Low level exposure to lead.

Only five people had used condoms on every occasion and eight people had not used them at all. In my clinic I have been asking girls who have had sex with strangers abroad how often they were able to persuade their partners to use condoms-or even withdrawal. I have so far reached zero out of seven. Although all the girls had asked the men to use condoms, they had refused, and the girls, all of whom had been drinking, then acquiesced after varying degrees of pressure. At least one is now positive for antibodies to HIV. I also see men who work in Africa on tours of duty lasting 6-12 months. Many have African girlfriends and are amazed when I tell them that the likelihood of the girls being positive for antibodies to HIV might be as high as 50%. Most of these men have wives and families in Britain. As far as I am aware the only propaganda to the effect that sex abroad is dangerous is the posters at airports reminding preoccupied travellers that AIDS does not go on holiday. Warnings should be directed at business travellers as well as holiday makers, should draw attention to the risks of alcohol in reducing vigilance, and should point out that HIV infection is now more prevalent in most travel destinations than it is in Britain. Almost all our European neighbours have a greater prevalence of HIV, as do cities such as Bangkok and Rio de Janeiro, whose attraction for many visitors is readily available sex. Eastern Europe probably has a massively underestimated problem, and the position in Africa is already apocalyptic. Failure to confront these issues adequately is likely to have catastrophic consequences because although the number of cases of AIDS among those in the traditional high risk groups is tending to plateau, the number of cases in which AIDS is acquired heterosexually while travelling continues to grow exponentially. The epidemiology of malpractice SIR,-In his editorial on malpractice in the United States Dr Richard Smith expresses regret that Britain has no similar statistics.' We hope that the government, now that it is accepting liability for indemnity, will produce figures for this country. The figures, however, would be quantitative and of no value to doctors except to increase alarm; to take preventive action a breakdown of medical causes is needed. We made a modest attempt at this by publishing an audit …