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| Canadian flight attendant Gaetan Dugas was known as 'Patient Zero' |
Flight attendant for Air Canada reported having about 250 sexual partners a year
27 October 2016
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| Demonstrators holding signs with numbers for each patient who died from AIDS at a memorial service in Central Park in June 1983. Scientists report that the strain of H.I.V. responsible for almost all AIDS cases in the United States spread from Haiti to New York City around 1971. Credit Alon Reininger/Contact Press Images |
H.I.V. Arrived in the U.S. Long Before ‘Patient Zero’
In the tortuous mythology of the AIDS
epidemic, one legend never seems to die: Patient Zero, a.k.a. Gaétan
Dugas, a globe-trotting, sexually insatiable French Canadian flight
attendant who supposedly picked up H.I.V. in Haiti or Africa and spread
it to dozens, even hundreds, of men before his death in 1984.
Mr.
Dugas was once blamed for setting off the entire American AIDS
epidemic, which traumatized the nation in the 1980s and has since killed
more than 500,000 Americans. The New York Post even described him with
the headline “The Man Who Gave Us AIDS.”
But after a new genetic analysis of stored blood samples, bolstered by some intriguing historical detective work, scientists on Wednesday declared him innocent.
The
strain of H.I.V. responsible for almost all AIDS cases in the United
States, which was carried from Zaire to Haiti around 1967, spread from
there to New York City around 1971, researchers concluded in the journal
Nature. From New York, it spread to San Francisco around 1976.
The new analysis shows that Mr. Dugas’s blood, sampled in 1983,
contained a viral strain already infecting men in New York before he
began visiting gay bars here after being hired by Air Canada in 1974.
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The
researchers also reported that originally, Mr. Dugas was not even
called Patient Zero — in an early epidemiological study of cases, he was
designated Patient O, for “outside Southern California,” where the
study began. The ambiguous circular symbol on a chart was later read as a
zero, stoking the notion that blame for the epidemic could be placed on
one man.
Myths
like that of Patient Zero echo in prevention efforts even today,
experts said. Many vulnerable groups, including young gay men and
African women, fail to use protective drugs or avoid testing because
they fear being stigmatized or accused of being carriers.
Reflecting
on the epidemic’s early days, Dr. Anthony S. Fauci, then a doctor
treating AIDS patients and now the director of the National Institute of
Allergy and Infectious Diseases, said he remembered it seeming
plausible at the time that one person was responsible.
In
hindsight, he added, the idea now seems absurd. “We were unaware of how
widespread it was in Africa,” Dr. Fauci said. “Also, we thought, based
on very little data, that it was only about two years from infection to
death.”
The new data is consistent with the scenario described in 2011 in “The Origins of AIDS,” by Dr. Jacques Pépin, an infectious disease specialist at the University of Sherbrooke in Quebec.
Relying on previous genetic research
and African colonial records, Dr. Pépin showed that H.I.V. was carried
from Kinshasa to Haiti in the 1960s — most likely by one of the
thousands of Haitian civil servants recruited by the United Nations to
work in the former Belgian Congo after colonial rule collapsed.
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|
Gaétan Dugas, the flight
attendant once described as
Patient Zero in the American
AIDS epidemic.
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In Haiti, he theorized, a few cases were multiplied by unsterile conditions at a private blood-collecting company,
Hemo-Caribbean, that opened in 1971 and exported 1,600 gallons of
plasma to the United States monthly. Plasma clotting factors were used
by American hemophiliacs, many of whom died of AIDS.
Haiti was also a sex-tourism destination for gay men, another route the virus could have taken to New York.
The
blood samples analyzed in the new study were collected in 1978 and 1979
in New York City and San Francisco as part of an effort to make a hepatitis B
vaccine. Researchers stored almost 16,000 blood samples; nearly 7
percent of those from New York and 4 percent of those from California
later turned out to be infected with H.I.V.
A
team led by Michael Worobey, an evolutionary biologist at the
University of Arizona in Tucson and the lead author of the Nature paper,
sequenced the genomes of the H.I.V. found in some of those samples and
compared them with viral DNA in samples collected in the early 1980s
from Haitians, Dominicans and others treated in American hospitals.
Because
decades spent in freezers had degraded many samples, Dr. Worobey said,
his lab developed an “RNA jackhammering” technique similar to that used
to reconstruct the ancient Neanderthal genome. Counting mutations
allowed the researchers to “wind back the molecular clock” and see when
each strain of H.I.V. diverged from its ancestors.
