As long as the epidemic didn't touch anyone close to them, many Americans found it easy to put AIDS out of mind. For all the suffering and pain and lives cut short, it just seemed like someone else's problem. AIDS was something that happened to ghetto dwellers, drug addicts or gays, not to middle- and upper-class folks who limited themselves to straight sex.
Now it's harder to ignore AIDS. When Magic Johnson stepped forward to announce that he had tested HIV positive, his plight suddenly seemed like everybody's nightmare. Johnson's claim that he picked up the AIDS virus heterosexually, rather than through intravenous-drug use or homosexual contact, dramatically raised some of the most crucial health questions of the 1990s: How easy is it to get AIDS from straight sex? How fast can it spread? Could an AIDS epidemic like the ones sweeping through Third World nations take root in the general U.S. population as well?
According to the latest figures from the Centers for Disease Control, the risk to most American heterosexuals is still small, but it is real and growing. About 11,000 reported AIDS cases -- or less than 6% of the 200,000 Americans afflicted over the past decade -- have arisen from heterosexual contact. But while the number of heterosexual cases is relatively tiny, it jumped 40% last year, faster than any other category. As many as 1 million Americans may be infected with the virus that causes AIDS but not yet suffering from the disease. And no one knows how many of those people were exposed heterosexually.
The epidemic has hit the U.S. in three waves. The first occurred among homosexual men and is now leveling off. The second swept through pockets of IV-drug users, especially in certain East Coast cities, and has yet to reach its peak. The third wave is just taking off among heterosexual men and women who have had sexual contact with one or more of the high-risk groups. The question now is how far -- and how fast -- it will travel into the rest of the population.
One cause for concern is that heterosexual transmission is the rule, not the exception, in most countries affected by the disease. Figures released by the World Health Organization last week show that 75% of the people who have the AIDS virus worldwide were infected heterosexually. In Africa, where one-tenth of the world's population accounts for half the estimated 10 million AIDS infections around the globe, heterosexual transmission is responsible for more than 8 out of 10 cases. In Southern and Southeast Asia, where the epidemic is growing more rapidly than anywhere else, heterosexual contact is also the dominant mode of transmission. Among the prostitutes in Bombay's red-light district, 25% to 30% are HIV positive. In the poorer sections of Nairobi, Kenya, infection rates among prostitutes run higher than 90%.