Abstracte
Fantacci, G., Koch. M.G.: The fight against drugs. Can Switzerland serve as an example? Perspectives of comparative epidemiology
The Swiss model and its drug policy is being referred to globally. The heroin trial project for heavy drug addicts has caused a stir. What does the drug policy look like in Switzerland, how many drug addicts are there? Could drug trafficking be reduced by the heroin trial? Could the heavily drug addicts be helped? The authors realise, according to the official figures and on account of a comparison with Europe, Sweden and the USA, that the Swiss way is not successful. The permissive Swiss drug policy led to an escalation of drug consumption, particulary with young people. This way the clientele was made for the next decades. No indications are being found (convictions against drug law, amount of drug seizures), which would point to a reduction of the drug scene. The figure of drug deaths increases with the tolerance of open drug scenes and decreases with the drug scene combated by the police.
Koblet H.: Testing for HIV infection in time: scientific reasons
The author advocates testing, diagnosis and therapy of HIV infection as soon as possible after contracting the virus and whenever feasible. The arguments are deduced from the results of basic research. The following should be reduced, delayed or inhibited: (1) the viral load in blood plasma and semen; (2) rapid internal progagation of the virus, which is combined with integration of proviruses into cells of unknown life span and compartmentalisation (e.g.the brain may present a sanctuary site); (3) rapid individual formation of quasispecies out of initially homogeneous virus strains of suboptimal fitness, combined with the transition of NSI strains to the more aggressive SI strains and escape from the immune response and therapy; (4) irreversible damage to the immune system; later opportunistic infections;(5) unconscious transmission of possibly drugresistant virus. Early diagnosis and therapy appear possible in many cases, involving major advantages for individuals and society.
April. K. Köster R.: Transmission Among Heterosexual couples
Report
Since the beginning of the 1980s it has been known that HIV is heterosexually transmitted. At present we know that this mode of transmission is the most common worldwide. But we still know little about the factors promoting or preventing heterosexual HIV transmission.
In a prospective multicentre study of the European Study Group focusing on heterosexual HIV transmission (1), 304 HIV-discordant heterosexual couples (index person = HIB positive, partner = HIV negative) werde observed at 10 hospitals in 8 countries of the European Community for an avertage period of 20 months. HIV tests were carried out every 6 months on the initially HIV-negative partners and standardised interviews and (non-standardised) counselling werde conducted.
48 of the 304 couples terminated their secual relations within 3 months of study entry and were not included in the evaluation, 82 couples terminated their sexual relations in the further course of the study. 256 couples maintained sexual relations at least three months after entry into the study (observation period: 22 months (median)). Of these 256 couples, 163 were male index persons and 93 female. 245 offered information on condom use. Of the latter, 167 had becomme infected through intravenous drug abuse, 29 through heterosexual contact, 27 through bisexual contact, 10 through transfusions, and the mode of infection is unknown in 12 index persons. Of the 254 couples, only 124 (48,4%) stated thet they had used condoms each time they had sexual intercourse. No seroconversion took place in this group (95% confidence intrval (CI): 0 to 1.5 per 100 person years). 121 couples admitted not having always used condoms, 61 on least every alternative occasion they had sexual intercourse and 60 rarely or never. 12 seroconversions (4.8 per person years, 95% CI: 2.5 to 8.4) took place in this group. The 11 couples who refused to divulge information on condom use manifested no seroconversion.
Persons always using condoms admitted to a lower frequency of sexual contacts, less oral and anal sex and fewer acts of sexual intercourse during menstruation than the couples who did not always use condoms. However, the number of cases was too low to perform multivariate analysis.
On comparing the persons in the group of inconsistent condom users who had seroconverted to those who had not, HIV transmission to woman did not differ significantly from that to men. The transmission risk increased signifacantly as the HIV infection stage progressed and in the presence of genital infections in the HIV-negative partner. Sexual intercourse without intravaginal ejaculation significantly reduced the transmission risk.
Comment
This study represents one of the first prospective investigations of HIV transmission among HIV-discordant heterosexual couples. It was therefore possible in this comparatively very well designed study to obtain significant positive or negative correlates for the resk of transmission for the following factors: condom use, HIV infection stage, genital infections and sexual intercourse without intravaginal ejaculation.
