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Current AIDS (HIV) issues in testing, epidemiology and public health messages to the public.
Below right: front page headline, Wall Street Journal, May 1, 1996
Below, in bold black print, is a a quick version of the article that follows. The article addresses two issues. (1) We cite the refusal of U.S. public health agencies to state that AIDS (HIV) transmission from women to men is, unlike AIDS in the "third world," very rare in the U.S. outside of hard-drug using circles. As a message, "Anyone can get AIDS," without citing this fact, is a public health fib told for a variety of reasons, among them the fear of causing men to not use condoms. Is it better, we ask, to tell the truth or not, in this case? (2) Testing is our eyes to see what is happening with AIDS (HIV) transmission, because clinical disease does not emerge for years following infection. Many gay groups, since the mid-nineties, have been testing gay men in the right way -- they get information from a person testing positive about his sexual and drug use practices. They get this important information by guaranteeing that they will not send any names to government agencies. Since anonymous testing (no names are taken) became the norm in AIDS testing, there has generally been a failure to see that such information -- personal risk history -- can be best obtained under the anonymous format, as gay groups are doing. People, gay or straight, are more likely to discuss their risk history honestly if their name is not sent to a government list, so it would make sense to take this approach at S.T.D. clinics: test at the city clinics but don't send names to the state file. Now the name taking, "reporting," is taking over in the U.S. This is the standard approach for sexually transmitted diseases, and there has long been a lot of pressure to make AIDS(HIV) conform to the standard. But the names are not important (except for contact tracing), the risk history is what is important, and reporting names can interfere with obtaining that history.
|(1) Outside of heavy drug use circles there is very
little AIDS transmission via heterosexual sex in the U.S. and Europe,
according to many health professionals. It appears that, unlike the third
world, in the U.S. and Europe men do not easily contract the virus from
women, with circumcision a factor. (For article on AIDS (HIV)
transmission and circumcision,
here.) AIDS (HIV) is being
transmitted at a much lower rate among heterosexuals than other STD'S
(sexually transmitted diseases), such as syphilis and gonorrhea, in the U.S.
and Europe. And, AIDS (HIV) in the U.S. and Europe is not being transmitted
at a rate at all comparable to the rates seen among heterosexuals in third
world countries. We would like to discuss the motivations for saying AIDS is
a heterosexual epidemic in the U.S. without including these limitations.
Articles in the mid 90's in the Wall Street Journal and New York Times
(click here for NYT's article)
have addressed these limitations, citing the desire "mainstream" AIDS rather
than define it as a gay and drug-addict disease, and the desire not to give
men the idea it's O.K. for them not to wear a condom. Assuming that
the cited limitations of HIV transmission in the U.S. and Europe are real,
we would like to post comments on whether it is best to make that apparent
to the public or to keep it quiet as we are have been doing for the last
to right, front page headline....... Wall St. Journal 5-1-96
(2) One reason the true picture of heterosexual AIDS transmission is best obtained by talking to doctors and public health professionals, rather than consulting published research, is that testing data are not derived from interviews with people who test positive, meaning that a history of drug use and sexual practice is not obtained. For many years after Surgeon General Koop, in 1987, endorsed testing without taking names, that approach prevailed, although some states chose to use "identified" test results. It makes sense to test anonymously because then people are not afraid to get tested, as they are, studies have shown, when they know their name will be sent to a government file. But what gay leaders, who were the main force behind advancing the cause of anonymous testing, and others who backed this cause, failed to do is to do is recommend obtaining a risk history from an individual who tests positive. People who test positive are willing to give a risk history if they trust that their name will not go on a government file, but will lie if their name is to be reported. So, anonymous testing actually made getting risk histories possible, and it would have been a brilliant finesse on the part of gay leaders to promote interviews with those testing positive. This would have left those who wanted to take names with nothing to complain about. The names are not important, the risk history is what is important for tracking AIDS..........Instead, gay leaders pushed the argument that "testing won't prevent AIDS transmission" and lobbied against the idea of using testing to get a picture of how people are getting AIDS (HIV). The whole idea of getting a risk-history testing-data map of the spread of the AIDS virus was seen as something that could then be converted into taking names and used to the detriment of people carrying the virus. A quarantine was certainly not an unrealistic possibility. But the claim "Testing won't prevent a single AIDS transmission" was a ridiculous assertion. Obviously, in the case of a virus that spreads years ahead of clinical disease, the test is all we have to understand how the virus is spreading, and to shape preventive warnings appropriately. No one in the media -- i.e. radio interviews on NPR etc. -- seemed to ever point this out. The important question, media interviewers should have said, is how can we test without invading privacy, and still get a risk history from those testing positive?"