Plagues in World History (29 page)

sooty mangabey monkeys. (The relative prevalence of al these strains of HIV may partly explain why AIDS behaves differently in various parts of the world.) Since chimpanzees in the wild do not normal y develop AIDS, despite having a genome that is over 98 percent identical to that of humans, it seems clear that chimps have evolved a mutual adaptation with the virus, just as waterfowl have with influenza, and that their resistance mechanism can perhaps be of future benefit to us. This is also, of course, an argument for respecting and preserving the natural boundaries of these animals, as likewise holds true for wild birds as the endemic source of influenza. The oldest HIV-positive blood result has been obtained from a native of Kinshasa on the eastern border of the Democratic Republic of Congo (formerly known as Zaire) who died in 1959. Genetic mapping of progressive changes in the HIV genome indicates that the first infection of humans from chimpanzees probably took place during the 1930s, which coincided with massive conscription of natives for railroad construction in the French colonies of west-central Africa, where famine forced workers to consume wild animals, including monkeys. From its “ground zero” point of contact, HIV then spread rapidly in human populations throughout Africa and around the world through the new, interconnected global networks of the second half of the twentieth century. The most likely means by which HIV was able to cross over from chimps to humans was through a sore or wound on a hunter handling the bloody remains of “bush meat” used to supplement the diet of those living in rural areas of Africa. Transmission of SIV

(not AIDS) to hunters was found to be stil taking place in Cameroon in the early twenty-first century. The theory that AIDS was cultured by Western labs in the Congo that used the kidney cells of chimpanzees to develop and test a polio vaccine during the 1950s has an attractive air of ironic drama to it—modern medicine in the very act of trying to use its technology to save lives gives birth to a new plague!—along with overtones of political correctness in terms of chronicling the ongoing negative impacts of Western imperialism in the third world.6 But it has now been proven that there is no connection between AIDS and the Congo polio vaccine. Independent laboratory analyses of frozen samples of the original vaccine found no traces of either HIV or chimpanzee cells—the vaccine was actually cultured in Asian macaque monkeys; moreover, the chimpanzees from the region of the Congo where the scientists originally worked do not harbor the ancestral SIV of AIDS. Historically speaking, it now seems quite likely that the crossover occurred before the polio trials of the 1950s. Contaminated needles used for medicinal or vaccination purposes may still have played a role, however, in rapidly cycling SIV through African populations, allowing it to be converted into HIV.7

A word here should be said about “dissident” scientists, such as Peter Duesberg, who cast doubt on whether HIV causes AIDS or that the disease originated in Africa. Setting aside the more far-out conspiracy theories such as that AIDS

AIDS y 143

came from outer space or that it was intentionally developed by Western laboratories as a biological or racial weapon, Duesberg’s dissidence has to be taken seriously because he is a respected research scientist at the University of California at Berkeley who specializes in cancer-causing viruses, although he is also known within the scientific community for his contrarian views. Duesberg does not deny the existence of HIV but rather contends that it is a harmless passenger in the bodies of infected victims and that the disease of AIDS is instead brought on by lifestyle “stressors” such as poor diet and nutrition, recreational drug use, or even by the very antiretroviral therapies currently used to control and manage the disease. This is not simply the harmless hypothesis of a marginalized crank, because although opposed by the “mainstream” scientific community, Duesberg’s theory has been taken up by a handful of other “dissident” scientists, including his cancer research colleague David Rasnick; the Columbian physician and spe-cialist in tropical infectious diseases Roberto Giraldo; the Belgian professor of pathology at the University of Toronto Etienne de Harven; the mathematical biologist Rebecca Culshaw; and the Nobel prize–winning chemist Kary Mullis, some of whom have formed their own advocacy group called “Rethinking AIDS.” In addition, AIDS dissidence has been championed by some “investigative” journalists, such as John Lauritsen, Henry Bauer, and Janine Roberts, and most prominently outside the United States by the former president of South Africa Thabo Mbeki, who provided a forum for Duesberg at the 2000 AIDS

conference in Durban and who opposed ART implementation in his country largely on the strength of Duesberg’s objections, despite drastic price concessions from pharmaceutical companies supplying AIDS drugs. Therefore, it could be argued that this is no mere academic debate but rather one with the lives of millions of men, women, and children at stake. In popular culture, Duesberg’s ideas also receive a hearing in the news media, science journals, and through Duesberg’s own publications, such as his 1996 book
Inventing the AIDS Virus
and his own personal website (augmented by the publications and websites of other dissidents). Complicating this controversy is that the lifestyle cofactors favored by Duesberg do seem to play a role in the onset of full-blown AIDS after HIV infection, and that viral loads in asymptomatic AIDS patients can be so low as to be virtually undetectable, even though a diagnostic test for HIV infection can still be devised by measuring antibodies. AIDS denial also perhaps plays into a wish fulfillment to blot out the horrors of this world, akin to the motives of some deniers of the Nazi Holocaust.

