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rfmcdonaldThe year 1981 is usually marked off as the beginning of the world's AIDS epidemic. In that year, American physicians in New York and California realized that certain of thweir clients were manifesting unusual diseases which were symptomatic of immune suppression, like Kaposi's sarcoma or pneumocystis carinii pneumonia. HIV didn't emerge de novo in that year: Enough retrospectively diagnosed cases have been discovered to show this. As a point of fact, HIV-1 and HIV-2, both simian immunodeficiency viruses, are most closely related to viruses dwelling in the bloodstreams of, respectively, chimpanzees and sooty mangabeys. How could the virus possibly get from those primates into the human bloodstream?
Look to the genocidal capitalism inflicted upon the subjects of the Congo Free State and among the French colonial subjects in Central Africa. Most brutally in the Congo Free State, but also in French territories where the Code de l'indigénat allowed subjects to be conscripted as forced labourers, Africans suffered and died in huge numbers in colonial projects like the Congo-Ocean Railway in modern Congo-Brazzaville.
In the 2000 paper "Origin of HIV Type 1 in Colonial French Equatorial Africa?", Amit Chitnis, Diana Rawls, and Jim Moore suggest that HIV crossed over to human beings through the hunters of bushmeat, people who killed primates and were contaminated with their bodily fluids, becoming infected with their viruses and later transmitting them to others. Moore doesn't think that practiced bushmeat hunters would have been prey to this, if only because the hunting and cooking styles that Moore saw practiced would have limited the hunters' exposure. The authors suggest that the hunters of infected primates were actually inexperienced hunters, perhaps people fleeing their colonial overlords. Regardless of the precise circumstances of the event, it only needed to happen once. After that, the virus had plenty of chances to spread.
In late colonial central Africa, HIV spread. Similar events may have happened in West Africa, where the less virulent HIV-2 virus spread, most notably in the Portuguese colony of Guinea-Bissau where the local independence war and Portuguese military medical campaigns may have aggravated the situation. The growing usage of intravenous needles throughout Africa, starting in the 1950s and taking off afterwards, may have worsened the matter significantly, as would blood transfusions. Undetected in the midst of weak if not failing states and their medical systems, HIV began spreading silently throughout Francophone central Africa.
Elsewhere, isolated cases of HIV infection existed outside of Africa from the 1960s on. One infectee, Arvid Noe, was a Norwegian sailor who contracted HIV in the Cameroon port of Douala, later returning to his home country and infecting his wife and youngest daughter with HIV before all three died of AIDS in the mid-1970s. Although Noe later became a truck driver who was sexually active across western Europe, he doesn't seem to have sparked a wider epidemic outside of Europe. That dubious distinction can be assigned by the unknown, unknowing person, perhaps a Haitian who participated in the migration of thousands of Haitian professionals and their families to the former Belgian Congo and--like others--contracted HIV there and brought the then-undetectable virus back to Haiti. There, silently, HIV appears to have spread slowly throughout the Haitian population at a low level from 1966 on. Evidence from transfusions and sexual intercourse seems to suggest that HIV/AIDS had spread to a noticeable level in the 1976-1978 period, but even before then many Haitians who were HIV-infected or AIDS patients in Canada, the United States, and French Guiana hadn't had left Haiti by the mid-1970s. Thereafter, HIV seems to have been reintroduced from the outside world via sex tourism, aggravating an already severe epidemic.
HIV seems to have made the leap to the United States towards the end of the 1970s and silently spreading. There, the first people known to be infected with HIV appear to have been users of IV drugs, the sexual partners, and their children. The first child suffering from AIDS that pediatric AIDS specialist James Oleske met was born in 1974 in New Jersey to a teenage girl with multiple sexual partners who used intravenous drugs. Later on, the first children born in New York City were children born in 1977, suggesting that HIV was present among users of IV drugs and their sexual partners as early as 1976. Shortly thereafter, the disease began spreading into gay/bisexual populations--in 1978, as many as 4.5% of a San Francisco cohort were infected with HIV. The connection of HIV with the socially marginal is reinforced by Michelle Cochrane's analysis of some of the earliest cases of AIDS in San Francisco in When AIDS Began: San Francisco and the Making of the Epidemic makes the point that, far from being the well-off middle- and upper-class gays depicted by Randy Shilts in And the Band Played On, many of the first recorded victims in San Francisco were actually badly off, including several homeless people and more people employed at menial wages.
