By Robert Bazell Chief science and health correspondent
NBC News
updated 11/6/2007 3:55:37 PM ET 2007-11-06T20:55:37
Commentary

The scene is a gay bath house in San Francisco in 1982:

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“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 1960s , 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.

We have to be careful with this information. 

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.

Just because the evidence now shows that the virus appeared in some Haitian immigrants in Miami in the late '60s does not mean they were the epicenter of the epidemic that went on to infect so many in the U.S. and the rest of the world.

Haiti served as a popular sexual tourism destination for gay men in the 1960s and '70s. Boys and men could be bought for little. Any of those tourists could, and probably did, bring the virus home. 

Tracking sexual histories
No matter where the first gay American men got the virus, what spread it so widely was the massive promiscuity that arose with the gay liberation movement of the 1970s. That is where Gaetan Dugas takes his place in the epidemic’s history.

After the first notice of gay men with Pneumocystis pneumonia and Kaposi’s sarcoma, the two rare diseases that defined the early cases, CDC investigators — along with California's health departments — obtained detailed sexual histories from 13 patients in Los Angeles County and Orange County. In the June 18, 1982, issue of CDC’s publication “Morbity and Mortality Weekly Reports,” the investigators describe how these men often frequented bath houses for anonymous sex and had an interconnected web of sexual associations with each other and with “1 patient who was not a resident of California.” The report also described how this man was “part of an interconnected series of cases that may include 15 additional patients from 8 other cities.”

The non-Californian, of course, was Dugas. In this investigation he was designated “Patient Zero.” That is standard epidemiological terminology (sometimes called the index case) for the main link in any particular chain of infection. The California investigation was crucial because it allowed the scientists to conclude in their stilted language that “one hypotheses consistent with the observations reported here is that infectious agents are being transmitted among homosexually active males” — or, as I rephrased it the night of publication on NBC Nightly News, “There may be a new, deadly, sexually transmitted disease.”

But no one was saying Dugas was the only “Patient Zero.”

Clearly, many highly mobile, promiscuous gay men were transmitting the virus simultaneously. It is critical to remember that before 1981, no one knew the disease existed. Because the time from infection to onset of symptoms can be up to 10 years, many thousands got infected before anyone had the slightest idea what was happening.

So it is not Dugas’s fault, nor the Haitians. Where the blame lies is that after scientists did understand the disease and how to prevent its spread, the epidemic continued within the U.S. and throughout the globe.

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