The HIV/AIDS story starts around 1921 in Gabon, Africa where one subspecies of non-swimming chimpanzees known as the Pan troglodytes troglodytes (Pan t. t.), have been bound in their native habitat between two rivers for many thousands of years.
The chimps developed simian immunodeficiency virus (SIV). Pan t. t. SIV probably originated from the recombination of distinct types of SIV infecting smaller monkeys: the red-capped mangabeys and spot-nosed guenons, which were hunted and eaten by the Pan t. t.s.
Using scientific methods, researchers have concluded that about 6% of Pan t. t.s may have been infected with SIV, which they then passed around their population through sexual transmission and blood from injuries sustained while fighting.
SIV may well have been present in the Pan t. t. population for hundreds of years. Although human populations (Bantus and pygmies) had lived in close proximity to the infected Pan t. t. chimps for around two thousand years, they never came into physical contact with the animals. Even if they could have captured the chimps, cultural taboos in several ethnic groups and tribes kept the native populations from considering the chimps a food source as they looked too much like humans.
The millennia-old natural balance and separation between humans and chimps was not upset until the early 1900s.
Industrialization in Europe demanded a constant flow of natural resources. Military forces from several European nations competitively and aggressively pushed their way throughout Africa, gaining political and economic control over the continent. By the early 20th century, all but Ethiopia and Liberia had been colonized by European powers. With the presence of the Europeans came their appetites. Whereas the native populations had avoided the chimps, white colonialists had the guns necessary to hunt the large and fast Pan t. t.s. So they hunted, killed, ate, and sold the chimps’ meat to satisfy their colonialist desire for bush meat.
SIV-infected blood in the Pan t. t.s entered the hunters’ blood system through wounds they got while butchering the animals. Because Pan t. t.s share about 99% similarity in genomes with humans, the SIV virus took hold in the humans and adapted, becoming HIV.
Using census records, chimp population estimations, and application of molecular clock dating on HIV virus cells in archived blood samples, scientists have traced the HIV virus back to as few as two or three infected white hunters in the Congo in the early 1920s. Though the HIV virus went unnoticed at the time, AIDS-related symptoms, such as brain atrophy, have been found in archival records of numerous autopsies. The numbers were simply too low then for anyone to notice the pattern.
Urbanization and prostitution come to the continent
Two cultural shifts permanently impacting the African population occurred as a direct result of European colonization: urbanization and urban prostitution.
France and Belgium had staked their claims in the Congo and were engaging in the exportation of raw products. From 1921 through 1934, French and Belgian colonizers built two massive and competing railroad lines to carry their countries’ exports to the Atlantic Ocean. The construction projects prompted the populations to explode to a previously unheard-of count of over 23,000 workers in the new twin cities.
Where there are men, “supply women” will follow. Prostitution was at first fueled by the sexual needs of the European support population. The number of prostitutes increased over time as conscripted native African workers, often away from their villages for as long as two years, added to the demands for female companionship.
Urban prostitution had never before been part of the African culture, but suddenly, it became more lucrative for a family to earn money prostituting their daughter than marrying her off.
At some point in the early 1920s, the HIV-infected white hunters from Cameroon migrated to Brazzaville and Leopoldville and apparently participated in sexual activities with prostitutes. However, sexual contact between a few HIV-infected hunters and their partners would not have occurred at levels necessary to spread HIV widely. Sex between partners where only one partner is HIV-infected can continue for months without passing the virus.
During the first few years of the rail construction, each prostitute only serviced an average of three or four regular clients. Even when her client base extended to native African railroad workers, the sexual transmission rate of the HIV virus would still not have been high enough to cause an epidemic. HIV might have gone unnoticed far longer if it had only been passed via sex. So what did escalate the virus’s transmission?
Epidemiologists found their answers in archived blood from the mid-1930s. Evidence of the HIV virus was discovered in blood samples from both older and younger people typically not members of the sexually active population. Further, the recorded cause of death for most of these individuals was brain atrophy, a condition consistent with AIDS-related diseases. So the scientists knew that something besides sex had started passing the HIV virus throughout the population.
