AIDS in the Age of Sex

GUESTS: Drs. William H. Masters and Robert C. Kolodny
VTR: 4/30/1988

I’m Richard Heffner your host on The Open Mind. …where essentially we’re interested in understanding new ideas (or old) – as presented – not in disputing their etiology or evaluation their research protocols. Others far more qualified do that all the time. But this is a program about ideas, and ideas don’t need credentials.

So that today marks the second time in recent months that it seems to me wiser by far, more productive, and surely more appropriate to our abilities to deal with a controversial publication on its own terms, cutting through the most intense and widespread public criticism of its research techniques to its central thesis instead, letting it stand or fall only as it seems to the rest of us to make good sense…or not…whatever its origins.

Now a quarter of a century ago, William H. Masters and Virginia E. Johnson startled Americans with their volumes on Human Sexual Response and Human Sexual Inadequacy, excursions into behavior that really only the Kinsey studies had dared before. Controversial then, they they are again now, with a Grove Press book, Crisis: Heterosexual Behavior in the Age of AIDS, Dr. Masters is my guest today along with his collaborator, Dr. Robert C. Kolodny.

Gentlemen, thank you for joining me today. Clearly the controversy over Crisis is something that we can’t set aside and I wanted to ask you, Dr. Masters, why in your estimation has a crisis arisen over such an obvious crisis, as you delineate in your book?

Masters: Well, I think the great difficulty is that, as a matter of fact there’s several difficulties that one has to emphasize. In the first place this book goes against tradition, public health tradition, in moving to present facts to the public that aren’t particularly secure or…the facts are secure, but the…we’re concerned about the effect on the general public. The basic premise has always been that you don’t really…you have to be awfully careful not to put too much in terms of concerned information to the public because there’ll be panic in the streets. Now we don’t happen to believe that.

Heffner: You don’t believe that there will be panic in the streets…

Masters: No.

Heffner: If this information is sent forth?

Masters: No. no, we don’t. We think the public is entitled to know.

Heffner: Well, isn’t there a difference though between feeling that the public is entitled to know, and judging that panic will not ensue. Maybe both things are true.

Masters: Well, the answer is, of course, that’s perfectly possible. I can’t argue that. The whole thing is done as a matter of personal opinion in any event.

Heffner: What do you mean?

Masters: Well, the basic premise of not fully informing the public is a matter of personal opinion, there’s no law stated that this is the way to go. It’s been a tradition but Bob Kolodny knows more about this than I do, really.

Heffner: Dr. Kolodny?

Kolodny: I guess what we’ve tried to do, in part, in our book is to point out the areas of scientific uncertainty, rather than to point out everything that’s known because if there is any lesson to be learned from the seven years of this epidemic of AIDS that we have dealt with so far, it’s that as each year passes, what was accepted as received wisdom and fact, changes. Back in 1982 and 1983, for instance, the scientific community was very convinced that this was an infection only transmitted homosexually or by needle sharing. Today, of course, we know that’s no longer the case. We were convinced that, at first, there was only a single variety of virus. Now we know that there are more than one type.

Heffner: You know, I’m surprised. I would have assumed that the scientific community was made up of…well, let’s say of “possibilists”. Those who understood that possibilities are so numerous and yet you’re suggesting that they don’t want to deal with these possibilities.

Kolodny: Well, no. this raises a very interesting philosophical question. The scientific community is, indeed, filled with people who have been brought up to recognize a multiplicity of possibilities and to realize the limits of the scientific method. What Dr. Masters was talking about and what concerned us in writing this book…is that that degree of uncertainty, which is inherent in most forms of science, has not been conveyed to the general public. The public for whatever the reason, and we certainly don’t know the motivations of all of the public health experts, of all of the politicians, of all of the institutions involved in this, but in the last year in particular, the public has been told over and over again that we know more about this epidemic and we know it with more certainty than we really do.

