Jacques Pepin - The Origins of AIDS

It is now thirty years since the discovery of AIDS but its origins continue to puzzle doctors and scientists. Inspired by his own experiences working as an infectious diseases physician in Africa, Jacques Pepin looks back to the early twentieth-century events in Africa that triggered the emergence of HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome) and traces its subsequent development into the most dramatic and destructive epidemic of modern times. He shows how the disease was first transmitted from chimpanzees to man and then how urbanisation, prostitution and large-scale colonial medical campaigns intended to eradicate tropical diseases combined to disastrous effect to fuel the spread of the virus from its origins in Lopoldville to the rest of Africa, the Caribbean and ultimately worldwide. This is an essential new perspective on HIV/AIDS and on the lessons that must be learned if we are to avoid provoking another pandemic in the future.

JACQUES PEPIN is a Professor in the Department of Microbiology and Infectious Diseases at the Universit de Sherbrooke, Canada, where he is also Director of the Center for International Health. He has conducted research on infectious diseases in sixteen African countries and, during the 1980s, worked for four years as a medical officer in a Zaire bush hospital.

Jacques Pepin

Published in the United States of America by Cambridge University Press, New York

Jacques Pepin 2011

This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press.

First published 2011

Printed in the United Kingdom at the University Press, Cambridge

Pepin, Jacques, 1958

The origins of AIDS / Jacques Pepin.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-1-107-00663-8 (hardback) ISBN 978-0-521-18637-7 (pbk.)

1. HIV infections Africa. 2. HIV infections Etiology. 3. AIDS (Disease)

Africa. 4. Emerging infectious diseases Africa. I. Title.

[DNLM: 1. HIV Infections etiology Africa. 2. HIV Infections history

Africa. 3. Acquired Immunodeficiency Syndrome history Africa.

4. Communicable Diseases, Emerging history Africa. 5. Disease Vectors

Africa. 6. HIV-1 pathogenicity Africa. 7. History, 20th Century Africa.

WC 503.3]

RA643.86.A35P465 2011

362.19697920096dc22

2011007350

Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.

I am grateful to several persons who helped me through the various steps of writing up this book. I will list them in chronological order.

At a very proximal stage, my career in the tropics (and thus my interest and competence in writing this book) would not have been possible without the support and patience of the late Christian Fisch and Jean-Louis Lamboray. I am also indebted to my former mentors and colleagues at the Universit de Sherbrooke (especially Raymond Duperval), the University of Manitoba, where I learned respectively to practise medicine and infectious diseases, the Medical Research Council Laboratories in The Gambia, where I understood how to do research, and the London School of Hygiene and Tropical Medicine, where I studied epidemiology. For more than fifteen years, the Canadian International Development Agency (CIDA) sponsored public health interventions in Africa during which I discovered a lot about sex workers. CIDA had also funded the primary healthcare project in Zaire where I became fascinated by African trypanosomiasis and other tropical diseases.

Over the seven years that I ultimately spent collecting the historical documents listed in the references section, I was assisted in an ever friendly way by the librarians of the following institutions (also in chronological order): Widener Library of Harvard University; Canada Institute for Scientific and Technical Information in Ottawa; British Library and School of Oriental and African Studies in London; Institute of Tropical Medicine in Lisboa (when I was mostly interested in HIV-2); Institut de Mdecine Tropicale du Service de Sant des Armes in Marseilles (where I discovered that what was true for HIV-2 also applied to HIV-1 and suddenly realised that there was enough material for a book, rather than a few standard 3,000-word scientific papers, which had been my initial goal); Archives Nationales dOutre-Mer in Aix-en-Provence; Belgian Ministry of Foreign Affairs, the Royal Library and Universit Libre de Bruxelles, in Brussels; Louvain University and Universit Catholique de Louvain; Institute of Tropical Medicine in Antwerp; United Nations Library and the World Health Organization in Geneva; Bibliothque Nationale de France in Paris; University of Ottawa, Universit Laval in Quebec City, Universit de Montral and Universit du Qubec Montral and my own institution, the Universit de Sherbrooke.

During the lengthy process of writing up the manuscript, I became especially indebted to Bernadette Wilson, who expertly edited the many chapters that I had written in English, and translated a few more written in French, and to Christian Audet, who professionally designed the illustrations.

When I finally reached the stage of seeking a publisher, Michael Watson of Cambridge University Press was kind enough to look at my manuscript and to find it worthy of publication. He then guided me through the difficult but necessary process of further editing the work. Like most academic authors, I initially saw this last step as a multi-organ amputation, but it turned out to be just a long-overdue haircut. Chloe Howell assisted with the finishing touches.

This having been said, the most important person who helped me through this whole adventure will be acknowledged in the Introduction.

Afrique quatoriale Franaise

Acquired immune deficiency syndrome

Centers for Disease Control and Prevention

Colonies Franaises dAfrique/Communaut Financre Africaine

Chemin de Fer CongoOcan

Central Intelligence Agency

circulating recombinant forms

desoxyribonucleic acid

Democratic Republic of the Congo

tat Indpendant du Congo (Congo Free State)

Global Programme on AIDS

hepatitis B virus

hepatitis C virus