Colonization leads to widespread inoculations
Several unfortunate events came together in a perfect storm at the beginning of the 20th century in Africa, causing “the mother of all tropical diseases”: sleeping sickness. The tsetse fly transmitted a parasite in its bite, causing this disease that killed its victims in just a few months. Though sleeping sickness had existed in Africa for thousands of years, it had remained in isolated population pockets—that is, until colonization.
In their insatiable hunger for more resources to supply to the European economies, the colonists, along with the native workers they used to accomplish their work, pushed deeper into previously uninhabited areas of Africa, thereby removing the natural geographic barrier that had existed between humans and the tsetse fly.
The natural food source of the tsetse fly had been cattle and wildlife, but an African cattle plague in the late 19th century practically wiped out the entire cattle population. With their natural food supply gone, the tsetse flies turned to close-by humans as a food source. At first, sleeping sickness spread quietly. Then workers and students attending missionary schools began contracting it in larger numbers. Severe outbreaks soon followed in the heavily populated areas that had been created under colonization.
Concerned about the disease spreading to other territories, officials started ordering widespread inoculations against it in the 1920s. It is estimated that three-quarters of the population in the Congo region—about 4 million people—received almost 600,000 injections total at the peak of the sleeping sickness epidemic. Because medical supplies were scarce and sterilization even scarcer, blood from one patient was transmitted to another in needles that were used up to a thousand times before they were sterilized or tossed away. In some instances, large amounts of blood were intentionally left in the needles in order to transfer antibody-rich blood from a recovering sleeping sickness patient to one who had just been diagnosed. It is estimated that the average person living in the Congo received over three hundred inoculations in their lifetime.
By the 1950s, the entire population of Leopoldville had undergone a cumulative 100,000 to 150,000 injections as precautionary measures to check the spread of sleeping sickness, leprosy, yaws, and sexually transmitted diseases. Once again, archived blood samples prove that the HIV virus had a growing presence in the population in and around the Congo in the late 1950s. Still, the virus wouldn’t be identified for another twenty-five years.
Civil War in the Belgian Congo causes HIV escalation
In June 1960, a civil war caused the Belgians to pull out of the Congo, and a flood of hundreds of thousands of refugees began pouring into Leopoldville from outlying areas. When the Belgians left, all the medical doctors who had served the population of 14 million people were among them. The Belgian Congo had had seven hundred medical doctors, yet not one of them was native Congolese; post-secondary education of the natives had been restricted under the Belgian regime.
The civil war also marked the end of government health regulations that had controlled the spread of sexually transmitted diseases and, with it, the spread of the HIV virus. Prostitution increased. Sex workers who had serviced a core group of only three to four customers per year were forced to service more than a thousand customers yearly to maintain the same income in the midst of the economic crisis. Now, prostitution and sex were at levels high enough to cause another amplification in the passage of HIV from person to person.
The general population of Leopoldville and Brazzaville became infected with HIV, and thus began the inevitable spread of the virus through the rest of Africa as the population moved and interacted with others across the continent.
The HIV virus gets to Haiti
When the Belgians withdrew 87,000 nationals from the Belgian Congo, it left 80% of the government posts unoccupied. All areas of the government suffered, including education. Colonization had elevated the role of European teachers and created a dearth of native Congolese teachers. The United Nations stepped into the education crisis and began to hire teachers who spoke French, the language of the Congo. Many teachers came from Belgium, but the bulk of them were French-speaking, black Haitians who were more similar in ethnicity to the Congolese than were the Belgians. Forty-five hundred Haitian teachers moved to Zaire (the country’s new name).
The HIV virus migrated from the sex worker population to the general population and increased by twelve times in the next ten years. As will happen, the Haitian teachers were having sex with Zairians, many of whom were infected with HIV. The virus’s silent passage throughout Africa, and its manifestation as AIDS-related illnesses, still hadn’t been noticed. One would expect that before long, as the Haitian teachers in Zaire moved back home, HIV/AIDS would migrate to the population of Haiti.
