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Saturday, December 29, 2007



There is little doubt that aids infection is rapidly spreading throughout Africa. Many countries and individuals have donated time, resources, and millions and millions of dollars to solve the problems of so many infected people. We feel sorry for those individuals, especially the children, so many of whom are orphaned because their parents have died of the disease.

But, we are completely unable to stop the spread of the disease. Aids is spread by several ways. One of the major ways in the US is the sharing of contaminated needles by drug users. Of course, the main way is via practicing sex by anal intercourse. This is probably the way it was spread during the early phases of spread of the disease, especially among the gay population. Initially heterosexual penis-vaginal sexual spread was rare. But strains of the aids virus have emerged which are now contributing to heterosexual spread. The reason why penis-anal sex results in transmission of aids is because employing this sexual method causes minor tears in the rectal area. The aids virus is not a hardy virus and cannot survive external elements. Fresh blood contact is required for easy transmission. Bleeding gums can be a potential method of transmission in the case of oral sex.

It must be realized that anal sex is still probably the chief method of transmission especially in Africa. The World Health Organization has recognized this problem but has been powerless in educating Africans about ceasing the sexual practices which result in aids. Anal sex is quite common in Africa not only between adult-adult sexual contact, but also among adult-children contact. It is a sad state of affairs, but it is the reality in many parts of Africa.

AIDS WILL EVENTUALLY BE THE BLACK PLAGUE OF MODERN TIMES. The incidence of aids has continued to rise since it first appeared upon the scene. Although medicines have kept people alive, some a few years, others for longer periods of time, it will never be the cure. Once in awhile there are apparent spontaneous cures, but these are rare when we consider the totality of those infected. Luckily, the virus requires very close contact of mucosal tissues as in the case of sexual contact. And herein lies the secret to control of the spread of the disease.

Since Aids cannot be cured, it must, therefore, be prevented. Individuals must cease anal sex or use condoms which provide a physical barrier between mucosal tissue contact. Education of the masses to change a common behavior will be very difficult . In my experience, education of the masses has never been an effective means of control of any disease. Historically, most infectious and contagious diseases have been controlled by instituting good public health practices. In the early part of the past century, the enteric diseases, such as the dysenteries, cholera, and salmonella, were eliminated by separating the water supply from sewage. Tuberculosis was prevented by insuring that the herds of cattle were clean of TB because the major spread of TB in the US was due to drinking contaminated milk. Isolation of TB infected individuals was another very effective means of control. Later with the advent of antibiotics, such as streptomycin and isoniazid, we had a method of treatment. Let us not forget that TB was once considered the “White Plague” and it killed many people, among which were probably Mozart and Chopin. It spread through Europe and led to the creation of the Sanitarium where many infected individuals went to rest which was the only method known whereby people could cure themselves.

In the early to mid 20th Century vaccines were developed for those diseases amenable to such an approach: the bacterial infections of tetanus, whopping cough, diphtheria; the viral infections of polio, measles, mumps, German Measles, etc.

There were still other diseases where good public health measures aided in control of the disease. I remember in the 1950's and 60's when a person was diagnosed with syphilis, public health officials would painstakingly seek out all contacts of an infected individual to put them on penicillin treatment. The key to the prevention of many diseases was to isolate the infected carrier away from the uninfected population. At one time, even drastic measures were taken by public health officials to isolate a carrier. One only has to think about the eventual fate of the infamous Typhoid Mary. Mary Mallon used to work as a food handler in NYC restaurants. There were several outbreaks of Typhoid Fever attributed to Mary because she was a Typhoid carrier. She was ordered not to work as a food handler. But more small Typhoid breakouts occurred and Mary was found to be the culprit. There were many deaths from typhoid fever. Since Mary continued to ignore the public health officials Mary was confined to the NY City prison where she eventually died. BUT, this will not happen with Aids. Why?

Because Aids has entered the political sphere, and when something enters the political arena, science and common sense goes out the window. One only has to think of the global warming debate to appreciate this. The political sphere is akin the an economist who states that on the one hand this is the case but on the other hand that is the case. This prompted President Truman to quip that he would like to have a one armed economist. The political sphere is controlled by lawyers and lawyer-types who will argue both sides of an issue even when there is only one side.

Isolation of a carrier has been an time-honored method for the control of the spread of contagious diseases. Aids will NEVER be controlled or eliminated unless either the carrier is isolated by the carrier practicing so called “safe sex” or the carrier is removed from the susceptible population. We have tried to educate the aids carrier to practice safe sex and it has worked minimally in an educated population. This is further complicated by the spread of the disease through contaminated needles. In Africa education has not worked because the low level of education and understanding precludes such an approach.

Aids will continue to be the scourge of modern times and eventually will do such havoc that we will be forced to institute more drastic control measures. The virus is a very smart virus. It essentially infects the very cell needed to develop an immunity to the disease. Additionally, as the virus exits the cell it takes a part of the individual’s cell membrane with it so the body is unable to recognize it as foreign. The virus eventually wins out in the battle between it and the body to survive.

In my opinion, an aids vaccine most likely will not work. Not all infectious agents are amenable to vaccine treatment and protection.

The African aids problem will continue to be a problem of enormous magnitude. The virus has found a population where it is winning the battle for survival and will continue to do so for many years to come.

nicola michael c. Tauraso, M.D.
Director, Tauraso Medical Clinic



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