Heffner: I hope it isn’t unfair of me to ask this, but I would ask both of you if you were to look at the brighter side of this posture that you’re describing, what proper motivation could you ascribe to those who are denying, vociferously, that there is a crisis and who are attempting so…with such great efforts to undermine any thoughts that you might put in our minds about that.

Masters: Well, I think we have to remember that almost all the statistics we have and present and discuss, not only in this book, but generally, with the exception of nose-counting in terms of the actual cases of AIDS, these are “guesstimates”. There’s no question that there’s no absolutely secure information as Bob was pointing out. And so what we have to do is do the very best we can to present what we consider the actual situation and obviously we’ve come up with different concepts.

Heffner: But when you’re feeling your most benign, what would you…what would you assume is the positive side of the argument of those who say, “No panic. No crisis. Don’t play upon people’s concerns that way”.

Kolodny: Well, let us say first that we also would not want the panic to occur. But I guess our position is that we attribute a little more intelligence to the reading public than those people, who if we ascribe that benign motivation, would say are deliberately withholding certain information on the basis that with that information about scientific uncertainty or even, in some cases, scientific fact, to get out, it would provoke panic. We don’t think that’s the case. Let me use a specific example. Last year the Public Health Service, the Red Cross, and a number of other important institutions were, in an effort to deal with the crisis in the blood banking industry, reassuring the American public, using very uniform language that the chances of a contaminated unit of blood slipping through the screening process was virtually nil.

Heffner: And that wasn’t true, was it?

Kolodny: That the blood supply is virtually safe. In fact, the estimates then were, by the scientific community, that perhaps one in a quarter million transfusions was contaminated and slipping through. That would mean, with the number of transfusions we have each year, some seventy cases a year of AIDS contaminated blood getting through. In our calculations, which were simply theoretical and not by going into blood banks and measuring, but taking what we know about the limits of accuracy in the testing lab and so forth, we computed that this figure was far too low and we wondered why it is. And we don’t know still why it is that such a reassurance of safety was given. Just at the time our book came out, interestingly, the government revised its figures and said that there are, in fact, almost ten times as many cases of contaminated blood slipping through as they had been saying last year.

Heffner: What are the practical consequences of not taking the point of view that you gentlemen do in this book?

Masters: Well, perhaps the best example we can give you is what happened to the homosexual population. You must remember that the crisis years for the homosexual, the bisexual, population in this country, were from ’77 on, ’78, ’79, ’80, ‘81.

Kolodny: That was before anyone knew that than epidemic was going.

Masters: Yes. We happen to think that the crisis years of the heterosexual population are just at hand. ’86 perhaps, at the earliest, ’87, ’88, up to ’91 or ’92.

Kolodny: Here’s the bottom line. If we’re wrong that there is a crisis brewing in terms of changing trends in this epidemic, then there’s no problem. We hope desperately that we are wrong. But if, for a minute, we look at the other side of that coin, if we are right that there is an incipient crisis going on, and the scientific community is not measuring it properly, for reasons we can discuss, then we’re talking about something that is not just an inconvenience, as for instance, general herpes, not just a disease that’s treatable by a shot of penicillin, as gonorrhea or syphilis, but a disease that as far as we know it today, is rather uniformly fatal. The stakes are high.

Heffner: But, Dr. Kolodny, that’s a question I’ve asked myself when people on this program have been very negative about any crying out about heterosexual contact and AIDS. To myself, well, what’s the downside of being concerned? And I haven’t been able to come up with a satisfactory answer except that there are those who say, by focusing on heterosexual transmission, one looks away from and takes resources away from areas where governmental intervention can be more successful. The expenditures of money in the drug-using community. How do you evaluate that thesis?

