If symptoms
persist . • .
NOT very long ago I had a patient, a drug addict, who was HIV positive. This meant there was a 75 per cent chance he would suffer from Aids within five years, and he knew it. Contrary to my expecta- tions, he was neither miserable nor fright- ened: indeed, he bore his misfortune not only with fortitude but with notable cheerfulness.
How could anyone live happily under such a death sentence? In his case the answer was simple: his infection, whose existence he never concealed from any- one who would listen, had made him irresistibly attractive to a certain group of young women who wanted to play viral roulette. He was now rarely without a bevy of young females clamouring for sex with him, preferably without protection of any kind: they were true HIV groupies. No doubt this will surprise bien pensant people who think that human behaviour is always the outcome of a rational calculus; but readers of Dostoievsky will not be so surprised. The great epileptic once remarked that men would disobey authority even if it were constituted solely for their own good, just to assert their own individuality. In any case, brushes with death often convey a mean- ing to lives that previously were meaning- less.
That is why health education can never be completely successful. Another reason why, with regard to Aids, it might fail is the evasiveness of much of its propagan- da. I recently picked up some pamphlets in one of my clinics, published and distributed by an area health authority and translated into Urdu, Bengali and Punjabi. They managed to avoid the word homosexual altogether, -referring only to the dangers of 'unprotected sex', and rather mysteriously informed the readers that they should never inject themselves with drugs. A pamphlet pub- lished by the Health Education Authority began by stating portentously that 'more people are dying of Aids every month and they are not only gay men and drug users'.
How many people with Aids have been infected by heterosexual intercourse in this country without the presence of other risk factors? 16 out of 3,021 cases up to the end of January 1990. This compares with 2,433 homosexuals and bisexuals, 130 intravenous drug abusers, 182 haemophiliacs and 48 other recipients of blood transfusions.
I wish this mealy-mouthedness among the pamphlets derived only from a Pods- nappian desire to avoid bringing a blush to the cheeks of certain people. But I think there is something more sinister at work: a proto-totalitarian self-censorship im- posed by fear of pressure groups, and a belief that if people knew the figures they would behave despicably, for example by lynching homosexuals. Like our secretive civil servants, those who designate them- selves as guardians of welfare often have a deep disdain for the objects of their manipulations: caring equals contempt. We should never forget that carers need the cared-for more than the cared-for need the carers.
To rebel against good sense, as in the case of the HIV groupies, is profoundly human. But can the cause of good sense be served by half-truths and evasions?
Theodore Dalrymple
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