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The Origins of AIDS
It is now thirty years since the discovery of AIDS but its origins continue to puzzle doctors and scientists. Inspired by his own experiences working as an infectious diseases physician in Africa, Jacques Pepin looks back to the early twentieth-century events in Africa that triggered the emergence of HIV/AIDS and traces its subsequent development into the most dramatic and destructive epidemic of modern times. He shows how the disease was first transmitted from chimpanzees to man and then how urbanization, prostitution, and large-scale colonial medical campaigns intended to eradicate tropical diseases combined to disastrous effect to fuel the spread of the virus from its origins in Léopoldville to the rest of Africa, the Caribbean and ultimately worldwide. This is an essential new perspective on HIV/AIDS and on the lessons that must be learnt if we are to avoid provoking another pandemic in the future.
310 pages, Paperback
First published July 27, 2011
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About the author
Jacques Pepin
2 books9 followersLibrarian note: There is more than one author in the Goodreads database with this name. For the chef, see Jacques Pépin.
Jacques Pepin is Professor in the Department of Microbiology and Infectious Diseases at Université de Sherbrooke, Canada. He has conducted research on infectious diseases in sixteen African countries.
Jacques Pepin is Professor in the Department of Microbiology and Infectious Diseases at Université de Sherbrooke, Canada. He has conducted research on infectious diseases in sixteen African countries.
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June 14, 2023
I read the 2nd edition of this book, published in 2021 (original publication date 2011).
Since it was first identified in 1981, AIDS has killed around 40 million people worldwide, and more are added to the total every year. Dr. Pépin argues that evidence from genetic sequencing and the “molecular clock” means scientists can now say the pandemic began with a cross-species transmission of the Simian Immunodeficiency Virus in the early part of the 20th century. This took place somewhere near Moloundo in SE Cameroon or Ouésso in Congo-Brazzaville, both towns lying on the border between the countries. Almost certainly it happened when someone cut themselves whilst handling the carcass of an infected chimp. Cross-species transmission had probably occurred a number of times over previous centuries, but these events had been “epidemiological dead-ends”. The affected person might have infected their spouse and maybe one or two others, but prior to the 20th century HIV had never been able to break out from those initial contacts.
On this occasion, the virus got transmitted to Léopoldville, in the Belgian Congo (now Kinshasa in the DRC) the “tinderbox” of the current pandemic. How exactly this happened cannot be proved, but the book suggests several scenarios. HIV can lie dormant in the body for years without causing illness, and the most common symptoms - weight loss, diarrhoea, and intermittent fever, looked exactly like any number of other tropical diseases. This and a complex set of other factors allowed it to continue to circulate at a low level in Central Africa for about 60 years, without being recognised. One significant factor was that both the Belgian and French colonial regimes pursued aggressive public health policies that involved the re-use of syringes when giving injections. The collapse of the Congolese economy from the 1960s onwards led to a huge increase in the number of women working in high-risk prostitution, some having as many as 1,000 clients a year. The 1970s saw a sharp rise in the proportion of the population infected.
As is well-known, the colonial regime left the Congo spectacularly unprepared for independence, and in the 1960s the country employed numbers of Haitian administrators. Being black and Francophone they adjusted easily, and naturally formed liaisons with local women. It’s thought that HIV arrived in Haiti in 1967, where the incidence exploded during the following decade. Again the book provides possible explanations.
In the 1970s Haiti was a destination for American sex tourists, mainly though not exclusively gay men. Tours were even organised from San Francisco. The virus landed there in 1976 and by 1978 6% of gay men in the city were infected. Three years later that figure had reached 44%. The HIV subtype introduced to the US was subsequently exported from there to western Europe, Canada, most of Latin America, Australia and even the white gay community in South Africa. In the latter country, a different subtype circulated amongst black heterosexuals - two overlapping but quite separate epidemics.
The subsequent worldwide dissemination of HIV was via multiple vectors, and beyond the scope of this book. One aspect that particularly interested me was outbreaks linked to unhygienic or unsafe plasmapheresis processes. In China in the 90s one such outbreak caused 250,000 cases. I was a plasma donor when I was a young man. In the UK people aren’t paid for donations, but the medical staff were skilled in making donors feel good about themselves. It simply didn’t occur to me that there might be any risk and fortunately for me, my naïve trust in the UK’s donor service wasn’t misplaced.
I didn’t agree with the author’s conclusion in the Epilogue, but it didn’t spoil the book overall.
This definitely wasn’t a quick read for me, as it is an in-depth examination of the epidemiology of the AIDS pandemic, that required plenty of concentration on my part. Personally though I found it a quite fascinating account.
Since it was first identified in 1981, AIDS has killed around 40 million people worldwide, and more are added to the total every year. Dr. Pépin argues that evidence from genetic sequencing and the “molecular clock” means scientists can now say the pandemic began with a cross-species transmission of the Simian Immunodeficiency Virus in the early part of the 20th century. This took place somewhere near Moloundo in SE Cameroon or Ouésso in Congo-Brazzaville, both towns lying on the border between the countries. Almost certainly it happened when someone cut themselves whilst handling the carcass of an infected chimp. Cross-species transmission had probably occurred a number of times over previous centuries, but these events had been “epidemiological dead-ends”. The affected person might have infected their spouse and maybe one or two others, but prior to the 20th century HIV had never been able to break out from those initial contacts.
On this occasion, the virus got transmitted to Léopoldville, in the Belgian Congo (now Kinshasa in the DRC) the “tinderbox” of the current pandemic. How exactly this happened cannot be proved, but the book suggests several scenarios. HIV can lie dormant in the body for years without causing illness, and the most common symptoms - weight loss, diarrhoea, and intermittent fever, looked exactly like any number of other tropical diseases. This and a complex set of other factors allowed it to continue to circulate at a low level in Central Africa for about 60 years, without being recognised. One significant factor was that both the Belgian and French colonial regimes pursued aggressive public health policies that involved the re-use of syringes when giving injections. The collapse of the Congolese economy from the 1960s onwards led to a huge increase in the number of women working in high-risk prostitution, some having as many as 1,000 clients a year. The 1970s saw a sharp rise in the proportion of the population infected.
As is well-known, the colonial regime left the Congo spectacularly unprepared for independence, and in the 1960s the country employed numbers of Haitian administrators. Being black and Francophone they adjusted easily, and naturally formed liaisons with local women. It’s thought that HIV arrived in Haiti in 1967, where the incidence exploded during the following decade. Again the book provides possible explanations.
In the 1970s Haiti was a destination for American sex tourists, mainly though not exclusively gay men. Tours were even organised from San Francisco. The virus landed there in 1976 and by 1978 6% of gay men in the city were infected. Three years later that figure had reached 44%. The HIV subtype introduced to the US was subsequently exported from there to western Europe, Canada, most of Latin America, Australia and even the white gay community in South Africa. In the latter country, a different subtype circulated amongst black heterosexuals - two overlapping but quite separate epidemics.
The subsequent worldwide dissemination of HIV was via multiple vectors, and beyond the scope of this book. One aspect that particularly interested me was outbreaks linked to unhygienic or unsafe plasmapheresis processes. In China in the 90s one such outbreak caused 250,000 cases. I was a plasma donor when I was a young man. In the UK people aren’t paid for donations, but the medical staff were skilled in making donors feel good about themselves. It simply didn’t occur to me that there might be any risk and fortunately for me, my naïve trust in the UK’s donor service wasn’t misplaced.
I didn’t agree with the author’s conclusion in the Epilogue, but it didn’t spoil the book overall.
This definitely wasn’t a quick read for me, as it is an in-depth examination of the epidemiology of the AIDS pandemic, that required plenty of concentration on my part. Personally though I found it a quite fascinating account.
