The Coming Plague (62 page)
Authors: Laurie Garrett
For the three lone Africans present at the “international” meetingâProject SIDA's Kapita and Nzila and Pangu Kaza Asila of Zaire's Ministry of Healthâmuch of what transpired in Atlanta was deeply offensive. Mann had insisted that the CDC pay to bring the Zairian scientists to the meeting, but he also worried that one of them might unwittingly say something to the aggressive North American press corps that would have dismal repercussions back in Kinshasa. Because none of the Zairois had ever dealt with Western journalists, Peter Piot was asked to stay with them at all times.
Though Kapita, Pangu, and Nzila were upset by allegations that AIDS was Africa's dubious gift to the rest of the world, they managed to keep their anger to themselves until approached by an American journalist who said, “We have all heard what Max Essex said here about AIDS originating as an African monkey disease. Tell me, Doctor, is it true that Africans have sex with monkeys?”
Kapita seethed. The three Zairois pretended not to understand the question, though English was one of the four or five languages they spoke with some degree of facility.
“Peter,
s'il vous plait, que est-ce-qu'elle a dit?”
Kapita asked Piot, hoping the journalist would give up trying to get an answer. Piot was enraged. He whispered a warning in French:
“Ne répond pas.”
But Kapita told Piot to translate a response to what he considered an exceedingly rude and demeaning query.
s'il vous plait, que est-ce-qu'elle a dit?”
Kapita asked Piot, hoping the journalist would give up trying to get an answer. Piot was enraged. He whispered a warning in French:
“Ne répond pas.”
But Kapita told Piot to translate a response to what he considered an exceedingly rude and demeaning query.
“Madam, I don't know what you're talking about,” Kapita said. “We don't do those things. But I believe that in Europe they make movies where women have sex with dogs. And I've also heard that in the U.S. there are all these dogs as pets at home, and that they sometimes, well, you know what I mean ⦔
It would not be the last time that distinguished African scientists would be grilled by foreignersâboth fellow scientists and journalistsâabout a
variety of alleged sexual and cultural practices that some Westerners believed explained Africa's nonhomosexual AIDS epidemic.
variety of alleged sexual and cultural practices that some Westerners believed explained Africa's nonhomosexual AIDS epidemic.
“They just can't seem to accept that you can pass the virus by putting a penis into a vagina,” Piot exclaimed at the Atlanta meeting. “I just can't understand this. These people are supposed to be scientists, after all. Would somebody please tell me why a virus would be willing to go from a penis to an anus, but not from a penis to a vagina? These people are disgusting!”
Piot knew better than anyone at the meeting, save perhaps Kapita, Nzila, Pangu, and Mann, that world press coverage of the statements made by Gallo, Essex, Montagnier, Biggar, and other Western scientists would have a chilling impact on AIDS research in Africa. He felt certain that many African governments would react to the finger pointing by shutting down what few research efforts were underway, just as the AIDS epidemics were emerging in their countries.
Sitting in a stairwell of the conference center trying to collect his thoughts, Piot could only shake his head and murmur, “This is a disaster.”
Matters worsened following the Atlanta meeting. As Western scientists continued to point at Africa, the continent's leadersâas Piot had predictedâresponded in kind.
“African AIDS reports are a new form of hate campaign,” decried Kenya's President, Daniel arap Moi.
“If scientists cannot find a home for the virus, Africa is not the solution to their dilemma,” declared Kenya's Minister of Health, Peter Nyakiamo, in a speech before his country's Parliament.
“There is no indication whatsoever where the disease started,” Dr. Fakhry Assad, director of the World Health Organization's communicable disease program, said. “The disease as we know it appeared here at the same time as in the United States.”
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The AIDS finger pointing was hitting impoverished Africa at a particularly difficult time. Major wars and insurgencies raged from the Horn of Africa to Cape Town, most fought as Cold War proxy battles fueled by rival industrialized world interests. In addition, several African nations suffered military coups during the early 1980s, prompting additional diversions of scarce resources toward military expenditures, usually at the expense of health and education spending.
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In addition, several countries were in the grip of their worst drought of the twentieth century, notably Mali, Mauritania, Mozambique, Zambia, Ethiopia, Somalia, Sudan, and Cape Verde. Scientists argued that the drought, and the famines and massive refugee migrations it produced, were due to structural changes in global meteorological patterns, possibly due to global warming. The Sahel desert belt across the northern part of the continent, they said, was expanding, claiming millions of acres of what had recently been arable land.
