The Origins of AIDS (2011)
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