December 14, 2011
I think we are all a bit spoiled by the recent genre of dramatic page-turning science non-fiction (see: Richard Preston). This is NOT one of those books. Its pure science - so at times I missed our new genre of science page-turners. But in the end, the book's thoroughness and clarity was addicting in itself. An admirable undertaking that tho pure science, makes an attempt AND SUCCEEDS to explain everything to a layman. For me, who knew the minimum (um, "monkeys in africa" / "a gay airline steward goes on a multinational sex binge" - debunked by the way in this book), Pepin explains everything we know now about the spread of the Aids virus; and we know much more than i thought. Most remarkable is that he shows that it is likely that the disease has been around for thousands of years, but until the advent of euro-colonialism in central africa, the conditions for massive contagion did not exist. If you are incredibly curious, but incredibly lazy - read the last 2 chapters only - it summarizes and reiterates the rest of the book completely. But that is not my recommendation.
December 27, 2022
A brilliant aggregation and distillation of hard evidence and conjecture concerning the origins of the viruses that cause AIDS in homo sapiens. Pepin manages to write clearly and with unexpected humor. The explanation of technical matters is handled adroitly and seductively--it almost makes one want to go out and get an epidemiology degree. It is an incredible story--from the species jump of a Simian Immunodeficiency Virus to the dissemination of the HIV viruses world-wide; a perfect storm involving colonial medical practices, migration patterns, the sex trade, and for-profit blood donation schemes.
Do not be misled by Mr. Dildine's 1-star review below. Though the theory that AIDS originated from the CHAT type 1 polio vaccine is still held strongly by some individual researchers, notably Robert Hooper, author of "The River: A Journey Back to the Source of HIV and AIDS", it is dispensed with briefly in Pepin's book, and the current scientific consensus rejects this theory (see http://www.ncbi.nlm.nih.gov/pmc/artic...). I would love to get around to reading Hooper's magnum opus and consider the evidence he offers. Readers who would like to view Mr. Hooper's point of view should consult his website which, while maintaining the polio vaccine theory, offers a more balanced consideration of Pepin's book. It must be kept in mind that Pepin is hardly doctrinaire; evidence that is circumstantial or conjectural is identified as such. There is much that we will never know about the origins of AIDS and Pepin's book should be seen as the latest salvo in a continuing debate; a summation of the best evidence at hand.
My point of view is that of a non-specialist/scientist and I recommend "The Origin of AIDS" to all who wish to know more about the origin and spread of this most deadly of modern plagues.
Do not be misled by Mr. Dildine's 1-star review below. Though the theory that AIDS originated from the CHAT type 1 polio vaccine is still held strongly by some individual researchers, notably Robert Hooper, author of "The River: A Journey Back to the Source of HIV and AIDS", it is dispensed with briefly in Pepin's book, and the current scientific consensus rejects this theory (see http://www.ncbi.nlm.nih.gov/pmc/artic...). I would love to get around to reading Hooper's magnum opus and consider the evidence he offers. Readers who would like to view Mr. Hooper's point of view should consult his website which, while maintaining the polio vaccine theory, offers a more balanced consideration of Pepin's book. It must be kept in mind that Pepin is hardly doctrinaire; evidence that is circumstantial or conjectural is identified as such. There is much that we will never know about the origins of AIDS and Pepin's book should be seen as the latest salvo in a continuing debate; a summation of the best evidence at hand.
My point of view is that of a non-specialist/scientist and I recommend "The Origin of AIDS" to all who wish to know more about the origin and spread of this most deadly of modern plagues.
May 23, 2016
Part epidemiological whodunnit, part late colonial history, Jacques Pepin's new book The Origins of AIDS is the definitive text on the origins and globalization of HIV. While the book contains many wonderful things, of particular note is its emphasis on how both the humanitarian horrors of colonial development and the chaotic breakup of colonial authority led to fundamental changes in a variety of deviant industries, which in turn facilitated the spread of AIDS.
At least six different deviant industries were crucial in enabling or propagating the AIDS epidemic. First, Belgian and French colonial development efforts (railroad building and mining, in particular) in central Africa increased demand for meat. This in turn spurred the hunting of simians, a dangerous and sanguinary activity which often led to injuries for those hunting and slaughtering the animals. It was this wrangling with apes that led to the seminal crossing of the HIV-1 virus from chimps to humans, some time around 1920.
Second, the breakup of colonialism in Africa, and particularly the extreme chaos of the Belgian departure from Congo in 1960, led to wholesale changes in the local markets for commercial sex. During the late colonial period, Central African prostitution generally took the form of a fairly stable institution where a "free woman" might perhaps have a handful of regular clients. In the wake of the Belgian departure, chaotic mass urbanization and pauperization transformed the local prostitution industry into one where the prostitutes had little choice but to turn dozens of tricks weekly with many more clients. This change in sexual habitus amplified the transmission of all sorts of STDs within urban centers of Congo and former French Central Africa, including HIV.
Third, the global transmission of the virus out of Africa itself was a product of a certain kind of moral arbitrage, as the United Nations dispatched troops to Congo as part of the mission to "restore order" in that broken country. Inevitably, these soldiers became consumers of the local prostitution industry, which would soon transform them into vectors for the propagation of what until then had been a disease confined to Africa. Specifically, it may be surmised that at least one of the 3500 Haitian soldiers brought the HIV virus back to Haiti some time in the mid-1960, where he introduced it into the general population, perhaps with further visits to prostitutes.
Fourth, like many other miserably poor countries with virtually nothing else to produce or export, Haiti in the 1970s was the site of two additional deviant industries, each of which would prove crucial for the globalization of HIV. On the one hand, in the early 1970s, Haiti became the site of a commercial market in blood products (organized by a Miami businessman) such as plasma. Poor sanitation in this industry may well have helped to diffuse the HIV virus within Haiti, though the evidence here is spottier. On the other hand, Haiti was also an important site for sexual tourism, an industry which was flourishing in the post sexual-liberation era. More specifically relevant, Haiti was a go-to destination for gay sex tours organized out of San Francisco and New York during the 1970s. It was in this way, Pepin argues, that HIV was introduced into the United States some time in the early-to-mid-1970s.
Finally, once the plague arrived on these shores, injection drug usage facilitated the spread of the disease within the archipelago of 1980s urban demimondes. More specifically, the prohibition on drugs encouraged needle-sharing among drug addicts, and this in turn proved crucial for exploding the number of infections within this population, as well as with their sexual partners.
At least six different deviant industries were crucial in enabling or propagating the AIDS epidemic. First, Belgian and French colonial development efforts (railroad building and mining, in particular) in central Africa increased demand for meat. This in turn spurred the hunting of simians, a dangerous and sanguinary activity which often led to injuries for those hunting and slaughtering the animals. It was this wrangling with apes that led to the seminal crossing of the HIV-1 virus from chimps to humans, some time around 1920.
Second, the breakup of colonialism in Africa, and particularly the extreme chaos of the Belgian departure from Congo in 1960, led to wholesale changes in the local markets for commercial sex. During the late colonial period, Central African prostitution generally took the form of a fairly stable institution where a "free woman" might perhaps have a handful of regular clients. In the wake of the Belgian departure, chaotic mass urbanization and pauperization transformed the local prostitution industry into one where the prostitutes had little choice but to turn dozens of tricks weekly with many more clients. This change in sexual habitus amplified the transmission of all sorts of STDs within urban centers of Congo and former French Central Africa, including HIV.
Third, the global transmission of the virus out of Africa itself was a product of a certain kind of moral arbitrage, as the United Nations dispatched troops to Congo as part of the mission to "restore order" in that broken country. Inevitably, these soldiers became consumers of the local prostitution industry, which would soon transform them into vectors for the propagation of what until then had been a disease confined to Africa. Specifically, it may be surmised that at least one of the 3500 Haitian soldiers brought the HIV virus back to Haiti some time in the mid-1960, where he introduced it into the general population, perhaps with further visits to prostitutes.
Fourth, like many other miserably poor countries with virtually nothing else to produce or export, Haiti in the 1970s was the site of two additional deviant industries, each of which would prove crucial for the globalization of HIV. On the one hand, in the early 1970s, Haiti became the site of a commercial market in blood products (organized by a Miami businessman) such as plasma. Poor sanitation in this industry may well have helped to diffuse the HIV virus within Haiti, though the evidence here is spottier. On the other hand, Haiti was also an important site for sexual tourism, an industry which was flourishing in the post sexual-liberation era. More specifically relevant, Haiti was a go-to destination for gay sex tours organized out of San Francisco and New York during the 1970s. It was in this way, Pepin argues, that HIV was introduced into the United States some time in the early-to-mid-1970s.
