The Patient Zero Myth
For decades, a French-Canadian airline employee named Gaetan Dugas, has been known as Patient Zero in the 1980s AIDS epidemic.
Dugas, a man who had sex with men , died in 1984. Since then he has been blamed by some as a primary source for the spread of HIV in North America.
Dugas was one of the primary villains in the 1987 book, And the Band Played On, by San Francisco journalist Randy Shilts.
However, the researchers now say Dugas was falsely accused and unfairly blamed.
Gaetan Dugas is one of the most demonized patients in history, and one of a long line of individuals and groups vilified in the belief that they somehow fueled epidemics with malicious intent, said Richard McKay, D.Phil., a Wellcome Trust Research Fellow in Cambridges Department of History and Philosophy of Science, in a press release.
In fact, McKay says, Dugas actually provided scientists with valuable information before he died.
Dugas told researchers after he contracted HIV that he had 750 sexual partners the previous three years. That wasnt necessarily an unusual number. Researchers said 65 percent of men in a Los Angeles cluster study at the time reported having more than 1,000 sexual partners in their lifetimes.
Much of that sexual connection was with anonymous partners, so many HIV patients couldnt give medical officials any names.
However, McKay says, Dugas provided medical officials with 72 names. That helped scientists track down a wide range of people infected with HIV.
Challenges Of Virus Tracking
One of the primary challenges experts have in tracking a virus to the initial infection is that it may present as another infection. For example, when HIV first appeared in the U.S., doctors reported rare lung infections in a group of individuals.
Because of this, doctors may never identify cases as being due to HIV. People may have had HIV before these individuals, but received a diagnosis for another condition or did not seek medical attention.
Even then, if doctors determine that someone has HIV, it is challenging to identify who had the virus first because of the speed at which it spreads.
- the host of the virus
- how many introductions to humans there have been
- how it connects to previous events
- if there is evidence for local adaptation
In some cases, an emergent virus is a variation of an existing virus, such as the SARS-CoV-2 coronavirus that causes COVID-19. This knowledge allows for the rapid development of treatments and vaccines as experts already understand the mechanics of similar viruses.
Understanding the origin of a virus makes it possible to determine how it transmits from one animal or person to another. Not only does this help scientists develop treatments, but they can also work on methods to prevent its spread.
Mythology Of Patient Zero And How Aids Virus Traveled To The United States Is All Wrong
The story of how Patient Zero and AIDS arrived in New York in 1979 and triggered the epidemic in North America has been told so many times in so many different ways that for many people its become an accepted truth of our modern history.
It begins with a single man, a young flight attendant named Gaetan Dugas, who presumably became infected abroad and then unwittingly gave it to some of his sexual partners. His sexual partners in turn gave it to their sexual partners and so forth until the whole continent was full of clusters of people dying of the mysterious disease. In journalist Randy Shilts 1987 book And the Band Played On, and in various media reports, Dugas was described as sexually adventurous and said to have told Centers for Disease Control and Prevention investigators he had approximately 250 sexual partners each year.
Its a compelling narrative, but its not quite right.
In a study published Wednesday in the journal Nature, researchers used genomic sequencing of blood samples from that era to go back in time and reconstruct the family tree of the virus in unprecedented detail. The findings are stunning, debunking many popular beliefs about the viruss origins and spread and filling in holes about how it made its way to the United States.
It could have been a person of any nationality. It could have even been blood products. A lot of blood products used in the United States in the 1970s actually came from Haiti, he explained.
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From Patient O To Patient Zero
And the Band Played On
Similarly to Darrow, Shilts attempted to track the spread of AIDS throughout America. He had been covering the unfolding of the epidemic for a few years, earning praise from the gay community for propelling AIDS out of the shadows. Yet, in contrast to the CDC study, Shilts work was not solely scientific but took a moral stance on the spread of the disease, which he saw as the result of the callousness and unchecked pursuit of sexual partners by those who had the disease.
In particular, Gaëtan Dugas played the role of the central villain in Shilts tale, where he appears as a pleasure-seeking sociopath. Rather than willingly assist the CDC and volunteer his time, Shilts Dugas angrily responds Ive got itthey can get it too when told he must stop frequenting gay bathhouses.
