by Mike Andrew -
SGN Staff Writer
We all 'know' that the AIDS epidemic began on June 5, 1981, when the CDC identified a cluster of mysterious pneumocystis cariniipneumonia infections in five Gay men in Los Angeles.
At that time the disease was not even known as AIDS. It was usually called GRID - Gay-related immune deficiency. The name AIDS - acquired immune deficiency syndrome - was adopted in 1982.
Now, however, a new book, The Origins of AIDS, by Dr. Jacques Pepin, traces the prehistory of AIDS back to the beginning of the last century when French and Belgian colonialism in Africa set in motion a chain of events that gave rise to the global pandemic.
A very fragile virus infecting a small subspecies of chimpanzees was introduced into the blood of a handful of humans, most likely hunters of what is called 'bush meat.'
One of them must then have introduced the virus into a chain of 'amplifiers' - disease eradication campaigns, brothels serving African workers, a Haitian plasma center, and Gay sex tourism.
Without those amplifiers, the virus would not be what it is now - a global phenomenon with more than 62 million infections.
Pepin is now an infectious disease specialist at the University of Sherbrooke in Quebec, but in the early 1980s, when AIDS was just being identified, he was a young doctor fighting a sleeping sickness epidemic at a hospital in Nioki, in what was formerly the Belgian Congo, then Zaire, and is now the Democratic Republic of Congo.
Later, he worked in Guinea-Bissau on HIV-2, which is related to HIV-1, but causes a milder and harder-to-transmit form of AIDS that some victims live with for decades.
In 2005, Pepin began field studies. By sampling the blood of Africans 55 and over, he showed that those who had many injections in their youth or had undergone ritual circumcision, in which many boys were cut with the same blade, often had antibodies to hepatitis C or HTLV.
HTLV is a little-known virus that, like HIV-1, comes from chimps and infects the CD4 cells of the human immune system. Unlike HIV-1, it is harmless to humans.
Nevertheless, for Pepin, it was hard evidence that blood and syringes had spread other viruses.
The viral ancestor of AIDS exists in one chimpanzee subspecies, Pan troglodytes troglodytes, which in nature lives only between the Sanaga and Congo rivers.
That virus, in turn, is a blend of simian viruses from red-capped mangabeys and mustached guenons, small monkeys that chimps hunt and eat.
Pepin examined colonial archives in Paris, Marseilles, Brussels, Lisbon, and London. He also dug out old records of clinics where, as early as 1909, African prostitutes were required to have venereal disease inspections.
He also went through stacks of newspapers, like the Voix du Congolais, which wrote extensively about polygamy and prostitution, and pored over studies by European ethnographers.
Blood and tissue samples stored in freezers in Africa and in European hospitals that treat Africans - some going back to the 1950s - form a map of AIDS viral subtypes, which is surprisingly complex. For example, white and black South Africans have different subtypes.
'Few homosexual Afrikaners have sex with heterosexual Zulus,' Pepin notes.
The whites' subtype is common among Gay European and American men. The one most common among blacks moved south through Zambia, often following trade routes.
Simian immunodeficiency virus, which infects monkeys and apes, is similarly mapped.
In nature, only about six percent of troglodytes chimps are ever infected. Within a troop, each female mates with many males, but mating with outsiders is rare, so most troops are untouched while a few are heavily infected.
HIV-1's four genetic groups, M, N, O and P, show that it made the chimp-human jump at least four times in history, but group M accounts for more than 99% of all cases.
Molecular clock dating shows that M reached humans around 1921. Chimpanzees are too big and agile to be hunted with anything but guns, which until the 20th century were almost entirely in white hands.
Using colonial census data, surveys of how modern bush meat hunters butcher their kills, and infection rates among nurses stuck by dirty needles, Pepin calculates that, in the early 1920s, a maximum of 1,350 hunters might have had blood-to-blood contact with troglodytes chimps.
Only six percent of the chimps - about 80 individuals - would have been infected, and fewer than four percent of the scratched hunters probably could have caught the virus.
That would suggest at most three infected hunters, and the disease might have died out with that tiny population, except, Pepin says, that amplifiers helped the disease spread more widely.
In the 1920s, machine-made glass syringes replaced expensive hand-blown ones, and the Belgians and French shipped them in bulk to their colonies, hoping to wipe out infectious diseases there.
Patients might get up to 300 shots in a lifetime, but standards of sterilization were primitive. Thus, one hunter's HIV-1 group M infection could have become dozens.
Then Pepin's focus shifts to the twin cities facing each other across the Congo - Leopoldville, now Kinshasa, on the Belgian side, and Brazzaville on the French.
They are the epidemic's cradle. Viral diversity is highest there, and the earliest positive blood sample, from 1959, was found there.
From 1900, both grew from tiny river outposts into cities, but only black men with colonial work permits were allowed to live in them legally. Naturally, women followed.
But until 1960, brothels were rare. Most of the women were 'femmes libres' - escapees from rural polygamy who typically had only three or four clients for whom they also cooked and did laundry.
Since femmes libres had few sexual partners, viral spread was probably sluggish, although occasional hepatitis outbreaks were noted at clinics where prostitutes got penicillin shots for syphilis - suggesting amplification by needle there, too.
In the 1960s, however, everything changed. World War II had swollen the twin cities, which supplied raw materials the Allies had lost when Japan conquered their Asian colonies.
Then, when whites fled the chaos of independence, economies collapsed. Poverty was rampant. Dozens of bar-brothels called 'flamingoes' sprang up, competition forced desperate women to have sex with up to 1,000 clients a year, and venereal disease treatment dried up.
There must have been a viral explosion like the one that happened 20 years later in a closely studied band of prostitutes in Nairobi. In 1981, five percent of them had the virus, but three years later, 82% did.
The next link was Haiti.
Because white Belgians never trained an African elite, only about 30 Congolese outside the priesthood had university degrees at independence.
To fill the gap, the United Nations hired bureaucrats and teachers from abroad. About 4,500 Haitians got jobs in the Congo area.
By mapping subgroups of HIV-1 group M, in particular subgroup B, Pepin speculates that AIDS may have returned to Haiti in just one Haitian. Molecular clock dating indicates it reached Haiti roughly in 1966.
Pepin argues that rapid expansion through sex alone is mathematically impossible and that there must have been an amplifier. He believes the culprit was a Port-au-Prince plasma center called Hemo-Caribbean that operated only from 1971 to 1972 and was known to have low hygiene standards.
Ironically, Hemo-Caribbean was owned by Luckner Cambronne, leader of the feared Tontons Macoutes secret police, and known as 'The Vampire of the Caribbean.'
Haiti was also a prime destination for American sex tourism. The Spartacus travel guides of the time even listed average prices for young hustlers.
By the early 1980s, HIV-1 group M, subgroup B, was killing both American Gay men and hemophiliacs, suggesting it arrived both through sexual contact and through contaminated blood.
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