One of Duesberg’s most cogent criticisms is that HIV does not fulfill scientific protocols for identifying a disease agent, such as the “postulates” drawn up the bacteriologist Robert Koch in 1890. It should be pointed out that even Koch could not fulfill all of his postulates when identifying the bacterial causes of 144 y Chapter 6

cholera and leprosy, and that to a certain degree we have to accept practical limits on how well the correlation between a given microbe and a disease needs to be proven before it can be accepted and put to use. Moreover, HIV is an extraordinarily complex microbe unlike any that Koch had to face. Its fragility outside the host cell, for example, makes it extremely difficult to grow the virus pure in culture, as one of the postulates insists. Even so, some would argue that in fact all of Koch’s postulates have by now been fulfilled with respect to AIDS, including the one in which the disease must be reproduced by artificial introduction into a human host. While a deliberate experiment in this regard is ethically un-tenable in the case of a deadly, incurable disease like AIDS, three laboratory workers who tragically exposed themselves by accident to HIV did indeed go on to develop AIDS. A large amount of circumstantial evidence also supports linking HIV with AIDS, such as that HIV can be tested in all patients with full-blown AIDS while almost no one who is HIV negative has gone on to develop the case definition of the disease; likewise, in no country around the world has AIDS appeared without HIV infection manifesting itself first. We also have to recognize that AIDS is a unique illness, in that it comes about through a latent suppression of the body’s immune system and by means of coinfection with an opportunistic disease or cancer. There is therefore no direct, immediate cause and effect from a single microbial invasion, as in the case of most other infectious diseases.8 Despite the dispiriting counterblast with which Duesberg opens his 1996 book—“By any measure, the war on AIDS has been a colossal failure”—in fact, the lives of countless AIDS patients around the world have been almost returned to normal by the very antiretroviral therapies he condemns. HIV may well be an ancient microorganism centuries or even millennia old,9 as Duesberg contends, but this still doesn’t explain how the virus established itself in the human community, and the recent emergence of the current AIDS pandemic argues for a strong connection with recent historical trends that are particularly apropos to sub-Saharan Africa, such as encroachment on wild animal habitat, widespread migrations of human populations and disruptions of their settlement patterns, and the relaxing or changing of traditional sexual mores. A crossover from monkeys as the natural reservoirs of the virus to humans in Africa remains so far the most plausible explanation of the origin of AIDS.

The focus of most historical narratives on AIDS has been the United States and sub-Saharan Africa. It was in the United States that public awareness of the emerging AIDS pandemic began, even though the crisis in sub-Saharan Africa has by now completely eclipsed the epidemic in Pattern I countries. The first notice taken of the new disease seems to have occurred in June 1981, when the Centers for Disease Control (CDC) published an article in its
Morbidity and Mortality Weekly Report
that detailed the strange case of five young gay men from Los An-AIDS y 145

