIV infection, it is particularly distressing when oneencounters sexually active single adults with this attitude. When twoadults are preparing to have sexual relations, protection must be asmuch a part of their discussion (whether it is verbal or not) as "yourplace or mine."