Why did no one see the big picture before the early 1980s? In badly-afflicted central Africa, as John Iliffe argues, the long latency period of HIV and the fact that AIDS manifested itself in terms of other well-known diseases helped hide the epidemic, even as civil tumult and economic collapse gutted local medical systems. César Nkuku Khonde's "An Oral History of HIV/AIDS in the Congo" does suggest that many Congolese in the mid- to late-1970s were worried by a growing number of unusual deaths, but the paradigm of a new disease processes wasn't picked up until the early 1980s. Many puzzling cases were diagnosed among people with central African connections by Western medical systems: a Belgian-Congolese married couple who left Congo in 1968 and died of AIDS in the late 1980s, a Belgian in Shaba state in the early 1970s who had multiple sexual partners, a Congolese child born in 1974 who a Belgian soldier who served in Zaire between 1976 and 1978 with multiple sexual partners, a Danish surgeon who was exposed to HIV-infected fluids while a surgeon in a hospital in the north of the country, a Canadian survivor of a plane crash outside of Kisangani in 1976 who received a blood transfusion there and died four years later in Edmonton ... Again, no one picked up the AIDS paradigm. By the time that it was, HIV was too entrenched to contain. The lack of the AIDS paradigm played a major role n the United States and elsewhere in the developed world, perhaps aggravated by the concentration of HIV/AIDS in some of these countries' most socially isolated and ignorable populations. Even in contemporary Canada, after all, 60-odd prostitutes could disappear in Vancouver between 1978 and 2002 before local police began a serious investigation.
The net result of this mixture of apathy and incapacity was that by the time that AIDS was first noticed in the United States, perhaps a quarter-million people had been infected with HIV around the world. Gaëtan Dugas, the famous supposed Patient Zero, had nothing to do with the emergence of HIV; he was just one more victim.
If any lesson can be drawn from the story of HIV/AIDS, it is this: Because horrible things were done to millions of people in virtually unknown lands, because only a few of these individuals were monstrously unlucky, and because few people cared to check to see what was happening to some of the most marginal members of the global community, by the time that doctors noticed that a terrible new disease had emerged in 1981 it was far too late to do anything about it. As a result, more than 25 million people have died in the space of a generation and another 33 million people are infected with HIV, with more suffering certain to come.
If only, if only, if only.
Look to the genocidal capitalism inflicted upon the subjects of the Congo Free State and among the French colonial subjects in Central Africa. Most brutally in the Congo Free State, but also in French territories where the Code de l'indigénat allowed subjects to be conscripted as forced labourers, Africans suffered and died in huge numbers in colonial projects like the Congo-Ocean Railway in modern Congo-Brazzaville.
Hochschild likewise notes that "In France's equatorial African territories, where the region's history is best documented, the amount of rubber-bearing land was far less than what Leopold controlled, but the rape [he apparently means gendercide] was just as brutal. ... The population loss in the rubber-rich equatorial rain forest owned by France is estimated, just as in Leopold's Congo, as roughly 50 percent. ... In the 1920s, construction of a new railway through French territory bypassing the big Congo River rapids cost the lives of an estimated twenty thousand forced laborers, far more than had died building, and later rebuilding, Leopold's railway nearby." (Hochschild, King Leopold's Ghost, p. 280.) The French Governor-General Antonetti, planning construction of a railway to the coast, was "frank about the human cost" of the project. "Either accept the sacrifice of six to eight thousand men, or renounce the railways," he declared, and later: "I need 10,000 dead [men] for my railways."
In the 2000 paper "Origin of HIV Type 1 in Colonial French Equatorial Africa?", Amit Chitnis, Diana Rawls, and Jim Moore suggest that HIV crossed over to human beings through the hunters of bushmeat, people who killed primates and were contaminated with their bodily fluids, becoming infected with their viruses and later transmitting them to others. Moore doesn't think that practiced bushmeat hunters would have been prey to this, if only because the hunting and cooking styles that Moore saw practiced would have limited the hunters' exposure. The authors suggest that the hunters of infected primates were actually inexperienced hunters, perhaps people fleeing their colonial overlords. Regardless of the precise circumstances of the event, it only needed to happen once. After that, the virus had plenty of chances to spread.
There was a massive influx of people into the major cities following WW II, constituting "... movement of previously isolated people into the newly expanding cities" (e.g., the population of Kinshasa increased almost 10-fold from 49,000 in 1940 to 420,000 in 1961). Whatever role this influx may have had in the development of the epidemic, it should be kept in mind that the cities were not "newly" expanding; the population of Kinshasa (and Brazzaville) also increased about 10-fold between 1905 and 1940. This earlier period of urbanization would have created conditions favorable to the initial establishment of the disease.
In addition, the social turmoil associated with forced resettlements and labor undoubtedly disrupted traditional sexual practices and networks. More directly, some of the labor camps (of thousands of men) encouraged the presence of women for "recreational" purposes. Finally, massive vaccination campaigns were carried out with limited resources (e.g., six syringes used to screen and treat nearly 90,000 people for sleeping sickness in 1917-19). An unknown proportion of nearly 100,000 smallpox vaccinations prior to 1914 employed arm-arm direct inoculation with material from pox vesicles (containing a high concentration of lymphocytes, the primary target of HIV-1).