Finally, once the plague arrived on these shores, injection drug usage facilitated the spread of the disease within the archipelago of 1980s urban demimondes. More specifically, the prohibition on drugs encouraged needle-sharing among drug addicts, and this in turn proved crucial for exploding the number of infections within this population, as well as with their sexual partners.
August 12, 2017
outstanding, aside from the appalling epilogue
March 11, 2024
jacques says some offensive shit in here, a skosh tone deaf bud
November 14, 2012
Jacques Pepin's The Origins of AIDS is an amazing book, one of those titles that will be cited by future generations of writers as a foundational text for its field. The Origins of AIDS, naturally, takes a look at the ultimate origins of AIDS, as a virus that somehow managed to cross over from the chimpanzee populations of west-central Africa a century ago to that region's human population, eventually exploding into a general epidemic.
How did it happen? Pepin carefully details how the environment of colonial central Africa allowed HIV to survive long enough to make it to the Belgian Congolese capital of Leopoldville and from there to spread through the world. I've posted a general overview at my personal blog and another post focusing on the specific demographic elements of the epidemic (the thin populations of central Africa at the time of colonization, the exceptional vulnerability of these populations to human and epidemiological threat, the sexual dynamics of STD epidemics, and the critical importance of migration). Suffice it to say that the details he brings to the study, drawn from his own experience as a doctor in post-colonial Central Africa and his studies of French and Belgian colonial archives, fills in the gap. The terrible irony, for instance, that a French colonial program of mandatory treatment for sleeping sickness led in good faith by a physician who wanted to save the peoples colonized by France may have allowed HIV to take off via unclean needles, is something no one has mentioned. Similarly, Pepin's discovery that Haiti in the early 1970s was a noteworthy source of blood plasma for developed markets, suggesting that HIV could have spread rapidly there through non-sterile conditions, is something no one before had raised. Pepin has done his work.
In his autobiographical novel To the Friend Who Did Not Save My Life, Hervé Guibert quotes his friend Michel Foucault--like Guibert, a man who would be a casualty of HIV/AIDS--as saying that the disease was ridiculous. Pepin proves Foucault right: if not for a long string of highly contingent events, from the first cut hunter to the vagaries of French and Belgian colonial policies to Haitian migration, the epidemic would have been much different. We're indebted to him for this, not least because of the relevance of Pepin's studies to the spread of other zoonoses.
How did it happen? Pepin carefully details how the environment of colonial central Africa allowed HIV to survive long enough to make it to the Belgian Congolese capital of Leopoldville and from there to spread through the world. I've posted a general overview at my personal blog and another post focusing on the specific demographic elements of the epidemic (the thin populations of central Africa at the time of colonization, the exceptional vulnerability of these populations to human and epidemiological threat, the sexual dynamics of STD epidemics, and the critical importance of migration). Suffice it to say that the details he brings to the study, drawn from his own experience as a doctor in post-colonial Central Africa and his studies of French and Belgian colonial archives, fills in the gap. The terrible irony, for instance, that a French colonial program of mandatory treatment for sleeping sickness led in good faith by a physician who wanted to save the peoples colonized by France may have allowed HIV to take off via unclean needles, is something no one has mentioned. Similarly, Pepin's discovery that Haiti in the early 1970s was a noteworthy source of blood plasma for developed markets, suggesting that HIV could have spread rapidly there through non-sterile conditions, is something no one before had raised. Pepin has done his work.
In his autobiographical novel To the Friend Who Did Not Save My Life, Hervé Guibert quotes his friend Michel Foucault--like Guibert, a man who would be a casualty of HIV/AIDS--as saying that the disease was ridiculous. Pepin proves Foucault right: if not for a long string of highly contingent events, from the first cut hunter to the vagaries of French and Belgian colonial policies to Haitian migration, the epidemic would have been much different. We're indebted to him for this, not least because of the relevance of Pepin's studies to the spread of other zoonoses.
Read
August 3, 2025A fascinating and well researched hard science book about the origins and spread of HIV and its subsequent permutations. This book does an excellent job of weaving together the many facets that made the spread of HIV possible in a way that feels well plumbed but understandable.
I think the author is very light on his connections between the exploration of the colonial system and how it let the spread of HIV be what it was. The spread of HIV would not have been possible without the large scale health care regimes and changing urban structures that came with colonization, and I think that a slightly deeper exploration of the exploitative nature of the colonial projects would well suit this book. In some sections this book presents the colonial projects of France and Belgium in Africa as mostly a fair trade - the resources, wealth, and people of these places for roads, healthcare, and education. This is obviously not a balanced exchange, and the author does acknowledge that only white Belgians were really benefitting from secondary and post-secondary education or that the money from resources taken from colonial projects was then exported to Europe, but he doesn’t really connect these things to the struggles that these new nations faced after their independence or that they face today in fighting HIV. For the most part this is a book that avoids moralizing, which is fitting when it comes to discussing sex work and other factors in the spread of HIV, but the author does rightly criticize the blood trade in Haiti, and it seemed a little odd that he would acknowledge that was exploitative and skim over vast parts of the colonial project that served to exacerbate the spread of HIV.
All in all, this book is very well done, and well worth a read when it comes to understanding how a virus that has killed 44 million people became what it is today.
I think the author is very light on his connections between the exploration of the colonial system and how it let the spread of HIV be what it was. The spread of HIV would not have been possible without the large scale health care regimes and changing urban structures that came with colonization, and I think that a slightly deeper exploration of the exploitative nature of the colonial projects would well suit this book. In some sections this book presents the colonial projects of France and Belgium in Africa as mostly a fair trade - the resources, wealth, and people of these places for roads, healthcare, and education. This is obviously not a balanced exchange, and the author does acknowledge that only white Belgians were really benefitting from secondary and post-secondary education or that the money from resources taken from colonial projects was then exported to Europe, but he doesn’t really connect these things to the struggles that these new nations faced after their independence or that they face today in fighting HIV. For the most part this is a book that avoids moralizing, which is fitting when it comes to discussing sex work and other factors in the spread of HIV, but the author does rightly criticize the blood trade in Haiti, and it seemed a little odd that he would acknowledge that was exploitative and skim over vast parts of the colonial project that served to exacerbate the spread of HIV.
All in all, this book is very well done, and well worth a read when it comes to understanding how a virus that has killed 44 million people became what it is today.
January 6, 2018
I decided to continue with my self-education project on the AIDS epidemic by reading The Origins of AIDS by Jacques Pepin. Pepin is an expert in the study and treatment of infectious diseases. Early in his career, he spent four years working as a medical officer in Zaire, and later, conducted research on HIV in The Gambia and other nations in central and west Africa. He is now a professor in the Department of Microbiology and Infectious Diseases at the University of Sherbrooke, Quebec, where he is also Director of the Center for International Health.
Pepin begins by offering the readers a brief summary of his explorations of the origins of HIV, noting areas where his narrative is based on solid evidence and others, where scientific evidence is unavailable and he has made use of the most reasonable hypotheses to fill in the lacunae in the scientific record.
"This book will summarise and assemble various pieces of the puzzle that have gradually been delineated over the last decade by a small group of investigators, to which I have added historical research of my own. Some elements are irrefutable, such as the notion that the Pan troglodytes troglodytes chimpanzee is the source of HIV-1. Other elements are less clear, for example the exact moment of the cross-species transmission (sometime in the first three decades of the twentieth century). My own contribution focused around the idea that medical interventions requiring the massive use of reusable syringes and needles jumpstarted the epidemic by rapidly expanding the number of infected individuals from a handful to a few hundred or a few thousand. This set the stage for the sexual transmission of the virus, starting in core groups of sex workers and their male clients and later spreading to the rest of the adult population. Some parts of the story rely on circumstantial evidence, such as the links between the Congo and Haiti and the potential contribution of the blood trade in triggering the epidemic in Port-au-Prince, from where it moved into the US."
