Guest essay

Teaching Responsibility in the Age of

There is no cure, but there is a way to contain the epidemic. It begins with knowledge.

By Cary Savitch, M.D.

One woman becomes infected with AIDS every
12 seconds worldwide.

babies were born HIV-infected last year.

adolescent becomes infected in the world every 10 seconds.

We could fill the Rose Bowl in the next week with new cases of HIV.

Cary Savitch was training in infectious diseases at San Francisco General Hospital in 1980 when he began seeing the first cases of AIDS: Men with "Gay Bowel Syndrome" (a myriad of intestinal infections), and deathly ill gay men with an uncommon pneumonia.

Dr. Savitch was already knee deep into this deadly epidemic, but without the slightest clue. HIV would be discovered four years later, but the havoc created by this tiny retrovirus was already underway. Over the next two decades 50 million people would become HIV-infected and the death toll would climb to 8,000 per day--with no upper limits in sight.

Today Savitch speaks mournfully of the multitudes of AIDS patients he has seen--and the now-infected spouses or partners of those he's cared for in the past. A recent study from Brown University points out that 41 percent of those HIV- infected do not alert their sexual partners. It is no surprise that 50 percent of the women who are HIV-infected had no clue they were at risk until the day they were diagnosed.

"I am considered an expert, yet I have saved no one," says Savitch. "Anyone newly HIV-infected will meet the same fate--a painful death. The cure rate locks in at zero. The benefits of the drug cocktails are exaggerated and the expectations always exceed benefit. The miracle AIDS vaccine may never arrive. Our only hope in containing this disease and saving lives is through sound public health measures--and we are squandering that opportunity."

Fifty-two communicable diseases are reported by name. HIV, the most deadly communicable virus, is off this list in California, Pennsylvania, Massachusetts, Georgia (the Centers for Disease Control's own back yard), and in a number of other states. "Public health officials are testing the political waters when they should be protecting the health and safety of this nation. Partner notification is in shambles," says Savitch. "The lack of leadership to control the AIDS epidemic is a national disgrace. Our children deserve better."

Savitch has organized a community response to this epidemic. He is a co-founder of Beyond AIDS (www. "Our mission is to contain the AIDS epidemic though sound and compassionate public health policy;' he says. "We are doctors, nurses, public health officials, infected, noninfected, gay, straight, right-wing, left-wing--it doesn't matter. We support confidential HIV screening and name reporting to public health officials. In the U.S. we are already 400,000 people deep (dead) into this epidemic. Beyond AIDS supports the medical and social needs of those who are HIV-infected, but we also expect those who are infected to conduct their lives with honor. Is it asking too much of someone not to spread this disease and take the life of another?"

In the concluding chapter of his new book, "The Nutcracker Is Already Dancing" (Teague House Press; $23.95), AIDS specialist Savitch speaks to his own three children:
Jessica, Rhett, and Teague.

Dr. Laura Perspective

April 1999

1. Daddy loves you. That never changes.

2. It is difficult to be happy when you are sick. Stay healthy. People with AIDS are very ill. They need help in living and in dying comfortably.

3. Everyone dies: you, me, mom, even those not yet born. The life cycle is bigger than any of us. Your lives are for you to create. Don't be afraid, just be careful.

4. You will hear a lot about AIDS statistics. Never forget that behind each number is a real person. Many of these people died too young, never allowed to reach life's full potential.

5. AIDS is not God's vengeance. It is an infectious disease caused by a virus. You are responsible for your social behavior. Sexual preference does not protect you from AIDS.

6. Not everything you hear about AIDS is true. Even what I tell you may not be correct in the future. Stay informed.

7. The Golden Rule is for all time and all circumstances. Treat others as you would like them to treat you. Trust no religion or organization that is not consistent with this simple rule. This applies to AIDS--you do not want anyone to infect you with AIDS; you do not want to infect anyone else with AIDS.