......Later, in the early 90's curiosity got the better of gay leaders and they quietly began testing gay men to see about the rate of new infections and how the transmissions were occurring -- contrary to the "testing won't stop the spread of AIDS" slogan, which was quietly discarded. The studies were run by gays and gay-friendly groups, so there was no anxiety on the part of the person testing positive about giving a full sexual and drug use history -- there was no fear that the information would go on government record. But the inner city heterosexual health agencies, despite pressure from the CDC and government threats to deny money if some data about AIDS virus was not produced, remained suspicious of testing programs and did not push testing forward. They did produce a little data for the CDC, but reluctantly. At this time African American politicians were afraid to even talk about AIDS, much less push for testing to see how high the rates were in cities..........Meanwhile the public health professionals who wanted to make lists of those infected with AIDS, and who had been angered by Koop's decision, were persisting with the argument that HIV- positive tests should be reported with names as is done with other STD's. Now this position is winning out and most states have fallen in line with reporting names with test results. But still the personal interview is not happening, and under a name-taking format it is not going to work anyway because people will lie. ...... The argument we would like to make it that what the gay community is now doing is the right way to track AIDS, with studies that guarantee no reporting to government lists, and because of this trust, honest information is exchanged about the personal history of someone testing positive for HIV. Would it not make sense to try to establish a similar kind of trust with people coming into inner city STD clinics -- that is, find ways to test for HIV that gets good personal history by guaranteeing that names will not be sent to government records? It would be best to do the HIV testing in the clinic, not send people off to some other site, as became the norm under anonymous testing. Even many gay groups are now endorsing name-taking as a general policy, which is hard to reconcile with the no-reporting approach to testing that has been the basis of gay-run testing of gay men.
For a N.Y. Times article, Feb. 17 2004 on the new trend towards reporting names with HIV-positive tests click here . Note: observe that names are being taken, but there is no mention of getting a personal history which would, for one thing, clarify the extent of the U.S. heterosexual AIDS transmission outside of heavy drug using circles.
For a N.Y. Times article, April 4, 2002 about AIDS tracking that gets personal history from HIV-positive women in New York City click here. Note: this article talks about women getting the AID virus from men they suspect of homosexual activity, but there is no discussion of women suspecting that their infectious male partner got the virus from another woman.
AIDS epidemiology in the the U.S. (Epidemiology is the study of a how an epidemic emerges and evolves, including what causes the given illness and, if it is contagious, how transmission occurs.)
(The following comments are outlined in the bold print abstract above)
When we are told by public health officials that AIDS is spreading via heterosexual sex, they avoid mentioning three important aspects of AIDS transmission in the U.S.. (1) AIDS in the U.S. and Europe is not spreading at a rate anything like other STD's (sexually transmitted diseases) like gonorrhea, herpes, syphilis, etc. among heterosexuals. Those testing positive for AIDS who are not I.V. drug users are almost always hard drug users, eg crack smokers, often with a history of many STD's that can help transmit AIDS. (2) Heterosexual AIDS in the U.S. and Europe is not spreading at anything like the rate of AIDS in third world countries -- where the heterosexual spread is on a par with other STDS, and not confined to the hard drug culture as it is in the U.S. and Europe. (3) AIDS in the U.S. and Europe is spreading from men to women but rarely from women to men, unlike the third world where men readily contract AIDS from women, at least this is what many health professionals say. There have been articles in the New York Times and Wall Street Journal addressing the exaggeration of heterosexual AIDS in the U.S., but in these articles pop up and disappear and no one pays them any mind. The difference between the third world and developed nations, with respect to woman to man transmission, is probably due in large part to circumcision. For article on new circumcision data click here.
It is telling a lie to say that AIDS is a "heterosexual disease" in the U.S. without pointing out that, outside of heavy drug using circles, the heterosexual rate is way below other STD's like syphilis. The reason for telling the lie, some observers suggest, is to keep heterosexual men from thinking they won't get AIDS, and thus don't need to use a condom. It has been suggested that "mainstreaming" AIDS by declaring it "heterosexual" was a way to get more government money for research, treatment and prevention. And it has been noted that exaggerating heterosexual AIDS serves to ease the isolation and stigma inflicted on the gay community when AIDS was perceived as a gay disease.