In his Introduction, Pepin acknowledges that, as a medical doctor, working in Zaire during the early 1980s, with limited resources, he probably engaged in procedures that, while considered best practices at the time and under those circumstances, contributed to the spread of HIV infection. He treated many patients for tuberculosis with a protocol that involved multiple injections of streptomycin, and many more for sleeping sickness with injections of a drug called melarsoprol; glass syringes were reused and sterilisation with an autoclave was not always possible - indeed, many of the medical outposts he worked in had no autoclave. Given the time period and the conditions of his work, it is almost certain that at least some patients were infected under his care. It was in part his realisation of this, which grew from later research into the links between treatment for sleeping sickness and HIV-2 infections in what had once been Portuguese Guinea, that led to his decision to research the origins of AIDS. He adds:
"Some may say that understanding the past is irrelevant, what really matters is the future. I disagree. There are at least two good reasons for attempting to elucidate the factors behind the emergence of the HIV pandemic. First, we have a moral obligation to the millions of human beings who have died, or will die, from this infection. Second, this tragedy was facilitated (or even caused) by human interventions: colonisation, urbanisation and probably well-intentioned public health campaigns. Hopefully, we can gain collective wisdom and humility that might help avoid provoking another such disaster in the coming decades."
As this suggests, in his narrative, Pepin looks not only at the scientific story of the transformation of the simian infection agent SIV to the human agent HIV, but also at the historical conditions that enabled the disease - which many scientists believe may have crossed the species barrier on multiple occasions during the history of human-ape interactions in Africa - to reach epidemic proportions on this occasion. In doing so, he takes aim squarely at the social choices that made these conditions possible - from the catastrophic effects of European colonialism on African societies, to the devastating role that the profit motive played in the spread of the virus through collection and distribution of blood and blood products.
Pepin's narrative is detailed and strongly argued; he provides a great deal of technical information, but not so much that the informed layman cannot follow the argument and see how its conclusions have been reached. Beginning with basic epidemiological information - the distribution and prevalence of the many types and sub-types of the virus found in Africa, and what this implies to the scientist searching for the origins of the disease - Pepin follows each link in the chain of evidence like a forensic puzzle.
I found it fascinating reading, and was impressed by the breadth and depth of Pepin’s research into every aspect of the scientific and sociological elements that led to the breakout, at this place and time, of a disease that had started to develop, then sputtered out on a number of earlier occasions. From the gender ratios of the residents of Brazzaville in the 1930s to post-colonial Zaireian policies on regulating prostitution to the history of large-scale public health programs involving injection treatments for disease such as sleeping sickness, trypanosomiasis, yaws and syphilis in the different colonies of French Equatorial Africa and the Belgian Congo, the degree of detailed documentation of the conditions that led to the HIV epidemic is exhaustive.
Pepin’s style is an interesting blend of the dry academic, and the wry wit. His occasional asides, which often point out issues of colonialism and racism, are personal and in a way, endearing. Case in point: when discussing the work of Louise Pearce, an early medical researcher, he begins “Louise Pearce, a visiting American scientist (always referred to as Miss Pearce rather than Dr Pearce, her unmarried status apparently being more important than her degrees!)...” I came to look forward to these trenchant observations as moments of connection to the author amidst the sometimes daunting mass of data.
Overall, an excellent epidemiological study that should answer all but the most technical questions anyone might have about the origins of the AIDS epidemic.
Pepin begins by offering the readers a brief summary of his explorations of the origins of HIV, noting areas where his narrative is based on solid evidence and others, where scientific evidence is unavailable and he has made use of the most reasonable hypotheses to fill in the lacunae in the scientific record.
"This book will summarise and assemble various pieces of the puzzle that have gradually been delineated over the last decade by a small group of investigators, to which I have added historical research of my own. Some elements are irrefutable, such as the notion that the Pan troglodytes troglodytes chimpanzee is the source of HIV-1. Other elements are less clear, for example the exact moment of the cross-species transmission (sometime in the first three decades of the twentieth century). My own contribution focused around the idea that medical interventions requiring the massive use of reusable syringes and needles jumpstarted the epidemic by rapidly expanding the number of infected individuals from a handful to a few hundred or a few thousand. This set the stage for the sexual transmission of the virus, starting in core groups of sex workers and their male clients and later spreading to the rest of the adult population. Some parts of the story rely on circumstantial evidence, such as the links between the Congo and Haiti and the potential contribution of the blood trade in triggering the epidemic in Port-au-Prince, from where it moved into the US."
In his Introduction, Pepin acknowledges that, as a medical doctor, working in Zaire during the early 1980s, with limited resources, he probably engaged in procedures that, while considered best practices at the time and under those circumstances, contributed to the spread of HIV infection. He treated many patients for tuberculosis with a protocol that involved multiple injections of streptomycin, and many more for sleeping sickness with injections of a drug called melarsoprol; glass syringes were reused and sterilisation with an autoclave was not always possible - indeed, many of the medical outposts he worked in had no autoclave. Given the time period and the conditions of his work, it is almost certain that at least some patients were infected under his care. It was in part his realisation of this, which grew from later research into the links between treatment for sleeping sickness and HIV-2 infections in what had once been Portuguese Guinea, that led to his decision to research the origins of AIDS. He adds:
"Some may say that understanding the past is irrelevant, what really matters is the future. I disagree. There are at least two good reasons for attempting to elucidate the factors behind the emergence of the HIV pandemic. First, we have a moral obligation to the millions of human beings who have died, or will die, from this infection. Second, this tragedy was facilitated (or even caused) by human interventions: colonisation, urbanisation and probably well-intentioned public health campaigns. Hopefully, we can gain collective wisdom and humility that might help avoid provoking another such disaster in the coming decades."
As this suggests, in his narrative, Pepin looks not only at the scientific story of the transformation of the simian infection agent SIV to the human agent HIV, but also at the historical conditions that enabled the disease - which many scientists believe may have crossed the species barrier on multiple occasions during the history of human-ape interactions in Africa - to reach epidemic proportions on this occasion. In doing so, he takes aim squarely at the social choices that made these conditions possible - from the catastrophic effects of European colonialism on African societies, to the devastating role that the profit motive played in the spread of the virus through collection and distribution of blood and blood products.
Pepin's narrative is detailed and strongly argued; he provides a great deal of technical information, but not so much that the informed layman cannot follow the argument and see how its conclusions have been reached. Beginning with basic epidemiological information - the distribution and prevalence of the many types and sub-types of the virus found in Africa, and what this implies to the scientist searching for the origins of the disease - Pepin follows each link in the chain of evidence like a forensic puzzle.
I found it fascinating reading, and was impressed by the breadth and depth of Pepin’s research into every aspect of the scientific and sociological elements that led to the breakout, at this place and time, of a disease that had started to develop, then sputtered out on a number of earlier occasions. From the gender ratios of the residents of Brazzaville in the 1930s to post-colonial Zaireian policies on regulating prostitution to the history of large-scale public health programs involving injection treatments for disease such as sleeping sickness, trypanosomiasis, yaws and syphilis in the different colonies of French Equatorial Africa and the Belgian Congo, the degree of detailed documentation of the conditions that led to the HIV epidemic is exhaustive.
Pepin’s style is an interesting blend of the dry academic, and the wry wit. His occasional asides, which often point out issues of colonialism and racism, are personal and in a way, endearing. Case in point: when discussing the work of Louise Pearce, an early medical researcher, he begins “Louise Pearce, a visiting American scientist (always referred to as Miss Pearce rather than Dr Pearce, her unmarried status apparently being more important than her degrees!)...” I came to look forward to these trenchant observations as moments of connection to the author amidst the sometimes daunting mass of data.
Overall, an excellent epidemiological study that should answer all but the most technical questions anyone might have about the origins of the AIDS epidemic.
