The Number 11 Killer AIDS   

Because a promiscuous Magic Johnson has the AIDS virus, why scare John and Jane Doe, whose chances of catching it may be remote?

Scary wire service story came bouncing into my newspaper's computer system recently. The slug was "Killer Garages." The article said that over the past decade 48 Americans had been killed by automatic garage door openers.

That seemed like a lot of people to die in such a strange way. On the other hand, when I looked further into the ways people die, I discovered that during the same 10-year period about 1,000 Americans had been killed by lightning, and another 150 or so had died when planes fell out of the sky on them. So, as tragic as it was that anybody had been killed by an automatic garage door opener, a little research revealed that the chances of dying in that manner are incredibly remote.

Many newspapers probably ran that story without bothering to assess how severe a threat garage door openers pose in comparison to other hazards. We journalists aren't very good at conveying to readers, viewers and listeners that we live in a world of relative risks. And we're not good at putting those risks in their specific social, economic, political or medical contexts.

Because of deadline pressures and our need to carve the broad spectrum of human events into bite-sized nuggets, we dish out a slice here, a chunk there. We keep it simple, tight and palatable. As a result, especially with complex science stories, we often transmit accurate facts but misleading impressions. Our failures in this regard can have enormous impact on public policy and private behavior.

Take, as a recent and conspicuous example, the press coverage of Magic Johnson's revelation that he carries the human immunodeficiency virus (HIV), which precedes AIDS. This was a big story, and it was covered intensely. Every paper and television report I saw pointed out that AIDS – acquired immune deficiency syndrome – has killed more than 128,000 Americans since 1981. That number, however, was reported in the usual vacuum. Almost nobody pointed out that the death toll from AIDS during the past decade has been low compared with the deaths caused by cardiovascular diseases or cancer or diabetes or even drunk drivers.

Few of our readers, viewers or listeners realize that. After 10 years of the most intensive reporting ever lavished on any human ailment, the public remains stunningly uninformed about the relative risk of AIDS.

The federal government plans to spend roughly $2 billion in fiscal 1992 to combat AIDS, which equals the $2 billion it will spend to battle cancer. The $1.13 billion it will spend on AIDS research alone this year dwarfs the $844 million allotted for cardiovascular disease and stroke research. That's a noteworthy statistic when you consider that cardiovascular ailments including stroke and hypertension kill more people each month than AIDS is projected to kill this year. Cancer kills more people every six weeks than AIDS is projected to kill this year. Twice as many Americans died last year in auto accidents than died from AIDS; roughly the same number committed suicide.

The federal Centers for Disease Control (CDC) has estimated that 215,000 of the more than 1 million Americans infected with the HIV virus will die during the next three years. During the same period, 2.6 million Americans will be killed by cardiovascular diseases and another 1.5 million by cancer.

Most of our audience has grasped the reality that AIDS is a horrible ailment that causes immense human suffering and despair. But does the public understand the scope of that suffering when compared with that created by more common causes of death? In a May 1991 Gallup Poll of 1,014 Americans, respondents who were asked, "What would you say is the most urgent health problem facing this country?" identified AIDS as a greater threat than cancer by a 3-to-1 margin. They believed AIDS was a greater threat than heart disease by a 23-to-1 margin.

Why do they think that? Because that's the message they've received from the news media.

The odds are that most people are unaware that the CDC recently estimated that new cases of AIDS could remain constant for the next few years after reaching a minimum of about 60,000 per year. Roughly 49,000 Americans with AIDS are expected to die this year and an additional 53,000 in 1993. As tragic as those numbers are, they're still considerably less than the annual toll from pneumonia and influenza, also contagious ailments.

How is it that so much money is being spent to combat an ailment that kills so relatively few? It has happened in no small measure because of a remarkably successful media campaign waged by AIDS activists. They understood from the beginning that a large segment of the public believes that homosexuals are degenerates and sinners, and that intravenous drug users are even worse. Bigots and small-minded hypocrites wouldn't shed so much as a tear if AIDS were to wipe these people off the planet. Having identified their target audience, AIDS activists then worked hard and with amazing effectiveness to convince Americans that the risk of contracting the virus was not closely related to sexual or drug use habits.

Take, for example, an advertisement that I first saw in the New York City subway. It showed a young woman with a grim expression saying, "I remember my mother's advice. I never go out without my rubbers." Or the TV ad that features a young woman and states, "Anyone Can Get AIDS. Anyone." The ads, of course, were designed to persuade people to protect themselves against AIDS by using condoms. They were also something more. By featuring women as typical potential victims, the AIDS prevention advertising was designed to scare the hell out of everybody. It worked. The words "safe sex" fall freely from the lips of formerly swinging singles. Celebrities go on television to assure everybody that AIDS doesn't discriminate against heterosexuals.

