The Nushawn Williams Affair
Health Officials Promote Homeless Bisexual New
York City Dope Injector & 10 Female Sex Partners as Heterosexual HIV Cases
Drug Injecting and Anal Intercourse, Not
Vaginal Intercourse, Are Implicated
1 in 10 Trillion Chance That Vaginal Sex is the Only
Vector When HIV+ Man Has 100 Female Partners
and 10 Become HIV+
If health officials of the upstate New York city of Jamestown suspected
that Nushawn Williams was a bisexual drug injector, they didn't say so
at the October 27 press conference in which they announced that the 21-year-old
New York City native was HIV-positive. Although they described Williams
as a crack dealer who often traded his wares for sex, they said nothing
about the drug habits of his four female partners who had so far been identified
as positive. Neither did they mention that the high HIV prevalence among
his partners implicated drug injection or anal intercourse rather than
Instead they simply proclaimed that the positive females had contracted
HIV from Williams through heterosexual contact, commonly regarded as meaning
coitus. They relayed a story sure to frighten anyone who thinks that HIV
transmits vaginally and causes AIDS. Williams had engaged about 100 females
in unprotected sex since becoming positive, they said. Furthermore, he
continued his aggressive promiscuity even after being notified a year earlier
of his positive status, which he never revealed to any of his partners,
including dozens in Jamestown. The New York Times (Nov. 13) explained
how health officers displayed his photograph, listed his various street
names, and "began telling the story to the world... in the hope of finding
On November 10 Newsweek devoted a large article to the Williams
affair, and the Times has covered it extensively (Oct. 30, Oct.
31, Nov. 4, Nov 13, Dec. 1). According to the Times , the publicity
helped investigators to identity six additional HIV-positive females claiming
to have had sex with Williams, bringing the total now to ten. Investigators
say that unlike the first four, these six contracted HIV from Williams
after he learned of his positive status, and that this will serve as a
basis for six separate charges of first-degree assault. (Newsweek
asserts that nine contacts, all from Jamestown, were identified prior to
the press conference and prior to linkage with Williams. Three of these
were exposed prior to Williams receiving his positive test, and six after.)
The Times has dubbed this "one of the most notorious outbreaks
in the 16 years that AIDS has been known." Since about half the drug injectors
and gays in large urban centers test HIV-positive (see chart), the notoriety
stems from the perception that penile-vaginal intercourse explains how
these eleven people (including Williams himself) became positive, and that
their health and HIV risks represent those of ordinary Americans. A careful
reading of these press accounts demolishes this popular view.
Bisexual Drug Injecting Transfusion Recipient?
Contrary to the impression created by health officials, it turns out
that Williams belongs to an assortment of medical and social risk groups
that are marked by high mortality and a variety of diseases, infections,
and characteristics (such as positive HIV status) which are otherwise rare
in the United States.
Four days after health officers presented the "outbreak" in purely heterosexual
terms, the October 31 Times reported that New York City police officers
were convinced that Williams had been injecting drugs for years. Then the
November 10 Newsweek story, published two weeks after the press
conference, reported that Williams had at least two homosexual relationships.
The combined details from Newsweek and The New York Times
produce a portrait of Williams that bears little resemblance to the vast
majority of sexually active Americans: a childhood characterized by hunger,
sexual abuse, and abject poverty; a drug-addicted mother who turned their
apartment into a crack house and provided no supervision; a schooling that
took place in special education classes until he dropped out at age 14;
a long criminal record that includes a year of hard prison time for a murder
charge; a brief adulthood characterized by homelessness and sex with girls
as young as 12 years old; and a gunshot wound requiring hospitalization.
Any number of these factors would preclude his medical history from
indicating the health risks of ordinary Americans, and some (homosexual
relations and blood injecting, and perhaps any blood transfusion he might
have received for his bullet wound) prevent him from qualifying as a "heterosexual"
The reports of drug injecting and homosexuality came after the October
27 press conference. None of the news accounts indicates how health department
representatives officially categorize Williams, or if their view has been
affected by the media reports. But the reports leave a strong impression
that government statistics record Williams as a heterosexual case.