July 10, 2015
The medical profession discovered the new disease now called AIDS in 1981. Five homosexual men in Los Angeles developed a rare lung infection, which was treated with a drug that was not commercially available and had to be ordered from the Center for Disease Control; a drug technician at the CDC noticed the coincidence and alerted her colleagues. Where did the disease come from before 1981? The virus now called HIV is divided into multiple subtypes; the most subtype-rich continent is Africa, and within Africa, the most subtype-rich region is Central Africa, which indicates the origin of the virus. HIV comes in two variants, HIV-1 and HIV-2; HIV-1, the more virulent and widespread of the two, seems to be an evolution of a virus called SIVchz, present in a subspecies of the common chimpanzee that lives just north of the Congo river, and not in the bonobo, which lives south of it; molecular analysis says that the virus jumped to humans in the early twentieth century. At the time, the range of the subspecies of chimpanzee was located in the French Equatorial Africa, while the range of the bonobo was located in the Belgian Congo. How did the virus jump from chimpanzees to humans, how did it spread, and how did it come to America? We don't know for sure, but we can make an educated guess.
Pepin delves into French colonial archives. Somehow the Congo Free State got all the bad rap, while the French Empire seems to have been hardly more humane ("in Bangui, forty-five women, who had been jailed because their husband[s] failed to bring back enough rubber, died in detention within a five-week period.") There were big projects such as a railway connecting Brazzaville, the capital of French Congo, to the ocean, built with forced labor; the cheapest way to feed the laborers meat was to hunt local game. It could be that a hunter with a scratch or a sore killing and butchering a chimpanzee was all it took for the virus to jump to humans. How did the virus spread? First, colonial towns had an overwhelmingly male population, and the few women found it profitable to become prostitutes, like on the American frontier, spreading syphilis and gonorrhea, and possibly the new disease. Second, there were public health campaigns in the colonies fighting the sleeping sickness and the like, with mass inoculations done in conditions that, by modern standards, were barbarously unsanitary; a poorly sterilized needle could have spread the virus further. Brazzaville and Kinshasa (then Leopoldville) was and is one metropolitan area with the population freely moving across the Congo river then as now; if a new infection appeared on one bank of the river, it could easily go across. After the formerly Belgian Congo became independent in 1960, it found itself lacking educated people, so it imported 4,500 Haitian administrators, who were black, spoke French, and were glad to escape the "ubuesque" rule of François Duvalier. A single Haitian having sex with a Congolese prostitute and going back to Haiti would have been enough to bring the virus to the Americas. Genetic analysis of the variants of HIV infecting Haitians shows this to have happened circa 1966. As Pepin tells it, in the 1970s Haiti was a favorite sex tourism destination for gay Americans, since the revolution in Cuba shut down this sort of vacation in this country. Also, a high-ranking official of the Duvalier regime, known as the "Vampire of the Caribbean", ran a blood plasma center in 1971-1972, which had poor sanitary standards and could easily have spread the infection among Haitian donors; he exported thousands of gallons of plasma to the U.S. each month. HIV could have gotten to the United States from Haiti through either route circa 1969.
For someone as far from the science of epidemiology and public health as I am, this book is totally fascinating. Think of all the science fiction stories about aliens using human social networks to infiltrate and conquer Earth - but this wasn't an alien but a virus from our own biosphere. The upheavals of colonialism and post-colonial independence, the poverty of Haiti next to the riches of the United States - and suddenly the "4H" (hemophiliacs, heroin addicts, homosexuals and Haitians) started dying of a mysterious disease.
Pepin delves into French colonial archives. Somehow the Congo Free State got all the bad rap, while the French Empire seems to have been hardly more humane ("in Bangui, forty-five women, who had been jailed because their husband[s] failed to bring back enough rubber, died in detention within a five-week period.") There were big projects such as a railway connecting Brazzaville, the capital of French Congo, to the ocean, built with forced labor; the cheapest way to feed the laborers meat was to hunt local game. It could be that a hunter with a scratch or a sore killing and butchering a chimpanzee was all it took for the virus to jump to humans. How did the virus spread? First, colonial towns had an overwhelmingly male population, and the few women found it profitable to become prostitutes, like on the American frontier, spreading syphilis and gonorrhea, and possibly the new disease. Second, there were public health campaigns in the colonies fighting the sleeping sickness and the like, with mass inoculations done in conditions that, by modern standards, were barbarously unsanitary; a poorly sterilized needle could have spread the virus further. Brazzaville and Kinshasa (then Leopoldville) was and is one metropolitan area with the population freely moving across the Congo river then as now; if a new infection appeared on one bank of the river, it could easily go across. After the formerly Belgian Congo became independent in 1960, it found itself lacking educated people, so it imported 4,500 Haitian administrators, who were black, spoke French, and were glad to escape the "ubuesque" rule of François Duvalier. A single Haitian having sex with a Congolese prostitute and going back to Haiti would have been enough to bring the virus to the Americas. Genetic analysis of the variants of HIV infecting Haitians shows this to have happened circa 1966. As Pepin tells it, in the 1970s Haiti was a favorite sex tourism destination for gay Americans, since the revolution in Cuba shut down this sort of vacation in this country. Also, a high-ranking official of the Duvalier regime, known as the "Vampire of the Caribbean", ran a blood plasma center in 1971-1972, which had poor sanitary standards and could easily have spread the infection among Haitian donors; he exported thousands of gallons of plasma to the U.S. each month. HIV could have gotten to the United States from Haiti through either route circa 1969.
For someone as far from the science of epidemiology and public health as I am, this book is totally fascinating. Think of all the science fiction stories about aliens using human social networks to infiltrate and conquer Earth - but this wasn't an alien but a virus from our own biosphere. The upheavals of colonialism and post-colonial independence, the poverty of Haiti next to the riches of the United States - and suddenly the "4H" (hemophiliacs, heroin addicts, homosexuals and Haitians) started dying of a mysterious disease.
May 5, 2012
The first of many errors in the book is the title. Pepin knows little about the origin of AIDS, and has done no research of his own; he merely parrots one side of the origins debate. Other parts of the book are interesting, and perhaps useful, but the origins sections are simply assertions that are not backed up by evidence or research. He does show how unlikely the bushmeat/cut hunter theory of the origin of AIDS really is, but he ignores the wealth of evidence that supports the alternative oral polio vaccine theory of the origin of AIDS. He does not engage in the origins debate, but simply declares it over. It has been proven that the CHAT vaccine was produced in the Congo using chimpanzee kidney tissue culture and administered to close to a million Africans in the 1950s. The dating of HIV to 1921, as Pepin supposes, requires that the chimpanzee virus did not make the jump from chimps to humans as a result of that oral polio vaccine experiment. (If it did, the genetic dating of the retrovirus doesn't work.) Thus, Pepin errs by relying on the 1921 dating for his origins story.
Other parts of the book are poorly researched. Pepin's case for an early instance of AIDS in Africa (pre 1950s) has been thoroughly debunked by Ed Hooper (see his origins of aids website); it was based on very shoddy research which casts the rest of the book into doubt.
Other parts of the book are poorly researched. Pepin's case for an early instance of AIDS in Africa (pre 1950s) has been thoroughly debunked by Ed Hooper (see his origins of aids website); it was based on very shoddy research which casts the rest of the book into doubt.
September 7, 2014
This is one of the most remarkable science books I've read in some time. It's astonishing to think that the HIV-1 epidemic is so thoroughly a legacy of colonialism (especially Belgian occupation of the Congo). Colonialism left a legacy of dirty needles used in (frequently useless) vaccination and treatment campaigns, abysmal economic conditions that led to rampant prostitution, and the introduction of incentives and technologies to encourage capture of chimpanzee meat in the first place. The author describes a harrowing story of coincidences and poor choices that led to a series of amplifications of HIV-1. It's a bit frightening to think what diseases are currently spreading at a slow rate, perhaps ready to fall into an exponential amplification like that what took place in the brothels of Leopoldville, or the blood plasma processing facilities of Port-au-Prince.