These seem to be worthy incentives, but is it right avoid the truth? The question at hand is: Is it right to say that AIDS is a heterosexual epidemic in the U.S. without citing the above claims?
Among the possible explanations for the difference between the third world and the industrialized countries is circumcision. The foreskin, which is removed from the penis in circumcision, is susceptible to microbe transmission. A circumcised penis gives protection from viruses to the man, and new research corroborates this for HIV(AIDS).
The higher rates of untreated diseases like syphilis and gonorrhea, both among drug addicts in the U.S. and many poor third-world people, suggests that blood contact from skin lesions and sores, which arise with these ailments, may be the dominant factor. STDs, prostitution and unprotected sex are all higher in the third world than in industrialized countries.
Two articles addressing these issues appeared in the mid 90's. One is by Gina Kolata, New York Times, 2/28/95 (click here for article), describing a 1994 CDC study by Dr. Scott Holmerg, in which crack cocaine and related sexual escapades and having sex with an infected I.V. drug user accounts for almost all of the new sexually-transmitted HIV infections among heterosexuals. Numbers the 1994 HIV infection study shows that heterosexual infections are rising -- but they remain clustered around drug use, with 70% to 80% being women. Thus, outside heavy drug using circles the odds of a man getting HIV are very slim.
A front page Wall Street Journal Article, 5/1/96 is headlined "AIDS Fight Is Skewed by Federal Campaign Exaggerating Risks" covers the same ground including the claim that man to woman was several times higher than woman to man. It begins: "In the summer of 1987, federal health officials made the fateful decision to bombard the public with a terrifying message: anyone could get AIDS. While the message was technically true, it was also highly misleading." Stating that the risk to heterosexuals is very small, the article goes on, "Nonetheless a bold public relations campaign promised to sound a general alarm about AIDS, lifting it from a homosexual concern to a national obsession and accelerating efforts to eradicate the disease. For people devoted to public health, it seemed like the best course to take."
"But nine years after the America Responds to AIDS campaign first hit the airwaves, many scientists and doctors are raising new questions. Increasingly they worry that the "anyone-can-get-AIDS message" -- still trumpeted not only by government agencies but by celebrities and the media -- is more than just dishonest: it is also having a perverse, potentially deadly effect on funding for AIDS prevention."
"The emphasis on the broad reach of the disease has virtually ensured that precious funds won't go where they are most needed. For instance, though homosexuals and intravenous drug users now account for 83% of all AIDS cases reported in the U.S., the federal AIDS-prevention budget included no specific allocation for programs for homosexual and bisexual men. And needle exchange programs, widely seen as among the most effective methods available in fighting infection among drug users, are denied any federal funding."
Citing the importance of targeting gay men with the "use a condom with anal sex" message, and of warning I.V. drug users not to share needles, the article quotes Ron Stall, a professor of epidemiology at U. Calif. S.F., "You can't stop this epidemic if you spend the money where the epidemic hasn't happened."
In the New York Times article Dr. Don Des Jarlais, a drug abuse expert at Beth Israel in New York, also expressed fear that the all-inclusive picture will sideline the most affected people, and said that fear of telling the truth about the epidemic "is one reason we have our priorities so out of order." He went on, "You're never going to have good public policy and stop an epidemic if you base your policy on misinformation or wrong information. You have to know where the disease is occurring and how to go after it."
In the years since these articles appeared their message has been discreetly discarded, based on the views, also cited in these articles, that it is unwise to suggest that people in the suburbs can't get AIDS. Figures like AIDS being the leading cause of death among young adults, the increase in heterosexual cases, and increase among minorities and women give the impression of an epidemic that is becoming more and more an epidemic of people at large. The figures that suggest otherwise are not cited.
And such figures are rare because test statistics for HIV rarely involve interviews. It should be observed that the Holmberg study (1994) deals with cases of HIV infection, not people who have clinical AIDS, and interviews are performed to get a personal history of risky behavior. This is the way to study AIDS (HIV) trends. Ten years later, with states now reporting HIV infections instead of just AIDS cases, the new standard is reporting names to state government files. Reporting names, unfortunately, is not going to help get a picture of what is happening with HIV transmission, and studies claim it makes people lie about their personal history. In a recent New York Times article about HIV testing (click here), there is nothing to suggest that interviews with people testing positive are a priority.
