Medicine

By Claudia Wallis.

Lessening Fears

Contact does not spread AIDS

Since acquired immunodeficiency syndrome was first recognized in 1981, it has struck 17,000 Americans, killing nearly half of them. But even more rampant than the deadly disease itself is a secondary epidemic: fear. AIDS patients around the country have become society's new untouchables. Workers have been fired; babies abandoned; children, like Ryan White of Kokomo, Ind., banned from school. The fears have persisted despite assurances from doctors that AIDS has been known to spread almost exclusively through sexual contact and exposure to infected blood. A poll taken last summer showed that nearly half of Americans thought they could get the disease by drinking from a glass used by a patient; 32% thought kissing was risky.

Last week the New England Journal of Medicine published the results of a study that should finally put such fears to rest. The study, conducted at Montefiore Medical Center in the Bronx, involved 101 people living in close but nonsexual contact with AIDS patients. Its conclusion: the risk of catching AIDS, even in an intimate household setting, is "minimal to nonexistent."

Those studied included children, parents, siblings and other family members who had lived with an AIDS victim for an average of nearly two years. Even more significant, all had spent at least three months with the patient during an 18-month period before AIDS symptoms actually appeared, when the disease is believed to be most contagious. Some of the family members had shared toothbrushes, razors and clothing with the patient; half shared combs and drinking glasses; 37% slept in the same bed as a patient, and nearly all had exchanged hugs and kisses. Says Dr. Gerald Friedland, who led the study: "These were households in which an AIDS patient lived in close quarters with other family members, with a lot of the kind of personal, affectionate interaction you would expect in a loving family."

Despite the high level of intimacy, only one of the 101 people in the study was infected with the AIDS virus. The sole victim was the five-year-old daughter of an infected, female drug user; the child had probably contracted the virus before her birth. The absence of the virus in the other 100 was particularly impressive because most of them belonged to low-income families living in the kind of crowded conditions that are thought to facilitate the spread of infectious diseases. If the disease cannot be transmitted in such family settings, says Dr. Harold Jaffe, chief AIDS epidemiologist at Atlanta's Centers for Disease Control, "it is far less likely to be transmitted in schools, offices, restaurants and churches."

Thus far, CDC officials know of no case in which the AIDS virus has spread through casual contact. Last week, however, the CDC did report the first known instance of child-to-parent transmission. The case, Jaffe notes, was highly unusual in that the child, who was infected by a blood transfusion, suffered from a number of congenital ailments. His mother, a paramedic, had served as his nurse both at home and in the hospital, coming into frequent contact with the child's blood and wastes. Says Jaffe: "This kind of care is not what goes on in most households."

Doctors and gay leaders last week expressed hope that the new study would dampen unrealistic fears about AIDS and reduce discrimination against victims. Dr. Merle Sande of San Francisco General Hospital wrote in an editorial accompanying the study: "It is now time for members of the medical profession to take a more active and influential role in quelling the hysteria."

With reporting by Joyce Leviton/Atlanta and Suzanne Wymelenberg/Boston