Indeed, that is exactly what happened, and once there, it again spread silently through sexual intercourse. That is, until another economically motivated disaster happened.
The “Vampire of the Caribbean” engages in a corrupt and unsanitary plasma business
In the 1970s, nearly 20% of the blood plasma used in the United States was imported from third-world nations, Haiti being the largest single supplier. Luckner Cambronne, also known as “the Vampire of the Caribbean,” opened Hemo-Caribbean, a massive plasma center in Port-au-Prince. Due to his connections with the very corrupt President Francois Duvalier (Papa Doc), Cambronne was able to freely operate Hemo-Caribbean under extremely poor hygiene conditions from 1971 to 1972.
Hemo-Caribbean collected blood from up to 850 people each day and exported 1,600 gallons of plasma each month to the United States. Blood from donors of the same blood type was pooled at the time of collection, the plasma was removed, and platelets were injected back into the donors, along with any infectious blood from other donors in a given session. Unsterilized needles and tubes were in constant use and re-use.
Following a New York Times exposé on the lack of hygiene in the blood trafficking facility, Hemo-Caribbean was shut down in 1972. But it was already too late.
Ten years later, as would be scientifically expected, there was an escalation in the death rate among Haitians and hemophiliacs (the prime consumers of blood plasma) due to AIDS-related illnesses contracted from the HIV-infected blood from Haiti.
Evidence supports this: From 1979 to 1981, there were eighteen cases of AIDS diagnosed in Haitians living in the United States; all eighteen individuals were dead within six months. In interviews with the HIV/AIDS-infected Haitians before they died, all stated that they had only engaged in heterosexual sex. At the same time, several Haitians in Haiti were diagnosed with Kaposi’s sarcoma, a disease never previously seen among the native Haitian population.
How did HIV/AIDS get to the United States?
Sex tourism between the United States, Canada, and Haiti increased in the 1970s and 1980s. Straight and gay men and women traveled Haiti to participate in sex tourism. In 1979, Port-au-Prince hosted an international gay men’s conference. The French-Canadian airline steward, Gaetan Dugas, famously dubbed “patient zero” by journalists, was known to have participated in sex tourism in Haiti. Dugas was later sexually linked to forty of the first 248 HIV/AIDS diagnoses in the United States. He died in 1984 of AIDS-related complications.
Early in 1980, reports emerged in California and New York of a small number of men diagnosed with a rare form of cancer, Kaposi’s sarcoma, and/or a form of pneumonia, Pneumocystis carinii pneumonia (PCP). Both diseases are normally found in people with severely compromised immune systems. But in this case, all the men were young, generally in good health, and gay.
The disease cluster was first identified in the Morbidity and Mortality Weekly Report, a Centers for Disease Control (CDC) publication, in June 1981. A month later, forty-one gay men had been diagnosed with Kaposi’s sarcoma. By the end of 1981, there were six new cases being reported each week.
Soon heterosexual men and women, half of them intravenous drug users, were also diagnosed with the disease. Later that same year, the acronym “AIDS” came into use, meaning acquired immunodeficiency syndrome. In December 1982, three heterosexual hemophiliacs died from PCP and other opportunistic diseases.
Suddenly, a handful of Haitians living in New York City were also diagnosed with PCP and died quickly. The disease came to be associated with “the four H’s”: homosexuals, hemophiliacs, heroin users, and Haitians.
By the time President Ronald Reagan would first publicly address the AIDS crisis in America in February 1986, 21,000 Americans would be dead from AIDS and 37,000 Americans would have contracted HIV.
READ the other five parts of this special series on HIV/AIDS:
AIDS Migrates From Africa to Haiti and the U.S.
C. Everett Koop — A Hero During the AIDS Crisis
How I Responded to the AIDS Crisis in the 1980s
The Face of AIDS Becomes a Child — Ryan White
Early Christian Responses to Epidemics Completely Unlike the 1980s Response