Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: MONDAY, February 11, 1991                   TAG: 9102110268
SECTION: EDITORIAL                    PAGE: A-8   EDITION: METRO 
SOURCE: CHARLES J. SCHLEUPNER, M.D.
DATELINE:                                 LENGTH: Medium

DANCER WITH AIDS POSED NO THREAT TO OTHERS IN BALLET COMPANY

In confidence, the dancer had informed the director of the Southwest Virginia Ballet of his infection because of the possibility for his need to "pace himself" during rehearsals. The story also said that the ballet's artistic director violated this confidence by informing two teen-age girls (who were performing with this individual) and their parents of his infection.

Subsequently, the infected individual was forced to withdraw from the ballet because of fear on the part of these parents or the girls that he would transmit his infection to others.

A letter Jan. 4 by Roger and Carol Foutz raised a question concerning the potential for transmission of HIV-1 infection by routes other than sexual contact, sharing needles for illicit drug use, accidental needle-stick or from an infected mother to a child in the womb. They cited the fact that 3 percent of cases of AIDS have an undetermined mechanism for transmission and added that "all the facts concerning the contagious nature of AIDS are not totally known."

This letter unfortunately reflects the innate biases that surround attitudes of a number of people concerning this disease and its transmission. While I agree that these parents have every right to make a choice to protect their children from what they perceive (incorrectly) as a risk, it would have been much more appropriate for the parents involved in this performance to withdraw their children from the ballet rather than ask the infected individual to withdraw.

However, there was no need for any of these actions. The concerns stated in the Jan. 4 letter were totally unfounded. Not mentioned is that the proportion of individuals for whom the mechanism of transmission is not known has declined from approximately 6 percent a number of years ago to 3 percent presently. As more and more of the supposedly unknown mechanisms for transmission are investigated, we find that individuals initially misrepresented their apparent lack of risk.

Additionally, the figure concerning unknown mechanisms for transmission will never reach zero because a number of individuals have died before they could be interviewed about their risk. Those individuals continue to be part of our statistics. A number of individuals also have been totally lost to follow-up and cannot be questioned about their mechanisms for transmission. They too are still counted among those with an unknown mechanism for transmission, along with those who initially misrepresented any risk they had. The statistics we have collected over the past 10 years clearly and consistently reflect the mechanism for transmission of this infection. Sexual contact, be it homosexual or high-risk heterosexual, is the major mechanism.

However, the trends clearly indicate that intravenous drug abuse is assuming a more dominant role in transmission because homosexual transmission has clearly declined. There has never been a documented episode of transmission by any form of casual contact (for example, dancing with another individual, living in the same household or even sharing eating and drinking utensils).

Careful studies of the potential for transmission between brothers and sisters in the same home when one of the children is infected have never demonstrated transmission. The one example of apparent transmission of HIV-1 infection from a dentist in Florida to a female patient may have resulted from unsafe infection-control practices in his office. If so, it would be consistent with our understanding of how this disease is transmitted and argues only for re-enforcement of infection control practices already recommended in the hospital setting and in medical or dental offices.

The attitude of the parents of the girls who refused to participate in the ballet with the infected dancer and the attitudes reflected in the Foutz letter are clearly inappropriate and unwarranted. Until our society recognizes what may be behind many of these fears (a bias against individuals whose sexual preference is different from their own, or a bias against individuals who abuse intravenous drugs), we will clearly not be able to function as a truly free society, a society where individuals respect an individual's personal rights insofar as they do not restrict another person's rights.