What Caused the AIDS Pandemic?

As the world becomes increasingly overburdened with the AIDS scourge that continues to advance with unmatched tenacity, we can attempt, in serenity and knowledge gathered in its history, to chart the causative factors before it achieved its epidemic status. The historical narrative is to some extent factual and positivist and also rich in causal explanations that are hypothetical in nature. In essence, such an analysis illumines but not predicts the present. The emergence of AIDS marked the beginning of era of viral pestilences, completely different from the past classic pestilences such as the influenza epidemics. Its emergence as a disease was unpredicted and as an epidemic it remained largely unpredictable under the old nosology framework. In summary, AIDS is representative of the emergence of post-modern plagues. It is under such an understanding that AIDS is classified as a new disease. Before the 1970s AIDS was utterly inconceivable. During these times, diseases were defined with regard to their symptomatic representations or associated anatomical lesions. AIDS could not be defined by these basic understandings of disease. It was thus perceived as a disorder that exhibited non specific symptoms; it was invisible and its causative agent undetectable. It is only until recently when sophisticated analytical methods were developed that its detection became commonplace in clinical diagnosis.

As a disease, AIDS is new but it is not known for how many years the virus had existed under the shadow of a host of infectious diseases and pathological conditions. Around 1980, physicians were astonished by an existence of a disease that seemed “new”. They referred to the new illness as knew because it could not be explained by the existent definitive classifications of disease as such they were forced to rely on explanatory models that were unknown in epidemiology and classical pathology. This initial surprise was a product of the discovery of new category of diseases never before recorded or postulated in medical theory. This discovery was followed by other unexpected and disquieting findings: a new plaque had once again struck mankind and that the intractable infection was on an inexorable spread, striking down the afflicted even under optimal therapy. As mass hysteria skyrocketed, the medical world disclosed that the new plaque was transmissible through sex, blood and drugs (Grmek et al 1993).

As the 1980s neared its terminus, the AIDS pandemic had acquired a variety of metaphors and meanings. Physicians, scientists and public health authorities posited the argument that AIDS was just another epidemic of infectious diseases and that it was no more different from epidemics caused by other diseases. Even though sections of the scientific and public health authorities warned of the grave consequences of the ignorance associated with the infection, their efforts were not enough to contain the epidemic. Additionally, as the AIDS virus had produced a wide variety of attributions, meanings and definitions, it was not possible to offer a conclusive preventive measure. The AIDS epidemic is biological and biomedical as well as cultural and linguistic (Treichler 1999; Berridge & Strong 2002). The interaction of these meanings on the political, economic and social contexts was the cause of the confusions, ignorance and lack of interest in the management of AIDS during the initial infections. Given that these infections were limited to a specific section of the community, it can be argued that the inability of the political class, the scientific community and the public health authorities to prevent the spread of the disease, due to discrimination, laid the foundation for the spread of the epidemic to the whole world (Gostin & Gostin 2004)

There are various theories and evidences that have been presented to the general public as well as in the scientific forums. It is certain that the retroviruses having the capability of causing AIDS had existed in the environment before the AIDS pandemic shook the world. To understand the origin of these viruses, we are bound to desist from limiting ourselves to the field of biology as there exists complex intertwine of social and biological factors that may have caused its origin. The current pandemic is attributable to two superimposed epidemics which may have been triggered with two agents that are distinct but genetically related by an indirect lineage. The initial pandemic was largely unknown but later identified by American doctors is believed to have originated from American soil. The second epidemic believed to have been caused by HIV-2 was centred in West Africa. HIV-1 began its spread in three places; two in North America and one in central Africa. Whether the origin of the American epidemic and the African epidemic are independent or correlated have been a matter of great controversy.

In 1969, in a Congressional Hearing, there arose a prediction that the military could create a super germ as a component of its experimental bio warfare program. On the basis of new capabilities provided by the advancement of genetic engineering, the program intended to manufacture a super germ capable of wiping out vast populations. Additionally the virus would be constructed and transmitted in a way that the human race would be powerless against its debilitating capacities. On the same program, the Department of Defence spokesman affirmed that,

“Within the next five to ten years, it would be possible to produce a new infective micro             organism which could differ in certain important respects from any known disease          causing organisms. Most important of these is that it might be refractory to the     immunological and therapeutic processes upon which we depend to maintain our relative   freedom from infectious disease.”(Testimony given before the Sub-Committee of the        House Committee on Appropriations, Department of Defence Appropriations for 1970,       Washington, 1969) (Cantwell 1992, p 137).

 

Four years later (1973), a Copenhagen epidemiologist; J. Clemmesen while giving a lecture to cancer researchers revealed his growing concern about the transmission of cancer causing viruses. His concern was that in the near future it may be possible that the transmission of these cancer causing viruses may led to a world cancer epidemic. Clemmesen visualized a situation where a mutation of the virus into highly contagious variants could lead to a pandemic of neoplastic disease before an effective vaccine was developed. In direct reference to the top secret biological warfare weapons program and its consequent disastrous ramifications, he challenged the imagination of his audience by posing a situation where some nations could employ such a virus to intimidate other nations till they acceded to their requests.