How to best deploy the AIDS test as a public health measure has been a longstanding feud between two factions. On one side are those who want take names of people who test positive and put them in records kept by government health agencies. By this approach sexual contacts would be notified, if the person testing positive will divulge them. This is the usual method of dealing with STD's at public health clinics, both the reporting of names and the contact notification.
Opposed to this standard approach have been those who say, backed by studies, that reporting names of people who test positive will not work with AIDS because people will lie, both about their name and their personal history. And many will simply not go to a clinic for testing, or even go to a clinic for treatment. "Anonymous" testing, at clinics separate from STD clinics, became the standard in most states, following the 1987 decision by Surgeon General Koop to endorse that approach.
Dr. Koop's decision angered many in the Reagan administration who did not want gay leaders and leftists changing the normal process of disease tracking. Other diseases are reported, so AIDS should be too. Now this position seems to have won out over anonymous testing, such that even many gay groups have begun to support the conventional approach of reporting names to a confidential data base. Unfortunately it remains true that identified testing, where names are taken, gets responses like "green" for race and "sheep" for sexual preference on questionnaires. Many people will not get tested if they know their name will be put in a government file with a positive test result. The answer to this problem is to acquire personal history information by establishing guarantees that names will not go on a government file.
When gay leaders won the day in 1987, with Koop's report in support of unidentified AIDS testing, no one backing this approach seemed to grasp or care that not taking names made it possible to get good information about their history, sexual practices and drug use, from people testing positive. Gay leaders and others who backed Koop recoiled from the whole idea of using testing to follow trends in new infections, because such monitoring was seen as a process that could only lead to invasions of privacy. What no one seemed to grasp is that failing to use the test to track HIV would leave the door open to those who wanted to report names to government lists, and that is exactly what has happened. Gay leaders could have used the influence they gained in establishing unidentified testing, and pressed on for establishment of AIDS-virus tracking via testing and interviewing that did not report names. It was really quite brilliant the way gay leaders lobbied for and prevailed with the principle of unidentified testing. But by recoiling from the concept of using the HIV test to track the unfolding nature of the epidemic, they left AIDS testing a no man's land -- vulnerable to the takeover by the name-reporting advocates. They could have instead sought the common ground of using the test wisely -- tracking trends without name reporting, and thus finessed the name-reporting advocates.
"Testing won't stop the spread of AIDS," was the politically correct mantra for years, repeated endlessly in the media by gay leaders and others who followed their lead beginning around 1986. The idea of this slogan was that if everyone practiced condom use there would not be AIDS transmission by sex. Tracking patterns with testing, such as rates among heterosexuals showing up at STD clinics, would not stop a single AIDS transmission, it was claimed.
But this was a ridiculous assertion given a virus that spreads years before symptoms appear. Obviously in a situation like this we would like to know how the virus is spreading, so we can shape our prevention policy accordingly, provided we can do it without driving people away from clinics who are at risk for AIDS. Somehow no one in the media ever responded to the claim "testing won't stop the spread of AIDS," with the truth that obviously testing will be a valuable resource in AIDS prevention -- it opens our eyes to how the virus is spreading which otherwise we can't see -- if we can test in a way that won't invade privacy.
Gay leadership eventually stopped saying "testing won't stop the spread of AIDS" when their curiosity got the better of them in the early 90's. Although it seemed almost all gay men were using condoms almost always, there was no way of knowing how much new AIDS transmission was occurring among gay men, either because they weren't wearing condoms, or perhaps because the claim that oral sex without a condom was causing transmission, contrary to the prevailing view, or perhaps for drug use issues. In any event no one had any idea since no test data was being retrieved because any kind of information gathering was deemed a privacy hazard, as we have described.
Gay leaders, quite rightly, could no longer stand not knowing what was happening with gay men and HIV (AIDS) transmission so they began testing. In studies conducted by gay agencies or gay-endorsed agencies gay men were content to describe what they have been doing with drugs and sex. They weren't worried about information going to the government. As for the slogan, "testing won't stop the spread of AIDS", gay leaders stopped saying it and let it slip quietly into posterity. Now gay leaders largely backing reporting, as a general policy, for reasons that aren't clear. With respect to the gay community, gay leaders realize meaningful testing data is going to come from gay-run studies, not from government name reporting without interviews.
