HIV/AIDS and Other STDs

The AIDS Epidemic

In the early 1980s, the leading causes of death among the middle-aged population were heart disease, cancer, and unintentional injuries. In 1988, the first year that it was identified as a separate and distinct cause of death, AIDS became the leading cause of death in the 25-44 age group. It has not relinquished that position. In 1993, the last year for which data has been published by the State, 1,703 New Jersey residents between 25 and 44 years of age died of AIDS - more than from heart disease and cancer combined.

While we do not fully understand the causes of heart disease and cancer, we do understand the cause and effect relationship between certain behaviors and AIDS. The Center for Disease Control and Prevention (CDC), a division of the US Department of Health and Human Services, reports that 55% of all AIDS cases diagnosed through June of 1996 in the United States were contracted during homosexual sex.

A Different Profile for New Jersey
While homosexual sex is the principal cause of HIV infection in the nation at large, in New Jersey there are more AIDS cases resulting from intravenous drug use than from any other cause. Up through 1993, the last year for which data has been published by the State, 54% of all AIDS cases were caused by use of infected needles.

According to data published by the CDC, from July 1994 through June 1995 4,738 new cases of AIDS were diagnosed in New Jersey. During that 12-month period, New Jersey ranked third among the 50 states in the rate (normalized to the State's population) of new AIDS cases with about 60 new cases diagnosed for every 100,000 people living in the State. Our neighboring state, New York, was ranked first with a rate of 69 cases per 100,000 population. These rankings do not include Washington DC (which is more like a city than a state) or US possessions. In both New York City and Jersey City, AIDS cases are reported at a higher rate than in San Francisco.

Since reporting began in the mid-1980s, over 30,000 cases of AIDS have been diagnosed in New Jersey. Today, more than 10,000 men, women, and children with AIDS are living in the State. This does not include people who have been diagnosed with HIV but who have not yet contracted AIDS. AIDS has claimed the lives of approximately 20,000 people in New Jersey alone. During that same time (from the mid-1980s to the present), more than 350,000 men, women, and children have died of AIDS across the Nation.

HIV Infection
In some ways the increase in the diagnosed cases of AIDS is a trailing indicator, while the rate of HIV infection is the better leading indicator. At this time, there is no cure for HIV: all who are infected with HIV are expected to contract AIDS. Unfortunately, our knowledge on the spread of HIV is quite limited. While all states report diagnosed AIDS cases in a uniform manner, only 26 states have laws requiring the confidential reporting of HIV infection, and many of those states allow anonymous HIV testing. Anonymous testing enables people to find out whether they are HIV positive without notifying health authorities, thereby insuring that we really do not know how many people are living with HIV infection. According to the CDC, there are at least 10,000 HIV infected people living in New Jersey - almost the same number as are living with AIDS (Centers for Disease Control and Prevention, HIV/AIDS Surveillance Report - 1995 , Volume 7, Number 2, Table 1, Page 7).

Infected Children

More than 100 children died of AIDS in the United States during the first 6 months of 1996. In New Jersey alone, there are more than 500 children under the age of 13 years living with HIV or suffering with AIDS. 83% of these children contracted the disease from infected mothers. (Centers for Disease Control and Prevention, HIV/AIDS Surveillance Report - 1995 , Volume 7, Number 2, Table 21, Page 29.)

Other Sexually Transmitted Diseases (STDs)
There are three other common STDs which are incurable: Human Papilloma Virus (HPV), Herpes, and Hepatitis B. HPV (also known as genital warts) is rampant on college campuses today: the Alan Guttmacher Institute estimates that 24 to 40 million Americans are infected with HPV and 31 million Americans are believed to have Herpes. The CDC does not maintain surveillance data on Herpes or HPV; however, the CDC does report that the National Disease and Therapeutic Index shows initial visits to physician's offices for HPV is up 50% from 1993 to 1995 after declining from 1988 to 1993 (Division of STD Prevention, Sexually Transmitted Disease Surveillance, 1995 , U.S. Department of Health and Human Services, Public Health Service. Atlanta: Centers for Disease Control and Prevention, September 1996.)

Unlike HIV/AIDS and HPV, Chlamydia, Gonorrhea, and Syphylis can be medically cured. Like HIV/AIDS and HPV, they are sexually transmitted. Gonorrhea and Syphylis have been declining over the years: in New Jersey, 5,783 cases of Gonorrhea were reported in 1995, down from 6,444 in 1993, and 188 cases of Syphylis were reported in 1995, down from 2,556 in 1993. The bad news on this front is that these diseases are showing increased resistance to the antibiotics which are normally used in their treatment: between 1994 and 1995 resistance to both penicillin and tetracycline increased. (Division of STD Prevention, Sexually Transmitted Disease Surveillance, 1995 , U.S. Department of Health and Human Services, Public Health Service. Atlanta: Centers for Disease Control and Prevention, September 1996. Division of STD Prevention, Sexually Transmitted Disease Surveillance, 1994 , U.S. Department of Health and Human Services, Public Health Service. Atlanta: Centers for Disease Control and Prevention, September 1995.)

While Gonorrhea and Syphillis are declining, Chlamydia is on the rise. Although there are few early symptoms, Chlamydia infections often result in serious reproductive tract complications such as pelvic inflammatory disease, infertility, and ectopic pregnancy. Furthermore, infected mothers can infect their babies during delivery. Though there are large numbers of asymptomatic carriers, in 1995, 4,056 Chlamydia cases were diagnosed in New Jersey, up from 2,742 in 1993.

The NJFPC Viewpoint
Our current public policy toward AIDS and other STDs revolves around "safe-sex". Various groups have attempted to point out that the very terminology is oxymoronic: there is no such thing as safe sex anymore. Study after study has shown condoms to be less than perfect. The Alan Guttmacher Institute, the research division of Planned Parenthood, reports that, in 1995, 32% of the abortion patients in the United States had pregnancies attributable to condom failure (Stanley K. Henshaw and Kathryn Kost, Abortion Patients in 1994-1995: Characteristics and Contraceptive Use, Family Planning Perspectives , Volume 28, No. 4, July/August 1996). With almost one-third of unwanted pregnancies resulting from condom failure, how can we responsibly promote condoms as a measure of STD prevention? Nevertheless, and with common sense aside, the very next issue of Family Planning Perspectives , (Douglas B. Kirby and Nancy L. Brown, Condom Availability Programs in U.S. Schools , Volume 28, No. 5, September/October 1996), goes on to say ...

"School condom availability programs have been promoted as a promising approach for increasing condom use among students, for reducing the risk of infections with the human immunodeficiency virus and with other sexually transmitted diseases and for preventing unintended pregnancy."

The same article points out that "at least" 431 public schools in 50 U.S. school districts have made condoms available to students. Apparently, some of these schools have condoms in baskets in the hallways to further reduce the effort required to pick one up.

As we formulate public policy, we should recall that AIDS is the leading cause of death in the 25-44 age group and that there are at least 500,000 people living with HIV and AIDS in the United States. We should recall that 32% of the pregnancies aborted in 1995 resulted from condom failure. What message will our kids remember when they hear in the classroom that abstinence is the only 100% sure way to stay healthy, but they pass by the condom basket in the hallway? Should we be surprised that 25% of our college students have some form of sexually transmitted disease? that 12 million Americans contract some STD each year? that, worldwide, 390 million people contract some STD each year? The only responsible course is to remove all "safe-sex" messages from our sex education programs, and teach our children how to avoid sexual situations and, when the situations can not be avoided, how to say "No" in ways that deflect and cope with peer pressure.