geles who all had come down with a rare lung disease, PCP, as a result of a “profoundly depressed” immune system. This was shortly followed up in July with two dozen more cases of PCP in conjunction with an equal y rare skin cancer, Kaposi’s sarcoma, occurring once again in gay men with dysfunctional immune systems, most of them from New York City. By the following year, 1982, hundreds of cases of the new disease were being reported to the CDC, representing a doubling in the size of the epidemic every six months, and of these cases 40 percent or more were dying. We now know that these cases had probably been incubating for a decade or more since the late 1960s and 1970s. A teenager who died in St. Louis, Missouri, in 1969 of symptoms that suggest PCP and Kaposi’s sarcoma was confirmed as perhaps the first American victim of AIDS when his frozen blood and tissue samples tested positive for the virus in 1986. It was also becoming evident by 1982 that the disease was now affecting populations aside from gay men. The CDC came out with its so-called 4H high-risk groups of heroin addicts or IDUs, hemophiliacs, and Haitian immigrants, in addition to homosexuals. In this same year, the CDC officially adopted AIDS as its preferred name for the disease over other alternatives such as gay-related immune deficiency (GRID). By 1983 and 1984, it was becoming clear that AIDS could be spread by heterosexual intercourse and MTCT, which meant that theoretically almost no part of the general population could assume itself to be safe from the disease; meanwhile, the gay community, particularly in San Francisco and New York, began modifying their “risk” behaviors, such as by reducing the number of sexual partners and increasing their use of condoms, so that by 1985 the number of new cases among gays began leveling off. At the same time, greater medical understanding of AIDS was quickly emerging, especial y with the announcement of the discovery of HIV, which was jointly attributed to Luc Montagnier of the Pasteur Institute in Paris and Robert Gallo at the National Cancer Institute in the United States, although it is now conceded that most of the credit should go to the French. The shelved cancer drug AZT was also found to be the first effective antiretroviral treatment for AIDS, which was administered to human subjects in 1985. The death of movie star Rock Hudson in October of that year raised awareness of and seemed to give a public face to the disease.10

The rest of the 1980s decade saw many of the social issues associated with AIDS play themselves out on the American stage. Some of the leading actors in this drama were the Gay Men’s Health Crisis (GMHC) in New York and the AIDS Coalition to Unleash Power (ACT UP), both founded by the activist Larry Kramer. While GMHC pursued what could be called a low-key role as an AIDS

service organization (ASO) or informational and resources clearinghouse for AIDS victims, ACT UP took a much more confrontational approach toward its political agenda, such as by performing “zaps” against perceived obstructionist 146 y Chapter 6

targets, which famously included the seat of the Catholic archdiocese of New York at St. Patrick’s Cathedral, where a communion mass was disrupted in 1989.

A central focus of AIDS advocacy at this point was to preserve civil liberties, particularly confidentiality and privacy concerns, in the face of public health imperatives to contain an epidemic through such measures as testing, contact tracing, and occasionally quarantine. Remarkably, AIDS activists were able to reverse a long precedent, going back in the United States to almost a century with respect to infectious diseases like syphilis, influenza, and tuberculosis, whereby individual rights had been superseded in the interests of preserving the public health. Instead, AIDS testing and notification, using the enzyme-linked immunosorbent assay (ELISA) and the “Western Blot” tests, first developed in 1985, were to be strictly voluntary with certain exceptions, such as recruits to the U.S. military or applicants to the diplomatic corps. Even by 1997, only half the states in the union required reporting by name of individuals who tested positive for HIV. A number of circumstances were responsible for this AIDS “exceptionalism,” including concerns about false positives (although when used together the two tests were nearly foolproof), the self-defeating specter of AIDS patients being driven underground for fear of discrimination, the unproven efficacy of past public health efforts, and the recent example provided by civil rights agitation in the 1960s and 1970s (including the gay liberation movement beginning with the Stonewall uprising in 1969). A recurring refrain at this time was that anyone could get AIDS and thus any oppressive measures would potentially encompass everyone, but this claim was rather specious given that already by the late 1980s evidence pointed to the epidemic, at least in the United States, becoming entrenched among certain sectors of the population who engaged in “high-risk” behaviors, namely, unprotected anal intercourse, multiple sexual encounters (i.e., prostitution), and IV drug use. By the early 1990s, it was clear that AIDS was not going to break out into the general population and become the universal scourge that everyone so feared, especially when it was estimated that the vast majority of Americans had five lifetime serial sex partners or fewer. Yet, the interests of continued AIDS funding dictated that the threat-to-all ortho-doxy be maintained even by medical authorities who knew better, and it was debunked only by a vilified few, such as Michael Fumento, author of
The Myth of Heterosexual AIDS
.11 One myth that was worth debunking, however, was that AIDS was supposedly spread by casual contact, such as coughing, sneezing, touching, kissing, sharing of surfaces or public spaces, mosquito bites, and so forth. On the contrary, the difficulty with which AIDS is spread—as well as the fact that its contagion is largely determined by premeditated and voluntary social behaviors—made it much less of a compelling health threat than, say, a disease like tuberculosis that is communicated involuntarily by airborne droplets. Yet, AIDS y 147