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The Invention of Patient Zero

How crystal-meth-fueled promiscuity, AIDS medical politics, and one very sick man combined to create a phantom superbug.


Chelsea's West Side Club (Photo Credit: Edward Keating)

Maybe the 46-year-old New York man who had managed to avoid HIV for the life of the epidemic finally succumbed on Friday, October 22, 2004, when he failed to use even one condom during a weekend of crystal meth and multiple sexual encounters. Ordinarily, the New York man was sexually dominant, the penetrator. That changed on October 22. “Apparently he used Viagra, but when he didn’t, he became a bottom,” says Dennis deLeon, a grandee in AIDS politics who has been briefed on the case. “Crystal can make anybody a bottom. I’ve heard stories that even straight guys flip over on this stuff.”

Maybe he was at the West Side Club that night, as one report says, and maybe out of the steamy recesses of the place came a man, as yet unidentified, who probably knew he was HIV-positive, who knew that his infection was defying treatment. Through the distorting lens of crystal, the New York man reportedly had hundreds of encounters around this time—and seven or eight that evening alone.

Let’s say most of these strangers assumed the man was himself HIV-positive, which would account for why none of them insisted on a condom either. Many gay men practice this gambit, colloquially called “sero-sorting,” based on the belief that having unprotected sex with somebody who shares your HIV status carries minimal risk. Most doctors believe otherwise, and point to the danger of reinfection. Studies show that in such encounters, those who are positive tend to assume their prospective partners are positive, and negatives make the opposite—and equally unspoken—assumption.

And maybe on that long night in Chelsea, the worst possible thing happened: This New York man contracted an extremely deadly “superbug” like nothing ever seen before. It appeared to carry a dreadful punch. While most people go a decade after infection before showing major symptoms, this man sank to a sickly shadow of himself by mid-November, and was an AIDS patient by December and a curiosity by January, when tests showed him resistant to most AIDS drugs. By February 11, when the New York City health commissioner, Dr. Thomas Frieden, called a press conference to alert the world to the case, the man had become a modern-day Typhoid Mary, Patient Zero in a foreboding new epidemic threatening New York City and the globe.

“We’ve identified this strain of HIV that is difficult or impossible to treat,” Dr. Frieden announced ominously. “Potentially, no one is immune.”

With those words, this man’s misfortune became the biggest AIDS story of the 21st century, shouted in headlines as far away as India. The New York Times discussed the supervirus in twelve stories in the first week alone. The alarm about the drug-fueled, sexually irresponsible gay-male community has given new fodder to old anti-gay mouthpieces. “There’s a new strain of HIV available in New York City. It’s because of gay men,” the Catholic League’s William Donohue said on MSNBC. “They’re endangering the lives of everybody.” Even William F. Buckley, who twenty years ago suggested the rumps of HIV carriers be branded with warnings, reentered the fray. “Murderers need to be stopped,” he explained in National Review.

Panicking about the new pathogen, most gay men didn’t race to denounce Buckley this time. Instead, they raced to their doctors. Physicians across the country reported a crush of visits from worried patients; the Gay Men’s Health Crisis Website experienced a 63 percent surge in hits. At two heated community meetings in Manhattan, gay men and AIDS service providers swapped accusations with rancorous outbursts reminiscent of early ACT UP meetings. Only this time, the anger was directed less at the health Establishment than at the patient himself. “My first reaction was one of anger—that someone in his mid-forties, who had escaped the devastation and pain of the eighties and nineties, had seroconverted,” Tokes Osubu, executive director of a Harlem-based group called Gay Men of African Descent, told more than 300 people gathered at FIT in early March. “We have lost that sense of outrage. Many of our friends and lovers are dead, but we are not afraid anymore.”

After the frenzy died down, however, the new epidemic began to look a lot less fearsome. In fact, on closer examination, almost everything about this case seems murky. An investigation by the Department of Health turned up no evidence that the New York man passed the virus to anybody. And on March 29, the department put out a press release saying that the patient was responding well to his medications.

“The virus that ate New York,” as Richard Jefferys, basic-science project director for Treatment Action Group, put it, “is just one case.”

The responsibility for this medical panic attack is spread widely: from the patient to the reporters who made him a caricature, to the city health commissioner for terrifying the city and the scientists who characterized the case, most notably Dr. David Ho, the top researcher at the world-renowned Aaron Diamond AIDS Research Center at Rockefeller University, and his deputy, Dr. Marty Markowitz, who warned of a “silent tsunami” of new infections spreading undetected across the land.

“There were all these signs that said, ‘Slow down, take this with caution’—and they just weren’t heeded,” says Martin Delaney, the founding director of Project Inform, an AIDS-information clearinghouse. “Everyone down the line miscalculated. It was like a perfect storm; every element had to be in place for this to happen the way it did.”

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