Just after a decade, these predictions were proven with the worldwide reality of the AIDS pandemic. By the 1985, 130 countries had reported cases of AIDS in their territories, and as earlier predicted every single nation on the planet was under threat. The World Health Organization estimated that an approximate total number of ten million people had been infected. A world that had existed in political discordance suddenly realized that there was need of a collective international effort to combat the crisis (Cantwell 1992; Mann 1989).

Thus, it is firmly held in some quarters, that even though the viruses may have had a history of existence in the environment, the specific strain responsible for the AIDS virus is believed to have originated from the military laboratories. An analysis of the time difference between the time of congressional announcement and the onset of AIDS pandemic affirms a strong connection. While the beginning of AIDS may have just been another coincidence, it is important to understand that prior to the announcement; there were no known cases of AIDS epidemic. Moreover, before 1980, the diagnostic capabilities were too inferior to effectively neither identify nor characterize the virus yet after the epidemic broke out, these techniques suddenly became commonplace.  The prophase of the epidemic is disturbing as well as astonishing owing to the multitude of chronological coincidences. For instance, in 1978 when the technical and conceptual means of identifying and isolating human retrovirus became available, the epidemic began its spread. To assume that a random mutation may have occurred to warrant such a coincidence is simply improbable.

Alternatively, between 1962 and 1982, a colony of macaques (Macaca mulatta and Macaca arctoides) had been decimated by four epizootics. These macaques were being used in research at Davis in California. Following the appearance of the disease these animals exhibited immune depression and malignant lymphomas coupled to the opportunistic infections. In 1981-1982; the duration of the fourth epizootic, the researchers connected these symptoms to AIDS creating an avalanche of attraction to this new disease by AIDS researchers. The epizootic was thus christened SAIDS meaning Simian AIDS. It is this connection that is used to postulate the role of monkeys in the origin of the AIDS epidemic. In the winter of 1982-83, the researchers at the California research centre injected four healthy macaques with the tissues harvested from the diseases macaques. The infected macaques developed generalized lymph node enlargement followed by the opportunistic infections after several weeks. One macaque that had skin lesions akin to Kaposi sarcoma, the other two died rapidly. When Murray Gardner in collaboration with his Davis colleagues eventually isolated the causative agent of the epizootic, they found out that it was SRV-1: completely distinct from HTLV-I (Grmek et al 1993).

In September 1984, Ronald Desrosiers, M. D. Daniel, Myron Essex in collaboration with Harvard University successfully isolated a different agent from a macaque infected with SAIDS. When the agent was analyzed, its serological properties almost matched those of HTLV-III (an acronym chosen despite the absence of HTLV-II). In 1987, a serological analysis of the stored sera from Davis colony macaques that had succumbed to SAIDS between the 1976 and 1978 yielded a different strain, SIV. Since the Davis colony of macaques were captive animals, it was not possible to resolve on the source of infection. The human AIDS virus can only be transmitted to chimpanzees through laboratory introduction of the virus into the vagina or blood stream. Infected chimps then became seropositive, carried the virus in their circulation but showed no symptomatic evidences of clinical disturbance.

The captive macaques that had succumbed to the disease that resembled the human AIDS had their origins in Asia yet when Myron Essex carried out a random test of blood samples from wild Asiatic monkeys, no trace of SIV was found. African chimps and baboons were taken through the same blood sample test but the results were negative. Contrastingly, when green monkeys (especially Coerpithecus aethiops) were taken through serological analysis, SIV antibodies were found to be existent in their blood. The seroprevalence ranged between 30-70%. However, some monkeys like Coerocebus atys were highly infected with SIV. Several strains of the virus were also isolated from mangabeys, green monkeys, mandrills and baboons (Grmek et al 1993).

Remarkably, all these animals infected in the natural environment suffered no disease symptoms that were linkable to the viruses in question. When these viruses were injected in macaques, these animals suffered a chronic illness similar to the nature of illness suffered in a minor form of human AIDS. Ironically, viruses isolated from these infected macaques were more virulent than strains that had been injected in the macaques initially. Subsequent inoculation into healthy macaques elicited characteristic acute, severe pathological reactions. Additionally, subsequent isolation from macaques and inoculation in mangabeys caused sickness even though the same mangabey is naturally resistant to the virus (Grmek et al 1993). The chronology of experimented attested to the fact the virulence HIV-I can be potentiated in an analogous process.

Since pathogenic viruses don’t spring up ex nihilo, they can not be entirely new. They originate from ancestors with similar genetic characteristics. They must also replicate somewhere whether it is in the human population or in the animal population; their replication in these environments is dependable on the existence of a biological equilibrium. The current causative agents of AIDS epidemic can not therefore be attributable to any recent origin of HIV-I and HIV-II that may have been caused by spontaneous or parallel mutations in a relatively short period of time. With the understanding recent integrated data on animal retroviruses that are related, such mutations can only occur over a longer period of time and even then successive selection pressures highly operate on a variable genetic pool. Work done on the evolutionary origins of retroviruses affirms that HTLVs are much closer to BLV (Bovine Leukaemia Virus) than it is to HIV or SIV. Genetic analyses affirm that AIDS virus is only linked to lentivirus such as the equine infectious anaemia(EIAV) and visna virus but not to the HTLV species. Drawing from the evolutionary tree, the relationship between the HTLV species and the lentiviruses and AIDS virus, dates back to pre-history(Grmek et al 1993).

