The Truth about AIDS

I got my copy of Elizabeth Pisani's sure-to-be bestseller, The Wisdom of Whores in the mail yesterday. This is from the preface:

Perhaps if I had known in the mid-1990s what a roller-coaster of triumph and despair HIV would turn out to be, I'd have chosen to work on maternal mortality. Perhaps if I had known how people at the next dinner table would react when my table traded stories about drinking foreskin soup, I'd have gone for dengue fever. Or if I had known how often I would be taken aside by a friend or acquaintance in meltdown because they had just tested HIV positive (or their brother had, or their girlfriend, or their boss). Perhaps if I could have foreseen how our lobbying successes would lead to billions of dollars of taxpayers' money being shovelled down an ideological drain, I would have chosen differently. But in the mid-1990s I didn't know any of this. A career in sex and drugs? It seemed like a good idea at the time.

I hope I'm not saying something like this myself in 10-15 years. Reading the little I've read so far - which is really great writing and thoroughly interesting, and very autobiographical as she discusses her accounts with AIDS - she sometimes seems like me in a way. She started in Chinese literature and then went into medical anthropology and then epidemiology because she was interested in sex and drugs, and because she quickly became really interested in the research methodology of epidemiology (specifically, it seems, on studies that are careful in delineating causality). I didn't start out in Chinese literature, but rather in English literature. I didn't go into medical anthropology, but into qualitative research and ethnography (which is one of the main methodologies in anthropology). And I didn't go into epidemiology, but rather, economics, but after reading several people, including Posner and Philipson, I tried my best to do something in epidemiology from an applied microeconomist's point of view. I didn't study HIV, but rather gonorrhea and syphilis, and specifically American prisons, but it's nonetheless as convoluted a path. Plus, as my wife can attest, I know what it's like to be casually and passionately talking about something like "foreskin soup" at a dinner party, and utterly alienating most of the people around me (including my wife). Sounds like, from reading the little of Pisani's book I've read so far, plus the next thing I'll quote, that I'm in for a rude awakening as to just what we now know about the heterosexual component of the HIV epidemic in the world. I've been experiencing a little cognitive dissonance, though. The per-act probabilities of HIV transmission for heterosexuals is unbelievably small that it's hard to see how such an epidemic could ever occur, especially given that the elasticities of demand for condoms are very sensitive to the local HIV/AIDS rates anyway.

I also saw this article entitled "The exploitation of Aids" by Brandon O'Neill. Here's a clip:

And it isn't the case that the heterosexual pandemic failed to materialise because officialdom's omnipresent pro-condom propaganda was a success. According to James Chin, a clinical professor of epidemiology at the University of California at Berkeley and author of the new book The Aids Pandemic, it was always a "glorious myth" that there would be an "HIV epidemic in general populations". That myth was the product of "misunderstanding or deliberate distortions of HIV epidemiology" by Unaids and other Aids activists, says Chin.

It is time to recognise that the Aids scare was one of the most distorted, duplicitous and cynical public health panics of the past 30 years. Instead of being treated as a sexually transmitted disease that affected certain high-risk communities, and which should be vociferously tackled by the medical authorities, the "war against Aids" was turned into moral crusade.

I'm only just beginning to understand some of this. But in Social Organization of Sexuality, by Laumann, Michaels and others, the authors have a chapter on Sexually Transmitted Infections, with a tiny little table noting the various per-act probability of infection for various STIs. HIV had the lowest rated male-to-female per-act probability of infection (0.002). Gonorrhea had the highest (0.50). In Andy Francis's "Economics of Sexuality", Figure 1, he produces the following graph:



As you can see, the per-act probability of transmission rises significantly for receptive intercourse - both vaginal and anal - but far more for anal receptive intercourse than it does for vaginal receptive intercourse. Thus, both women and gay men who engage in anal receptive intercourse are more likely to be infected. But, it's important to just note something here - the dynamics of HIV, if these per-act probabilities are taken to be correct, should grow more in gay networks than in heterosexual networks. First of all, there's lower probabilities that the infection will ever migrate out of the homosexual network and into the heterosexual network, even with bisexuals bridging the two networks. It will, and has, but rarely. I suppose that this is what is being gotten at by Pisani's book (which I've not read yet) and O'Neill's article (which sounds much like Pisani's book so far).