Peter Usher, UN adviser to Kenya, said there was a good chance that Africa's drought plight was truly something new, and worsening. “Which
could mean that Africa is getting drier, and the future consequences are going to be even more serious than they are now,” Usher said.
could mean that Africa is getting drier, and the future consequences are going to be even more serious than they are now,” Usher said.
Bradford Morse, chief administrator of the UN Office for Emergency Operations in Africa, asserted that at least twenty African countries were facing severe drought conditions and food shortages in 1984â85, and at a minimum 30 million Africans were at risk of starvation as a result. In addition, he said, at least 10 million drought refugees were on the move, having abandoned their Sahel belt homes in search of food.
“This is the greatest single phenomenon of this sort in human history,” Morse declared.
Ethiopian climatologist Workineh Degefu warned that whether or not fundamental changes were taking place in the planet's atmosphere and weather patterns, history was moving relentlessly toward increasing human need for resources on the continent as populations swelled and demands for farmland and firewood increased. As had happened in the American Midwest during the 1930s, overfarming was producing dust bowls, rendering the once fertile, feral lands nonarable wastelands.
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But African leaders knew that the world wasn't much interested in their drought and famine. The crisis began in the late 1970s, but drew little global interest until 1985, when African journalists finally managed to get film of the Ethiopian disaster broadcast on British television and a group of rock-and-roll performers subsequently staged a seventeen-hour benefit concert, called “Live Aid,” that was simulcast in 152 countries, raising $70 million for African relief.
African leaders were less than pleased about the attention their AIDS situation was garnering, particularly as they had no idea exactly how serious it really was. Few, if any, of them believed in 1985 that AIDS could possibly match the severity of the drought and famine, or of the region's malaria epidemic, or of its general economic woes.
In Zambia, Njelesani was angry that Robert Biggar told international reporters the results of blood tests done in the country before clearing the data with Lusaka collaborators. Elsewhere on the continent antagonisms were developing against foreign researchersâ“safari scientists”âwho would dip into a country for a few days, possibly a couple of weeks, leave with cases of blood samples, and write up their results for major medical journals without first clearing the data and interpretations of it with local collaborators.
A chill settled over the nascent African AIDS research community.
Nathan Clumeck and Belgian colleagues decided to convene a meeting on AIDS in Africa during the fall of 1985âin Brussels. By the early summer some African leaders were protesting, saying they wouldn't go to Europe to discuss Africa, particularly if the Americans and Europeans were going to continue blaming Africa for originating the AIDS epidemic. Eventually the governments of Zaire and Burundi pulled all their papers from the Brussels meeting, Project SIDA followed suit, and the CDC took its
cue from Zaire, also withdrawing its support and presentations from the conference.
cue from Zaire, also withdrawing its support and presentations from the conference.
A second, competing meeting was organized by the CDC and WHO to take place in Bangui, capital of the Central African Republic, four weeks before the Brussels gathering.
Shortly before the Bangui meeting Robert Biggar's group published a study that unintentionally provided the first evidence of the serious errors scientists had been making in estimating the size of Africa's epidemic. Biggar's team noted that it seemed strange that the early HTLV-III (HIV) blood tests had discovered the highest incidences of infection in remote areas where nobody seemed to have overt AIDS. So, in May 1984, Biggar's group had journeyed to the Kivu District of eastern Zaire, taken blood samples from 250 hospital patients, and tested them back in the U.S. National Cancer Institute laboratories for antibodies to HTLV-I, HTLV-II, HTLV-III (HIV), and
Plasmodium falciparum
malaria. They found that about 80 percent of the people had antibodies to malaria, far fewer reacted positively to the three HTLV viruses, and the same age groupsâeven the same individualsâthat reacted most strongly against malaria also responded to one or all of the HTLVs.
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Plasmodium falciparum
malaria. They found that about 80 percent of the people had antibodies to malaria, far fewer reacted positively to the three HTLV viruses, and the same age groupsâeven the same individualsâthat reacted most strongly against malaria also responded to one or all of the HTLVs.
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It was soon apparent that the initial HTLV assays were useless when executed on the blood of people chronically infected with malaria, leishmania, or other parasites, all of which produced what in laboratory lingo was termed “sticky sera.” The first HTLV tests involved mixing suspect blood with antibodies to one of the virusesâsay, HTLV-III (HIV). If viruses were present in the patient's blood, the antibodies and viruses would form complexes that would stick to the test surface and could be seen following a rinsing step. But parasitically infected bloodâparticularly malarial bloodâformed nonspecific “sticky” complexes that also adhered to test surfaces through rinsings. Thus, the first HTLV-III (HIV) tests produced huge numbers of falsely positive findings.
