The Coming Plague (61 page)

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Authors: Laurie Garrett

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Joe McCormick had no difficulty convincing health authorities in Zaire and Belgium to take AIDS seriously. And the authorities in Kinshasa were enthusiastic about McCormick's suggestion that a joint Belgian/Zairian/ American AIDS research center be established in the country. McCormick's headaches didn't start until he returned to Atlanta, where Curran supported a long-term Zaire AIDS study, and outgoing CDC director Bill Foege was eager to be helpful; but Reagan's newly appointed CDC director, James Mason, seemed lukewarm toward the idea. At Foege's urging, McCormick
spoke directly with Assistant Secretary of Health and Human Services Brandt.
“There's a one-to-one sex ratio of AIDS cases in Zaire,” McCormick told Brandt, “proving that AIDS can be, and is, a heterosexual disease.” Brandt absolutely refused to believe McCormick, maintaining that some overlooked factors had to be involved in Zaire. AIDS, Brandt insisted, simply was not a heterosexual disease.
It would be more than a year before the Reagan administration's health leadership would accept the idea that AIDS in Africa was primarily heterosexual. The administration would never fully acknowledge that the virus might also be heterosexually transmitted in the United States. Indeed, disputes over heterosexual transmissibility of the virus and the applicability of the African (read: black) experience to the Euro-American (read: white) context would rage within the upper echelons of the U.S. government throughout the eight-year-long Reagan administration and well into the term of his successor, George Bush.
The Euro-American scientific community would be similarly divided over interpretations of African AIDS and heterosexual transmission of HIV, and that tension would persist well into the 1990s. Because AIDS had first been noted among gay American men, many scientists and politicians insisted that the modes of transmission of the virus were rigidly limited to those first observed in the United States—anal intercourse, injecting drug use, blood product contamination, and “Haitians.”
But, of course, there was heterosexual transmission of AIDS in America, in Europe, in Haiti—in every geographic location on the planet into which HIV had infiltrated. Among the very first cases of AIDS reported in New York City were heterosexually acquired infections.
Some public health officials critical of the Reagan administration quietly argued that there was a racist subtext to the debate: nearly all heterosexual cases reported worldwide by mid-1984 involved people either living in Africa or of African heritage. In Europe and the United States nearly all clearly identified heterosexual transmissions reported to authorities by mid-1984 involved blacks or Hispanics; most were immigrants or visitors from African countries, the Dominican Republic, Haiti, and Puerto Rico.
A well-intentioned effort to gather evidence for heterosexual transmission of the virus began, its focus consciously directed at Africa. In essence, European and North American researchers had domestic agendas that underlay much of their African research.
But Jacques Liebowitch reflected a sentiment more popular among AIDS researchers at the time, saying, “We built a focus on Zaire … [to look at] people who didn't fit into any of the other known risk groups, such as being homosexual.”
119
Joe McCormick had no such initial intent for Project SIDA,
120
as the joint Zairian/American/Belgian research effort would be called, nor were the physicians of Kinshasa particularly interested in seeing precious resources
wasted on proving what their medical charts already made clear: namely, that AIDS in their country was a heterosexual disease. Curran and McCormick decided that Project SIDA would be a serious African AIDS research center, designed to answer questions important to Africans. Curran immediately began scrambling for funds, carefully avoiding Brandt's office, while McCormick tried to find the right CDC scientist for the job.
The creation of Project SIDA went on quietly in Atlanta and Kinshasa while most of the Euro-American research effort in Africa continued to focus on two issues: heterosexual transmission and the scope of Africa's epidemic. As soon as the Pasteur group had a crude LAV test available, they collaborated with McCormick, Piot, and Quinn on analysis of the blood samples collected in Kinshasa hospitals. They confirmed that 97 percent of the patients Kapita had diagnosed as AIDS cases had antibodies against LAV (HIV). Most troubling: so did many of the controls, which indicated that there was an asymptomatic stage of the disease and that infection was far more prevalent in Zaire than it had initially seemed. Seven percent of the apparently non-AIDS patients hospitalized for noninfectious reasons came up antibody-positive, as did 5 percent of the new mothers who were on the obstetrics ward of Mama Yemo Hospital in 1980. In addition, serum collected from a mysteriously ill woman on the Mama Yemo obstetrics ward in 1977, who died of apparent immune deficiency in 1978, proved positive for antibodies to LAV.
