Lessons from ‘Patient Zero’ who never was
Scientists announced Wednesday that Gaëtan Dugas, the Canadian flight attendant once described as the HIV epidemic’s “Patient Zero,” was not in fact the first person to carry the virus in North America.
This was confirmed through a breakthrough technique that allowed researchers to stitch together pieces of the virus found in a collection of 40-year-old blood samples and confirm HIV had been circulating in the United States since around 1970 — long before Dugas was diagnosed.
This is a remarkable piece of science, but the crucial lesson of this story is that viruses have social lives.
HIV, the virus that causes AIDS, probably emerged in western-central Africa about100 years ago after mutating from a similar virus that infects primates. In humans, HIV mutates at a predictable rate.
This means that by comparing the genes of various strains of the virus, scientists can count backward, “clocking” each blood sample and mapping out the branches in the viral family tree.
One problem with this strategy is that the genetic information in old blood samples degrades, making it hard to find usable genetic information. The new technique can actually cobble together a whole genetic sequence from stray bits. It is this complex technique that, curiously, seems to have exonerated Dugas.
Dugas was born in Quebec City in 1953. He was by many accounts a charismatic figure on the underground gay scene of the 1970s and early ’80s. By his own admission, he was highly promiscuous and his job with Air Canada had him travelling widely.
In 1984, scrambling to understand the new disease exploding in the gay community, the U.S. Centers for Disease Control discovered Dugas was at the centre of a cluster of cases of AIDS.
What happened next is a tangled series of events that this week’s announcement finally helps to unravel. When Randy Schilts’ bestselling book, And The Band Played On, hit the shelves in 1987, he described Dugas, who died in 1984, as HIV’s “Patient Zero.” This was partly an oversimplification and a simple misunderstanding: most of the other cases in that cluster were in California and Du- gas, the lone Canadian, was labelled not Patient Zero but “Patient O” for “Outside of California.”
Scandalized readers and reviewers, however, ran with the narrative that Dugas was the villain of HIV. The reasons why Dugas made such an appealing scapegoat ultimately lie not in biology, but history.
Dugas’ story unfolded in the 1980s in Ronald Reagan’s America. The virus was reported in America’s medical journals just a few months into his presidency, in June of 1981, but Reagan didn’t make a formal speech on AIDS until 1987. The same year, he proposed cutting the federal AIDS budget by 11 per cent. For Reagan, AIDS was politically toxic — a problem only for gay men, immigrants, drug users and others pushed to the margins of society. He saw no votes in the issue and ignored it for years, to disastrous effect.
Dugas was therefore irresistible in a media, political and popular culture environment desperate to pin the blame on an immoral outsider. Dugas almost certainly did spread the disease to others, but it was his bad luck to be a gay Canadian in America’s time of crisis.
These are truly exciting times in the world of HIV research. In recent years, a series of breakthroughs in basic science, treatment and advocacy have ushered in a new era. Discrimination against patients has been greatly reduced, while survival times are vastly increased. But it’s important to use this as a chance for reflection: Are we still making the same mistakes? Have we learned the lessons of the Patient Zero who never was?
The search for the true story of AIDS in America was never going to be limited to microscopes and mathematical models. Viruses find us as we are; at our strongest and our weakest, with prejudice and hatred, with compassion and courage. We still stigmatize those afflicted with HIV and countless other conditions, adding a brutal moral baggage to an already heavy burden.
Dugas is not the first person to be vilified by a frightened and angry public, nor will he be the last. For every case that is eventually vindicated, there are thousands more relegated to the dusty corners of history as stigmatized scapegoats. At least the people who knew and loved Dugas may now rest knowing his name has been, to some small extent, cleared. The rest of us, hopefully, have learned a lesson that goes beyond biology.
Gaëtan Dugas almost certainly did spread HIV to others, but it was his bad luck to be a gay Canadian in America’s time of crisis