This study has been occasionally cited as proof of the very good protection provided by condoms against HIV transmission. But its relevance has been undoubtedly overestimated. This unjustified optimism may be attributable to the fact that the authors themselves generalise the conclusion drawn from the Abstract stating that consistent use of condoms offers a high degree of protection against HIV transmission during heterosexual intercourse. On the other hand, they postulate in the discussion and in a reply to a reader's letter that the study disposes of a low statistical power and that the findings should not be generalised for heterosexual HIV-discordant couples. The editorial and a readers' discussion, also point out, inter alia, the folowing further methodical shortcomings, which in some cases cannot be avoided but which detract from the authenticity of the study: the case history data are based on statements made by the subjects and have not thus been verified by objective means. Neither is a guarantee given for the monogamy of the couples; inteed, a newly acquired case of syphilis infection hat been noted. The number of sexual contacts was not taken into consideration: the non-condom users engaged in sex twice as often as the condom users. Had this been considered as a factor, the difference in the frequency of HIV transmission would no longer be significant.
An issue which is of such central importance to the health of the population should not be evaluated on the basis of a sole study. Current reports in the literature indicate ahat condoms reduce the HIV transmission risk by about 70% or by the factor five. To evaluate a preventative method, it is not only the quality but also the acceptance that have to be considered. Afer all, only half of the subjects regulary employed condoms in this high-risk situation (known HIV infection of one partner).
The question as to whether, in view of the poor acceptance ans the protective action of condom usage, more reliable preventative measures should not be recommended must be pondered: "careful partner selection" for those looking for a partner, "fidelity" when both partners are HIV negative, and "abstinece" for HIV-discordant couples.
April K. Köster R.: AIDS a leading cause of death among young adults in Switzerland. Schweiz. Med. Wochenschr. 1994; 124: 2119-2122
Analysis of Swiss mortality statistics reveals that from 1980 to 1992 AIDS has become one of the leading causes of death among Swiss women and men aged 25 to 44 years. In 1992 77% (n = 414) of all AIDS-related death cases (n = 540) were in this age group. In the mortality statistics of men aged 2544 years, AIDS (n = 307; death rate = 27.8/100,000) was found to be in third place after accidents and suicides. Among women aged 2544 years, AIDS (n = 107; death rate = 9.9/100,000) was second after cancer. In spite of the inadequate epidemiological data position in Switzerland it may be suspected that in a few years AIDS will be the leading cause of death for both sexes in this age group in Switzerland.
Steinke W., Barben J., Delmore G.: The reactions of Swiss Health Policy to the HIV/AIDS Epidemic. AIDS-Forschung. 1994; 9: 7-17.
Switzerland, the European country with the second highest number of registered AIDS cases per capita (following Spain), demonstrates some remarkable features in coping with the HIV/AIDS epidemic. The WHO claims that the Swiss anti-AIDS campaign is exemplary, but a closer examination shows considerable deficits in HIV control. Traditional rules of coping with an epidemic, i.e. localisation of sources of infection, transmission routes and speedy intervention, are only applied inconsistently and by chance. This is contrary to the current law concerning epidemics. In 1983 Swiss physicians were asked via a bulletin of the Federal Office of Public Health (Bundesamt für Gesundheitswesen, BAG) to report all AIDS cases. But this did not become mandatory until December 1987, and the reporting of names was expressly excluded, although this is indispensable with other infectious diseases. Since spring 1985, the Swiss confirmation laboratories have reported all HIV-positive results (18,266 cases registered until August 31, 1993). The actual number of HIV-infected persons in Switzerland is therefore still unknown and cannot be reliably estimated, as not even anonymous unlinked testing (AUT) an undisputed method concerning confidentiality has been introduced. Partner notification and contact tracing a reliable and efficient way of controlling epidemics are not recommended by the authorities in Switzerland due to problems involving individual rights and privacy. Certain lobbies (mainly homosexuals) have successfully managed to establish their own policy of maintaining a special status for HIV disease and to pursue gay politics under the cloak of AIDS prevention. The Swiss Physicians Association (FMH) states in a strategy paper (November 1989) that HIV infection should be dealt with following the approved principles of epidemic control. This is in clear contrast to the AIDS-Hilfe Switzerland, a non-governmental organization founded by 14 homosexual groups, responsible together with the BAG, for the official «Stop-AIDS Campaign.» Also the physicians association AIDS Information Switzerland (AIDS-Aufklärung Schweiz), founded in 1989, has developed a strategy, uninfluenced by any particular lobby and calling for an end to HIV exceptionalism - i.e. a prevention approach based on adequate epidemiological surveillance, monitoring, and intervention.