By omitting specifics on relative risks, the message that got across was one of substantial, more or less equal, risk for everyone. The equal-opportunities theme was aided enormously by the flawed ways in which we in the media cover the news. In Albany, New York, the leading hospital staged a press conference featuring what hospital officials presented as two typical AIDS patients. One was a gay male, a member of the group that accounts for about 66 percent of AIDS cases, the other a woman who had contracted the HIV virus solely through heterosexual sex, a member of the group that accounts for about 3 percent of AIDS cases.

Later, New York state would begin a program of AIDS education for children as young as five years old. The state also recommended that doctors perform state-funded, $6 blood tests on every person they saw who had sex outside a monogamous relationship or had used IV drugs. And this at a time when soaring health care costs were deservedly a topic of growing public concern.

We in the media did what we always do. We reported these developments as they unfolded. We also, at least in the early stages, refrained from reporting what was at the time the primary mechanism for spreading the disease: anal intercourse. Most of us felt those words were too impolite for our audience. Instead of taking every opportunity to emphasize this key bit of information, we used euphemisms such as "exchange of bodily fluids" or "intimate sexual contact," which served to educate no one. Or, if we put "anal intercourse" into one AIDS story, we would carefully put it on an inside page or avoid it altogether in follow-up stories.

As a result, children who became infected through blood transfusions came to be portrayed by omission of content as typical AIDS sufferers.

Saddest of all, however, many people whose lifestyles put them at greatest peril continued high-risk activities for months or even years after those activities had been identified by health authorities as deadly. Why? For the most part, because journalists were more worried about being polite than truthful.

Many editors and reporters are past that now. We're clinically specific in most cases. But we still fail to place our AIDS stories in a larger, more meaningful context. Virtually none of us covering the Magic Johnson story effectively explained that AIDS, for all its horror, is only one risk in a world of far greater risks.

We are, by the way, guilty of this all the time, especially with articles involving percentages. How many times have you heard or read that 50 percent of U.S. marriages end in divorce? It's not true. Yes, the number of divorces each year is about half the number of marriages that same year. But that's like computing the death rate by comparing the number of people who die with the number of people who are born. That ignores those who neither were born nor died during that 12-month period. The 50 percent divorce figure ignores the number of intact marriages from earlier decades than the divorce-laden 1970s and 1980s; the truth is that about one in 50 marriages ends each year, according to the National Center for Health Statistics. Pollster Louis Harris maintains that 90 percent of marriages survive until one partner dies.

Another example: Most of our audience realizes that smoking is the leading cause of lung cancer. We've told them that repeatedly. But few know than only 10 percent of smokers ever die from lung cancer, according to the National Institutes for Health. In fact, only a quarter of all smokers ever die from anyillness linked to their habit. We've almost never told them that.

The examples are endless. Look at our recent concentration in the Magic Johnson stories on the growth of AIDS among heterosexuals who don't use IV drugs. The percentage of AIDS cases attributed solely to heterosexual intercourse has jumped 40 percent since 1989, according to the CDC. But that percentage hides the raw numbers involved: fewer than 3,200 of the Americans diagnosed with AIDS last year obtained the HIV virus via that route. Our stories have failed to communicate to our audience that male victims such as Magic Johnson who say they could only have contracted the disease through heterosexual sex are but 3 percent of the total number of persons with AIDS. (Among both genders, it's 6 percent.) And nobody knows how many of these men are telling the truth. We still live in a society where people have good and sufficient reason to lie about homosexuality and IV drug use.

The reality, painful though it may be to people concerned about discrimination against gays and the poverty-stricken minorities who make up the bulk of IV drug users, is that AIDS in the United States remains overwhelmingly confined to members of those groups and their sexual partners.

Those who are affected solely through blood transfusions, including hemophiliacs, make up no more than 3 percent of the AIDS population, and such infection is now considerably less likely with the safeguards put into place to protect the blood supply. As for contracting HIV from your dentist, you're in much more danger from your automatic garage door opener.

Despite the erroneous impressions left by our decade-long body of reporting, the reality is that for most Americans, cancer and heart disease remain far greater threats than AIDS. The CDC estimates that more than a million Americans presently have the HIV virus; the American Cancer Society estimates 76 million people now living will develop cancer. One in three Americans will eventually die of cancer. And among the leading causes of death among Americans – including cancer and cardiovascular diseases – AIDS ranks 11th.

