The Man Who Was Wrongly Labeled As HIV’s ‘Patient Zero’

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You’ve heard of Gaetan Dugas, even if you don’t know his name. Dugas has long been identified as HIV’s “Patient Zero,” who was often characterized by media reports as an irresponsible flight attendant whose promiscuity sparked the AIDS epidemic in North America in the 1980s and 1990s. To be sure, leading scientists studying the history of HIV in the U.S. have never blamed Dugas quite so bluntly — and now new evidence has emerged that may finally, posthumously, clear Dugas’s name.

It’s not exactly clear how Dugas came to be known as Patient Zero, but many argue that journalist Randy Shilts’s 1987 book And the Band Played On may inadvertently be patient zero for the myth of Patient Zero. In that book, Shilts wrote that “there’s no doubt that Gaetan played a key role in spreading the new virus from one end of the United States to the other,” though Science magazine’s Jon Cohen points out that Stilts did not explicitly (or implicitly) suggest that Dugas was the so-called “index case” for HIV in the United States.

If only media outlets at the time were so careful. In a piece for Science late last week, Cohen writes that after the publication of Stilts’s book, both Time and the New York Post claimed rather straightforwardly that Dugas had triggered the epidemic; the latter even went so far as to publish a headline that screamed “THE MAN WHO GAVE US AIDS.”

And yet, according to a new analysis of some of the earliest recorded HIV cases, Dugas was in neither the right place nor time to have possibly triggered the spread of the disease across the U.S. Evolutionary biologist Michael Worobey examined eight blood samples taken in the late 1970s from gay and bisexual men in both New York City and San Francisco; he also analyzed a 1983 sample from Dugas.

As Cohen explains:

HIV mutates at a constant rate each time it copies itself, so Worobey [used] the differences among the sequences to create a family tree of the viruses and estimate when each isolate emerged.”

Dugas’s version of the virus, according to this analysis, looked much more like later mutations of HIV, which would mean that Dugas did not spark the epidemic. (“There’s nothing special about his genome,” as Worobey put it in an interview.)

And then there’s this:

His work suggests that the U.S. epidemic most likely began in New York City around 1970, when the real index case brought in a virus that closely matched the sequences of older HIVs isolated from people in Haiti and a few other Caribbean countries. Although his sample size is small, Worobey said that the probability that New York City was the origin of the U.S. epidemic “is very, very high indeed.”

In plainer language: Dugas couldn’t have started the epidemic in the 1980s, because the virus had already been around in the U.S. since the early 1970s, beginning in New York City in 1970 — likely coming from someone who had caught the virus in Haiti or a nearby country — and then spreading to San Francisco by 1975.

There is no scientific evidence, then, for our cultural notion of Patient Zero as we currently understand it, and inaccurate reporting certainly did play a role in shaping that idea. (It’s fun to blame the media; even those of us who number among “the media” enjoy it sometimes.) But Cohen points out that CDC researchers are at fault, too: In the beginning stages of research, scientists referred to Dugas in their writings by the letter O, meaning that he was from “outside” California. Could that letter O have been misread by someone as the number 0?

Maybe. Maybe not. Regardless, Dugas provided a narrative: HIV as a consequence of promiscuous homosexuality, which placed it firmly in the category of “other” — something that couldn’t happen to most Americans. “It was too scary to think HIV was a general risk due to the vagaries of biology rather than a callous ‘bad guy,’” Dr. Richard Elion, an HIV/AIDS researcher at George Washington University, told Vox’s Julia Belluz. Decades after the fact, that narrative turns out to be unraveling.