Kolodny: Well, it’s a difficult question as long as the government holds the number of dollars to be spent n research and prevention and treatment to a low level. We would advocate a broader view of the crisis, not only in the United States, but on a worldwide basis and say that the stakes are so high in this pandemic, this worldwide pandemic, that governments across the world must increase their spending by orders of magnitude in order to effectively address each arena. And we would certainly not favor withdrawing support or withdrawing research from one sector that very badly needs it, from the drug community, from the gay community, from the bisexual spread or from any of the other more specialized groups such as the hemophiliacs and so on.

Heffner: But hasn’t that been the concern of the editorialists?

Masters: The answer’s yes. That has been the concern. But if we do anything with this, if we at all can get the message through, then obviously, as Bob says, not only must one, more money be appropriated, more money will be appropriated.

Kolodny: This is a case where if we don’t plan realistically now, the economic consequences and the costs…

Masters: Just incredible.

Kolodny: …to provide care, after the fact, is going to be ten, twenty or a hundredfold greater than it would be to apply the funds now to seek out a reedy. Not necessarily in terms of a cure, but a remedy in terms of containment. Here’s the practical reason for that. In the gay community, in a country such as ours, where you have, relatively speaking, only a small percentage of the population, the numbers from any point of view you look at it, although a human tragedy to be sure, but the numbers are relatively self-contained by the size of the community. If this epidemic does, in fact, break out into the heterosexual community in a way analogous to what happened in the gay community in ’82, ’83, ’84, we will be seeing many, many millions of additional cases at a cost of how many billions of dollars we couldn’t know.

Heffner: You say “if”. I gathered from reading Crisis that basically your thesis is not “if” but that “it is happening”. Is that a fair statement?

Masters: Yes.

Kolodny: It is breaking out now.

Masters: Yes, that’s a fair statement. We have no idea of the dimensions of the…pulling the finger from the dike, , we really don’t know that. Nor does anybody else. As a matter of fact the thing that bothers us more than we can say is that there have been no definitive studies done, epidemiologic studies. There are none.

Kolodny: The government has inexplicably not sponsored a nationwide prevalence study amongst heterosexuals to determine in 1988 or 1987 what is the extent of infection.

Heffner: Well, now you said a moment ago, you said twice in fact, talking about motivation, reasons, “Well, that’s something we could discuss”. I want to discuss that. Why do you feel and what is the reason that you could offer for dragging heels at this particular point in this particular area? Is it because it has to do with human sexuality?

Masters: Well, that’s what the book’s all about…human sexuality.

Kolodny: That certainly is o part of it. I think one part that we’re probably not the right people to answer, but I would wager the guess that had a different Administration been in power, during the time that this began, in the early years of the AIDS epidemic, there might have been a different posture taken.

Heffner: But I’m talking…I’m talking about the press. I’m talking about a non-Reaganite press that seems to be horrified that you have, in your book, put such an emphasis upon heterosexual spread of AIDS.

Kolodny: Well, it is not so difficult to understand because what we say in our book is that the Federal authorities are underestimating what is happening. Not only among heterosexuals, but in the gay community or the broader community as well. We point to the fact that by their own estimate, the Centers for Disease Control undercounts the number of cases by at least twenty percent by their own admission. We say it’s probably more like fifty percent. They go to the Federal experts and say, “Who’s right?”. It’s unlikely that those Federal experts will say, “Well Masters, Johnson and Kolodny are right” because their jobs are at stake. So, if we’re talking about motivation, we’re talking in part about that type of credibility. Those are the people we put on the hot seat by the statements that we make.

Heffner: Dr. Masters your long experience with questions of human sexuality, in terms of the responses to your earlier books, turning back another generation, are you sanguine about the possibility that the message that you deliver in Crisis will be understood, adopted and acted upon in time for this threshold of heterosexual spread of AIDS?

Masters: As long as this stands alone, without any other people joining the party – I don’t mean we haven’t had support, because it’s been tremendous from the scientific community, but I mean writing and appearing and that sort of thing…as long as this stands alone then I’m not very sanguine about it. It has to be supported.