8. Your health is precious. Its value is best measured when gone. AIDS is caused by a virus that will never leave your body. It always kills. There will be no cure in your lifetime. Unlike cancer or heart disease, it is spread from one person to another. Put another way, everyone who is infected was infected by someone else. There is a chain of dying and suffering that you do not want to be part of.

9. If any of us should ever acquire HIV: I expect we'd all help each other through this tragedy. Your brothers and sisters extend beyond our immediate family.

1O. Society is fast losing compassion. The human race is being driven by money and greed. For HIV-infected people this turns a difficult life into a miserable existence. Be spiritually motivated.

11. Don't be afraid to be tested for HlV virus. In the event you are infected, you must know it. Get early treatment and counseling. We, your parents, also want to know and be involved. No secret pinkie swears!

If the entire world finds out, so be it. People who don't inform their family and friends often suffer the most. They also contribute to the stigma of HIV

12. One thing is worse than being infected with HIV--to infect someone else. The human suffering suddenly doubles. You will not survive, and now one more person will die unnecessarily. Transmission is preventable. Your behavior must change if you become infected; your life becomes different. You are potentially very dangerous to others. Millions of people have died or are dying of AIDS because ofthe behavior of others. Lovers are killing lovers. Accept the fact your life has changed. Maintain your integrity. People will be more willing to assist you if they believe you would do nothing to harm them.

I agree 100 percent with Cary Savitch about the necessity
of full disclosure in this ghastly epidemic. Parents, read this book! --Dr. Laura

Accept the fears of others at face value. They don't want what you have.

13. As long as you remain HIV-negative, never expose yourself to bodily secretions from someone who is HIV-positive or from a person whose HIV status you do not know. Make no exceptions. Even brushing your teeth creates abrasions that can allow this virus to enter your body. One mistake and your life is turned upside down. This epidemic is expanding! Any random exposure today carries a higher risk for HIV exposure than it did yesterday or anytime in the past. Ten thousand new people around the world become infected every day, each one by someone else. Don't play Russian roulette, especially with more bullets than blanks.

14. If any of you children become HIV- infected, keep your bodily secretions to yourself. They are never to be shared by anyone who is HlV-negative. Your blood is dangerous. Your saliva might be blood-contaminated. In my opinion, saliva by itself might be very dangerous. No French kissing or passionate kissing.

Do not share razor blades, tooth brushes, or other instruments of hygiene. Be honest about your HIV status. Your status is someone else's business if you engage in any activity that endangers someone else's life.

15. Safe sex is no sex with anyone HIV- positive. Safe sex is no sex with anyone whose HIV status you do not know. The same goes for sharing saliva. Some proclaimed educators (who are not your parents) may disagree.

16. Unprotected sex with someone testing negative and whose background you are familiar with is safer than condom protected sex with anyone whose HIV status is positive or not known. The failure rate of condoms resulting in pregnancy is 1 to 2 percent per month. Ten million infectious viral particles can fit through the same microscopic tear that a single sperm can squeeze through. Don't bet your life on a condom made of vinyl, latex, or steel. Always know the HIV status of your partner.

17. There is a vulnerable window period during which an HIV test may not yet indicate infectivity. This is the period of time it takes the body to develop detectable antibodies. Beware! A negative HIV antibody test is not a 100-percent guarantee of safety. As this epidemic progresses more HIV-infected people may be in this early window phase of disease.

18. Life comes without a warranty. Do as I suggest and you can still get HIV- infected. An inadvertent needle stick, a blood splash, an unpredictable dental exposure, and rape are continuous risk factors. These risks increase as the epidemic intensifies.

19. If you should be so unlucky, never hide your HIV status, never pass the virus to someone else...never pass the virus to someone else...never pass the virus to someone else....

20. Daddy loves you. That never changes.


Cary Savitch is Assistant Clinical Professor of Medicine at UCLA. His book is available through bookstores, through on the Internet,

or by calling 800-729-3636.

You can contact Dr Cary Savitch via


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