Given that nearly everyone living below Africa's Sahara Desert chronically carried some malarial parasites in their blood, it was surprising that early AIDS researchers didn't obtain results naming every single African as an AIDS carrier. Instead, they found 50 to 90 percent alleged infection rates. The discovery of the HTLV test flaw meant that all estimates of African AIDS and HTLV-I infection rates made on the basis of that set of assays were thoroughly erroneous.
Some African countries did have serious emerging AIDS epidemics in 1985, but they were certainly not on the orders described at the Atlanta conference. Project SIDA estimates of infection rates of just under 10 percent in some Kinshasa groups were based on LAV antibody tests, which were less vulnerable to the “sticky sera” problem and would prove reasonably accurate.
Amid the exaggerated reports there were several crucial but less dramatic studies that received little immediate attention. Key among them was a
joint Anglo/Zambian/Ugandan study of an apparently new disease seen in the Rakai District of Uganda, just across the border from Tanzania's Kagera District. Called “slim disease,” the ailment produced dramatic weight loss and overwhelming fatigue, eventually proving universally lethal. The researchers used an improved British-developed HTLV-III (HIV) test on forty-two “slim disease” patients, finding AIDS antibodies in thirty-four. They also discovered that 17 percent of their healthy Ugandan controls were antibody-positive. The implication was that AIDS and “slim” were the same disease.
joint Anglo/Zambian/Ugandan study of an apparently new disease seen in the Rakai District of Uganda, just across the border from Tanzania's Kagera District. Called “slim disease,” the ailment produced dramatic weight loss and overwhelming fatigue, eventually proving universally lethal. The researchers used an improved British-developed HTLV-III (HIV) test on forty-two “slim disease” patients, finding AIDS antibodies in thirty-four. They also discovered that 17 percent of their healthy Ugandan controls were antibody-positive. The implication was that AIDS and “slim” were the same disease.
“Slim,” they argued, surfaced in Uganda at about the same time as the “gay plague” appeared in California and New York. There was certainly no evidence that AIDS was endemic in Africa. So, they said, blaming Africa for being the origin of AIDS had no clear basis in available fact.
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Speculation arose that the coincident responses in the early HTLV tests to the retroviruses and malaria might indicate that there was mosquito transmission of the virus. This prompted panic not only in Africa but in other parts of the world where
Anopheles
insects were pervasive. Members of Project SIDA and Curran's group at the CDC tried to counter this concern by pointing out that most victims of feeding malarial mosquitoes were small children who took no precautions to protect themselves from the insects and weren't yet immune to the parasites. Yet over 95 percent of all known AIDS cases involved adults.
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Anopheles
insects were pervasive. Members of Project SIDA and Curran's group at the CDC tried to counter this concern by pointing out that most victims of feeding malarial mosquitoes were small children who took no precautions to protect themselves from the insects and weren't yet immune to the parasites. Yet over 95 percent of all known AIDS cases involved adults.
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The epidemiological argument was not enough to quash speculation about mosquitoes, however, and throughout the 1980s concern that insects could transmit the virus would be repeatedly resurrected, particularly by those who were anxious to argue away heterosexually spread outbreaks of AIDS in places such as Belle Glade (Florida), Haiti, Brazil, and India.
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By the time African, American, and European scientists gathered in October 1985 in Bangui, there was a fair amount of antagonism in the air. Franco-American tensions were evident, as the Pasteur group and their allies became more vocal in their claims that Gallo's group had stolen not only credit for discovery of the AIDS virus but possibly the virus itself. Some Belgians were angry about the threatened boycotts of their upcoming Brussels meeting. And the Africans shared varying degrees of wrath about the Western portrayals of their epidemic.
Joe McCormick, who engineered the Bangui meeting, made sure that representatives of all points of view were invited, and pushed WHO's Assad to be forceful in his management of the discussion. In McCormick's mind the rivalries and anger were only contributing to the epidemic's spread and its emergence in new areas. He wanted the Bangui gathering to accomplish four things: air everybody's grievances, flush out a true apolitical sense of the dimensions of the pandemic, create a working diagnostic definition of AIDS that could be used in poor countries in the absence of blood-testing capabilities, and set priorities for future researchâparticularly in Africa.
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