When Shilts interviewed employees at the CDC, they mistakenly referred to Dugas as AIDS Patient Zero rather than Patient O, the result of a small typo. Shilts recalled he thought Ooh, thats catchy and seized upon the dramatic epithet for his book. This encouraged the implication that AIDS Patient Zero was the first man to contract the disease and was therefore responsible for its spread.
Who Was Patient Zero
The first verified case of HIV derives from a 1959 blood sample of an individual who lived in the Democratic Republic of Congo. However, scientists cannot say whether this person was the first human with HIV, or the first documented case, known as patient zero.
There are numerous documented cases before this one in which the patterns surrounding death suggest HIV as the cause. However, there is no way to prove this through a blood sample. The 1959 sample is the first recorded case in which a blood sample can confirm HIV infection but may not be the first official emergence of HIV.
For many years, Gaétan Dugas was presumed patient zero in the U.S., originally termed patient O for outside Southern California. He was a flight attendant suspected of picking up HIV in Africa or Haiti and bringing it back to the U.S., transmitting it to dozens of men before his death.
However, an analysis into genetics in 2016 found that the viral strain Dugas had was already spreading among men in New York before he began visiting the citys gay bars. This means that Dugas was not the initial individual with HIV. It seems he was an early case but was by no means the first.
There is limited actual knowledge on how the epidemic entered the U.S. because of the challenges in tracing HIV to one individual.
, a virus that attacks the immune system of apes and monkeys.
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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.
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.
But Mr. Dugas gave investigators 72 names.
Why Its Such A Toxic Term
Heightened fears surrounding COVID-19 have once again brought the idea of patient zero into public consciousness. Ever since it was coined by accident in the 1980s, this popular yet slippery term has regularly and misguidedly been applied to infectious disease outbreaks and public health efforts to control them.
Steve Wozniak, co-founder of Apple, tweeted earlier this month that he and his wife might be patient zero for the epidemic of COVID-19 in the US after they returned from a trip to China with symptoms. He later described his use of the phrase as kind of a joke.
Less frivolously, the hunt for patient zero formed part of a recent BMJ headline for an editorial examining the devastating epidemic unfolding in Italy. The piece described local attempts to find the countrys initial coronavirus cases, hypothesising that they might be a pair of visitors from Chinas Wuhan region, where health authorities were confronting the worlds earliest recognised large-scale outbreak.
Amid heightened contact-tracing efforts to locate cases linked to a doctor in the UK who was displaying symptoms of the infection, the Daily Mail used similarly dramatic language. An article described the desperate hunt for an unknown coronavirus spreader who gave note the implied volition of this word the deadly illness to the UKs 20th victim the first Briton to catch it in the country.
Blame and scapegoating
What we dont see
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Hiv Arrived In The Us Long Before Patient Zero
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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 .
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. Dugass blood, sampled in 1983, contained a viral strain already infecting men in New York before he began visiting gay bars in the city after being hired by Air Canada in 1974.
Who Was Gatan Dugas Aids Patient Zero
Le MondeGaëtan Dugas.
Born in 1953 in Quebec, Gaëtan Dugas was a handsome flight attendant who had begun working for Air Canada in 1974.
Darrow was able to trace eight of the cases reported in Los Angeles directly back to Dugas. The CDC quickly contacted him asking for his help in research in what they were now sure was a completely new sexually transmitted disease.
Dugas was more than happy to oblige. He flew to CDC headquarters in Atlanta and donated large amounts of his blood that would prove critical in future research.
He even volunteered to give the scientists an incredibly detailed list of some of his other partners who he thought might have been infected to help them trace the spread of the disease throughout the country. In total, Dugas estimated hed had around 750 sexual partners over the past three years and provided the CDC with roughly 10 percent of their names.
The charismatic,kind, and energetic, but ultimately doomed young Canadian returned home to Quebec and decided to volunteer at a clinic for HIV-infected men in Canada. He passed away from AIDS-related complications in March of 1984, one month after turning 31.
