Can we help Aids?
Andrew Brown
The story of the man who invented chess: the prince for whom he had invented the game was so delighted that he asked the counsellor to name his own reward. The counsellor replied that he would like one grain of wheat put on the first square of the chessboard, two on the next, four on the next, and so on. The Prince was still further delighted by the simplicity and seeming modesty of this request, so a grand ceremony was arranged. Elephants loaded with wheat stood by; the Prince beamed munificently; the counsellor smirked. By the time the end of the second rank was reached, with six ranks still to go, the Prince found himself needing to fit 65,536 grains of wheat onto the 16th square. So naturally, he had the counsellor killed instead. That is the arithmetic of Aids.
The Royal College of Nursing last week pointed out that the number of diagnosed cases of Aids in this country has been doubling every six months since 1981. If this trend continues, there will be a million cases inside six years. This is not a firm prediction that there will in fact be a million cases of Aids in six years' time (and four million seven years from now). Pre- dictions based on exponential growth are notoriously tricky, especially when they are made about human activities. The Club of Rome managed to predict a tremendous environmental holocaust by extrapolating exponential growth curves which were almost immediately broken. Human beings are adaptable, even human societies are adaptable; and it is in the nature of exponential growth that the kick comes at the end: if the number of Aids victims stops growing six months before there would have been a million, there will be half a million; six months before that, there will only be a quarter of a million, and so on.
These figures refer to the number of diagnosed victims; not to the carriers of infection, a figure which has always been very much higher in the past, and is now too. Since one can carry the infection for four years or more without contracting the disease, there is very little that anyone now can do about the growth in the number of diagnosed cases for the next two or three years. That will continue to double every six months — from what is a very low base — and all these people are going to die very horribly.
Before anyone writes in to say that I take pleasure in this prospect, or even approve of it, I should make plain that I cannot imagine any human crime or folly that deserves to be punished with Aids, and that only a complete moral imbecile could do so. Not even he would deserve the disease, or several other, more common ones. Leprosy, multiple sclerosis, stomach cancer, tertiary syphilis — the point is reasonably plain: if there is a God, and if we may judge from His past policy on diseases, then the victims of Aids are not being punished for being buggers or junk- ies, but because they are human beings.
The point, however, is to change things. That is what makes the Royal College of Nursing's report so frightening. For what emerges from between the lines is that no one has any idea of what to do, nor any clear idea about how the disease is spread. Stringent precautions are recommended: the use of visors, face masks, gloves, buckets of antiseptics. Even the corpse is to be sealed in a `heavy duty cadaver bag'; and the undertakers are to be told of the cause of death. Except for this last detail, one could argue that these precautions are as much to protect the patient from infec- tions against which he cannot — by defini- tion — defend himself as to protect the nurses from the patient.
Until one unfortunate woman pricked herself with a needle she had used to inject an Aids victim, there was no known case of a nurse or other attendant of the sick contracting Aids in the course of duties. (And, as far as I know, no nurse who has contracted Aids in his spare time and then infected patients has been identified, If it wasn't for the rates going up, and down I'd die of boredom.' though it is clearly possible that this may happen.) But it may already be too late to use 'he' as the generic pronoun. Only 70 per cent of the identified Aids victims in America at the moment are classified as homosexuals or bisexuals. Seventeen per cent are junkies, amongst whom the dis- ease is spread, like hepatitis, by dirty needles. This provides at least one obvious route into the heterosexual population: prostitution is one of the few professions that pay enough to support a heroin habit. And no one knows which sexual acts actually spread the disease. Certainly, no one seems any longer prepared to bet that buggery is the only route of transmission for Aids.
The `safe sex' recommended for homosexuals (cuddling, `dry kissing', mutual masturbation) involves as little intimacy as possible. The Royal College of Nursing appears to doubt that condoms can halt the spread of the disease: indeed one of their recommendations is a real counsel of despair: the use of `social drugs' — alcohol, marijuana, and so on — should be avoided in public places, in case the consequent loss of inhibitions should lead you to do something regrettable. If fear of Aids is going to turn us into a nation of solitary drunks, then the disease is more dangerous than anyone can at present imagine.
Yet no one seems really to believe that it is that dangerous. There is an organisation called the Terence Higgins Trust, a reg- istered charity named after one of the disease's first English victims. It operates a telephone service for people who fear they may have the disease. On average 20 people an evening ring up — that's a hundred a week, a figure that gives some idea of the number of potential Aids victims in London. But what I find im- pressive about the trust is that it provides what is known as a `buddy' service: visitors for those who have had the disease di- agnosed. Since one of the diagnostic signs is `Karposi's sarcoma', a skin cancer that can be so revolting in appearance that even nurses are warned to stifle their distaste, this shows considerable courage as well as charity, for as the man I spoke to told me: `If the disease has been diagnosed, we can only help them with practical things, like making their wills.'
There is some evidence that the prom- iscuity that has so far spread Aids is going out of fashion. The incidence of more traditional venereal diseases among the homosexual population is said to have fallen, in London at least. But the Terence Higgins Trust appears to pin its hopes on the idea that some people can contract the Aids virus and live. If this is true — again, no one knows — then it may prove possible to develop a vaccine, providing the virus does not change in that time. In parts of Central Africa it is an endemic heterosex- ual venereal disease. If it has attained that status by the time a vaccine is developed in the West, it will be interesting to follow the resulting debate about morality.
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