Kolodny: The public is told in many editorial pages, “Relax,…”

Heffner: Yes.

Kolodny: …there is no problem”. And let’s explain to you audience exactly why that is. The Federal authorities are, by and large today, keeping track of the epidemic by counting cases of AIDS, the disease. Now that’s fine and that’s important as one aspect of what we need to do. But because the time from infection with this virus to the appearance of the disease averages five to six years, counting cases of AIDS tells us what was happening in 1982 or 1983, not what’s happening in 1988. We suggest that rather than being blinded by the case-counting method, which is always looking backward over your shoulder, based on a number of fragmentary studies, to be certain, and what we and other experts know about the nature of sexual behavior, which we can talk of, clearly this virus is spreading to the partners of IV drug-users, to the partners of bisexual men and from there it’s spreading to other people, sexually. Unless we watch the trends now and do something today to prevent what’s happening, five years from now we’ll finally come to recognition of what was happening today.

Masters: Then we’ll have a chance to count all the AIDS cases.

Kolodny: And then it will be too late.

Heffner: Then you are talking now about testing, aren’t you?

Masters: Yes.

Heffner: How widespread?

Kolodny: Well, testing is really only a partial solution and it’s a solution that we think does play a role. But we’re talking something more than that. We’re talking about a change in mindset. I’ve referred to the editorials that say, “Relax. This isn’t a problem. Cases of AIDS are staying in the original high-risk groups”. We’re not talking New York City, for instance, where in a number of surveys of pregnant women have this virus today. Women in their reproductive years. This is a problem that has gone beyond the original high-risk groups. Not that the same thing is happening all over the country because New York is, unfortunately, ahead of other parts of the country in most ways in this epidemic, but it gives us a warning it’s a harbinger of what will be happening elsewhere. Today, for instance, there are seventeen cities in the United states that have as many cases of AIDS as San Francisco had three years ago. That’s a scary fact.

Heffner: Dr. Masters, as one who has again observed the field of human sexuality for so long, how sanguine are you that in this particular area, with this particular disease, sexually related as it is, that we will do the things and make the progress that you want us to do and make?

Masters: I’m equivalent on the subject. I desperately hope that this message gets across. We’re doing our best to see that it does. This is not a particularly popular role, as I’m sure you can imagine. Bob pointed out very clearly that we desperately hope we’re wrong. Our great concern is that we’re afraid we might be right, or at least, to a significant degree.

Kolodny: But we are afraid that too simplistic solutions are being offered to the public. For instance, the notion that you can protect yourself by using condoms is not a scientifically very sound thing. We know that just as a contraceptive device, condoms have a ten to fifteen percent failure rate. And…

Heffner: But better to use them than not to use them…

Masters: Oh yes.

Heffner: …in terms both of contraception and the spread of AIDS, wouldn’t you say?

Kolodny: Better to use them than to expose yourself to total risk, but better still to be selective enough in choosing the sex partner that you’re with that you take all prudent steps, including being tested, if there’s any question in your mind.

Masters: Let me give you an example of what we’re really talking about. For instance you don’t hear very much…we’re concerned with the spread of AIDs in the heterosexual population. You don’t hear very much about the use of prostitutes. And yet this is a tremendous source of spread of the virus.

Kolodny: And yet, public health authorities are not speaking out and warning the general public that prostitutes are probably triply unsafe because of their frequent IV drug use, not to mention their frequency of sexual contact.

Heffner: Which is why I asked whether this is the case because of the historically sensitive nature of sexual exchange in this country. Is that the double whammy that we’re suffering from here?

Masters: I think we have an advantage. I know we have an advantage compared to a quarter of a century ago. People can talk about sex. It was very rare that there were programs on sex on television in the fifties or sixties as you’re more aware than we were. But we can talk about it, we can discuss ways and means of protection. We can talk about the grave concerns of prostitute visitation, as just as I did, and it’s acceptable material to present. We have a chance to better educate the public. Now, so far, the education from my point of view, attempt to educate the public with AIDS, has been basically a failure.