It has been widely established that the AIDS virus could not have been a parasite to man for so many years before the disease was discovered but there are opinions that the current epidemic could have been caused by the transfer of the viruses from primates to man. Viral infections not too dissimilar to HIV-2 are endemic among many species of African primates such as the green monkeys. In Africa, these monkeys are hunted, handled with bare hands and eaten. There are instances where children and monkeys have been bitten by monkeys. To explain the transmissibility of these virus strains to human beings, some researchers have presented evidence to the fact that among some tribes in Zaire, consumption of raw monkey brain was a common practice. Thus, there is no need to invoke the possibility of sexual contact between the primates and human beings. Moreover, there are some unique sexual customs practiced by some tribes around the African Great Lakes region where men are injected on the thighs with male monkey blood and women with female monkey blood to either stimulate or arouse intense sexual activity(Grmek et al 1993). Under such customs, it is not surprising that the virus may have found its way into the human population.

However, given the duration in which AIDS has existed as an infection of human beings, such postulations or evidence of transmission do not explain why the infections could not have originated earlier on among these tribes. Owing to the intensified trade in live monkeys from West Africa to Europe and the United States for use in medical experimentation and biotechnology, some authors attribute the spread of the viruses to the American population as a consequence of infection in the research laboratories. In this case the transmission in no more different from the transmission of the virus to hunters.

According to the simian hypothesis put forward by Phyllis Kanki and Myron Essex, due to the fact that the SIV is endemic among many species of primates in Africa, the same was transmitted to an African man in West Africa. Subsequently, through viral adaptation to new host, the human AIDS virus was formed. These hypotheses fail to conclusively attest to the causes of the current AIDS pandemic. Moreover, an association of the SIV            viruses and the AIDS viruses can not hold as it has been widely proven that in the span of a few years, no major mutations would have occurred to causes any similarity between the two viruses. An evolutionary analysis and genetic analyses refute such a hypothesis (Grmek et al 1993). On the other hand a genetic recombination may have occurred between two ancient viruses to generate a new strain that was more adaptable to the human body somewhere in Central Africa.

As to the origin of transmission of the virus from its probable origins to the human body, the matter remains as issue of great controversy, what have been agreed on are patterns of initial spread (Berridge & Strong 2002). Historians and researchers agree that the epidemic began its spread from three distinct centres; two are American primordial areas (San Francisco/ Los Angeles and New York/Miami). Scholars also agree that the origin of the virus that led to the start of AIDS epidemic in these areas have a connection (Grmek et al 1993). This was proven by the initial confinement of the epidemic among the gay community. This feature of the initial geographical distribution of AIDS is buttressed by the prevalence of organized group sex and drug abuse in the gay community (Turner 1989; Fournier & Herlihy 2006). Controversy over the connection between the African origin of the epidemic and the American origin of the epidemic is still unresolved.

It is prudent that the first indications of the AIDS epidemic be detailed. The first warning of the epidemic was reported in 1979, by a Los Angeles physician; Joel Weisman, who because of his sympathy for homosexuals, began noticing that there had been an increase in the number of patients with a mononucleosis like syndrome that was characterized by weight loss, hectic fever, and swollen lymph nodes. The patients were young men originating from the cycle of California’s growing gay community. With medication these patients improved fitfully but failed to fully recover from the affliction. At first the disease was diagnosed as cytomegally as it had a causal link with cytomegalovirus. Serologic tests proved that the disease was mostly concentrated to the homosexual community. Apart from the symptoms characteristic of cytomegalovirus, these patients also had anal and oral thrush, diarrhoea, immune system deficiency, weight loss and respiratory diseases (Grmek et al 1993; Brandt 1987; Mayer & Pizer 2005). At the same time, the number of such patients was increasing in public hospitals across Los Angeles. In New York, these characteristic symptoms were becoming prevalent among the gay community as well.

The recorded history of the beginning of the AIDS epidemic shows that the political establishment, the scientific and the medical community failed to halt the spread of AIDS. In the early years of the disease, AIDS infections were limited to the gay community. The recognition of the seriousness of the affliction and the magnitude of its spread as not limited to the gay community but these ramifications created no increased interest in prevention measures. In fact it almost became a fact that AIDS was a disease of drug addicts and gays. It is the overall ignorance about the disease that has led to the degree of AIDS epidemic in the world today. As men in San Francisco, Los Angeles and New Yolk City died in their hundreds, their please for assistance went unheeded for over three years. Later when AIDS began benefiting from social, political and economic support, it had become rooted in the community and spread quickly despite any efforts. To the current modern societies, AIDS still moves on, killing millions in its wake.