It should be clear, we would like to argue, that what gay leaders are doing to track HIV among gay men is what should be happening at STD clinics in U.S. cities. Instead of sending people off to remote sites for their HIV test, as became the standard under the post-Koop-decision mentality, we should get people tested at the clinic and get interviews that will not get lies because we establish trust and guarantees that names will not go on government records. This kind of trust could be created if African American, Hispanic, and other minority urban leadership, as well as public health officials and gay leaders supported the idea. Trust could be established, as it is in gay-led studies, and we could use the HIV test to open our eyes as to how AIDS is spreading.
It is probably to late, for now, to expect such a program to catch on. Name reporting is on the ascendant. But it will eventually become clear that taking names with HIV testing will leaves us blind as to how the virus is spreading, because interviews with the people testing positive, if interviews are even attempted, will get a lot of false answers. And without interviews all we have are sex, race, and zip code or the like -- inferior data that public health professionals pretend is telling us much about HIV spread.
Taking names can be of value in avoiding duplicating data, but if we get good interviews without taking names, we can ask about other testing occasions. In any case the value of a good interview far exceeds the detriment of an occasional duplication. Contact tracing uses names, but that can be done without putting names on permanent government files.
One objection to doing getting testing data at STD clinics is that this population is skewed towards those with a high probability of being HIV-positive. So the sample is not a random sample. The answer to that is we want to track in the hot spots, and we want to know how people are contracting the virus, so we test where the virus is prevalent to learn trends in that population. It also makes sense to correlate HIV transmission with other STD's which can be more easily done by testing for AIDS at STD clinics.
It is worth remembering that the first attempt at reporting demographic trends was a 1983 study showing a cluster of AIDS cases in the gay Castro district of San Francisco. This should have come as no surprise since almost all the AIDS cases were gay men. But gay leaders protested to the group doing the study and postponed it's publication for about six months. This was the centerpiece of gay leader thinking in 1983 in New York, San Francisco and Washington DC -- don't let them pin this disease on us, it's not a gay disease. So they stifled publication of the Castro study when they should have been rushing it to the gay community as a warning. They refused to discuss with the gay community about the CDC's picture of AIDS, namely, a new virus being spread among gay men sexually without showing symptoms for at least a year, and without a high rate of sexual spread among heterosexuals. The idea of an STD that only went after gay men was considered politically motivated, but testing in '85 and '86 found about 500,000 gay men infected, and almost no heterosexuals.
And, we should not forget if we are to learn from our mistakes, gay leadership (in NY, SF, DC) was uniformly (with the exception of Larry Kramer and Will Warner) obsessed with the right of gay men to go on giving blood, unless they had been very promiscuous, variously enumerated. Since almost all gay AIDS patients had a history of many sexual episodes, promiscuity, STD's and "immune overload" were held to be the more likely cause of AIDS. As testing interviews in '85 and '86 showed (before then there was no test), the CDC was right and gay leaders were wrong. But as soon as testing showed gay leaders the truth and forced them to call for condom use, these same gay leaders turned around and began to declare "testing won't stop the spread of AIDS." And the media nodded and said, "yes, of coarse."
The other risk history, that gay leaders cited with respect to the blood supply was a hepatitis-B antibody showing past exposure to that virus. This test was positive in about 95% of AIDS patients, and gay leaders called for blood banks to screen blood not people, that is, not ask about sexual habits.
It was insane of blood bankers not to employ this test, which should have been used anyway as a hepatitis-B screen to catch cases missed by the active infection test (Hep-B surface antigen). Blood bankers, who controlled the FDA blood and blood products committee, kept the test from being deployed in the 70's so they would not lose the donors -- 5% of all donors -- who tested positive for the antibody, the hepatitis-B core antibody. There was an unknown yearly death rate, maybe 100, in saving that blood because the antigen test missed some positive blood that the antibody test would have caught as a backup. A small percentage of acute (that is first stage) hepatitis-B infections become "fulminating" and something like half of those cases are fatal. Only an article in the New England journal of Medicine by Hoofnagle (who later had a tragedy of patient fatalities with an experimental liver treatment) complained about the failure to use the antibody test. A standard set by Dr. Harvey Alter some years earlier clarifies that any exposure to hepatitis was grounds for "donor deferral." But the blood bankers kept their 5% until recently.
