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Most experts attribute the prevalence of heterosexual AIDS transmission in Africa to widespread venereal diseases such as syphilis and chancroid. These diseases cause sores and infections that make it easier for the virus to pass from one person to another -- a problem exacerbated by a medical system that is shockingly inadequate. Gonorrhea rates in Africa are as much as 20 times those of the industrialized West, and yet there are one-sixtieth as many doctors per capita as there are in the U.S. A case that would be treated promptly in a young American is likely to become chronic in his African counterpart. "After a couple of weeks, the person gets used to it and resumes having sex," says Dr. Myron Essex, chairman of the Harvard AIDS Institute. In crowded African urban centers, the virus has become ubiquitous, threatening to kill off almost an entire generation of young adults.
Few experts believe anything like that is going to happen in the U.S. Most Americans do not have the venereal diseases that make it so much easier for the virus to be transmitted through heterosexual intercourse. The general level of hygiene, the relative isolation of the pockets of infection from the rest of the population and the widespread availability of treatment for sexually transmitted diseases, even among the poor, make it unlikely that an African-style epidemic could sweep across America.
But the U.S. does have trouble spots: the largely African-American and Hispanic ghettos in the East. Widespread needle sharing among drug addicts allowed the AIDS virus to get a solid foothold in major U.S. cities in the 1980s, and now practices such as trading sex for drugs threaten to broaden the problem. AIDS is already epidemic in the poorest neighborhoods of New York City, Newark, Baltimore, Washington and Miami, places where social problems and the lack of good medical care mimic Third World conditions. "The fact that we see sexually transmitted diseases rising in our inner cities is an ominous sign," says Helene Gayle, an international AIDS expert at the Centers for Disease Control.
There are already indications that AIDS fostered in the inner cities may be beginning to creep into outlying areas. In parts of Georgia and Texas, mini- epidemics are appearing. "The fastest growth is in rural areas and small cities," says Sten Vermund, chief of AIDS epidemiology at the National Institutes of Health. Investigators suspect that drug users who contracted AIDS in the city have started to move back to their hometowns, either to be cared for by family members or to try to straighten out their lives. Once there, they may start a chain reaction of local AIDS infections.
But while health officials caution against complacency, they emphasize that < there is no need for most people to panic. The fact is that unless a person has a chronic venereal disease -- or engages in a high-risk activity such as needle swapping or anal sex -- the AIDS virus is not that easy to get. Medical literature is filled with cases in which husbands and wives had sex hundreds of times over several years without passing the virus from one to the other.