Without the amplification in Haiti that brought it to America in force, I wonder how long HIV would have taken to be noticed? Another decade? Two? Three? What other viruses are wending their way through the world, ready to spring into view when a coincidence allows them to be amplified, as occurred among the gay community in in the late 1970s in the US.
Without the amplification in Haiti that brought it to America in force, I wonder how long HIV would have taken to be noticed? Another decade? Two? Three? What other viruses are wending their way through the world, ready to spring into view when a coincidence allows them to be amplified, as occurred among the gay community in in the late 1970s in the US.
August 7, 2012
This was a very well written, very well researched book. In places it was a little bit difficult to understand, but that's not the author's fault--he did an excellent job of simplifying complex information. The book isn't intended for general reading, I don't think, so it's not surprising that someone without a medical/scientific background might struggle a bit.
Pepin also does an excellent job of summarizing the effects of colonialism on African nations in the context of a pandemic. I recommend this book to anyone who is interested in where HIV came from.
Pepin also does an excellent job of summarizing the effects of colonialism on African nations in the context of a pandemic. I recommend this book to anyone who is interested in where HIV came from.
August 17, 2012
Dr. Pepin chronicles where the AIDS virus and the origins of HIV in a well-organized, methodical manner. He also discusses some of the history surrounding the efforts to isolate the virus further as well as initiatives involving treatment and prevention. At one level I found it to be unnerving; there was a lot that went on that I'm not sure was known to the general public around the time after the existence of the virus was made known. Just the same, it was a worthy book and I would certainly recommend it to anyone considering expanding their own knowledge about where HIV originated from.
June 13, 2012
Great job of explaining complicated things in a clear and engaging way. In addition to focusing on the disease itself, Pepin also discusses the social, cultural, technological, and political events that shaped the spread of AIDS. A good pick for a general interest reader.
April 11, 2012
Achei um livro excelente. Didático, acessível e muito completo. Pelo conteúdo, eqüivale a um mega review. E de quebra explicou a possível importância de vacinas e doação de sangue no surgimento da epidemia de HIV, que eu desconhecia.
October 30, 2017
An incredibly dry, but detailed, history of AIDS. A good read for anyone interested in science or public health.
May 30, 2025
This review is of the 2nd edition, published 2021.
Medical history shares with military history a strong flavour of the epic and the tragic, as well as many features of the classic detective story. Jacques Pépin’s The Origins of AIDS traces the epidemic to colonial Africa around the beginning of the last century, when the virus was first transmitted from a chimpanzee to a human being. By tracing the genetics of this virus backwards, it is possible to discover the precise variety of chimpanzee that contributed this lethal pathogen. Because chimpanzees in the wild live in isolated groups, it is also possible to discover where it lived, near the remote town of Moloundou, in Cameroon. The ape was probably killed for food, what Africans call ‘bush meat’. The hunter may have been wounded by the animal, or the cook accidently cut whilst butchering it; in either case there was blood-contact and the virus found a human host. From there the virus made its way to Léopoldville, the principal city in the Belgian Congo and a major trading centre. As a sexually transmitted disease, its spread would have been facilitated by the large number of single men needed as workers, and the prostitutes who served their needs. But medicine probably played a role as well. Both French and Belgian colonial authorities attempted to alleviate the tropical diseases like sleeping sickness and malaria endemic to the region of central Africa, often without the facilities to sterilise needles. The oldest physical evidence of the virus itself is a blood specimen taken from a man who died in 1959, not coincidentally just before the colony became independent and immediately erupted in a civil war that would figure as well in the transmission of the disease. A good many of the UN relief workers who travelled to the Congo were Haitians, being French speakers of African descent, and some of them acquired the virus and took it back home to Haiti. From there sex tourists brought it to North America. As it typically takes a decade to pass from infection with HIV to a diagnosis of ‘full-blown’ AIDS, the virus had an opportunity to spread to millions before a strange form of pneumonia appeared amongst gay men in California in 1980 and the world was in the midst of an epidemic causing many millions of deaths to victims ranging from derelict drug users to movie stars.
The likely date that the virus was transmitted from chimpanzee to human was sometime in the first three decades of the 20th century. That’s what fascinated me as a history buff as well as ex-literary scholar. When I first read Conrad’s Heart of Darkness as a schoolboy, nobody bothered to notice it was about the Belgian Congo, more precisely the Congo Free State. (The sadistic sergeant in P. C. Wren’s Beau Geste had been a rubber factor there.) Conrad’s book was based on his experience captaining a Congo riverboat. And the HIV may have been brought originally by a riverboat man to Léopoldville. But alternatively there is another possibility. Before the First World War, Cameroon was Kamerun, a German colony. Whilst I knew about the campaigns in East Africa between the Germans and the British, I’d not been previously aware that Kamerun was invaded in 1914-1916 by a mixed force of French and Belgian colonial troops.
On page 301 there is a photograph creepy as all get-out. It shows a man and a chimpanzee sitting alongside each other. The man is wearing a hat like a fez and propped in front of him is his rifle (looks like it might be an old single-shot, not a magazine-loader) barrel resting on his shoulder. According to the caption, the man is a Belgian soldier (probably a member of the colonial Force Publique) and the ape is dead. But it looks alive, or like a giant stuffed toy. And it seems to have an expression similar to the soldier’s. (Probably the photograph was taken by a racist European officer—few Africans then would likely own cameras—who thought this a huge joke). From the French military archives Pépin discovered that the Franco-Belgian invading force was chronically short of supplies, relying on bearers plagued by death and desertion, and their men were trying to live off the country by shooting and eating anything that moved. (Pépin is censorious that European officers were supplied half a litre of wine per day, but by standards of the time that was positively abstemious. French soldiers going up the line to Verdun were given two to four times that much cheap wine to anaesthetise them to the horrors they were about to face.) So it is quite possible that the first human to host the HIV virus was one of those colonial troops. Maybe he cut himself with his bayonet whilst carving up a chimpanzee he had shot. Though as the soldiers’ sexual appetites were virulent as well, he may have raped a local woman who was already infected. Whatever the route, the terrible crimes first inflicted by the Europeans on the Africans were finally to be revisited on the whole world through a most unlikely but utterly poignant chain of events driven by chance and greed and desire.
Medical history shares with military history a strong flavour of the epic and the tragic, as well as many features of the classic detective story. Jacques Pépin’s The Origins of AIDS traces the epidemic to colonial Africa around the beginning of the last century, when the virus was first transmitted from a chimpanzee to a human being. By tracing the genetics of this virus backwards, it is possible to discover the precise variety of chimpanzee that contributed this lethal pathogen. Because chimpanzees in the wild live in isolated groups, it is also possible to discover where it lived, near the remote town of Moloundou, in Cameroon. The ape was probably killed for food, what Africans call ‘bush meat’. The hunter may have been wounded by the animal, or the cook accidently cut whilst butchering it; in either case there was blood-contact and the virus found a human host. From there the virus made its way to Léopoldville, the principal city in the Belgian Congo and a major trading centre. As a sexually transmitted disease, its spread would have been facilitated by the large number of single men needed as workers, and the prostitutes who served their needs. But medicine probably played a role as well. Both French and Belgian colonial authorities attempted to alleviate the tropical diseases like sleeping sickness and malaria endemic to the region of central Africa, often without the facilities to sterilise needles. The oldest physical evidence of the virus itself is a blood specimen taken from a man who died in 1959, not coincidentally just before the colony became independent and immediately erupted in a civil war that would figure as well in the transmission of the disease. A good many of the UN relief workers who travelled to the Congo were Haitians, being French speakers of African descent, and some of them acquired the virus and took it back home to Haiti. From there sex tourists brought it to North America. As it typically takes a decade to pass from infection with HIV to a diagnosis of ‘full-blown’ AIDS, the virus had an opportunity to spread to millions before a strange form of pneumonia appeared amongst gay men in California in 1980 and the world was in the midst of an epidemic causing many millions of deaths to victims ranging from derelict drug users to movie stars.