Africa
has a dozen H.I.V. groups, and Haiti’s epidemic came from one of those.
The New York samples all derive from one Haitian strain, and those from
San Francisco are all so closely related that they probably all
resulted from one person introducing one New York strain, Dr. Worobey
said.
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| Thomas Ramos, an AIDS patient, at a hospital in New York, in July 1987. The epidemic has killed more than 500,000 Americans. Credit Alon Reininger/Contact Press Images |
The symptoms that were later called AIDS were first recognized in 1981, and the legend of Patient Zero began with a 1984 study
that traced the sexual contacts of 40 gay men with Kaposi’s sarcoma or
other indicators of late-stage AIDS. Eight of them, half in New York and
half in Southern California, had had sex with an unidentified flight
attendant.
Initially described as “Case 057” and then as Patient O, he reported having about 250 sexual partners a year.
That
study incorrectly assumed that most patients developed AIDS symptoms
within about 10 months of infection. In reality, it takes years — so
some participants may have been infected long before meeting Mr. Dugas.
Also,
Mr. Dugas may have become the cluster’s focal point partly because he
kept a diary. Men in the study reported an average of 227 partners a
year, often quick, anonymous encounters in bars and bathhouses.
But Mr. Dugas gave investigators 72 names.
Dr.
Harold W. Jaffe, who was one of the original investigators and is now
the associate director for science at the Centers for Disease Control
and Prevention, said the text of the original article referred to a
“patient outside California.”
But
the chart, of which he had an early copy, was admittedly ambiguous. At
the center is the “O” or “0,” identified as the “index patient.” The
other cases are numbered: “LA3” and “NY15,” for example.
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The
legend itself sprang from the publicity campaign for a best-selling
1987 book, “And the Band Played On,” by Randy Shilts, a gay San
Francisco journalist who himself died of AIDS in 1994.
In
a 1993 interview, Mr. Shilts said he had heard C.D.C. investigators use
the term Patient Zero and thought, “Oooh, that’s catchy.”
By
hunting down former boyfriends of men in the 1984 study, Mr. Shilts
established that the flight attendant was Mr. Dugas, who was born in
Quebec but lived his last years in Vancouver, British Columbia.
Mr.
Shilts said he was initially horrified that his publisher, St. Martin’s
Press, focused his book tour on Patient Zero instead of the
government’s slow response to the epidemic, but he went along.
Although
Mr. Shilts did not accuse Mr. Dugas of starting the American epidemic,
he demonized him as a deliberate spreader of the virus who ignored a
doctor’s demand that he stop having unprotected sex, and coldbloodedly
told some sex partners that he had “gay cancer” and now they might get it.
Back
in 1984, the term Patient Zero was not normally used to describe an
outbreak’s first case, said Dr. Jaffe, an author of the new Nature
paper. “I don’t remember who first used it,” he said. “But after Randy
Shilts did, we started saying it ourselves.”
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Later, he said, when reporters asked if Mr. Dugas had brought AIDS to North America, “We said no, that he wasn’t the first.”
Dr.
Jaffe added: “But I think they went with it anyway. The idea of Patient
Zero was very attractive. Letter O would not be a story.”
Richard
A. McKay, a Cambridge historian and another author of the Nature paper,
has long fought for Mr. Dugas’s reputation, saying his friends in
Vancouver’s gay community had painted a sympathetic portrait of him for
Mr. Shilts, who ignored it.
Humanizing
Mr. Dugas could help in the fight to end the epidemic, said Dr. Robert
M. Grant, an AIDS researcher at the University of California, San
Francisco.
Even
though the disease can now be prevented and controlled, many people —
in San Francisco and in Africa, he said — resist getting tested for
H.I.V. and fool themselves into believing they are not at risk because
they fear being blamed by their social circle.
“No
one wants to be the Patient Zero of their village,” he said. “But this
may be helpful because it says, ‘Just because you are the first to be
diagnosed doesn’t mean you started the epidemic.’”
Correction: October 26, 2016
An earlier version of a picture caption with this article,
using information from a photo agency, overstated what is known about
the location where the men are shown walking. While they were in San
Francisco, they were not on Castro Street. (The agency cannot determine
the street in the 1986 photograph.)
Read more articles from The New York Times, here.
Read more articles from The New York Times, here.
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