DOCTORS today face an interesting problem in that the very success of their profession makes their job harder. Medical science has made several astonishing leaps in recent years, from the creation of new imaging and surgical techniques to the generation of novel drugs and therapies for diseases as diverse as cancer and hypertension. Ironically, though, the existence of these new treatments frequently comes back to haunt those who try to keep their patients healthy. People seem to think that the existence or potential for new miracle cures releases them from any obligation to take preventative steps to ensure their health. The effects of this mindset can be devastating.
Complacency is a natural human reaction to almost any kind of technological advancement. After all, we spend all that time improving our technology so that we can have more time later on to do the things we like more. We have dishwashers so that we can watch TV instead of standing at the sink. We have washing machines so that we can go to the movies instead of rubbing our clothing up against a washboard in a tub. So it's natural to think that we create cures for diseases so that we don't have to spend all that time eating healthily and looking after ourselves so that we don't get sick.
This complacency produces the most devastating results when people ignore their safety around more dangerous illnesses. The Centers for Disease Control reported Sept. 10 that the number of documented cases of bacterial sexually transmitted diseases (such as syphilis, chlamydia and gonorrhea) in Seattle increased dramatically over the last few years. According to the Morbidity and Mortality Weekly Report, cases of syphilis reported in Seattle increased from zero in 1996 to 46 in just the first half of 1999. The increase was alarming not only because it represented the reappearance of a disease that had seemed to go away, but also because people who have syphilis are more likely to contract and transmit AIDS. In fact, 75 percent of gay men who tested positive for syphilis in Seattle also had AIDS.
The reason for the increased transmission of AIDS among those who have syphilis has more to do with the mode of transmission than the diseases themselves. Unprotected sex is the principle way STDs move through a population, and the increase in syphilis can be linked directly to a decrease in proper use of preventative measures.
The evidence suggests that once again this is becoming a major problem among gay men in the Seattle area, and possibly San Francisco and Chicago as well. That 85 percent of the syphilis cases reported over the last year and a half were in men who had sex with other men. Syphilis, however, was not the sole problem. The incidence of chlamydia and gonorrhea also increased, gonorrhea cases jumping from 180 for every 100,000 gay men in 1997 to 420 per 100,000 gay men so far in 1999. CDC officials fear that the increases reflect an newly growing trend of unprotected sex in one-night stands with strangers.
The source of the problem is complacency. Much of the recent news about AIDS has been positive. The use of protease inhibitors and multi-drug cocktails has contributed to a much more hopeful feeling for those who have the disease. What's often lost in these articles is that while the cocktails hold off the symptoms, they do not eliminate the disease.
Recent studies indicate that the cocktails suppress, but do not destroy the virus. Furthermore, these treatments are very expensive. Scientists do not know how effective they will be in the long term. And finally, HIV often has shown an ability to evolve rapidly. It's quite possible that the virus will gain resistance to the drug cocktails. At that point, treatment will be back to square one.
The enemy in this instance, the force that's fighting against the goal of stopping the AIDS epidemic (48,269 new cases in 1998), is not the virus. It's man's own tendency towards inaction. The positive reporting on AIDS hasn't been out of line or inaccurate, but it has contributed to a false picture that the disease can be controlled once a person has been infected. This is not the case. As far as we know, people who have AIDS never will be free of the disease, and always will be capable of transmitting it. AIDS is still a death sentence. You just get a few years' more time.
Sexual activity, therefore, still carries a substantial risk. And that doesn't just apply to gay men. According to the CDC's surveillance report from 1998, the proportion of women in the infected population has been rising steadily since 1992, and sexual intercourse causes the most infections. Nobody can afford to take the risk of having unprotected sex.
The urge to be lazy and ignore the preventative lessons taught by high school health teachers is understandable, given the recent media attention to those who are living with AIDS. People should take care, however, that optimism does not lead them to take a foolish -- and fatal -- chance.
(Sparky Clarkson's column appears Tuesdays in The Cavalier Daily.)