The likely date that the virus was transmitted from chimpanzee to human was sometime in the first three decades of the 20th century. That’s what fascinated me as a history buff as well as ex-literary scholar. When I first read Conrad’s Heart of Darkness as a schoolboy, nobody bothered to notice it was about the Belgian Congo, more precisely the Congo Free State. (The sadistic sergeant in P. C. Wren’s Beau Geste had been a rubber factor there.) Conrad’s book was based on his experience captaining a Congo riverboat. And the HIV may have been brought originally by a riverboat man to Léopoldville. But alternatively there is another possibility. Before the First World War, Cameroon was Kamerun, a German colony. Whilst I knew about the campaigns in East Africa between the Germans and the British, I’d not been previously aware that Kamerun was invaded in 1914-1916 by a mixed force of French and Belgian colonial troops.
On page 301 there is a photograph creepy as all get-out. It shows a man and a chimpanzee sitting alongside each other. The man is wearing a hat like a fez and propped in front of him is his rifle (looks like it might be an old single-shot, not a magazine-loader) barrel resting on his shoulder. According to the caption, the man is a Belgian soldier (probably a member of the colonial Force Publique) and the ape is dead. But it looks alive, or like a giant stuffed toy. And it seems to have an expression similar to the soldier’s. (Probably the photograph was taken by a racist European officer—few Africans then would likely own cameras—who thought this a huge joke). From the French military archives Pépin discovered that the Franco-Belgian invading force was chronically short of supplies, relying on bearers plagued by death and desertion, and their men were trying to live off the country by shooting and eating anything that moved. (Pépin is censorious that European officers were supplied half a litre of wine per day, but by standards of the time that was positively abstemious. French soldiers going up the line to Verdun were given two to four times that much cheap wine to anaesthetise them to the horrors they were about to face.) So it is quite possible that the first human to host the HIV virus was one of those colonial troops. Maybe he cut himself with his bayonet whilst carving up a chimpanzee he had shot. Though as the soldiers’ sexual appetites were virulent as well, he may have raped a local woman who was already infected. Whatever the route, the terrible crimes first inflicted by the Europeans on the Africans were finally to be revisited on the whole world through a most unlikely but utterly poignant chain of events driven by chance and greed and desire.
January 22, 2023
Aquest llibre ressenya els motius que van portar a la disseminació del virus del VIH arreu del món; de la infecció primigènia dels humans amb els ximpanzés, reservoris originals del patogen; fins a la seua exportació als Estats Units, on es va estendre arreu del món occidental per a representar una de les pitjors pandèmies de la història recent de la universitat. Jacques Pepin explica amb termes comprenedors el coneixement mèdic i les condicions sociopolítiques essencials per a entendre els factors determinants de la transmissió del virus. El canvi en les eines de caça permeteren un contacte més estret amb els animals i els virus, alimentat per la depredació humana dels territoris naturals arran del colonialisme. El desplaçament cap als centres urbans, el creixement demogràfic explosiu, el desenvolupament d'una indústria de prostitució massiva arran de la restricció a les dones per a migrar cap a aquests nuclis urbans, les polítiques de sanitat pública contra les malalties tropicals que afavorien la transmissió de patògens per via parenteral, el comerç de plasma sanguini, i per últim, el turisme sexual. Tots aquests elements, interrelacionats d'una forma complexa, són explicats amb un alt grau de detall per a donar una imatge completa i ben documentada de tots els factors que expliquen la cadena de successos fins a desembocar en l'explosió de la SIDA tal com la coneixem en l'actualitat.
October 13, 2024
The lists of statistics, acronyms, jargon and HIV groups and subgroups caused my eyes to glaze over from time to time, but the overall journey and data/research associated with it is fascinating. So many well-intentioned acts contributing to cause such a horrific pandemic. Thank goodness for PrEP and other modern medications + vast public health campaigns which are helping fight HIV/AIDS.
June 18, 2024
Read for my own interest and curiosity, and to better teach the basics of HIV/AIDS in my World Geography class. Interesting to learn about the role of colonial health policies in spreading this disease out of its isolated reservoir deep in the jungle. Obviously very science heavy, but the summaries are helpful for the average reader.
February 21, 2024
What readers will find most interesting about this book, is that it likely that HIV only was able to become a global pandemic in the 1900s, not before and not after. HIV started as SIV (Simian Immunodeficiency Virus) cpz (Chimpanzee) and was transmitted from a Common Chimpanzee to a bushmeat hunter in the 1920s in the African Congo. While the virus likely crossed between humans and Chimpanzees several times throughout history, it probably occurred more in the 1920s due to the recent availability of guns in the region, as Chimps are not easy to hunt. From there, colonialism of the Belgian Congo lead to two amplifiers. First is that cities in the Belgian Congo required a disproportionate number of male workers such that the gender ratio in cities was skewed heavily male. History has shown this almost always leads to large amounts of prostitution. Second, in an attempt to reduce the incidence of disease (trypanosomiasis, yaws, syphilis, etc.) colonial tactical medical teams were deployed to inject arsenical medicines intravenously. Unfortunately, the needles were not properly sterilized between patients. While little serological evidence was preserved, two other sources of evidence corroborate iatrogenic infection. First, is that HIV-2 did not become as potent as HIV-1, because it arose in West Africa where no such colonial medicine was practiced. Second, a cohort effect of hepatitis C infection was noticed among the age group that was treated with the arsenicals, indicating other bloodborne pathogens were transmitted specifically during this period. Keep in mind that hepatitis C does not spread easily through sexual contact, and such contact is not sufficient to explain such a high rate of infection.
Colonial rule then collapsed in the Belgian Congo, leading to economic devastation. This devastation lead to a vast reduction in the market price of sex, which lead to the increase of the number of customers per prostitute. As an additional consequence of the collapse, the medical staff that were largely of Belgian nationality left the Congo. To help fill the void, Haitian doctors were brought in as they were inexpensive, spoke French, and of similar complexion, and thus were not associated with colonial rule. Unfortunately, this brought HIV across the Atlantic where it became entrenched in Haiti. Haiti, also being an impoverished country, had blood product companies that paid poor and homeless people very little money in exchange for blood. The blood extraction machines were not properly sterilized, which caused HIV to spread amongst the donors. Further exacerbating the problem, was that for many only plasma was extracted, while the red blood cells were re-injected into the donor, thus increasing the infection rate given improperly sterilized equipment. In the 1970s, blood products were bought and sold across several intermediaries internationally, so it was difficult to trace the origin or safety of the product. Between the blood trade and male homosexual sex tourism from the US to Haiti, HIV was able to reach the United States and the rest of the world.
Colonial rule then collapsed in the Belgian Congo, leading to economic devastation. This devastation lead to a vast reduction in the market price of sex, which lead to the increase of the number of customers per prostitute. As an additional consequence of the collapse, the medical staff that were largely of Belgian nationality left the Congo. To help fill the void, Haitian doctors were brought in as they were inexpensive, spoke French, and of similar complexion, and thus were not associated with colonial rule. Unfortunately, this brought HIV across the Atlantic where it became entrenched in Haiti. Haiti, also being an impoverished country, had blood product companies that paid poor and homeless people very little money in exchange for blood. The blood extraction machines were not properly sterilized, which caused HIV to spread amongst the donors. Further exacerbating the problem, was that for many only plasma was extracted, while the red blood cells were re-injected into the donor, thus increasing the infection rate given improperly sterilized equipment. In the 1970s, blood products were bought and sold across several intermediaries internationally, so it was difficult to trace the origin or safety of the product. Between the blood trade and male homosexual sex tourism from the US to Haiti, HIV was able to reach the United States and the rest of the world.
January 2, 2013
The first officially documented AIDS cases surfaced in the United States in 1981. With the epidemic, so started the quest for AIDS origins, and also a cure. More than three decades later, a cure is not yet in sight, but the image of the cradle of AIDS, its time and place defined, has come into new focus, as have the trails the virus first took to take over the world.
There are several theories surrounding the origins of AIDS, some more controversial than others. The widely accepted theories involve a few common factors: Africa as the birthplace of the pandemic; a monkey hunter as its Patient Zero; a virus that jumped species from a chimp to a human, and then tens of millions of individuals.
