AIDS Phobia

AN EPIDEMIC OF FEAR

Dr Raj Persaud

Despite the attention devoted to AIDS, a related epidemic has gone unnoticed, variously termed by doctors as AIDS phobia, AIDS panic, pseudo AIDS, AIDS stress, AIDS hysteria or AIDS anxiety. It consists of unfounded fears of having contracted AIDS, incorrect beliefs as to how HIV is transmitted, producing bizarre attempts to avoid the illness. American Psychiatrists have even suggested the acronym FRAIDS or fear of AIDS.

Some recent examples in Britain include: - a man who regularly immersed his penis and feet in undiluted bleach after entering public toilets; a young girl who gave up her piano lessons because she was convinced there was infected blood on the key board since her tutor's wife worked in the blood transfusion service, the AIDS phobic's lips were raw from continually being wiped, in case she had got someone else's spit on them; a woman who bathed only in darkness to avoid finding AIDS lesions on her skin; a man who operated all household gadgets with a sterile wooden stick to avoid catching AIDS from any surfaces; yet another man stopped eating and drinking altogether for fear of ingesting the HIV virus.

Meanwhile in the USA: - a New York postman refused to deliver mail to an AIDS public health office as he feared catching the disease from their letters; hairdressers have refused to cut the hair of AIDS victims and clergy asked AIDS sufferers to stay away from church for fear of infecting the congregation.

Since all these people are physically completely healthy they are the 'worried well'. Research among university students found 24% thought AIDS could be picked up from toilet seats, 14% were convinced it could be caught from trying clothes on in a store, while 10% believed money touched by AIDS victims was contagious.

The term pseudo AIDS is used because these worries produce anxiety and depression, which are associated with physical responses similar to AIDS symptoms, like weight loss, night sweats, malaise, lethargy, loss of appetite and headaches! These features reinforce the erroneous belief of AIDS infection.

It could even be argued that stringent guidelines set out by the Department of Health last week, where health authorities must now inform patients who received treatment from HIV infected medical staff, is just such an example of AIDS phobia.

8000 people directly linked with the three recent cases of doctors suffering from HIV infection have been tested - but none of them has yet been found to be infected with the virus. National AIDS phobia may explain the vast sums we spend on AIDS to the neglect of other serious medical problems. Emeritus Professor of Public Health at Glasgow University, Gordon Stewart, complained recently in the press that the 700 million the UK has spent during the past decade on AIDS research, was ten times that spent on cancer. In 1988, AIDS hysteria produced dire predictions of the future - Government committees forecast that by now there would be up to 40,000 AIDS sufferers, instead the total is actually 7,000 cases in Britain to date.

However, to be diagnosed genuinely AIDS phobic, the required symptom is irrational avoidance of AIDS - yet this seems an implicit paradox - can it ever be illogical to go to extremes to elude deadly diseases?

AIDS fear produces hyper-vigilance - a characteristic response to any fearful situation. This leads to a 'better safe than sorry' - 'you can't be too careful' approach which has served our species well historically, otherwise we would not have survived to write articles complaining about AIDS phobias. In fact fear is a vital evolutionary legacy that leads to threat avoidance; without fear, few would survive long under natural conditions.

However there is an optimal amount of fear - too little produces carelessness, too much and we are so paralyzed that performance deteriorates. Hence the dilemma for public health programs and concerned AIDS doctors, who are partly responsible for generating AIDS hysteria; will AIDS phobia save us, or cause more distress than AIDS itself? As a nation will we divert so much resource to AIDS because of AIDS fear, that other more prevalent diseases will be left unfettered to kill many others?

This is not a new predicament, in the words of Sir Philip Sidney (1554-1586) favorite poet of Queen Elizabeth I, 'Fear is more pain than the pain it fears'.

While professionals' views are based on actual or expected mortality figures, research has shown the public's assessment of risk is determined more by feelings of dread for the unknown and the unobservable, particularly events which they are exposed to involuntarily. For example skiers will accept risks involved in sport roughly 1000 times as great as they would tolerate from involuntary hazards such as food preservatives.

Today we are likely to feel the world is a riskier place than ever before, although this runs against the views of professional risk assessors. This produces the paradoxical situation where in the West the wealthiest, best protected and most educated civilization, is on its way to being the most frightened.

Yet in fact it may be precisely our anxieties and fears which have reduced our risks. Research has suggested that AIDS fear is heightened among less promiscuous homosexuals who are actually at smaller risk. It may be that it is precisely their greater fear which results in less promiscuity, so reducing their risk.

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AIDS phobia has undoubtedly contributed to the remarkable changes in Gay risk behaviours over the last few years, the most dramatic voluntary changes in health-related behaviours in history. As a direct result of these AIDS prevention strategies, other diseases transmitted in the same way, like syphilis and gonorrhea, have declined dramatically in incidence since 1985.

Contrast this situation with cigarette smoking, which has been the most preventable cause of death and disease in the UK for some time, yet has actually increased among women over the last few decades.

But generating FRAIDS does not just simply save lives - extreme fears of death, can also kill. The billionaire, Howard Hughes developed an obsessional disorder and illness phobia leading him to become a recluse, refusing to see doctors. When he became seriously physically ill, a doctor could only be brought to him when he was unconscious and on the point of death. By then it was too late, yet elementary medical attention much earlier could have saved him. It was his fear of death which killed him.

Next: Treating Phobias

Last updated: 10/05

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