These numbers all prompt the question: Why is the medical establishment cooperating with AIDS activists in trying to convince the general population that we're all at substantial risk from the worst epidemic since the Black Plague?

The answer is that medical researchers are lobbying, as they should, for more money to develop vaccines for HIV and a wide variety of other viruses. The medical industry understands that the public money and political commitment necessary to wipe out HIV would be harder to come by if AIDS were to be widely perceived as anything other than a looming threat to everybody.

That's why Magic Johnson and the quality of our coverage of his story is so important. Other celebrity AIDS victims such as Rock Hudson and Liberace contracted the virus through homosexual relationships. Johnson, however, says he is among that minority of men who caught it from a woman. He has said that he never engaged in any homosexual act. Nobody to my knowledge has asked him publicly whether he ever took intravenous drugs.

As things stand, however, Johnson is the current face of AIDS to most of America.

It's almost a dictate of American journalism that editors and reporters focus uncritically on the victims of suffering. Many of us got into this business because we wanted to present people with the truth and prompt them to do the right thing for the oppressed, the less fortunate and the wrongly reviled. As a result, most journalists report on what a horrible disease AIDS is and on how devastating it has been. With a few exceptions, the press has reported the political debate over AIDS research and treatment largely in terms of how more money might be shaken free to fight this killer.

Most journalists simply haven't applied to the AIDS story the same standards we would apply to, say, defense spending. So most Americans are certainly unaware that the country spends more to fight the No. 11 killer than the No. 1 killer. Or, to put it another way, the federal government will spend at least 20 times as much to prevent each AIDS death in America this year as it spends to prevent each death from stroke or heart attack.

Too many reporters and editors have treated AIDS only as an isolated medical story, ignoring the reality that this is also a story of cultural and political conflict, filled with the usual distortions we should expect in such stories.

None of this means that society shouldn't put as much muscle as it can into finding a vaccine that would relegate HIV, like the polio microbe, to the history books. The evil of AIDS is not its risk to the general population but that its victims are disproportionately young and disproportionately poor. Though both cancer and cardiovascular diseases each kill more people under 50 than AIDS, it's also true that cancer, strokes, heart disease and pneumonia generally kill older people. AIDS too often cuts short the lives of people in their prime.

And AIDS is devastating black and Hispanic communities in many inner cities, with heterosexual contamination on the rise. If many Americans are relatively safe from AIDS, that is hardly an argument for turning our backs on the epidemic that israging in some neighborhoods. We owe it to our sense of human decency and dignity to fight it ferociously. "Safe sex" measures have their obvious validity against all levels of risk.

On the other hand, we have an obligation as journalists to relate the facts to the entire spectrum of human experience. Advocates, whether AIDS activists, tobacco industry spokespeople, cancer lobbyists or party politicians, routinely distort reality to achieve their ends. The partisan's role in our political system is to sell a point of view with blind devotion. The proper role of the journalist, though, is to examine the competing claims of advocates, to assess to what extent those claims conflict with reality and then tell the truth as best as it can be determined. That's why, in reporting on AIDS, it's useful to remember this:

Magic Johnson's illness is a tragedy, but so was the death of Gilda Radner, who died of cancer. And the reality, when you talk about death rates, is that for every AIDS victim there are 19 Gilda Radners. For every AIDS victim, there are two James Deans who die in car wrecks, a John Lennon who's murdered or a Marilyn Monroe who commits suicide. For every AIDS victim, there are 29 Elvis Presleys who die of cardiovascular disease.

There is no reason for people to be unduly fearful of personal vulnerability when their chances of contracting the AIDS virus are remote. And there is no reason for Americans to be as misinformed as they are about the relative risks of AIDS versus other ailments.
 
 

Annual U.S. Deaths

 1. Diseases of the heart: 725,000 (34% of deaths)
 2. Cancer: 506,000 (23%)
 3. Stroke: 145,000 (7%)
 4. Accidents, including auto wrecks: 94,000 (4%)
 5. Respiratory diseases: 89,000 (4%)
 6. Pneumonia/influenza: 79,000 (4%)
 7. Diabetes: 49,000 (2%)
 8. Suicide: 31,000 (1%)
 9. Murder: 26,000 (1%)
10. Liver diseases: 26,000 (1%)
11. AIDS: 24,000 (1%)

Source: National Center for Health Statistics, 1990 estimates (latest available). If CDC estimates of a minimum of 49,000 deaths in 1992 and 53,000 deaths in 1993 are accurate, AIDS would rise to 7th. From January through October 1991, 16,233 Americans died of AIDS.