Both the rate of adult infection in Kinshasa and the apparent age of the Zairian epidemic merited serious concern. By contrast, the French overall rate of apparent LAV infection in 1983 seemed to be less than 0.3 percent.
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The Pasteur group was at the time receiving blood samples from other African countries, and had evidence for similarly alarming rates of LAV (HIV) infection in the general populations of Rwanda and the Central African Republic.
During the 1983 winter holidays Jonathan Mann answered his phone in Albuquerque. Joe McCormick—a scientist Mann admired immensely but had never met—introduced himself and got down to business.
“How would you like to work in Africa?”
Mann was stunned. But the CDC's New Mexico-based epidemiologist and bubonic plague expert listened intently as McCormick described what he had seen in Kinshasa.
Though Jon and Marie-Paule Mann had three young children, and none of them had lived in a developing country, it didn't take much to convince the family to move to Kinshasa. For Parisienne Marie-Paule it meant speaking her native tongue; the kids relished the adventure. And Mann recognized with considerable excitement the scientific importance of such work.
Curran, who had long been impressed with Mann's work, was quite pleased with the choice. Mann had displayed a talent for handling dicey political and press issues during his tenure in New Mexico. This skill, demonstrated from the first day Boston-born Mann had arrived in the state
and faced public concern about a case of bubonic plague, would be crucial. The often tense status of relations between the U.S. and Zaire governments and the competing interests of AIDS researchers from all over the world who were eager to investigate the African epidemic would test Mann's mettle.
By March 1984, McCormick and Mann were in Kinshasa, working with Kapita, Drs. Nzila Nzilambi, Ngaly Bosenge, Kalisa Ruti, and other Zairian scientists to establish Project SIDA. McCormick acted as Mann's mentor, passing on in the course of a month as much as he could about Zairian languages, customs, and politics, as well as how to properly play the role of an outside American expert when working in a postcolonial, impoverished country lacking in basic infrastructural support.
Mann learned his lessons well—perhaps too well from the perspective of other foreign scientists and members of the press. He never spoke to outsiders without first clearing his comments with the Zairian Ministry of Health; he fought off foreign researchers who failed to collaborate with Project SIDA on its terms; and primary among those terms was a willingness to collaborate as equals with Zairian scientists and abide by the press and publication limitations set by the Zaire government.
“I'll tell you anything you want,” Mann would say to all non-Zairian callers, “if you come here with a letter from the Zaire government. But without that letter, I won't talk to you at all.”
Ten years later some rival scientists would still speak bitterly of Mann's policies at Project SIDA, claiming that he froze them out of Zaire and treated the country's AIDS epidemic as his personal “turf.” But Zairian scientists would have nothing but praise for Mann, as well as for Piot. Project SIDA would prove to be the most prolific AIDS research effort on the continent from 1984 until its closure, due to civil war in Zaire, in 1991.
While most other African governments either were confused about the extent of their epidemics and still in the rudimentary stages of local research or were deliberately maintaining public silence out of a sense of national pride and economic concern, Zaire was quite open. An unfortunate side effect of the government's candor was a series of false international assumptions that would persist for over a decade: that Zaire had the worst of Africa's epidemics; that AIDS definitely started in Zaire; that all other AIDS outbreaks could be traced back to a Zairian origin.
Though Mann was in charge, Project SIDA included Drs. Henry Francis and Tom Quinn of the National Institute of Allergy and Infectious Diseases. Together with their Zairian colleagues, the team did HIV prevalence studies showing that by 1985 the general population infection rate in Kinshasa was about one-third that seen among gay men in San Francisco, and that multiple heterosexual partners, medical injections with nonsterile needles, and foreign travel were the key risk factors.
