The Origins of AIDS (Jacques Pepin)

Published March 30, 2013 · Estimated reading time: 4 minutes · Share your thoughts
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The Origins of AIDS (2011)
Jacques Pepin
306 pages

AIDS was first identified in North America in 1981 and its infectious agent human immunodeficiency virus (HIV) was isolated two years later. In the subsequent 30 years, AIDS has become a global pandemic that has led to around 30 million deaths. Pepin’s book tackled the origins of this devastating infectious disease subject in three parts: first, he examined the origin of the virus itself; second, he examined the context that permitted and even promoted outbreak of the virus; finally, he examined the global routes by which the virus traveled. Each part of the story was addressed through a historical lens and supported several lines of evidence, including viral biology, epidemiological and sociological data.

The book began by examining current scientific understandings of where and when HIV made the transition from a simian ancestral virus to a human virus. Pepin examined colonial-era records, and modern molecular clock analysis of samples to pin-point the origin of the M strand of HIV-1 which is responsible for the vast majority of the global burden of AIDS. These lines of evidence point to a ‘patient zero’ in the Congo around 1921, with a confidence interval of ±10 years. Outlining the theories proposed to explain how the virus jumped, Pepin suggested that the most plausible is the ‘cut hunter theory’, where handling and consumption of chimpanzee bush meat is believed to have provided a route for cross-species transmission. However, palaeo-virological evidence suggests that simian variants of the virus have existed since at least the 15th century, in areas populated by humans. Why did the AIDS epidemic not emerge earlier?

To investigate this question, Pepin took the reader to late 19th century, where sociopolitical trends led to greater access to weapons for hunting, and increased urbanization and public health campaigns which facilitated the spread of HIV. The colonization of central and West Africa by European powers brought about increasing urbanization, accompanied by great gender imbalance as these newly created cities became predominantly populated by young men seeking jobs. In early 20th century, these urban centers became breeding grounds for the sexual transmission of the virus facilitated by prostitution.

While the behavioural component of the spread of AIDS has long been established, Pepin explored a second less-discussed but perhaps equally important factor: interavenous injections conducted as part of colonial public heath campaigns. I cringed a little when I began to read this part of the book since it quickly brought to mind the discredited AIDS origins theories. However, Pepin outright rejected such conspiracy theories. Rather what he described, thoroughly and with good evidence, is a classic “road to hell is paved with good intentions situation” and the culprit: un-sterile injections. Pepin provided evidence for repeated use of needles and lack of sterilization processes that may have exposed individuals to greater risk of exposure to HIV than they would have been otherwise. An excerpt in the book from medical archives describes common practices of the time, where “the syringe [was] used from one patient to the next, occasionally retaining small quantities of blood”. Pepin described “the largest ever iatrogenic epidemic” in Egypt where non-sterile anti-schistosomiasis injections were associated with a rise in blood-borne HCV infections. He postulated that in Central Africa the iatrogenic amplification of AIDS may have similarly occurred via “well-meaning” campaigns targeted to combating tropical diseases among the general population and containing sexually-transmitted such as syphilis among prostitutes and high-risk individuals.

The latter chapters of the book followed the route of HIV out of central Africa in the 1970s at the heels of globalization and decolonization processes that led to great inter-continental migrations and dispatching of foreign nationals into the area. Pepin provided evidence that the jump was likely facilitated by a single Haitian who worked in the Congo. In Haiti, the virus proliferated and jumped to North America via commercial blood trade and sexual transmission, though the author argued that the former is probably responsible for the vast dissemination of the disease. While the latter part of the book was very interesting, I felt that it lacked the detail of the former part of the book. I think this in part had to do with the fact that there has been massive investigations into the African origins of HIV, and details about the early years of HIV in the Carribean and North America remain more murky.

Overall, the Origins of AIDS provided a comprehensive and enjoyable to read account of the origins and the rise of AIDS. Through synthesizing current scientific research and archival documents Pepin reinforces the book’s central thesis that AIDS is a “tragedy… facilitated (or even caused) by human interventions.” The book’s narrative, interwoven with vast amounts of quantitative and qualitative evidence, made a compelling case that this global pandemic was not singularly driven by biology or individual behaviours, but broader social, political and economic frameworks.

Permanent linkMarzieh Ghiasi

Drug-resistant Tuberculosis

Published March 25, 2013 · Estimated reading time: 5 minutes · Share your thoughts
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Image source: Stop TB PartnershipImage source: Stop TB Parnetship

Drug-resistant Tuberculosis
Very much an issue, and it’s spreading like wildfire
By Marzieh Ghiasi
March 25, 2013

New strains of tuberculosis (TB) threaten efforts to eradicate one of the world’s deadliest diseases. An alarming study published in the March edition of the U.S. Centers for Disease Control and Prevention’s Emerging Infectious Diseases journal reveals the discovery of the first cases of totally drug-resistant TB in South Africa. These findings come on the heels of the discovery of virtually untreatable strains of TB in the hospital wards of Mumbai, India last year.