Kolodny: But there is a precedent with what was done by public health services at the Federal and state level in the late thirties and early forties in fighting the syphilis epidemic of the times. Where stringent educational measures, testing measures were implemented, that did certainly make a different in stemming the tide. The difference is that, so far in this epidemic, virtually no public health measures have been brought into play. And we think until that happens it will not convince the general public of the seriousness of what’s happening in terms of the risk to the average person.

Heffner: I keep coming back to this major question. You say, Dr. Masters, that in the fifties the disadvantage was that one didn’t or couldn’t very easily talk about sexual matters in public, on the air certainly. And I do understand that. The Open Mind was involved with efforts to keep us from doing so. But a generation and a half later, a generation of freedom, of sexual freedom, how sanguine can you be that a people used to doing what it wants to do sexually is going to be able to discipline itself. I had the sense that you’re willingness to talk about Crisis is an indication that you know perfectly well that unless people are scared to death, they’re not going to change these patterns.

Masters: No, they don’t have to be scared to death. They have to be educated with a broad background of basic information. They have to be educated with a sense of continuity of authoritative opinion, rather than a multiplicity of different ideas, different presentations.

Heffner: But they’re not going to be, are they?

Kolodny: Well if…

Masters: Yes, I think there’s a good chance of that if this really serves as a breakthrough.

Kolodny: It is possible of course, for fear to be a motivator…

Heffner; Fear is the spur.

Kolodny: …and when that fear is a realistically based fear, not of some trivial issue but of something that could be fatal, it may give people reason to re-think decisions that they would otherwise make on some other grounds. And if that can be conveyed by public health authorities, if that can be conveyed to young people as well as middle aged people and older people and if we have the additional benefit that we have today, of a far more advanced scientific armamentarium to factor into the equation, we may have a chance to stem the tide.

Masters: We’re not going to stop it…

Heffner: Are you going to take bets?

Masters: …we’d like to slow it down.

Heffner: Dr. Masters, are you going to take bets, seriously. How sanguine are you…

Kolodny: We’re not optimistic right now because it seems that both the Federal government and the powers-that-be are content to let this thing play out on its own as they have been all the way through this epidemic.

Heffner: And the longer it plays out on its own…

Masters: The more danger we have.

Heffner: And the less controllable it is, or stoppable.

Masters: No question about that. That’s what scares us too…us significantly.

Heffner: Well, it used to be we’d think that fame is the spur but seriously my assumption would be that fear is the only spur and I suggest that that’s why you call your book Crisis. Is that unfair?

Kolodny: Not really. Crisis has a specific medical meaning, a turning point in the nature of medical events. A patient with pneumonia, for instance, who develops a crisis either gets better or goes downhill very fast. We think that in the face of this epidemic the nature of what’s happening is at a critical juncture right now and what we do in this country and on a worldwide basis in the next year to two years will determine what happens for the next twenty-five.

Heffner: We literally have no time left, but the question I still would want to ask is, are you taking bets on whether we do or we don’t meet this crisis.

Kolodny: This is a case, Dick, where you bet your life.

Heffner: Well put, Dr. Kolodny. Dr. Masters, thank you so much for joining me today on The Open Mind.

Masters: It was a pleasure.

Heffner: And thanks, too, to you in the audience. I hope you’ll join us again next time. And if you care to share your thoughts about today’s program, please write to THE OPEN MIND P.O. Box 7977, FDR Station, New York, NY 10150. For transcripts send $2.00 check or money order. Meanwhile, as another old friend used to say, “Good night and good luck.”

Continuing production of this series has generously been made possible by grants from: The Richard Lounsbery Foundation; the M. Weiner Foundation of New Jersey; the Mediators and Richard and Gloria Manney; the Richard Lounsbery Foundation’ and the New York Times Company Foundation.