The Stop Aids Campaign – The Pinnacle of Scandal in Switzerland
by Msg. Professor Arthur F. Utz
In a recent publication entitled "ärzte für HIV-Prävention" (Medical doctors for HIV-Prevention), about four hundred respected doctors, who have formed themselves into an Association for the distribution of information on the HIV infection (hereafter AAS), have published their findings on the Swiss Stop AIDS Campaign. This solid publication deserves our attention; these doctors must be congratulated on their courage. All reasonable people have rightly been outraged by the obscene posters instructing passers-by how to enact sexually deviant practices without risking infection. Those responsible for this poster campaign were clearly unconcerned about considerations like conjugal fidelity. Everybody knows that appeals to the Swiss public on moral grounds have no effect, but are we on that account merely to show people the easiest ways of pursuing a life of sexual perversity without infection? The doctors behind this critical publication have chosen the purely medical/scientific approach. However, on the basis of this purely scientific approach we arrive at moral behaviour patterns which are inescapable, and which should not be despised even if one's only concern is to avoid infection.
AIDS AND HOMOSEXUALITY
AIDS is caused by the HIV virus. It is a sexually transmissible disease which apparently began to spread three or four decades ago. In 1981 this fatal disease was first identified in a few American homosexuals. That is no coincidence, since promiscuity and 'sex tourism' are characteristic of homosexuals in every Continent. This 'epidemic motor' for spreading sexual infection thus ran at maximum revs. So it came about that in the western world the promiscuous homosexuals constituted the most vulnerable group, from which the epidemic was spread. Among homosexuals there was considerable consternation focused on three main fears:
- the fear of dying of this fatal disease
- the fear that they might lose their recently hard-won political rights and status as well as their social recognition as 'The Third Sex',
- the fear of losing their sexual freedom - that of unconstrained promiscuity.
Throughout the world the fact that it were homosexuals who were the most affected was to become the overriding factor in AIDS prevention measures. By the end of the Seventies the homosexuals were already organised in interest groups. These left or extreme-left orientated interest groups immediately decided to go over to the offensive and exploit AIDS as a weapon in the political struggle for more rights. In the USA this strategy was crowned with success. Homosexuality in the eyes of the American public is not merely 'chic'; the homosexual lobby is strong and plays a significant part in elections. We only need to think of how the current President Clinton used his acceptability to the homosexuals as part of his election propaganda.
THE HOMOSEXUAL LOBBY IN SWITZERLAND
In Switzerland the homosexual lobby seems to be at least as influential as that in the USA, but its power is concealed. Whoever infringes it or merely exposes it is immediately accused by the homosexuals of discrimination. Teachers and doctors in Canton Zurich who have spoken out have been harassed in the pursuit of their professions. This is possible because in Switzerland there are many homosexuals in leading positions in government and the media. One area which the left/homosexual lobby uniquely dominates is that of Swiss AIDS health policy. How has it come about that a small group has been able to achieve such influence? The Federal Government from the start neglected to tackle AIDS. The left/homosexual working groups worked out an HIV Prevention Plan for homosexual men. Fear of AIDS made many homosexual men susceptible to the ideological influence of the New Left. In this situation the left wing of the homosexual movement was able to exert decisive political influence.
LEFT WING POLITICS IN THE GUISE OF AIDS PREVENTION
In 1985 fourteen Swiss homosexual groups amalgamated to become "Aids-Hilfe Schweiz" (AHS). Most of the core groups of AHS are steeped in the tradition of the '60s student revolts. Founder members of AHS were among others Roger Staub (Homosexual Workgroup Zurich, presently AIDS delegate for Canton Zurich) and Herbert Riedener (author of the perverse booklet "Safer sex for Leathermen"). 'AIDS prevention' was simply a camouflage. The real aim of the AHS groups was to strengthen their political influence and to make the gay lifestyle socially acceptable. Accordingly Christian Schneeberger, member of the Swiss Aids section of AHS, said, "My commitment in the AIDS campaign is the continuation of gay politics by other means". AHS deliberately parts company with social values and elevates for example promiscuity as practised by homosexual men to the status of normality. In just the same manner Michael Häusermann (Director of AHS) takes as a measure of the success of AIDS Prevention not the state of knowledge among the general population about HIV prophylaxis but the extent to which "a high percentage of the Swiss population knows the answer to the question, 'What is a gay man?"' (Quoted from his lecture to the Swiss Conference of Education Directors, Berne, 7th Sept 1990). Fidelity and lasting relationships are not put forward as socially desirable. The left wing of the Swiss gay movement suggested as the motto for AIDS Prevention: 'The least possible change of sexual orientation through reduced risk'. (Safer sex, not safe sex). The strategy is clear: sensible preventive measures are opposed and decried as discrimination against gays. Protection of healthy people is less important than the right of (infected) homosexuals to free sex (using condoms). The AHS, up to now dominated by homosexuals, determines the overall AIDS health policy.