TB, a bacterial lung disease, infected an estimated 8.7 million people in 2011, according to the most recent statistics from the World Health Organization (WHO). While inactive in the majority of those infected, the active form is transmitted through air. The disease is a leading infectious killer worldwide. Second only to HIV/AIDS, it kills one person every ten seconds. In those afflicted, it leads to severe weight loss, chronic coughing – often of blood-stained mucus – and destruction of lung tissues. Dr. Madhukar Pai, a leading McGill tuberculosis expert, explained that the disease is not only physically debilitating, but also accompanied by social stigma and a heavy economic burden.

Multi-drug-resistant TB (MDR-TB) encompasses strains of the bacteria that do not respond to two critical drugs used to treat TB, isoniazid and rifampicin. When an individual is infected with the drug-resistant bacteria, physicians have to resort to ‘second-line’ drugs for treatment, which, according to Pai, have many side effects, are more expensive, and are not readily available.

“The regular drug-sensitive TB requires a standard six month treatment, [and] it’s not inexpensive, like three days of antibiotics,” he explained. “[For MDR-TB] that treatment lasts two years…even if you give all of this stuff for two years, about 50 per cent of patients are dead.”

In the past five years, a subset of patients has begun developing extensively drug-resistant tuberculosis (XDR-TB), which is resistant to even more drugs and has worse survival rates. Although the WHO has not yet formally adopted the term totally drug-resistant TB (TDR-TB), the strains identified in India and South Africa are believed by researchers to be unresponsive to all known drugs.

While the contexts of India and South Africa are very different, Pai says drug resistance in TB has similar “underlying drivers in both countries.” In India, the mismanagement of patients, which pushes them from physician to physician, has been identified as an important culprit in exacerbating TB. Poor diagnostics and fake drugs, which make up 10 per cent of the total TB drug supply in India, also leave patients receiving ineffective treatment.

The crisis is further complicated in South Africa, where nearly one out of every five adults lives with HIV. The presence of “extensively drug-resistant TB plus HIV” Pai says, “is a complete disaster.”

In recent years, a combination of efforts, including vaccination campaigns and national control strategies, have been implemented to fight TB by the South African government. However, the fight remains at a standstill as the casualties rise. The TB vaccine of choice BCG (Bacillus Calmette–Guérin), developed ninety years ago, is only partially effective. The rise of drug-resistant strains has prompted greater efforts to develop improved vaccines against the disease in order to protect people before they’re infected, but these efforts have led to disappointment. In February, MVA85A, which was touted at the first new TB vaccine in a century, failed clinical trials.

Meanwhile, control efforts have given mixed results. Some reports suggest that India’s current strategy to defeat TB may actually be promoting more deadly drug-resistant strains. In an interview with the Wall Street Journal, Dr. Zarir Udwadia, whose research team discovered totally drug-resistant TB in India, criticized the country’s strategy as “a futile exercise [that will] serve to amplify resistance.”

One of these strategies includes giving the same standard regimen of drugs to anyone suspected of having TB, without checking for resistance, which would entail additional costs. For some patients, these regiments do not work and only heighten the presence of drug-resistant strains. Similarly, in Eastern European countries, poor management of TB has only aggravated the problem. Other strategies have included quarantining. Notably, in South Africa, when extensively drug-resistant tuberculosis broke out, many patients were involuntarily detained in prison-like hospitals.

“It doesn’t work. They broke out,” Pai said. “Keep on doing the wrong thing and you end up with drug-resistant bacteria that don’t respond to any interventions.”

The broadest effort to combat TB, the Stop TB Partnership, consists of 1,000 international governmental and non-governmental organizations. The project aims to provide treatment for fifty million people and prevent 14 million deaths by 2015. However, the economic crisis has led some countries to reduce or stop contributing to TB prevention programmes.

On March 21, McGill University launched its International TB Centre in an event attended by experts from across Canada. Dr. Anne Fanning, researcher at the University of Alberta and the Chair of Stop TB Canada, described global efforts against TB, local efforts against TB particularly in Inuit communities, and scientific research as three areas that need serious attention.

“[All of this] needs the support of the government of Canada,” she emphasized.

Pai similarly believes that all countries need to take TB more seriously. He warned that the chronic underfunding of these programs across the world might only lead to compounded costs for everyone later.

“In today’s day and age there is no sense in thinking of global health as a problem that doesn’t bother us or affect us.” He said, “TB anywhere is TB everywhere.”