The media for its part has declined to push officials for clarification
on this matter. The October 31 Times pursued the drug injecting
angle, but all subsequent editions ignored this topic. The Newsweek
piece detailed two homosexual relationships with HIV-positive men, including
one which his relatives believe is the source of his positive status. Neither
publication discussed how their information should disqualify Williams
as a "heterosexual" case. In addition, Newsweek said nothing about
drug injecting, and the Times has said nothing about homosexual
activity, though there has been plenty of time for the respective reporters
to read other's articles.
Nor has either publication explored the possibility that Williams may
have received a blood transfusion.
Assessing the Risks
Since Williams has been presented as a warning to the general public,
it is essential for health officials and reporters to very carefully establish
the risk factors that characterize Williams and his HIV-positive sex partners.
Most Americans believe that HIV causes AIDS, and they fear they may contract
it from vaginal intercourse.
If Williams develops any of the various official AIDS diseases, it will
be important to know why he may have become ill. Where AIDS pathologies
-- wasting, dementia, opportunistic infections such as pneumonia and tuberculosis
-- are rare in the general American public, even HIV-negative homeless
drug addicts with prison records are at increased risk for them. In the
only mention in any account of an AIDS condition for Williams, the Newsweek
writers state that by January, 1997, he was "already looking gaunt." But
gaunt from what? HIV? Years of poverty and drug abuse? In describing the
squalor where Williams lived in January, 1997 -- in a one-room apartment
shared by a friend and the friend's mother and sister on the 12th floor
of a "notorious" New York City housing project -- the writers mention "sparse
furnishings," "a pool of urine" on the elevator, and "a few skinny kittens."
Might Williams be "gaunt" for the same reason his former feline roommates
The general fear inspired by this affair is unwarranted if the principal
parties represent special risk groups characterized by special circumstances
and activities that render them susceptible to all sorts of rare medical
Anal intercourse and drug injecting are officially considered to be
so much more efficient at transmitting HIV, and the HIV prevalence among
gays and drug injectors are so much higher than among the general population,
that patients are automatically disqualified from the "heterosexual" category
if they admit to any instance of male homosexuality or drug injecting.
If Williams was a drug injector or had homosexual relationships, then
he probably became HIV positive from dirty needles or receptive anal intercourse.
And perhaps his female partners became positive the same way.
But government health investigators do a very poor job of identifying
anal sex recipients and drug injectors in their tracking of HIV and AIDS
cases. For one thing, they rely on self-identification, which involves
high rates of false denials when taboo activities like anal sex and drug
injecting are involved. In compiling HIV and AIDS statistics, officials
accept all denials as accurate and include no adjustment factor to account
for false denials.
Furthermore, they make no explicit attempt to identify anal sex recipients.
Instead they employ euphemisms such as "men who have sex with men" and
"women who have sex with bisexual men." That second code phrase is particularly
ineffective since many bisexual men do not make their homosexual experiences
known to their female partners, and it creates the impression that bisexual
men are transmitting their positive HIV statuses to women via vaginal rather
than anal intercourse.
The Williams affair illustrates many of the problems with HIV and AIDS
risk assessment epidemiology.
The November 13 Times article said that the government contact
tracer attending this case "ruled out intravenous drug use as a means of
infection" for the first four females identified. Their sexual histories
led to Williams, the only person named on all four lists. The tracer then
interviewed Williams multiple times, and apparently concluded that Williams
qualified as a heterosexual case.
Newsweek reporters, though, found agreement among relatives and
neighbors who recall homosexual relations. And the October 31 Times
even more convincingly established a drug injecting habit for Williams.
"Law enforcement officials in Brooklyn said they were certain... that Mr.
Williams had been injecting drugs, including heroin, with a needle for
years," the article stated. "'We know it for a fact,' said one investigator."
The same article quotes Frederic D. Winters, a spokesman for Jamestown's
Health Department as saying, "We have heard rumors, thus far unconfirmed,
that he might have been an IV drug user." According to the Times
writer, "Mr. Winters said that asking any HIV client about intravenous
drug use is standard practice, but confidentiality laws prevented him from
disclosing how Mr. Williams had answered that question."
