Re: Re: Re: Questions for Christopher Noble & Nicholas Bennett 16 September 2004
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Peter J Flegg,
Consultant Physician
Blackpool, UK FY3 8NR

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Re: Re: Re: Re: Questions for Christopher Noble & Nicholas Bennett

If Mark Bartlett does not believe HIV is a communicable disease, perhaps he can tell us what he thinks it is and what is the origin of AIDS? Perhaps he means it is communicable, but that he subscribes to the school of Perth Group epidemiology, which states that if a disease is sexually transmitted then absolutely everyone is equally susceptible to it and equally liable to acquire infection irrespective of their behaviour? This is patently untrue, and the fact that different subpopulations with different behavioural characteristics can have different disease prevalence should not come as a surprise to him in his profession.

Yes, there was a fear was that there would be a large heterosexual epidemic of HIV, and this never fully materialised in the West (but the limited infectiousness of HIV is only one of the many reasons why not). Try telling the 35000 HIV-infected heterosexuals in the USA that they are not part of an epidemic. HIV transmits poorly in the context of normal penile/vaginal intercourse in the absence of other cofactors for transmission, but one has to be unlucky enough to encounter the virus in the first place (currently a less likely event for a heterosexual than it is for a gay man). Infections do not always behave in the way the general public and newspaper editors predict. For that matter, they may not always behave as public health officials and epidemiologists may predict either.

Bartlett points to the low number of Canadian heterosexuals with AIDS (13%) as evidence against HIV's sexual transmissability. This is a cumulative total, but last year over 40% of reported cases were acquired by heterosexual transmission, which is more than in gay men. HIV figures indicate a steady rise in the percentage of heterosexually-acquired HIV, 29% of the total in the last 5 years, and 37% in 2003, close to the percentage of infections in gay men(1).

It seems rather strange to decide whether one accepts an infection as being sexually transmissable purely on the basis of its prevalence or incidence in a particular epidemiological subgroup. I presume Bartlett does not regard syphilis as not being communicable either? It certainly canít be in the UK anyway Ė most of those who get it here are gay men, not heterosexuals.

(1) vsac1203/pdf/haic-vsac1203.pdf

Competing interests: None declared