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It would be difficult to imagine anyone better qualified than Jacques Pepin to write about the origins of AIDS. An infectious diseases specialist who worked for 4 years in a bush hospital in Zaire (now the Democratic Republic of Congo), he trained in epidemiology at the London School of Hygiene & Tropical Medicine, has an encyclopaedic knowledge of French and Belgian colonial history, and has himself conducted groundbreaking research on the epidemiology of HIV-2 in West Africa.
This book reads like a detective story, and I found it hard to put down. Starting with the virological evidence that simian immunodeficiency virus in chimpanzees (SIVcpz) was first transmitted to a human around 1920, Pepin takes us through the evidence underlying the ‘cut hunter’ hypothesis as to how his might have happened, the social life and geographical distribution of various subspecies of chimpanzee and the retroviruses that they harbour, and the heroic efforts made by the French colonial authorities in Afrique equatoriale francaise to control sleeping sickness in the 1920s—which unfortunately involved several million intravenous injections given to rural villagers by locally trained ‘injecteurs’. As a result of this and other well intentioned mass treatment campaigns—including yaws control programmes—more than 40% of the population born before 1945 were found to be infected with hepatitis C virus in Southern Cameroon in the 1990s.
He goes on to describe the development of the first urban metropolis in Central Africa—Leopoldville (now Kinshasa), the capital of the Belgian Congo. Leopoldville had a huge number of bars—the Belgian governor estimated that 25% of income was spent on beer there in 1946—and a large population of single women, who provided services of many kinds to the working male population and were registered as ‘femmes libres’ by the colonial authorities. The Belgian Red Cross established the Dispensaire Antivenerien in Leopoldville in 1929, and femmes libres were obliged to attend for regular check-ups. By the early 1950s more than 3500 women were attending this clinic regularly, and 1000 or more patients were seen there every day. In 1953 more than 150 000 injections were given there. Needles and syringes were re-used many times, being rinsed with water between patients. Pepin's conclusion that the HIV epidemic increased exponentially in Leopoldville at this time is supported by the virology, with Kinshasa harbouring the greatest diversity of HIV strains by 1980.
Finally he describes the hasty decolonisation of the Belgian Congo in 1960—not a single Congolese doctor had been trained—and the influx of skilled migrants sent by the United Nations, including 4500 Haitians, one of whom probably took HIV type B back to Haiti in the early 1970s. An international plasma business set up in Port au Prince by one of Papa Doc Duvalier's cronies offered an excellent opportunity for its dissemination.
This is a beautifully written book, which explains epidemiological and scientific concepts such as phylogenetic analysis in clear and simple language. Pepin has assembled a vast amount of information from a wide variety of sources, and paints a clear, coherent and convincing account of the origins of AIDS. This book is required reading for anyone with a serious interest in infectious diseases.
Provenance and peer review Commissioned; internally peer reviewed.