Why is that? Winters bypassed those same laws in order to name Williams,
enumerate his heterosexual contacts, disclose how many have tested positive,
and reveal that after learning of his status Williams continued having
unprotected sex without informing his partners.
That's pretty confidential information.
The word "unconfirmed" strongly implies that Williams denied to health
investigators that he had ever injected drugs, and that they believed him.
RA has found no indication in the press that the investigators have
addressed the allegations of homosexuality, but it increasingly looks like
officials have inaccurately identified Williams as having lacked both homosexual
and drug injecting experiences. That damages the credibility of their characterization
of his ten HIV-positive female contacts as heterosexual cases.
The Nushawn Ten
Where government officials and reporters have divulged many highly
personal details about Williams, much less is known about his ten HIV-positive
female sex partners who have been identified so far. They remain protected
by confidentiality laws, and the press is not eager to uncover unsavory
facts about them anyway. The contact tracer who interviewed them refuses
to discuss the case in order to maintain his own anonymity.
Nine of them live in Jamestown, "a mostly rural, down-at-the-heels industrial
town of 142,000" located 400 miles north-west of New York City, Newsweek
says. The description brings to mind images of healthy young teenagers
being debauched by Williams. But it was a pre-existing drug market that
drew Williams there, and kept him coming back. This makes female drug users
his most likely sex partners. Williams spent a great deal of time in Jamestown
peddling drugs from about the middle of 1995 (at the age of 19, when he
was released from a one-year jail stint on charges he'd hacked a man to
death with a machete) until early 1997, at the age of 21, when New York
City police arrested him for selling crack. Piecing together the various
press accounts, the nine Jamestown girls tested positive at the ages of
12, 13, 15, 16, 17, 17, 18, 19, and 21, respectively.
Each new press account makes it appear ever more likely that these very
young women and girls belong to some of the same extraordinary categories
that make Nushawn Williams an inappropriate example of the general American
risk for HIV and AIDS.
Although reporters say nothing about anal intercourse and its likely
role given Williams' alleged homosexual history, they persistently link
his female sex partners to drug use, and other factors, such as poverty,
child abuse, and promiscuity.
"Mr. Williams, 21, traded on his charm and drugs for sex in [Jamestown],"
the November 4 Times article said. The October 30 edition reported
that Williams attracted "the Jamestown area's poorer, street-hardened and
The November 13 article described "the gum shoe work of piecing together
Mr. Williams' story" as being difficult because of "how hard it is to trace
sexual contacts in a sub-culture of rootless young people, drugs, abandoned
tenements and anonymous sex. Some of the girls who knew him in [Jamestown]
are homeless, some are drug users and sellers, and many are school dropouts."
The next door neighbor of a "shabby" apartment out of which Williams
sometimes operated told Newsweek that "the constant parade of local
girls who flocked to Williams' door" included "runaways and street kids."
His drug selling partner Brian Jones described to the magazine how
Williams liked to use crack to seduce girls. "They'd do some drugs, have
sex with another capsule of crack sitting out, and he'd give her the crack
when they were done."
Newsweek also described how the Williams affair showed that "at
least some teens in [Jamestown] were dabbling in drugs."
Andrea Caruso, who tested positive at age 17 and has made herself available
to reporters, posed for a large photo on the front page of the Newsweek
article, which was subtitled, "He charmed the lost and the unwanted." The
writers described her as having "a long history of emotional problems and
a devastating lack of self-esteem." Her "liaison" with Williams, they continued,
was "laced with drugs," though they did not specify injection drug use.
The press also describes these girls as uncommonly promiscuous. "Because
sex among the group has been extensive, Mr. Williams might not have infected
all the women," the November 4 Times reported. "Health officials
knew of... 53 people who had sex with the ten women Mr. Williams infected."
