Quinn, T.C., Glasser, D., Cannon, R.O., et al. (1988). Human Immunodeficiency Virus Infection among Patients Attending Clinics for Sexually Transmitted Diseases. New England Journal Of Medicine, 318, 197-203.

To determine the extent to which heterosexuals are becoming a high-risk group for AIDS in the United States, and to determine whether teenagers are thereby becoming a high-risk group.

BACKGROUND

Although over half of American teenagers are having sexual intercourse—and many of these having it very frequently—and 96% of sexually active teens know that AIDS is spread heterosexually, only 39% of sexually active high school teens use contraception (according to New York Audits and Surveys [1987] and Coles, R. & Stokes, G. [1984].). Percentages of sexual activity among some groups of inner city youth run far higher than these averages and their use of contraceptives lower.

Reports from Africa strongly suggest that HIV infection can become prevalent through heterosexual activity and that the presence of other sexually transmitted diseases can increase the likelihood of contracting AIDS.

DESIGN

4,028 Patients were screened in inner city STD (Sexually Transmitted Diseases) clinics to determine risk rates and factors.

FINDINGS

• Testing HIV-positive were 6.3% of men and 3.0% of women.
• Homosexual and bisexual men, intravenous drug abusers, and women with bisexual or drug-abusing sexual partners were at high risk.
• In addition, men with syphilis and women with genital warts were at higher risk. These data suggest that disruption of the genital epithelium by sexually transmitted diseases increases susceptibility to the AIDS virus.
• Nearly one third of HIV-positive men and one half of HIV-positive women denied that they engaged in high-risk behavior. Yet they acknowledged the high-risk behavior of their sexual partners.

CONCLUSIONS

These data suggest that heterosexual transmission of AIDS will become an increasing problem in the United States. A recent study of newborns in Massachusetts showed that 9 of every 1,000 rural babies, 2.5 in every 1,000 suburban babies, and 8 in every 1,000 inner city babies tess positive for the AIDS virus (Grady, G.F. [1988, February]. New England Journal Of Medicine).

IMPLICATIONS

1. These trends suggest that AIDS will become an increasing health, economic, and social problem. Teenagers may become a high-risk group in the 1990s because of the frequency of their sexual experiences, beginning in the inner city with intravenous drug users and prostitutes. As drugs moved from city to suburbs in the 1970s, so could AIDS strike suburban teenagers in the late 1990s.
2. The rise in AIDS is emerging in a society determined to separate moral and public health issues. It is also a society deeply confused about how to handle drugs and sex. Some favor giving or selling clean needles to drug addicts; others see this as encouraging drug use or weakening the fight against drug abuse. Nor is there agreement about advertising and dispensing condoms for teenagers. We need a public morality from which priorities can be developed.
3. Parents, teachers, and youth leaders must be dealing with AIDS—its prevention and its legal and religious implications—as well as dealing with attitudes toward and the treatment of its victims.