Tuesday, October 18, 2011

Quebec researcher sheds perceptive light on the origins of AIDS, and subsequent epidemiology; some bad luck?

The New York Times has a detailed and important story in the “Science Times” Oct. 18, “Chimp to Human to History Books: The Path of AIDS”, news analysis by Donald G. McNeil, Jr, discussing a book by Canadian-Belgian clinician Dr. Jacques Pepin, “The Origins of AIDS,” from Cambridge University Press.  The link is here. The author should not be confused with the well-known chef.

Pepin says that a few unlucky events may have led to the transmission of HIV-like viruses from chimps to humans, and that the virus could have been amplified in the Congo a half century ago by less than optimal sterilization procedures in the handling of injections, blood and surgery.  A few, or even one, bureaucrat hired from Haiti after the Congo became independent could have brought it to Haiti, where it could have been “amplified” again in the early 70s at a Port-au-Prince plasma center. Pepin documents how HIV has many subgroups, and most of the infections in Haiti and then among gay men (or MSM’s) was of Type B, whereas the subtype spread by heterosexual contact in Africa may be other subtypes, which could have slightly different transmission capacities.

In other words, the epidemic that erupted in the male gay community in the 1980s might never have happened without the plasma center.

I was living in Dallas in the 1980s, and Dallas saw the epidemic spread about two years after NY and LA, with potentially enormous political implications, including a draconian attempt to reinforce the Texas sodomy law with a bill (Ceverha’s HR 2138) introduced in 1983; it did fail to get out of committee, but only because of effective lobbying by the Dallas Gay Alliance.  The right wing made arguments about “chain letters” which I won’t detail here; an epidemic could still percolate among a relatively closed population.  During the 1990s, the political panic of this sort subsided; and in 2003, of course, the ruling Lawrence v. Texas put it to bed. 

The McNeil article suggests that many subtypes of HIV are indeed very difficult to transmit. But the experience in Africa should allay any complacency. Anecdotally, the experience if the past ten or fifteen years has been even in the US that birdrectional heterosexual transmission is relatively much more common than it had been.

The moralizers can still have their debates whenever they want to.  I still have the original "And the Band Played On" by Randy Shilts.

Cambridge University Press has a blog  ("This Side of the Pond") entry about Pepin’s work here

The picture is from a trip to the Texas border areas (south of San Antonio) in 1985

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