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Genetic Analysis Shows Hiv Came To Us Via Haiti In Early 1970s Long Before Identification Of First Aids Cases Patient Zero
The Atlantic: How One Man Was Wrongly Blamed for Bringing AIDS to AmericaHIV arrived in the U.S. from Haiti a decade before the first cases were identified and well before the so-called Patient Zero contracted the virus .
New York Times: HIV Arrived in the U.S. Long Before Patient ZeroIn 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 HIV in Haiti or Africa and spread it to dozens, even hundreds, of men before his death in 1984. But after a new genetic analysis of stored blood samples, bolstered by some intriguing historical detective work, scientists on Wednesday declared him innocent .
NPR: Researchers Clear Patient Zero From AIDS Origin StoryThe scientists also sequenced the virus from eight other men infected with HIV during the 1970s. From these genetic codes, the scientists estimate HIV came to the U.S. from Haiti in 1970 or 1971, but it went undetected by doctors for years .
The KFF Daily Global Health Policy Report summarized news and information on global health policy from hundreds of sources, from May 2009 through December 2020. All summaries are archived and available via search.
Not Just A Hypothetical Case
These developments played into the Reagan administrations slow-to-develop and socially conservative response to the epidemic. Jennifer Brier has argued that the most important factor shaping the Republican administrations response to AIDS was the lead role taken by members of the Department of Education. The departments secretary, William Bennett, and the under secretary, Gary Bauer, who was also Reagans advisor on domestic policy issues, developed a response that was in keeping with the religious support base of the New Right. Their approach took every opportunity to reinforce the supremacy of heterosexual marriage and traditional gender roles.92 To the notion of the innocent victim of AIDSthe HIV-infected blood transfusion recipient, for exampleBennett and Bauer set up a rhetorical counterpoint, the deserving person with AIDS. This idea was articulated in the writing of John Klenk, one of Bauers former aides: The most common cause of the spread of AIDS is irresponsible sexual behavior. Anyone who engages in such behavior endangers him self, his partner, his children, and other innocent victimsnot to speak of causing enormous medical costs to taxpayers and the public. Society must show its disapproval for such behavior.93
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How A Typo Created A Scapegoat For The Aids Epidemic
A 1984 study planted the seed that would lead the media to falsely demonize Gaëtan Dugas as Patient Zero of an epidemic that would kill more than 700,000 people in North America
Gaëtan Dugas loved to fly. Adopted by a large family in the Quebec City suburb of LAncienne-Lorette, he grew up next to the airport, watching planes take off and wishing he were on board. He trained as a hairdresser, but once airlines lifted the ban on men doing the work of stewardesses, he found his dream job. He became one of Air Canadas new cohort of male flight attendants.
It was 1974. Dugas was a wildly handsome, flamboyant and utterly promiscuous 22-year-old surfing a jet stream of sexual liberation. It was an era when flying was still glamorous, people smoked on planes and the horizon of casual, carefree sex appeared limitless. With a bleached-blond coif and the pants and shirt of his uniform re-tailored to be skin-tight, Dugas wore his gay pride to work. He shared makeup tips with his female colleagues and competed with them to pick up the hottest male passengers. By the end of the decade, the Air Canada flight attendant with the cute French accent and men in every port was a minor legend, known from the airline crew lounge to the bathhouses of New York and Los Angeles.
And it all began with a typo.
How Hiv Arrived In The United States
Sequencing genomes allows scientists to take a peek back in time to determine how a virus emerged and where it traveled by examining how many mutations appear in the genome.
Scientists estimate that HIV was transmitting in humans after a chimpanzee infected a single person sometime in the early 20th century in sub-Saharan Africa. The general consensus among scientists is that HIV then crossed the Atlantic and quickly spread through the Caribbean before it arrived in the United States, probably from Haiti, Curran said.
Scientists at the University of Oxford in June suggesting that HIV spread through specific migration routes based on tourism and trade throughout the past 50 years as it made its way around the world.
The research team behind the new genetic analysis now hopes that its findings may lead to a better understanding of how HIV moved through populations and how blaming a single patient for the pathogens rise remains troublesome.
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