122
As the dimensions of the global AIDS epidemic grew, the CDC organized the first International Conference on AIDS, which convened in April 1985
in Atlanta. About 2,000 scientists and reporters from thirty nations attended the grim gathering, during which the scale of what was by then considered a pandemic became apparent.
Though the Atlanta meeting would, correctly, draw attention to Africa's plight, it would later be established that nearly all the assumptions, and the data upon which they were based, were false. As the scientists assembled in Atlanta, AIDS
was
indeed emerging in Central Africa. But it was not doing so via some of the means described or on the terrifying scales presented.
At the meeting, Luc Montagnier said blood tests on samples drawn in Kinshasa in 1970 showed that one out of every 220 men and women then had antibodies to LAV (HIV); in 1980, he claimed, one out of ten Kinshasa adults was antibody-positive. And, he told the gathered scientists, AIDS was spreading within African households by a variety of nonsexual means. Robert Gallo disputed the household transmission claim, but agreed that AIDS was rampant in Africa, noting that 65 percent of children in Uganda tested positive for antibodies to HTLV-III (HIV).
Nathan Clumeck reported that 88 percent of the female prostitutes tested in Kigali, Rwanda, had antibodies to HIV—up from 70 percent levels of infection in 1982 blood samples drawn from local prostitutes. The general population, Clumeck said, had an infection rate by the end of 1984 of 9 percent.
123
Dr. Robert Biggar, of the U.S. National Cancer Institute, reported that infection with both the HTLV-I and HTLV-III (HIV) viruses was extremely common all over Kenya, even in remote pastoral areas. On the basis of HTLV-III antibody tests run on blood samples collected by the CDC in Kenya in 1982–84 during various disease studies (not AIDS), Biggar claimed that over half of the Kenyan population had at some time been infected with the AIDS virus and nearly a third had antibodies to HTLV-I. The strongest responses, he said, were among the nomadic Turkana people of northern Kenya, nearly 80 percent of whom were infected with the AIDS virus.
124
Biggar also claimed that up to 15 percent of the children, 25 percent of the elderly, and 20 percent of young adults in the remote Kivu District were infected with HTLV-III.
125
And he told reporters that over half the young women tested on the antenatal ward of Lusaka's University Teaching Hospital—55 percent, to be precise—carried antibodies to HTLV-III (HIV) in 1984.
Similarly terrifying levels of infection in Africa were reported by a team working with Robert Gallo. On the basis of HTLV antibody tests of stored blood samples that had been collected by the National Cancer Institute in 1972 and 1973 from schoolchildren in Uganda as part of a Burkitt's lymphoma study, the team concluded that 66 percent of the children were infected with HTLV-III (HIV)
nearly a decade before anybody realized that AIDS existed.
The blood samples had been collected in the remote West Nile region of Uganda, an area of tiny villages located amid swamps and heavy rainfall.
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Finally, Max Essex and his Harvard colleague Phyllis Kanki referred to the recent discovery of a virus in captive rhesus macaques in U.S. primate centers that produced an AIDS-like ailment in the monkeys. The virus was dubbed STLV-III (mac), or simian T-lymphotropic virus type III (macaque). The virus, they said, grew easily in human T cells. A second virus, dubbed STLV-III (agm), was announced at the meeting. It was found, Essex said, in half of all tested wild African green monkeys, or vervets.
127
Essex told the gathering that it was reasonable to assume that AIDS started as an African monkey disease, and only recently, through an unknown means, entered the human population.
Though the essence of nearly every one of these headline-grabbing reports would later prove false, they made their impression: the world was convinced that Africa was witnessing an older, widespread epidemic that originated in monkeys and spread among humans of all ages on the continent via heterosexual transmission and some as yet unclear “household” means.

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