FEDERAL MINISTRY OF HEALTH AS GOLDEN DONKEY?
The AHS was able to extend its power and influence chiefly because an acknowledged and influential institution - the Federal Ministry of Health (Bundesamt für Gesundheitswesen, hereafter BAG) - took on AHS as its single and exclusive partner in the AIDS prevention field. Under the guidance of its then Vice Director, Dr B. Somani, the BAG handed over the responsibility for instituting an AIDS prevention plan in Switzerland to AHS, and provided the necessary funds. Eventually the Ministry amalgamated with the AHS, a step quite without precedent. Thanks to the goodwill of the BAG, AHS has in effect a free hand to conduct the campaign, which was closely modelled on the one which the founders of AHS had worked out in 1986. It comprised three planks:
- popularisation of preventive practices,
- safer sex,
- 'talking things over together' - adapting the recommendations to individual practice.
TAXPAYERS' MONEYS FOR THE AHS'S "FOREIGN POLICY"
Internationally, AHS is in cahoots with affected groups such as Act Up. Act Up groups, particularly in the USA, but also in some European countries, have already often distinguished themselves by their perversity and their use of terror. During the VIth International AIDS Conference in San Francisco Act Up activists threatened to pelt the police with HIV-infected blood if they moved against them. Larry Kramer, a founder-member of Act Up, expressed his attitude as follows, "I am of the opinion that the time is ripe for the use of force... I personally would have no stomach for it, but I would gladly see an AIDS terrorist army, like Irgun..." (translated back from the German). AHS regularly conducts joint actions with such organisations. In 1991 Act Up organised a demonstration against the American AIDS Health Policy in front of the American consulate during the VIIth International Aids Conference in Florence. In this action some three or four dozen activists from AHS took part using the official Stop AIDS bus. How came AHS to be using the Stop AIDS bus, paid for by the Swiss taxpayer, to demonstrate against the USA in a foreign country? And who paid the travel and living expenses of the AHS activists? Protests to the Federal Ministry remain unanswered. Does AHS incite the Act Up activists to acts of vandalism? At the IXth International AIDS Conference in Berlin in 1993, Act Up occupied and demolished the French Government's information stand, that of the Pharmaceutical firms Hoffmann-La Roche and Astra, and also that of the AAS, the Association which we have to thank for our information on the background of AHS. First there were leaflet campaigns by AHS and AIDS-Info Docu and People With AIDS. These private Swiss organisations slandered AAS and demanded that it should be excluded from the Congress. Two days later Act Up promised direct action against AAS, interestingly word for word repeating the accusations used by AHS in its leaflets. After the media had hung about expectantly for two hours the AAS information stand was brutally destroyed. Who put the American and Malayan Act Up activists up to their hate campaign against this association of Swiss doctors, of whom they had previously never heard? These are the methods used by the Swiss homosexuals, whose activities transcend the country's borders. Some participants at the Congress expressed the suspicion that AHS used Act Up, as the most powerful arm of the movement, for its own purposes. In any case, neither AHS, nor Aids Info Docu nor PWA have distanced themselves from Act Up's act of vandalism. It is hard to conceive that organisations which represent Switzerland abroad and are 90% financed by the taxpayer should behave in such a way. The demand for exclusion from a scientific Congress is against all scientific thinking and democratic behaviour. For the homosexuals science is clearly only of importance insofar as it supports themselves. In this connection be it remembered that the National Congressional Interpellation - based on information supplied by AAS - as early as 1991 demanded that the BAG should break off its relationship with AHS. It is high time that the Federal Government and also the Cantons should honour these demands and should finally stop financing the AHS, thus also saving the money, handed out to this organisation.
AAS finances itself entirely out of private contributions from its members. The fact that some 50 000 small contributors support the AAS every year proves that it is appreciated by the people, even though it is pointedly ignored by official bodies.
The book mentioned in the first paragraph is:
" Ärzte für HIV-Prävention – AIDS-Aufklärung Schweiz 1989-92"
114pp, CH-Zurich 1993, ISBN 3-905085-16-X
Address:
AIDS Information Switzerland
PO Box 26
CH 8610 Uster 1