The youngest of the nine Jamestown girls -- now 14 but perhaps 12 when
she was having sex with Williams -- spoke anonymously with a Times
writer, who reports nothing about her possible drug usage, but on December
1 quoted her as saying, "in a small place, everybody does everybody." The
October 31 edition revealed that she had been a victim of previous sexual
Not one report suggests that any of the ten HIV-positive female contacts
are drug-free. Only the Newsweek article attributed any illness
in these girls to HIV. A few months after "hearing rumors" that Williams
was positive, one of the girls, a high school freshman said, "I remember
getting a rash all over my body. I felt sick all the time and somehow I
knew I was positive." The writers simply assumed, like the girl, that a
transient rash and persistent feelings of sickness are signs of HIV, rather
than other factors, including drug use, or even psychosomatic effects from
worrying about HIV.
"Contracting HIV through heterosexual sex is hard to do," Newsweek
reported, "and HIV infection among young women is rare." The writers intended
"heterosexual sex" to mean vaginal intercourse, and probably don't fully
appreciate the difficulty of vaginal transmission, or the rarity of HIV
outside the risk groups.
It's not just hard to transmit HIV from a positive to a negative
partner via unprotected vaginal intercourse, it's nearly impossible
. The latest research puts the unprotected vaginal transmission frequency
at about one per thousand contacts man-to-woman, and one per eight
thousand woman-to-man (Padian N, Am J Epidemiol 146:350-357, 1997).
This compares to unprotected frequencies of more than one transmission
per ten contacts for all other microbes that are classified as venereally
Using the one per thousand figure, and arbitrarily assuming a sex spree
involving 500 acts of vaginal intercourse spread among many women, the
odds of a man transmitting HIV to ten women are 7.6 per 100 trillion, or
about one per 10 trillion (see chart). Those odds are comparable to being
struck many times by lightning in the same year, or winning several state
Other factors can make HIV transmission more efficient, such as concurrent
infections with true disease-causing microbes, genital bleeding and ulcers,
and poor health. The press accounts describe venereal disease among Williams
and some of his partners. But the Times was more impressed with
the possibility of drug needle transmission. "The virus, while transmittable
through heterosexual sex, is not typically passed along in that manner
as efficiently as it seems to have been with Mr. Williams," read the October
31 report. "But transmission through shared needles is much more common.
[Injection] drug use would... help explain why Mr. Williams appears to
have been such an effective transmitter of the virus."
Health officials offered only ludicrous explanations for how heterosexual
sex could explain ten positive females out of about 100 partners. They
said "the relatively high rate of transmission of the virus among Mr. Williams'
contacts probably reflects high-risk activity, like sex without a condom
or with multiple partners," the November 4 Times reported.
But the tiny vaginal transmission rates are for condomless sex,
and having multiple partners does not affect the transmission rate. Studies
show that frequency of anal intercourse and blood injecting, but not vaginal
intercourse, are associated with HIV seroconversions (Brody, Archives
of Sexual Behavior 24:383-393). The relatively high efficiency of
these transmission factors helps explain why about half of all drug injectors
and gay men in large urban centers test positive, and why subjects who
identify themselves as belonging to either category are automatically excluded
from "heterosexual" transmission status.
Furthermore, men who have sexual experiences with other men have an
increased likelihood of engaging female partners in anal intercourse, and
women who have sex with drug injecting men have an increased likelihood
of injecting drugs themselves (Brody, ibid .). Since Williams evidently
has experienced both homosexuality and drug injecting, this suggests that
his ten positive female partners have as well.
So do epidemiological data (see chart). There is virtually no HIV to
be found among American females who deny having injected drugs. Only one
female in 10,000 who gives blood for the first time tests positive. On
the other hand, HIV rates are remarkably high among anal sex recipients
and drug injectors: 54% of the gay men in San Francisco test positive,
as do 38.6% of the female drug injectors in New York City. If appreciable
numbers of Williams' female sex partners are receiving anal intercourse
or shooting drugs, it's easy to see how ten out of about 100 (10%) would
turn up HIV-positive.
The "outbreak" of HIV positive test results in Jamestown, then, is best
explained by drug injecting and anal intercourse. And any AIDS conditions
that subsequently develop in these HIV-positive individuals will likely
have non-HIV explanations.
-- Paul Philpott