The origins of HIV and the making of an AIDS scapegoat

The cherry trees are still there, blossoming every spring, on a patch of land near Stanley Park in Vancouver. They were planted in 1985 by a group of volunteers from AIDS Vancouver, to honor the memory of three Canadian sons who were among the early victims of AIDS. One of these men was Gaetan Dugas, who died in 1984. During this same period in San Francisco, Randy Shilts, a reporter for the San Francisco Chronicle was covering the exploding infectious catastrophe and was piecing together a 600-plus page tome on the disease.  He had hoped that the book, “And the Band Played On,” would expose what he described as ‘institutional indifference’ that was confounding a major health crisis.

But when the book was released in the fall of 1987, pre-hyped by tabloid headlines, almost all of the limelight was cast on a dead Canadian whom Shilts had singled out as the possible source of HIV in the United States.  The Typhoid Mary of AIDS, as Shilts depicted him, even had a name.  It was Gaetan Dugas.

Who was Gaetan Dugas?

Dugas was born in Quebec on April 20,1953 and raised in Quebec City by working-class parents.  He started out as a hairdresser in Toronto and he later transitioned to a new career as a flight attendant. A Quebecois who only spoke French, he was obligated to learn English as part of the requirements for the job.  He then moved to Vancouver, learned the second language, and ultimately joined Air Canada to begin his dream career.  His travels included trips to the United States, Europe, and the Caribbean.  He was particularly fond of San Francisco and the handsome airline steward made the yearly trip to partake in the annual gay parade and weekend-long partying.

His head-turning good looks and charm ensured a steady stream of sexual partners; and in a typical year his exploits amounted to approximately 250 encounters.   When Dugas developed swollen lymph nodes in 1979, his ordeal with HIV began. In 1980, a brown spot appeared on his face, and a biopsy confirmed the cause: Kaposi’s sarcoma. He had what was then called the ‘gay cancer.’

During the early years of the epidemic, the Centers for Disease Control (CDC) crafted an extensive and very detailed, 24-page questionnaire to gather information from the first AIDS patients.  From this survey, the researchers learned that the affected men participated in certain types of sexual activity and were rather promiscuous.

The cluster

The interviewers also asked the patients to name all their sexual contacts. After a few dozen of these interviews, they noticed that multiple patients mentioned a certain Canadian air steward.  In March, 1984, the so-called “Cluster Study” was published in the American Journal of Medicine. The introduction expressed the context of the study :

In March 1982, several persons in southern California informally reported to public health officials that some men in whom AIDS was later diagnosed had attended the same social gatherings and may have had sexual contacts with one another. Consequently, an investigation was initiated to assess the social and sexual relationships among homosexual men in whom AIDS had been diagnosed.

The paper included a diagram illustrating the links between the patients, with each person represented by a place and number.  Within this cluster of circles was Patient O (the letter, not the number zero). Directly emanating from Patient O were 8 indivduals; and from there, further links to other AIDS patients. Of course, there were no names in this scientific study. Not yet. But this would be basis for the name “Patient Zero.”

Back to Vancouver

The CDC did interview Dugas, and on multiple occasions, when it was becoming evident that AIDS was an infectious disease, doctors sternly advised him to stop having sex. He refused these suggestions — orders, really, as he was stubbornly unconvinced that he could transmit cancer. He remained sexually active. Dugas later confided that he felt that the CDC did not treat him very well. He had moved to San Francisco, gained a significant degree of notoriety at the bathhouses to the point that some members of the gay community hatched a conspiracy to force him out of town. Eventually, he did move back to Vancouver. His disease advanced, he suffered through multiple bouts of  Pneumocystis pneumonia,  and on March 30, 1984, he passed away in Quebec.

Yellow journalism

Three years later, Shilts revealed Dugas as the Cluster Study’s Patient Zero. While Shilts (who also later died of AIDS) held a nobler agenda in writing the book, the publication’s success was initially in doubt. Phil Tiemeyer, author of “Plane Queer” documented his interview with Michael Denneny, Shilts’ publisher. Denneny described the initial dismal prospects for “And The Band Played On” that motivated them to find a more creative way to promote the book. The solution was to use Patient Zero and present him as the handsome, promiscuous French-Canadian airline steward who may have brought AIDS to America. This was the pathway to the bestseller list, and it worked. Tiemeyer noted Denneny’s rationalization that once the book gained publicity, Shilts could use the platform to denounce the Reagan administration’s indifference to the AIDS problem. Apparently Shilts himself was averse to the idea, but Denneny convinced him to go along with it. When the frenzy over the book was in full swing, however, it seemed that the interest over the Patient Zero story trumped the other issues, and ironically hurt the AIDS cause.

The origins of evils

Dugas was of course, not the source of HIV in the United States. He was also not a saint, and he passed on the opportunity to be an active advocate for AIDS patients. But he was never Patient Zero. And yet so many were willing to believe that he was. Why was that?  It turns out that this phenomenon is not unique to the AIDS story.  The Science Museum’s History of Medicine website includes a section titled “The fault of others: exiles, scapegoats and the human face of disease.” It describes the tendency throughout history to target marginal groups, minorities, and the poor as scapegoats for plagues and diseases. It was a means to allay fears and reinforce prejudices. Examples cited include the Black Death that was blamed on Jews and cholera on immigrant Irish workers. Syphilis was called ‘The French Disease” in England, and the French in turn blamed the Italians who in turn blamed the French.

Benjamin Rush, a physician and one of the signers of the U.S. Declaration of Independence wrote:

It, moreover, flatters his avarice and pride, by throwing the origin of a mortal disease from his property and country. The principle of thus referring the origins of the evils of life from ourselves to others is universal. It began in paradise, and has ever since been an essential feature in the character of our species.

New diseases always seemed to originate from somewhere else (sometimes they actually did). Patient Zero was simply that outsider who was just too easy to blame.

Can you think of other parallels in the history of medicine?

Rod Tanchanco is an internal medicine physician and a writer. He blogs at Tales in Medicine and can be reached on Twitter @rodtmd.

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