Permanent linkMarzieh Ghiasi

Man rooh miforoosham/I sell souls

Published March 22, 2013 · Estimated reading time: 3 minutes · Share your thoughts
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من روح می فروشم (سیمین بهبهانی) (I Sell Souls (Simin Behbahani
تو را که خانه‌ی نیین است
بازی نه این است
– سعدی

You whose house is of straw and hay
Do not take fire for play

Sa’adi –

من روح می فروشم،
وز هرچه نارواتر،
در شهر خودپرستی،
سودا و سود خلقی
پرواری جسم و جان را،
گر زانکه چاره باید،
طبعی عزیز کُشتم
وانگه به سوگواری،
آیات کفر دیدم،
وانگه به خیره گفتم
در حلقه‌ی خموشان،
تا خود، خموش بودن
از «دور و کور گشتم»،
شد بوف آن غزالی
باغ دو چشم خود را
کاین خوشه‌های اشکم
شامم چه نام دارد؟
بر بام من چه بارد؟
سرد است سرد جانم،
گویی که خانمانم
گویم به خود که باری…
صد شعله بر فروزد
سعدی خموش خواهد
«تا خانه‌ات نیین است،
کالای من همین است
این نارواترین است
در چارسوق پستی
دیری‌ست کاین چنین است
پروانه‌ی امان را
این است و آخرین است
در آستان خواری
اشکم در آستین است
طعن جنون شنیدم
کاین حکم عقل و دین است
سر حلقه چون نگینم
فرمان هر نگین است
دل موج خیز خون شد
کز آهوان چین است
آباد می‌پسندم
انگور دستچین است
ژرفی که وهنماک است
برفی که سهمگین است
یخ بسته استوخانم
قطبی ترین زمین است.
گوگردِ سرخ داری
شعری که آتشین است.
این شعله را و گوید:
بازی تو را نه این است.»

I sell souls, the merchandise of my trade1
Of all things vile, this is most depraved
In the city of vanity, on the intersection of depravity
Worldy trade and profit, has for some time been this way
To indulge the body, and security ensure
This is the first and the last resort
A cherished spirit I killed in an abject state
Tears on the sleeve, my anguish relate
I saw blasphemous verses, I heard a deranged tirade
This is the order of reason and faith, gazing I bade
In the ring of the silent ringmaster, the gem I am
For silence is the commandment of every gem
The blind search, with blood the heart deluged
The owl to a gazelle transformed2
The garden of my eyes, blossoming I desire
For the clusters of my tears are but handpicked grapes
What can my night be called? It is a frightening abyss
What falls on my roof? It is burdensome snow
My body is cold, cold, my bones are bound in a frozen fold
It is as though I dwell, on the Earth’s farthest pole
To myself I have told… when red sulfur you hold3
.A fiery poem set ablaze, a hundred flames will it raise
:Sa’adi quenches this flame and says
,Until your house is of straw and hay“
”.Do not take fire for play

[1] The namesake of the poem is difficult to translate and frankly ambiguous in meaning. The poem actually uses a singular form of ‘soul’ (rooh) as opposed to ‘souls’ (rooha). My choice was between the more accurate “I sell my soul”/”I sell the soul”/”I sell a soul” (all of which are different and depend on personal interpretation of the poem in Persian), because Persian doesn’t have definite/indefinite articles and the less accurate “I sell souls”. I was very reluctant to make this choice, but creating an aesthetically pleasing translation won out over literal translation.
[2] This line, the previous and the few after were difficult for me to decipher. I would appreciate any input. Considering the previous line, I am speculating that the “owl” in this line is probably referring to the nihilist masterpiece by Sadegh Hedayat “The blind owl“. In the book the narrator confesses his thoughts to his shadow on a wall which looks “exactly like an owl”, these thoughts include the memory of girl with black eyes who the narrator is fixated by: “In her eyes, in her black eyes, I found the eternal night, the dense darkness I had been searching for”. The ‘Chinese deer’ (changed to ‘gazelle’ in the translation) refers to a deer which produced a substance in a gland under its belly used as a perfume, musk. The line may have been inspired by Mohtasham Kaashaani or Bedil Dehlavi. The former (line 4) refers to sharp black eyes that can cut the throats of Chinese deers (recalling the black eyes that the ‘owl’ is obsessed with). The latter refers to musk from hair having had origin in the blood in the belly/heart of Chinese deers.
[3] Sulfur has long been associated with fires (in the phrase ‘fire and brimstone’, brimstone refers to sulfure), while red sulfur was a therapeutic pancea/elixir/cure-all used by Middle Eastern alchemists.

Permanent linkMarzieh Ghiasi