One of the more striking AIDS advertisements in the renewed campaign to heighten public awareness of the menace is headed “Most parents suffer from AIDS” and goes on to urge parents to “talk, plead, shout, cry” but not to “suffer in silence” about their teenage children’s chances of contracting the disease. It makes the claim that if a teenager’s latest girlfriend or boyfriend has shared needles, “They would [sic] pass the virus on through unprotected sex”.

This is a highly tendentious claim which, accompanied by the suggestion that parents should encourage their children to “simply not have sex at all at this stage”, suggests the public health agenda has been hijacked, to a degree, by neo-puritan ideology.

It also raises many important questions about how decisions are made about priorities in AIDS prevention and control. It asks, in particular, why authorities are persisting with expensive strategies aimed at the low-risk population when, for example, only four people are now employed as Outreach counsellors to cover the hundreds of public toilet beats in the state where thousands of men, many bisexual, meet every day to have anonymous, often unprotected sex.

How infectious, then, is the HIV virus? Studies of the seroconversion rates of the regular heterosexual partners of HIV-infected bisexual men, intravenous drug users (IVDUs) and haemophiliacs have come up with answers that may surprise many people. A study of 93 women published in JAMA, the Journal of the American Medical Association, estimated that a woman having 100 or more episodes of unprotected intercourse in a year with an infected partner has about a 31 percent chance of acquiring the virus, a much lower infectivity rate than occurs with hepatitis B, herpes and other STDs. Others have estimated from this and other partner studies that any single act of intercourse without condoms with an infected person has about a one in 500 chance of passing on HIV.

But what about the odds with “one-night-stand” sex with someone with no high-risk history? Estimates based on data from the USA, where the incidence of HIV is higher than in Australia, suggest that the chances of a heterosexual acquiring the virus during one sexual encounter with someone undiagnosed as having HIV is one in 5 billion. When fatalities from bee stings run at one in 5 million, such odds are hardly suggestive of a major health crisis requiring multi-million-dollar scare campaigns.

What, then, about the argument that the pool of infected heterosexuals is slowly building, but hasn’t yet reached a critical mass that will cause it to explode and rapidly spread the virus? A later review of heterosexual infection published this year in the journal AIDS states that “new infections in heterosexuals, acquired either through intravenous drug use or heterosexual contact, are not increasing at the rates observed among cohorts of homosexual men and IVDUs during the early 1980s”.

The review states that of 8,810 heterosexual AIDS cases reported in the USA to September 1989, 83 percent occurred among intravenous drug users and 7 percent among the heterosexual contacts of people at risk, primarily female sexual partners of male IVDUs. This leaves 10 percent – some 880 individuals in the USA – who may be true members of the so-called third wave of transmission: those who have caught the virus from a sexual partner twice removed from a primary infection.

Even in this case, there is much doubt about the authenticity of people’s reports of their not being in a high-risk group. The report states: “Although some of these cases may represent secondary or even tertiary heterosexual transmission, most are found to be IVDUs or sexual partners of men at risk” when they are more intensively interviewed and investigated. The review concludes that among identified cases, the proportion that may represent unrecognised heterosexual transmission has remained relatively constant for men and women since 1986.

In Australia, despite regular prophecy that the incidence of HIV will skyrocket and that recorded cases are only the tip of the iceberg, all available indicators suggest that the incidence in the overall population is low. For example, from May 1985 to 30 June 1988, 2,662,593 separate blood donations were made in Australia. Twenty HIV-positive cases were found in this group, representing eight cases per million donors. The Australian rate decreased from 0.004 percent in 1985 to 0.00004 percent in 1987, probably reflecting the voluntary withdrawal of infected donors from the donor population. All military recruits have been screened in Australia since late March 1988. Between March and June of that year, 5,000 people were screened; none was found to be seropositive.

Experts themselves are largely guessing about the extent of HIV in the population. By the end of March this year, the cumulative total of notified cases stood at 12,552. Yet in 1988, 35 Australian epidemiologists were asked to estimate the likely prevalence of HIV in the Australian population. Estimates appearing in press reports had ranged up to nearly 100,000. The figures I have cited are easily accessible to anyone acquainted with the voluminous scientific literature on AIDS and are yet to be coherently disputed by anyone other than those carrying alarmist or sexually conservative baggage.

The tone and wording of the current AIDS campaign thus raises important questions about why official policy on AIDS education appears willing to condone rampant exaggeration and unfounded scare tactics. Whenever this criticism has been raised in the past, the response from people like the former federal minister of community services and health, Dr Neal Blewett, has been to argue that it is better to be accused of scaring people needlessly than not taking the epidemic seriously enough. Certainly, there is plenty of anecdotal evidence that a significant section of the population is scared of contracting the virus.

The goal of AIDS education efforts should be to give the public a realistic sense of the seriousness of AIDS and what is involved in its prevention. But AIDS publicity also appears to have done a great deal more than inform the population about the fundamentals of the disease. It has aroused considerable unwarranted anxiety in a large section of the population and has either spawned or reinforced socially divisive and hostile attitudes about gay men, drug users and even children who have been infected.

Serious and coherent challenges are now being made to the wisdom of continuing to direct AIDS control messages to the whole population, a large proportion of which is at negligible risk, instead of more intensively targeting the high-risk groups to which the disease appears to be confined in Australia. Given the disturbing extent of hysterical and exaggerated perceptions of AIDS, and of potentially socially divisive attitudes, these challenges should prompt AIDS-control authorities to consider whether the means (scaring the population unnecessarily) can continue to justify such stigmatising and neurosis-producing ends. Not least among these ends may be the unforeseen legacy of the distortion of public perceptions about the size and nature of the AIDS problem on future efforts to have the public at large show concern for issues where they really are at distinct risk.