But equally insane was the call for gay leaders to cry "screen blood not people" with a test that, after all, was not an AIDS test but a hepatitis test. A follow up study of stored blood found that HIV(AIDS)-positive donor blood was positive for the Hep-B antibody in only 8% to 25% of cases. (Jim Mosely, USC, conducted study of NIH samples) So gay leadership was wrong about promiscuity, and they were wrong about the hepatitis test. (For this site's article on these 1982-5 issues click here.)
We raise these issues here because these are public health/epidemiology issues -- how the disease is caused, who is getting it, how it shows up clinically so that we can know how its spreading, how long the lag time is between infection and onset of clinical disease if there is a microbial cause. The truth in 1983 was that the CDC's message, even if there was no test to prove it, should have been set forth in communications with the general public, not stifled. The CDC did not claim certainty, but they claimed all parties should take stock of what they were saying as a serious and very likely correct scenario for AIDS. (The fact that the long incubation proved to be longer on the average than the CDC's estimate of one to three years is sometimes cited by gay leaders to show the CDC was wrong. But the CDC was the only one saying very long incubation state at a time when there was only sketchy data, and they were right in what they said not wrong. Gay leaders who refused to discuss the idea at all with the gay community -- they covered it up and and extorted silence from the CDC, and now some of these same people resort to the tactic of saying the CDC got it wrong because they did not say 7 years or whatever it's supposed to be instead of 1 to three years.)
You can see for yourself what gay leadership was saying and not saying about AIDS in the early going by looking at the gay presses. Check the 1982-1985 NY Native, the Advocate, the B.A.R., the DC Blade, and publications from gay groups like the Gay Men's Health Crisis in the library or private archives. The CDC is only described as trying to stigmatize gays for bad blood. The CDC's ideas, most importantly the long lag time before disease onset, are not discussed in the gay press. There is a glancing mention of the long incubation state idea by the "American Physcians for Human Rights" in an issue of the Advocate in early '83, but that's about it. There is no discussion.
The early going with AIDS was a disaster of political reaction, with gay leaders and blood bankers aligned and consorting on how to stymie the CDC. Neither wanted the CDC to make a major announcement that hundreds of thousands of gay men were probably already infected, without showing signs of disease, and that gays being especially avid blood donors, posed a major threat to the blood supply. This amounted to saying all gays had AIDS and gays have bad blood.
As we recount in this site's article about AIDS in the years '82-'85, the CDC needed gay leaders, whose approval was needed to recruit gay men for transmission studies. And they needed blood bankers, who controlled the pertinent FDA committee and who could block CDC access to blood banking records which were the only way to clearly show a long incubation state for AIDS. (Remember, there was no test for AIDS in 1983.) Besides having gay leaders turn against them, the CDC, if they went public with their message, would have had a public dispute with the FDA over the correct picture of AIDS. Blood bankers called the risk one in a million, and that was only if those blood recipient cases were in fact from donor blood. Blood bankers, like gay leaders, were only able to make their small-risk argument by not discussing the CDC's long lag time idea. Again, we would like to point out, that these blood donor issues are epidemiology issues because we have the questions about who is at risk, how is the disease caused, and if there is an infectious agent, what are its properties. The smart message, from the most knowledgeable people, the message that turned out to be true, was stifled.
There is clearly an epidemiology lesson here. It can be found in Randy Shiltz's 1987 book "And the Band Played On." The book upset a lot of the gay community because it showed that gay leaders were a major force in muzzling the AIDS alarm in 1983. It shows that the young motivated CDC doctors, Curran, Jaffe, Francis, Koplan et. al., had the message and gay leaders told them to stick it. But gay men love the movie which lambastes blood bankers but doesn't say bad things about gay leaders. And the general public is equally ignorant of how gay leaders behaved in those years.
You might ask, if gay leaders in NY, SF, and DC spoke with one voice on the right of non-promiscuous gay men to give blood, and with gay men hearing nothing from gay leaders or blood bankers about hundreds of thousands of healthy gay carriers of a new virus claimed (but not proven) by the CDC, why wasn't there a huge blood bath perpetrated by gay donors? The reason is that gay blood donors sensed a threat to the blood supply and gay men talked about it to each other. Perhaps they had heard Larry Kramer or Dr. Will Warner or seen something they wrote, warning of a threat of unknown dimension. For some such reasons, gay men did a good job of not giving blood. There were about 10,000 transmissions via donor blood from those years, but by this site's estimate that number could easily have been 100,000 if gay men had gone on giving blood. Donors give blood several times a year or more, and units are split into infectious fractions.
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