In late colonial central Africa, HIV spread. Similar events may have happened in West Africa, where the less virulent HIV-2 virus spread, most notably in the Portuguese colony of Guinea-Bissau where the local independence war and Portuguese military medical campaigns may have aggravated the situation. The growing usage of intravenous needles throughout Africa, starting in the 1950s and taking off afterwards, may have worsened the matter significantly, as would blood transfusions. Undetected in the midst of weak if not failing states and their medical systems, HIV began spreading silently throughout Francophone central Africa.
Elsewhere, isolated cases of HIV infection existed outside of Africa from the 1960s on. One infectee, Arvid Noe, was a Norwegian sailor who contracted HIV in the Cameroon port of Douala, later returning to his home country and infecting his wife and youngest daughter with HIV before all three died of AIDS in the mid-1970s. Although Noe later became a truck driver who was sexually active across western Europe, he doesn't seem to have sparked a wider epidemic outside of Europe. That dubious distinction can be assigned by the unknown, unknowing person, perhaps a Haitian who participated in the migration of thousands of Haitian professionals and their families to the former Belgian Congo and--like others--contracted HIV there and brought the then-undetectable virus back to Haiti. There, silently, HIV appears to have spread slowly throughout the Haitian population at a low level from 1966 on. Evidence from transfusions and sexual intercourse seems to suggest that HIV/AIDS had spread to a noticeable level in the 1976-1978 period, but even before then many Haitians who were HIV-infected or AIDS patients in Canada, the United States, and French Guiana hadn't had left Haiti by the mid-1970s. Thereafter, HIV seems to have been reintroduced from the outside world via sex tourism, aggravating an already severe epidemic.
HIV seems to have made the leap to the United States towards the end of the 1970s and silently spreading. There, the first people known to be infected with HIV appear to have been users of IV drugs, the sexual partners, and their children. The first child suffering from AIDS that pediatric AIDS specialist James Oleske met was born in 1974 in New Jersey to a teenage girl with multiple sexual partners who used intravenous drugs. Later on, the first children born in New York City were children born in 1977, suggesting that HIV was present among users of IV drugs and their sexual partners as early as 1976. Shortly thereafter, the disease began spreading into gay/bisexual populations--in 1978, as many as 4.5% of a San Francisco cohort were infected with HIV. The connection of HIV with the socially marginal is reinforced by Michelle Cochrane's analysis of some of the earliest cases of AIDS in San Francisco in When AIDS Began: San Francisco and the Making of the Epidemic makes the point that, far from being the well-off middle- and upper-class gays depicted by Randy Shilts in And the Band Played On, many of the first recorded victims in San Francisco were actually badly off, including several homeless people and more people employed at menial wages.
Why did no one see the big picture before the early 1980s? In badly-afflicted central Africa, as John Iliffe argues, the long latency period of HIV and the fact that AIDS manifested itself in terms of other well-known diseases helped hide the epidemic, even as civil tumult and economic collapse gutted local medical systems. César Nkuku Khonde's "An Oral History of HIV/AIDS in the Congo" does suggest that many Congolese in the mid- to late-1970s were worried by a growing number of unusual deaths, but the paradigm of a new disease processes wasn't picked up until the early 1980s. Many puzzling cases were diagnosed among people with central African connections by Western medical systems: a Belgian-Congolese married couple who left Congo in 1968 and died of AIDS in the late 1980s, a Belgian in Shaba state in the early 1970s who had multiple sexual partners, a Congolese child born in 1974 who a Belgian soldier who served in Zaire between 1976 and 1978 with multiple sexual partners, a Danish surgeon who was exposed to HIV-infected fluids while a surgeon in a hospital in the north of the country, a Canadian survivor of a plane crash outside of Kisangani in 1976 who received a blood transfusion there and died four years later in Edmonton ... Again, no one picked up the AIDS paradigm. By the time that it was, HIV was too entrenched to contain. The lack of the AIDS paradigm played a major role n the United States and elsewhere in the developed world, perhaps aggravated by the concentration of HIV/AIDS in some of these countries' most socially isolated and ignorable populations. Even in contemporary Canada, after all, 60-odd prostitutes could disappear in Vancouver between 1978 and 2002 before local police began a serious investigation.
The net result of this mixture of apathy and incapacity was that by the time that AIDS was first noticed in the United States, perhaps a quarter-million people had been infected with HIV around the world. Gaëtan Dugas, the famous supposed Patient Zero, had nothing to do with the emergence of HIV; he was just one more victim.
If any lesson can be drawn from the story of HIV/AIDS, it is this: Because horrible things were done to millions of people in virtually unknown lands, because only a few of these individuals were monstrously unlucky, and because few people cared to check to see what was happening to some of the most marginal members of the global community, by the time that doctors noticed that a terrible new disease had emerged in 1981 it was far too late to do anything about it. As a result, more than 25 million people have died in the space of a generation and another 33 million people are infected with HIV, with more suffering certain to come.
If only, if only, if only.
