The Origins of AIDS
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It is now thirty years since the discovery of AIDS but its origins continue to puzzle doctors and scientists. Inspired by his own experiences working as an infectious diseases physician in Africa, Jacques Pepin looks back to the early twentieth-century events in Africa that triggered the emergence of HIV/AIDS and traces its subsequent development into the most dramatic and destructive epidemic of modern times. He shows how the disease was first transmitted from chimpanzees to man and then how urbanization, prostitution, and large-scale colonial medical campaigns intended to eradicate tropical diseases combined to disastrous effect to fuel the spread of the virus from its origins in Léopoldville to the rest of Africa, the Caribbean and ultimately worldwide. This is an essential new perspective on HIV/AIDS and on the lessons that must be learnt if we are to avoid provoking another pandemic in the future.
a booming town that it constantly attracted a flux of migrants from the adjacent rural areas and young men would come first, perpetuating the imbalance. On both sides of the trade, prostitution involved mainly the unmarried and within this subgroup as late as the 1950s there were more than five men for each woman in Léopoldville. For the first few decades of its presence in Léopoldville, the dissemination of HIV-1 was slow and limited. According to mathematical models, for a long time there was
to some of their regular clients. And thus a perfect storm developed.17 More widespread sexual transmission became possible when the face of prostitution in Léopoldville was dramatically altered around 1960–1. The political chaos and civil war in parts of the Congo brought hundreds of thousands of internal refugees into the capital, resulting in massive unemployment and poverty (Chapter 11). As documented by several observers, high-risk prostitution appeared, with sex workers providing sexual
Francisco HIV-1 epidemic (1978–79). AIDS Res Hum Retrovir (2000), 15: 1463–9. 8. Moore JD et al. HTLV-III seropositivity in 1971–72 parenteral drug abusers – a case of false positives or evidence of viral exposure. N Eng J Med (1986), 314: 1387–8. 9. Garrett L. The coming plague. Newly emerging diseases in a world out of balance. New York: Penguin Books, 1994. 10. Anonymous. Ebola haemorrhagic fever in Zaire, 1976. Report of an international commission. Bull World Health Organ (1978),
anywhere in the world, to produce OPV. Scientists had easy access to small monkeys of the Macaca genus, which were abundant in Asia, cheaper and easier to handle than chimpanzees, raised fewer ethical issues and worked well in cell culture systems. In 1955, up to 200,000 rhesus monkeys were imported into the US for medical research. Furthermore, as noted by the late Dr Paul Osterrieth, a scientist who worked at the Stanleyville laboratory for a few years, it was technically impossible for this
one of which concerned prostitution. The law of 1923 with its weekly check-ups was mentioned, but without any information about whether this was actually implemented. There was not a single brothel in Cameroun at that time.5,24–27 In 1909, sanitary check-ups were made compulsory for prostitutes in Brazzaville, and in 1912 about fifty showed up each week. The 1927 report for French overseas territories mentioned that in Brazzaville sex workers had to go for a weekly examination and those with an