THE AIDS epidemic is a truly modern dilemma in which the political, ethical and scientific parts of the problem are not easily separated from one another. The different aspects of the disease have stirred enormous controversy and thought for more than four years now. Meanwhile the dying continues. To demonstrate concern for the victims and a desire to prevent an increase in their ranks, a responsible commentator on the disease must balance warnings with reassurances. Too little fear will lead to complacency; too much, to paranoia, quarantine and hatred.
Crisis: Heterosexual Behavior in the Age of AIDS
By William H. Masters, Virginia E. Johnson and Robert C. Kolodny
New York: Grove Press, 243 pages
One thing is certain: no one today can or should ignore AIDS. Yet the general public has turned an even blinder eye to the disease's ravaging of central Africa than it has to the tragedy in the homosexual community--which may reveal something about our prejudices. Recent attempts to make warnings strike "closer to home" can easily have the reverse effect. At best, exaggerated wolf-crying will not, in the long run, teach people caution. At worst, it will cause people to strike back at "them", who they fear are on the verge of spreading the disease to "us", even though the disease increasingly affects all citizens.
William Masters, Virginia Johnson, and their collaborator, Robert Kolodny, write the truth when, at the beginning of Crisis, they say that much that has been written on AIDS is incorrect. Even more of the writing on the subject is misleading. Unfortunately this study only adds to the mounting toll of misinformation the disease. Their claim that AIDS is "rampant" in the heterosexual population is unsubstantiated by their research; their treatment of the ways in which AIDS is spread is irresponsible, and their recommendations are ill-advised. Their evidence does show that the public is not modifying its sexual behavior to prevent infection and it should be taken seriously, but one suspects that the misinformation and half-truths contained in this work are more likely to spread--and faster than any virus.
IN no way does the book fulfill the dust cover's claim that the study assesses the risks in a "scientifically precise" way. This is a lie, and Masters and Johnson are abusing their scientific credentials by allowing such a claim to be made. Because it's impossible to be precise in researching this subject, one should be especially careful, lest ignorance produce its usual offspring, fear.
There is a great difference between the phrases "not impossible," and "very, very, unlikely." Like the glass both half empty and half full, they are the same, yet connote very different things, and on a topic as volatile as the modes of AIDS transmission, the difference is powerfully important. In the chapter, "Can You Catch AIDS From a Toilet Seat?", Masters and Johnson consistently refuse to rule out even the tiniest and most speculative risks. Whether they are describing the fear contained in the title, or kissing or any of the other rumors about how one catches the disease, they parlay unproven and miniscule possiblities into "some risk". Such a loose phrase could all too easily grow in the retelling.
Masters and Johnson present no new evidence on these matters to warrant their decision. With dangers so small, it is as hard to discount them totally as it is to specify them, but what good can the authors hope to accomplish by their ominous litany of "maybes"? We cannot laminate ourselves to avoid contact with all germs, nor hide below ground for fear of meteorites. If transmission by casual contact exists, current evidence suggests it is a rare occurrence, and becoming ever more infrequent.
The actual experiment that prompted the book was conducted on 400 "monogamous" and 400 "non-monogamous" heterosexuals in New York, Los Angeles, St. Louis and Atlanta. The researchers found that in the latter, promiscuous, group, 5 percent of the males (or 10), and 7 percent of the females (or 14) tested positive for the AIDS virus. This is a small sample on which to base national policy, and there are a number of flaws that make the results untenable. If those 24 people were in any way representative of the general populace, there would indeed be cause for grave worry, but they are not.
THE authors commit a number of serious statistical sins, and their conclusions are based on demographic fallacies. All "non-monogamous" subjects had at least six different sexual partners each year for five years--a figure which in itself makes the sample unrepresentative.
The method of choosing subjects in this subpopulation may have been biased towards people who were afraid they might have the disease, and thus the relatively large number of subjects who tested positive in the study. Furthermore, all of these subjects were frequenters of the nightlife in a major metropolitan center; none were from any other demographic area. I can think of considerably lower risk places for a sexually transmitted disease.
The methodological biases are overshadowed, however, by the misuse of statistics. The great majority of the individuals in the survey who tested positive actually had more than 13 (rather than the minimum of six) sexual partners annually, and how many more is never specified. These extremely sexually active people were the ones who raised the overall total in the "non-monogamous" group, and they are the ones who are really at risk.
Masters and Johnson simply cannot extrapolate from those who tested positive in their study to the general population. Extremely sexually active people in urban settings form a relatively closed group. We can expect that all the partners of those AIDS carriers in the study are just as sexually active. It's easy math to figure out that the risk of transmission follows a geometrical, and not a linear progression in this subpopulation. The number of people an individual has had sex with "by extension" grows by leaps and bounds if the partners are also at high risk. The second conclusion we can reach is that sexual contacts, and thus the disease, will remain relatively confined within the subpopulation. Masters and Johnson have only identified significant risk in a quite specialized group which is very unrepresentative of the heterosexual population as a whole.
OBVIOUSLY, a deep sigh of relief is not in order. Certainly, sexually active persons are at some risk and should take reasonable precautions. Current evidence on AIDS gives no cause for complacency, especially considering our duties to its victims. Recent legislation enacted in the state of Washington to promote AIDS education may be a step in the right direction, but time will be the judge of that.
Crisis should put a chill in anyone who has a habit of nightly picking up strangers at bars in major cities, or regularly frequents prostitutes. These are the people at whom the book should be aimed. As for the rest of us, we must make haste to save lives, even if they are not our own. Or sexual behavior should be cautious, yet not terrified; our political behavior should be swift, yet not tyrannical.