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The Invention of Patient Zero

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But others took a more skeptical approach. “I thought this sounded familiar, so I Googled ‘superbug’ and ‘AIDS,’” said GMHC’s Gregg Gonsalves. He found two cases reported in 2001 by a noted Vancouver AIDS specialist, Dr. Julio Montaner. The Vancouver Sun quoted Montaner about the cases, but he could have been describing the newest Patient Zero: “In a matter of months, these people have gone from totally asymptomatic to very low immune systems.”

Frieden says he was caught unawares by the Vancouver cases, and that he wishes he had known about them before deciding to hold his own press conference. Ho, who still maintains the uniqueness of the New York case, wasn’t aware of the specifics of the Vancouver cases, and called Montaner the Monday following the press conference. “It was very cordial,” Montaner says with a laugh. “He phoned me up to find out more about it.” (Both Canadian patients, it turned out, have responded well to treatment and now have fully suppressed viral loads.)

Ho, meanwhile, was coming under heavy criticism. “When I first heard this, I said, Holy shit—there is no evidence,” says Dr. Robert Gallo, an eminent virologist. “Clearly, conclusively, scientifically, it was inappropriate to make that statement.”

Gallo and other leading figures in the field—including Dr. Tony Fauci, director of the National Institute of Allergy and Infectious Diseases—believe the new case report, while unfortunate for the patient, is likely a statistically predictable outlier. Unfortunately, according to data generated by Ho’s institute, drug-resistant HIV is now commonplace: Nearly 30 percent of newly diagnosed HIV cases are resistant to at least one AIDS drug, and 11 percent are resistant to drugs in two or more drug classes.

In much of the criticism, there was an undercurrent of resentment toward Ho. Many saw the announcement as grandstanding. Michael Petrelis, an AIDS activist and blogger from San Francisco, fanned the flames with revelations about Ho’s links to Frieden (who sits on the Aaron Diamond Board of Directors) and the San Francisco laboratory that does the resistance testing, ViroLogic (as a scientific adviser, he receives a stipend and stock options). “I’m not saying any of that is wrong, or undermines the concern that Ho or others have about this mutant strain. I’m saying, we should know these things as we consider this case. That’s all I’m asking for: Give us all of the facts.” (In the interest of full disclosure, I should say that I also have some relevant history—I am a volunteer fund-raiser for Housing Works, the AIDS services agency that has been critical of Frieden, and I’m friendly with some of the players—including Frieden’s press spokeswoman.)

"I think it is only a couple individuals working really hard to spread bad news about us,” Ho says. “Whenever there is some news surrounding me or our institution, the usual suspects emerge—it’s not surprising to me.”

While Ho was contending with this backlash, his deputy Marty Markowitz surprised the February 15 New York meeting with a lecture stridently defending his superiority and referring to himself in the third person. “This is not for amateurs,” he said at one point, in response to a question. “You are arguing the . . . you are taking the doubting-Thomas point of view. However, you must also yield to the expertise of people who do know better.”

“You want to generate demand,” says Frieden. “You want people to think, Oh, I just had unsafe sex a couple of weeks ago . . . I should see my doctor.”

It was true that a kind of circuslike atmosphere was developing, with a laboratory in San Diego saying it had found a match there (not true, according to Frieden). South Park did an episode featuring a supervirus. And a doctor in Connecticut claimed he was treating the couple that infected Markowitz’s patient in the first place. “My guys were at the West Side Club on the weekend in question,” Dr. Gary Blick, a longtime AIDS practitioner based in Norwalk, told me. “The timing fits.” Blick says Frieden tried to keep him from going public with his findings, but he sent out a press release anyway. “I felt obligated before the Black Party [a vast annual party, held this year at Roseland] to give a message about this transmission.”

On March 29, Frieden announced the conclusion of the detective phase of his investigation. More than a dozen sexual contacts of the New York patient’s have been interviewed, and thousands of blood samples have been retested. But the investigation failed to find an original source for this viral strain, nor did it locate anybody who might have contracted it from the New York patient. Frieden has ordered further tests on about ten additional mutated strains that surfaced in his investigation, but for now it seems his worst fears haven’t come to pass. He hastens to say that he is relieved by this, not disappointed. And he has no second thoughts about going public. “The role of public health is to prevent outbreaks, not to describe them,” he says.

The problem, however, is one of crying wolf—the alarm gets harder and harder to hear. Despite the spike in doctor visits, the gay community apparently hasn’t changed course. Condoms are no more widely available at gay meeting places; drug use was just as prevalent at the Black Party as in previous years.

On one level, the case is a cautionary tale about the dangers of meth, unprotected sex, and complacency. And the mythological trappings surrounding the supervirus feed into that very sense of complacency. The introspection that rose up around the early epidemic has given way to what Dan Carlson, co-founder of the HIV Forum, calls a “culture of disease,” in which HIV is now accepted as an intractable reality. “Whether there’s a dangerous new virus among us or not, we need to talk about what HIV means to us,” Carlson says. “Why are we so skittish or afraid to talk about the issues that lead us to have unsafe sex? Do we talk about the decisions we make that put us at risk? We have a lot of work to do.”

And where does that leave Patient Zero? “It’s not a walk in the park,” Mullen says. “He’s taking a lot of drugs”—his regimen involves two daily injections—“and there are toxicities. He was short of breath for some time. But he’s responding to medications.” And he’s back at work.

If he continues his slow return to health, he may be allowed to fade into the ranks of the 110,000 New Yorkers who live every day with HIV without causing anybody alarm. But a 39-year-old veteran of AIDS scare stories named Hush McDowell wonders if that’s possible. In 1998, McDowell made global news as the first known person to catch multiple-drug-resistant HIV—and the last one responsible for unleashing the phrase “superbug” in the press.

“I feel awful for him,” says McDowell. “Maybe he’s able to ignore the press and focus on his care, but I never was.” These days, McDowell is doing well on medication, and he lives far from the media’s glare, tending bees on a farm in Tennessee. “Best thing I ever did,” he says.


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