Health: We need just the right dose of fear: Raj Persaud argues that there is a place for anxiety about Aids - but not panic measures

AMID the fuss generated by Aids, there is a related epidemic that has largely gone unnoticed. American psychiatrists have suggested the acronym 'Fraids', standing for 'fear of Aids', to describe the condition; other doctors know it as Aids phobia, Aids panic, Aids stress, Aids hysteria or Aids anxiety. It consists of unfounded fears of having contracted HIV, and incorrect beliefs as to how the virus is transmitted. It results in bizarre attempts to avoid the illness.

Recent examples that have come to the attention of psychiatrists in Britain include a man who regularly immersed his penis and feet in undiluted bleach after using public lavatories. Then there was a young girl who gave up her piano lessons because she was convinced there was infected blood on the keyboard - her tutor's wife worked in the blood transfusion service.

Another Aids phobic rubbed her lips raw by wiping them in case she had got someone else's spittle on them; a woman bathed only in darkness to avoid finding skin lesions associated with the disease; and a man operated all household gadgets with a sterile wooden stick to avoid catching HIV from any surfaces. One man stopped eating and drinking altogether for fear of ingesting the virus.

The United States has its share of cases, too, as reports from psychiatrists there reveal. A postman in New York refused to deliver mail to an Aids public health office because he thought he could catch the disease from its letters. Hairdressers have refused to cut the hair of customers who have Aids, and clergymen have asked sufferers to stay away from church for fear of infecting the congregation.

Despite vigorous education programmes, widespread ignorance persists about the disease and leads to irrational fears. Research among university students has found that 24 per cent thought Aids could be picked up from lavatory seats, 14 per cent believed it could be caught from trying on clothes in a store, and 10 per cent thought that money touched by Aids victims was contagious.

In some cases, fears about Aids are so extreme that the sufferer shows physical responses similar to symptoms of the illness. These are known as 'pseudo Aids' and include weight loss, night sweats, malaise, lethargy, loss of appetite and headaches.

But it is not only individuals who may be affected by the Fraids phenomenon. It could be argued that the stringent guidelines set out recently by the Department of Health - under which health authorities will have a duty to tell patients if they have undergone 'invasive' treatment by an HIV-positive health worker - is an example of a government's knee-jerk response to Aids phobia.

The guidelines followed disclosures that several doctors who were HIV-positive had continued to treat patients. But there has never been a case of a doctor infecting a patient with the virus anywhere in the world - although there have been several cases of patients infecting health-care workers. More than 8,000 people treated by three British doctors carrying the HIV infection have been tested, but none has yet been found to be infected with the virus.

Some experts believe that a national Aids phobia may also go some way to explaining the vast sums we spend on research into the illness, to the neglect of other serious medical problems. In 1988 government committees made dire predictions: they forecast that by now there would be up to 40,000 Aids sufferers in Britain. Instead the total is 7,000. Gordon Stewart, Emeritus Professor of Public Health at Glasgow University, complained recently that pounds 700m had been spent on Aids research during the past decade - 10 times the amount spent on cancer.

So how much fear is too much, and is that the situation that prevails now? Can it ever be irrational to go to extremes to elude deadly diseases? Fraids 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. But to work in our favour there must be just the right amount of fear; too little produces carelessness, too much and we are so paralysed that performance deteriorates.

Herein lies the dilemma for public health programmes and concerned Aids doctors. Will fear of Aids save lives, or merely cause unnecessary distress? As a nation, will we divert so many of our resources to Aids, because of fear of the illness, that more prevalent diseases will be left unfettered to kill many others?

While professionals' views are based on actual or expected mortality figures, research has shown that the public's assessment of risk is determined more by feelings of dread for the unknown and the unobservable, particularly situations to which they are exposed involuntarily. For example, skiers may accept the risks involved in pursuing their sport much more readily than they would tolerate hazards such as chemicals in their food.

Fear of Aids has undoubtedly contributed to changes in the behaviour of gay men - and many heterosexuals - in the past decade. As a direct result of these Aids prevention strategies, other sexually transmitted diseases, such as syphilis and gonorrhoea, have declined dramatically in incidence since 1985. Contrast this situation to the one surrounding smoking, which is the single most preventable cause of death and disease in the country. Fear of cancer and heart disease is not always so great that it can stop people smoking, although they are well-informed about the risks.

Today we in the West are likely to feel that the world is a riskier place than ever before - although this does not tally with the views of professional risk assessors. The wealthiest, best protected and most educated civilisation is on its way to becoming the most frightened. Yet it may be precisely these anxieties and fears that are reducing the risks to our health.

The author is a clinical lecturer in psychiatry at the Institute of Psychiatry, London.

(Photograph omitted)