The Epidemic: A Global History of AIDS

439 Pages·2006·1.1 MB·English

by  Jonathan Engel

THE EPIDEMIC
[ A GLOBAL HISTORY OF AIDS ]
JONATHAN ENGEL
FOR MY CHILDREN:
EZRA, RUTH, MIRIAM, AND JUDAH
CONTENTS
Prologue 1
1. First Reports 5
2. Growing Panic 25
3. Race to the Vector 55
4. Conservative Backlash 69
5. Organizing and Selling 103
6. Drugs 127
7. The Shooting Galleries 147
8. Who Pays? 175
9. Myths 193
10. Africa 211
11. Breakthrough 233
12. Asia 255
13. Backsliding 267
14. Pandemic 291
Epilogue 321
Abbreviations 327
Notes 330
Acknowledgments 392
Index 393
Other Books by Jonathan Engel
Cover
Copyright
About the Publisher
PROLOGUE
Sometime in the 1930s, most probably 1931, a small bit of ribonucleic
acid (RNA), one of two types of genetic material found in the world,
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spontaneously mutated. This bit of RNA was the carrier of all genetic
information for an insignificant virus now known as simian immunode-
ficiency virus, which had lived in the bodies of various types of African
monkeys and apes for several hundred thousand years. The virus lived
parasitically in the apes, hindering them modestly without killing them,
and thus enabled its hosts to live and incubate more viruses, generation
after generation.
The mutation that occurred in 1931 was hardly unique. Genetic ma-
terial—both DNA and RNA—mutates frequently, and such mutations
are the basic engine of evolutionary change. This particular mutation,
however, would prove to be extraordinarily consequential for the world,
as it allowed the virus, which could previously live only in its ape hosts,
to live in human beings.
Once the mutation occurred, random chance dictated that the virus
would eventually find a human host. Whether by an African hunter
eating an infected monkey, or a chance contamination of an open human
sore with monkey blood, the virus would come to roost in a human
host, and from there spread to any other humans with whom
the primary host shared any of his or her bodily fluids that could harbor
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the pathogen.
Such transmission from monkey to human probably occurred multiple
times over the ensuing four decades, but for reasons specific to this
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particular virus, the range of contamination remained limited. For one,
the virus was unusually weak, unable to survive in air, and often unable
to penetrate the skin, epithelial tissue, and the mucosal linings of its
host’s sexual partners. For another, lack of good roads or commercial
air routes into infected areas of Africa prevented the virus from
spreading beyond small, isolated tribal groups. And third, the absence
of hypodermic syringes in these areas prevented its spread through
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contaminated needle pricks.
The virus did spread sporadically, however. At least 19 times between
1950 and 1972 it managed to travel by car, boat, or plane, to infect an
isolated individual in a far part of the globe. In 1959, for example,
David Carr was admitted to the Manchester (England) Royal Infirmary
with a variety of inexplicable symptoms including inflamed nostrils
and gums, skin lesions, and severe fever and weight loss. Moreover,
his immune system seemed to have wholly ceased functioning. And
upon his death, 20 weeks later, an autopsy revealed that he had suffered
from a rare form of pneumonia, Pneumocystis carinii (PCP), which was
associated almost exclusively with elderly men of Mediterranean or
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Ashkenazic Jewish extraction. That same year, a Bantu man died in
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Leopoldville, Belgian Congo, after having suffered similar symptoms.
Other cases retroactively identified in those early years include that
of Robert R., a Saint Louis teenager who died mysteriously in 1969 after
having been found to suffer from odd swelling of the legs, torso, and
genitalia, and whose autopsied body proved to be riddled with a rare
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skin cancer known as Kaposi’s sarcoma (KS); a Danish surgeon in 1977
who several years previously had been working in a rural surgical ward
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in Zaire; and a Canadian woman who had once been a nun who left
her order in 1972 to rehabilitate prostitutes in Port-au-Prince, Haiti, and
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who died in Canada in 1981.
Toward the late 1970s, these early cases, all identified as resultant of
similar pathogenic infections, began to appear more frequently. Between
1973 and 1979 at least 5 New York men contracted the myste-
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rious illness, as did at least a dozen others in Western Europe, the
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United States, and Israel. But it was from Africa, particularly central
Africa, that the preponderance of early cases emanated. Although
medical records are scarce for many of the rural populations of that
part of Africa, retrospective tests on collected sera conducted one to
two decades later showed presence of the mysterious virus in the blood
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of decedents in Zaire from the early to mid 1970s, in over 50 cases.
By 1982, Zaire, alone, had produced 18 identifiable victims of the strange
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new disease, all of whom had sought care in Belgium.
Years later, after the mutated pathogen had been identified, mapped,
charted, described, explored, and blamed for the death of tens of millions
of people, scientists would debate how and when the bit of RNA had
jumped species. Was it definitely in Africa, or was this merely another
example of a Eurocentric establishment blaming their ills on the dark
continent? And if it had been in Africa, could the cause have been rooted
in human actions? One tenacious author seized on the explanation that
the virus, or at least one iteration of it, while of monkey origins, had
actually been inadvertently included in batches of oral polio vaccine
that were administered to patients in the Belgian Congo in the late
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1950s. The thesis, while compelling, and perhaps even titillating,
couldn’t stand up to rigorous investigation. As cases became known
that predated the vaccine administration, and as genetic researchers
confidently dated the primary mutation to two decades prior, the
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thesis was dismissed.
The truth, it turned out, was more mundane. The troublesome
pathogen was one of several that had mutated more toxic qualities
during the course of the 20th century, and lodged in human hosts.
Others, such as Ebola and Marburg, had arisen as rapidly and mysteri-
ously. This one, however, had spontaneously stumbled upon the sublime
trick of slow pathogenesis. While other fatal viruses killed so rapidly
that they scarcely gave their hosts time enough to transmit the virus
before dying, this one killed slowly. In the decade or so that it took the
virus to wholly immobilize its host’s immune system, and ultimately
kill him, the host could spread the virus to hundreds of unknowing
new hosts, whether through sexual coupling, needle sharing, or blood
transfusions. And for much of that decade, the symptoms of the viral
infection were so mild that the pathogen’s presence remained all but
unknow-
JONATHAN ENGEL / 3
able. The one great defense on the side of the humans—the essential
weakness of the virus’s protein coat—protected humans for decades.
Once the virus breached the jungle, however, and learned to travel by
automobile and jet, that defense was no longer adequate.
Our story starts, then, not at the inception of the new virus, but at
the moment it entered the modern world. For it was here that the virus
found fertile ground to grow and spread, jumping intercontinentally
in a matter of months, and growing exponentially in frequency, until
it overwhelmed whole communities, towns, cities, and even nations.
Our story starts in the raucous Castro and Greenwich Village neighbor-
hoods of San Francisco and New York City in the early 1980s, where a
weird amalgam of unprecedented eroticism and fierce political defiance
combined to create a near perfect environ for the virus’s spread.
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