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Review: The Origin of AIDS

Jacques Pepin’s book disposes of popular alternative origin theories of AIDS and traces the disease back to Central Africa.
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Kampala, Uganda:

One of Uganda’s top public health policy makers kicked off a firestorm in the local media in July with a column marking the 30-year anniversary of the discovery of AIDS. In the piece in one of Uganda’s biggest papers, Sam Okuonzi – a former top official in the ministry of health and recently elected MP – called common conceptions about the origin of HIV a “scientific fraud” masking a much larger conspiracy perpetrated by the US government.

His theory borrows heavily from the work of Alan Cantwell, a retired dermatologist and prolific writer on the origin of AIDS. Cantwell claims the virus was created in an American laboratory in the mid-1970s and spread in gay communities in the US and throughout Africa via large-scale vaccination programs.

The merits of the argument were heatedly thrashed out over the following weeks in the paper. The debate was finally quashed when the chairman of the country’s monolithic AIDS commission put out a statement calling the original column “disquieting” and “extremely diversionary”.

It is unclear if Okuonzi won any converts through his column. The international scientific community has debunked Cantwell’s theory – along with most AIDS origin stories rooted in government conspiracies. What Okuonzi did accomplish, though, was to highlight a deep dissatisfaction among some Ugandans about the way the origin of AIDS is described. That Africa, as he told Think Africa Press, has been stigmatised, and not just as the source of AIDS but as a “cursed” place housing all manner of terrible new diseases.

For decades AIDS has been used to stigmatise all manner of communities, from gays to Haitians and Africans. That could change with the recent publication of Jacques Pepin’s The Origin of AIDS. Pepin offers a readable, detailed account of how the virus jumped from chimpanzees to humans at the exact time that medical interventions and human migration were paving a path for wide-scale transmission. What Pepin describes is a perfect storm of biological developments and human activity that defies any attempt to assign culpability to a specific community.

Pepin, a practicing infectious diseases physician and epidemiologist, spent four years in a bush hospital in then-Zaire in the early 1980s – a stint that coincided with the initial discovery of AIDS in the US and the slow realisation that it was already a global epidemic. The question he looks to answer in The Origin of AIDS, though, is what happened before he arrived on the scene? How could the transmission of a virus from one chimpanzee to one man sometime around 1921 explode into a global pandemic?

Within the first few chapters of the book, he disposes of many of the most popular alternative origin theories, including Cantwell’s, in favor of the least clandestine, but only possible option: HIV was transmitted from chimpanzee to man. And, because HIV evolves over time, by comparing the diversity of sub-types of the virus that have developed in specific communities scientists have been able to determine where that transmission occurred. The answer is Central Africa. As Pepin writes, “HIV-1 diversity in Kinshasa twenty-five years ago was far more complex than among strains currently found in any other parts of the world!”

He does concede Okuonzi’s point: early assumptions that AIDS originated in Central Africa were naïve and biased, and came ahead of the scientific evidence. They just happened to be correct. These attempts at even-handedness dot the work and signal that Pepin is not looking to assign blame. He is looking for truth. Thus, Pepin gives all existing origin theories a fair hearing before slowly, scientifically dismantling them.

If there is any headline finding in the book, it is Pepin’s own research into what happened after the virus crossed from chimps to man. The reuse of improperly sterilised syringes and needles during widespread vaccination campaigns around the time of the first transmission “jumpstarted the epidemic”.

This section of the book reads, in part, as a mea culpa. Pepin concedes, “during my time in Zaire patients under my care were probably infected with HIV-1 during health care”, when glass syringes and reusable needles were not properly sterilised. And his subsequent research into the impact of this laxity is critical. It explains how, instead of one infected man with a small likelihood of transmitting the virus beyond, maybe, his wife, there was a community of people who had shared a needle with him and had been exposed to the virus. Perhaps hundreds became infected. And the likelihood increased that one of those people might join the growing migration to urban centers like Kinshasa or Brazzaville and become part of a sexual network with concurrent sexual partners.

It was then that the pandemic could begin in earnest, with HIV tracing a path from partner to partner, through whole communities and across borders, until, as Pepin writes, “an astute CDC technician” found simultaneous requests for a rare drug strange and began asking questions about an illness that had suddenly sprung up in America’s gay community.

Aside from turning an astonishing mass of research into a highly readable book, one of Pepin’s great accomplishments is the way he methodically addresses everyone’s – usually unknowing – culpability in spreading HIV. No one, not the bushmeat hunters in Central Africa, not the doctors distributing vaccines, not the sexual tourists who carried HIV from Haiti to the US, and not Pepin himself, realised the role they were playing in launching the worst pandemic in modern history. One of the key subtexts he proffers is that no one is to blame for the origin of AIDS, but that everyone must take responsibility.

Pepin wrote this book for the ages. “As the years go by, it becomes less and less likely that researchers will uncover novel information that could substantially alter this narrative,” he explains. He admits some of his more minor circumstantial hypotheses might not withstand future tweaking, but what he has produced is something definitive – the answer to future debates like the one that spilled across a Ugandan newspaper in July.

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