The scene is a gay bath house in San Francisco in 1982:
“When the moaning stopped, the young man rolled over on his back for a cigarette. Gaetan Dugas reached up for the lights, turning up the rheostat slowly so his partner's eyes would have time to adjust. He then made a point of eyeing the purple lesions on his chest. "Gay cancer," he said, almost as if he were talking to himself. "Maybe you'll get it, too."
Randy Shilts detailed that episode in “And the Band Played On,” his best selling history of the early years of the AIDS epidemic. Dugas, an attractive, blonde flight attendant for Air Canada had been labeled as “Patient Zero” in records kept by the Centers for Disease Control and Prevention in its early investigations of the disease. As it always does, the CDC kept Dugas’ identity confidential. Shilts identified him and popularized the term “Patient Zero.”
Because of Shilt’s excellent, but often embellished, writing, many people came to believe that Dugas had actually spread the virus throughout North America and much of the rest of the world by himself. But Shilts, who died of AIDS in 1994, was wrong. Dugas, who succumbed to the disease a decade earlier, was not the Johnny Appleseed of AIDS.
Jump from Africa to Haiti
“When the moaning stopped, the young man rolled over on his back for a cigarette. Gaetan Dugas reached up for the lights, turning up the rheostat slowly so his partner's eyes would have time to adjust. He then made a point of eyeing the purple lesions on his chest. "Gay cancer," he said, almost as if he were talking to himself. "Maybe you'll get it, too."
Randy Shilts detailed that episode in “And the Band Played On,” his best selling history of the early years of the AIDS epidemic. Dugas, an attractive, blonde flight attendant for Air Canada had been labeled as “Patient Zero” in records kept by the Centers for Disease Control and Prevention in its early investigations of the disease. As it always does, the CDC kept Dugas’ identity confidential. Shilts identified him and popularized the term “Patient Zero.”
Because of Shilt’s excellent, but often embellished, writing, many people came to believe that Dugas had actually spread the virus throughout North America and much of the rest of the world by himself. But Shilts, who died of AIDS in 1994, was wrong. Dugas, who succumbed to the disease a decade earlier, was not the Johnny Appleseed of AIDS.
Jump from Africa to Haiti
Indeed, with the recent publication of research showing that HIV, the virus that causes AIDS, first came to the United States from Haiti in the late 1960’s, a fairly detailed history of the spread of the virus falls into place.
Using modern genetic technology, researchers have now established that the virus first jumped to humans from chimpanzees in the Congo around the 1930s. Many residents of the area relied on chimps for food, and it is likely that someone slaughtering an animal got the virus into his or her bloodstream. The virus festered among humans in Africa for decades until sometime in the 1960s it made its way to Haiti.
Based on the data so far the jump from Africa to Haiti is the weakest link in the chain, but it appears to have happened. When the Congo won its independence from Belgium in 1960 many Haitians sought work there. Some could have brought the virus home where it spread through many parts of society. The latest research shows that some Haitian refugees with the virus arrived in Miami in the late 1960s.
Remembering the "Four Hs"
Using modern genetic technology, researchers have now established that the virus first jumped to humans from chimpanzees in the Congo around the 1930s. Many residents of the area relied on chimps for food, and it is likely that someone slaughtering an animal got the virus into his or her bloodstream. The virus festered among humans in Africa for decades until sometime in the 1960s it made its way to Haiti.
Based on the data so far the jump from Africa to Haiti is the weakest link in the chain, but it appears to have happened. When the Congo won its independence from Belgium in 1960 many Haitians sought work there. Some could have brought the virus home where it spread through many parts of society. The latest research shows that some Haitian refugees with the virus arrived in Miami in the late 1960s.
Remembering the "Four Hs"
Haitians already have endured one long bout of blame for the AIDS epidemic. They certainly do not deserve another. In TV reports in 1983 I detailed how, when AIDS was first diagnosed in Haitians in Miami and New York, people fired Haitians instantly from a variety of jobs, even refusing to touch them. At that time the CDC infamously described the ''Four H'' group of risk factors for AIDS — “homosexuals, heroin users, hemophiliacs, and Haitians.”
A scientist who was with the CDC at the time told me recently that the “Four Hs” description ranks almost as high as the Tuskegee syphilis experiments on African-Americans in the annals of wrongdoing by the U.S. Public Health Service.
A scientist who was with the CDC at the time told me recently that the “Four Hs” description ranks almost as high as the Tuskegee syphilis experiments on African-Americans in the annals of wrongdoing by the U.S. Public Health Service.
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The Association of Haitian Physicians Abroad (AMHE) responds to Worobey study, November 7, 2006
The Association of Haitian Physicians Abroad (Association des Médecins Haitiens à l'Etranger or AMHE) has reviewed the recent article by Thomas Gilbert and colleagues, reporting a phylogenetic analysis of archival blood samples collected from five early recognized AIDS patients at Jackson Memorial Hospital in 1982-1983.
The study authors identify these five patients as Haitians who left Haiti after 1975. This article has several important limitations and does not provide any scientific breakthrough. Before a detailed critique of this paper, AMHE would like to point at the following remarks in methodological biases that may explain some of the study findings. First, the bias in selection of early samples of HIV among Haitians is quite obvious. The investigators chose a convenient sample under the unproven assumption that all these Haitian immigrants acquired HIV infection in Haiti. They obviously ignore that the clinical course of these patients perfectly fits the natural history of HIV/AIDS. No culturally-sensitive epidemiological investigation has ever been conducted of these initial Haitian immigrants presenting with HIV infection at Jackson Memorial Hospital in Miami. Therefore, the assertion that they contracted HIV in Haiti is presumptuous and not based on facts. Moreover, no archival samples from Haiti are included in the phylogenetic analysis and this constitutes a serious flaw. We do not know either how many samples of the pandemic clade B might have come from Haitian subjects, which raises the prospect of misclassification.
Second, the authors do not adequately report on some of their methods and results. For example, they do not specify clearly the number of sequences for which there was uncertainty as to which subtype they belonged to; neither do they try to replicate their results by sequencing other HIV genes. While computer simulation techniques and phylogenetic analyses are important to our understanding of biological evolution, the application of these methods with such serious methodological limitations does not prove unequivocally the origin of the pandemic clade B subtype in the United States.
Because these findings lack scientific validation, we need to raise questions about the motives of the authors; their paper not only does not advance our knowledge of the HIV epidemic but it continues with a dangerous precedent of victimizing an ethnic group with flimsy data. Needless to say that such half truths have been very harmful to the country and its people. The hasty classification of Haitians as a group at risk for HIV more than 20 years ago can be considered as a cloud hanging over good scientific practice. It destroyed the tourist industry in Haiti; its citizens have since been suffering from the social stigmata of presumed carriers of dangerous germs even though that classification was finally removed by the CDC.
We are also afraid that such mishandling of data can have the unintended consequence of the refusal of Haitian patients to participate in research studies at American Universities for the fear that they will be used as guinea pigs in the furtherance of biased scientific protocols and conclusions. That would be the saddest of ironies for we all need good science to help us all against this calamity.
La Science sans conscience n'est que ruine de l'âme.
Christian Lauriston, MD
President of the Central Executive Committee of AMHE.
www.solutionshaiti.blogspot.com
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