Challenging the Proposition of Female to Male Transmission

By Michael Callen
May, 1987

Web editor’s note: For over a dozen years, Michael Fumento has taken the credit — or blame, depending on one’s point of view — for first promulgating the thesis set forth here. Michael Callen found it interesting, and somewhat galling, that Fumento never bothered to mention the existence of the following article, which appeared in the People With AIDS Coalition Newsline six months prior to Fumento’s Commentary piece.

There are reasons which have little to do with science why various forces are manipulating Americans into believing that AIDS is a major threat to heterosexuals.

I’m not going to talk about the “agendas” of the various groups which are marketing AIDS for straights; rather, I’d like to explain why AIDS, in any significant numbers, has not occurred, is not occurring and is not likely to occur among American heterosexuals who don’t shoot drugs or take it up the tush (without a condom).

* * *

The recent spate of articles on the threat of AIDS to heterosexuals has been based on the fiction that AIDS has increased suddenly and dramatically among them. The oft-repeated statistic that the percentage of AIDS cases attributable to heterosexual spread has “increased by over 200 percent in the last year” (Atlantic Monthly) represents at best an embarrassing misinterpretation of both politics and epidemiology.

Why would journalists claim something is so when it’s not? Here’s what happened.

In the summer of ’86, the Centers for Disease Control began lumping Haitians with AIDS in with the cases of AIDS presumed attributable to heterosexual transmission. Haitians with AIDS have, from the beginning, accounted for just under 2% of cases; cases of AIDS attributed to (presumed) heterosexual spread (mostly women who are believed to have gotten AIDS from men) have likewise accounted for just under 2%. So, in the summer of ’86, the figure for heterosexuals with AIDS “doubled” from 2% to 4% merely because the Haitian 2% had been added. Thus, as an artifact of a change in classification the illusion that heterosexual cases of AIDS had dramatically doubled was created.

I made many calls to try to track down what was really going on. I spoke with representatives of the NYC Dept. of Health who, to their credit, have refused to go along with this statistical ruse.

When I was at the recent conference in Atlanta, I made a special trip to the CDC and discussed this matter with Harold Jaffe, head of AIDS epidemiology. He indicated that he too was “concerned” that so many medical correspondents were “misinterpreting” the data.

I asked Dr. Jaffe if the CDC had responded to the many egregious misinterpretations of this data; he said “No.”

I asked Dr. Jaffe why the CDC now assumes that all Haitian/African cases of AIDS are the result of heterosexual transmission. He acknowledged that this presumption was probably “not 100% accurate,” but felt that on the whole, it was a safe assumption. I politely disagreed.

The unilateral decision to count all Haitian cases of AIDS as evidence ofheterosexual transmission presumes that all Haitians with AIDS are heterosexual and have no other AIDS risk factors. This presumption is clearly unwarranted.

During this conversation, I was shocked to learn that only a minority of cases are investigated. Due largely to lack of staff, the CDC is forced to accept as true whatever risk factors most patients volunteer. In other words, a Haitian with AIDS is presumed to have gotten AIDS from heterosexual intercourse unless s/hevolunteers that s/he received a transfusion, is hemophiliac, is gay or bisexual or has a history of intravenous drug use.

* * *

I’ll now try to walk you through an epidemiological explanation of why it’s unlikely that sexual transmission from a woman to a man occurs.

  • Assume arguendo that in 1981 in New York City there were 100 female prostitutes with HIV infection. (Obviously, there were probably thousands of HIV positive prostitutes, but unlike hysterical reporters, let’sunder-assume for once.)
  • Let us further assume that each of these 100 prostitutes worked only 5 days a week and had only 5 male customers a day (likewise, probably an underestimate).
  • That’s 25 men a week per prostitute for a total of 2,500 men potentially exposed to HIV per week beginning in 1981.
  • Let us assume that half of these 2,500 men are weekly repeat customers. Therefore, let’s say that only 1,250 different men per week were newly infected with HIV.
  • Now, let us assume that (1) not all 100 prostitutes were infectious for HIV at all times and/or (2) not all sex acts performed involved the exchange of bodily fluids. To account for this, let’s again halve the number of men potentially infected with HIV to 625 per week.
  • Let us further assume a mere 10% rate of efficiency of transmission from women to men (meaning that only one out of ten of the 625 exposed men contracted HIV.)
  • That would mean that our hypothetical hundred whores would have transmitted HIV to 62.5 men per week. (It’s interesting to consider what a .5 sexual contact might be–perhaps coitus interruptus or maybe he was “only half a man.”)
  • Fifty-two weeks in a year times 6 years (1981 to 1987) times 62.5 men/week equals 19,500 men infected by HIV by the 100 prostitutes. (Of course, the pool of infected prostitutes may be assumed to have expanded; but we won’t bother to figure that in.)
  • Let us further assume that only 5% of the men who become HIV positive through contact with prostitutes develop AIDS within 1 to 5 years (the estimates being bandied about these days are that 5 to 30% of those who are antibody positive will develop AIDS within 5 years).
  • Based on all of the above assumptions, we should be seeing in New York City 975 confirmed cases of AIDS in men whose only risk factor was sex with prostitutes.
  • The AIDS Surveillance Update data, published by the NYC Dept. of Health as of January 1987, lists a grand total of 3 males in the risk category of “sex partner of at risk group.” That’s right: only 3!!!

If one wishes to grant the benefit of the doubt and add to those 3 liars the “interviewed–no risk factor identified” category (43 men)–to assume that none of these 43 men had gay sex or used IV drugs–then you come up with a grand total of 46 men who, in the 6 years since AIDS was first described, could possibly have contracted AIDS from an infected female.

* * *

So what? you may ask. Why am I making such a big deal about slippery statistical manipulation when the result has been that heterosexuals are now awakening to the tragedy of AIDS?

First, I have a fundamental and abiding respect for the facts as they are, not as some might like them to be. Second, violence and discrimination against gay men and PWAs rises with each media deluge in proportion to the level of fear among heterosexuals.

I attended the excellent demonstration organized by ACT UP on the steps of the Post Office. (Partial credit where it’s due: The Lavender Hill Mob had clearly done their homework this time; everyone worked together on this one and it was a major success.)

Those at the demonstration frequently returned to this favorite chant: pointing at the police or the crowd they’d shout “We’re fighting for you! You can get it too!!” It was effective theatre; it was a powerful challenge; but it was bad science.

Media reports to the contrary, AIDS has not broken out of the original “risk groups.” The minuscule percentage of AIDS cases theoretically attributable to heterosex remains constant.

* * *

If AIDS transmission were “bidirectional”–that is, could be transmitted efficiently from women to men (or, for that matter, from women to women)–then the epidemiological pattern of AIDS in the United States would be very different. If female transmission doesn’t occur, then an important link in the chain is broken.

I am not suggesting that the possibility of bidirectional heterosexual transmission ought not be considered; I’m merely suggesting that such consideration ought to be rational. It ought to begin with an examination of how AIDS is actually spreading rather than focus on all sorts of theoretical worst-case-scenarios.

The debate about HIV positive children attending school provides an example useful for comparison. Every time some theorist raised hare-brained and far-fetched scenarios of biting, scratching, defecating monsters, the epidemiologists would calmly counter that no family member of a child with AIDS had in 5 years contracted HIV or AIDS from the kinds of intimate social contact which occur in a family setting.

Off the record, several epidemiologists I’ve spoken with doubt the likelihood of female to male transmission. It’s time they spoke up.