While many books captured various facets of AIDS after its impact on the mainstream community, Randy Shilts’ And the Band Played On offered a chronicle of the early years of AIDS. Following in Shilts’ footsteps, Canadian epidemiologist Jacques Pepin captures an even earlier picture of the AIDS pandemic through its catalysts—social factors that allowed HIV’s incendiary spread and the virus’s innate ability to start a pandemic. In the process, Pepin finds, possibly once and for all, the answers to questions we’ve been asking ourselves for decades:
What (and maybe who) helped the few initial HIV infections to set off a pandemic?
Why?
How could we let it happen?
In his new book, Pepin revisits “the origins of AIDS,” taking us on a journey back in time and place, to early twentieth century Central Africa, offering a scientific documentation of the evolution of AIDS from cradle to pandemic. Pepin follows this remarkable journey chronicling the many factors—including political, economical, and also human—that have facilitated the first few HIV infections to grow exponentially, travel from Africa to Europe and Haiti to reach the United States, and come to light in the summer of 1981.
In his book, Pepin explains his theory that the original HIV infections (from chimps to humans) were very few and thus impossible, by themselves, to set off a pandemic. Human and social factors helped as well: the en-masse immunizations for sleeping disease, while using same needles, and also the virus’s ability to initiate this pandemic under certain conditions. And it was possible because we/humans facilitated these conditions.
The language of Pepin’s book is academic, yet easily accessible to a lay, educated readership. Graphics, charts and maps emphasize the text content. The Origins of AIDS offers, for the first time, an in-depth look into the pandemic prior to 1981 and, with that, the missing pieces that complete the story of AIDS.
Note: review originally published in A&U Magazine
There are several theories surrounding the origins of AIDS, some more controversial than others. The widely accepted theories involve a few common factors: Africa as the birthplace of the pandemic; a monkey hunter as its Patient Zero; a virus that jumped species from a chimp to a human, and then tens of millions of individuals.
While many books captured various facets of AIDS after its impact on the mainstream community, Randy Shilts’ And the Band Played On offered a chronicle of the early years of AIDS. Following in Shilts’ footsteps, Canadian epidemiologist Jacques Pepin captures an even earlier picture of the AIDS pandemic through its catalysts—social factors that allowed HIV’s incendiary spread and the virus’s innate ability to start a pandemic. In the process, Pepin finds, possibly once and for all, the answers to questions we’ve been asking ourselves for decades:
What (and maybe who) helped the few initial HIV infections to set off a pandemic?
Why?
How could we let it happen?
In his new book, Pepin revisits “the origins of AIDS,” taking us on a journey back in time and place, to early twentieth century Central Africa, offering a scientific documentation of the evolution of AIDS from cradle to pandemic. Pepin follows this remarkable journey chronicling the many factors—including political, economical, and also human—that have facilitated the first few HIV infections to grow exponentially, travel from Africa to Europe and Haiti to reach the United States, and come to light in the summer of 1981.
In his book, Pepin explains his theory that the original HIV infections (from chimps to humans) were very few and thus impossible, by themselves, to set off a pandemic. Human and social factors helped as well: the en-masse immunizations for sleeping disease, while using same needles, and also the virus’s ability to initiate this pandemic under certain conditions. And it was possible because we/humans facilitated these conditions.
The language of Pepin’s book is academic, yet easily accessible to a lay, educated readership. Graphics, charts and maps emphasize the text content. The Origins of AIDS offers, for the first time, an in-depth look into the pandemic prior to 1981 and, with that, the missing pieces that complete the story of AIDS.
Note: review originally published in A&U Magazine
August 17, 2015
This is an astonishing and cogent piece of research into the origin and spread of HIV around the globe. Pepin tracks down not only the town where HIV made the first leap from chimps to humans, but also the rough date: 1929. By the time it was noticed in Gay men in New York and San Francisco in the 1980's, AIDS had already been ravaging Africa for decades, but nobody knew or cared. Pepin's studies and research have laid out the most plausible scenario of the underpinnings of HIV's explosion in such a relatively short time:
While HIV probably jumped to humans from chimps on more than one occasion over thousands of years, the real change in the number of infections came in the mid-20th century when European mining companies began inoculating millions of African workers against malaria and sleeping sickness. These untold numbers of dirty needles provided the amplification method for HIV to become the global pandemic that we know of today. Pepin also traces HIV's pathways out of Africa, into Haiti and subsequently the US.
By exhaustively combing African and colonial medical records, analyzing 50 year old HIV+ blood samples, and comparing similar HIV infection amplification methods from other sources, Pepin provides the most accurate map we now have for the origin and spread of HIV.
This is highly recommended reading for anyone with more than a passing interest on the subject.
While HIV probably jumped to humans from chimps on more than one occasion over thousands of years, the real change in the number of infections came in the mid-20th century when European mining companies began inoculating millions of African workers against malaria and sleeping sickness. These untold numbers of dirty needles provided the amplification method for HIV to become the global pandemic that we know of today. Pepin also traces HIV's pathways out of Africa, into Haiti and subsequently the US.
By exhaustively combing African and colonial medical records, analyzing 50 year old HIV+ blood samples, and comparing similar HIV infection amplification methods from other sources, Pepin provides the most accurate map we now have for the origin and spread of HIV.
This is highly recommended reading for anyone with more than a passing interest on the subject.
November 4, 2018
Written by Jacque Pepin the epidemiologist, not the famous chef. A great intro to the epidemiology of HIV/AIDS, which, in a roundabout way makes a very good case for the Black Death of historic infamy not being bubonic plague but rather a hemorrhagic fever akin to a proto-ebola (though, as Plague was a perennial scourge for centuries, a separate outbreak also happened to occur around the same time in southern Europe as this likely hemorrhagic fever was ravaging the North; thus confusing epidemiological historians). Rationale: increased immunity to HIV in populations most affected by The Black Death, which as a result (theoretically) exhibit selection against specific surface proteins, the means by which HIV requires to enter our cells.
Also, Pepin makes a convincing case for the origin of HIV as occurring in the Belgian Congo, with a likely sex worker being patient zero, contracting SIV (the simian variety from which HIV evolved) very likely from infected bush meat.
An interesting read, from which I have developed an x-rated mnemonic from remembering the hallmarks of HIV subtypes A, B, and C... which I will not, out of propriety, include here.
Also, Pepin makes a convincing case for the origin of HIV as occurring in the Belgian Congo, with a likely sex worker being patient zero, contracting SIV (the simian variety from which HIV evolved) very likely from infected bush meat.
An interesting read, from which I have developed an x-rated mnemonic from remembering the hallmarks of HIV subtypes A, B, and C... which I will not, out of propriety, include here.
May 18, 2012
'The Origins of AIDS' was a fascinating read. Pepin provided the reader with sufficient background information so that they could understand the logic behind certain assumptions and the science behind various procedures and tests. He took the time to explain much of the complex science involved in understandable terms while avoiding 'dumbing down' the science and thus watering down his findings. I appreciated that Pepin incorporated the political and socioeconomic background to help better explain why prostitution and medical staff reusing needles may have been occurred in the regions of interest.
The book is amazing and helps to shed light on why AIDS may have 'suddenly' jumped into the human world with a vengeance. Pepin quietly suggests that sometimes through the best of intentions a shocking, unexpected issue can arise. It is well worth the read, but don't expect to breeze through the book in a weekend, there is some heavy reading and interpretation to be done, but you will be glad you took the time!
The book is amazing and helps to shed light on why AIDS may have 'suddenly' jumped into the human world with a vengeance. Pepin quietly suggests that sometimes through the best of intentions a shocking, unexpected issue can arise. It is well worth the read, but don't expect to breeze through the book in a weekend, there is some heavy reading and interpretation to be done, but you will be glad you took the time!
February 21, 2017
So it turns out the last half of this book is almost entirely notes, which is a good thing because I was starting to lose focus a little. That should not be seen as a reflection on the book, which is very well-written and researched, but rather as a reflection on my currently hectic life. In fact, I didn't really do the last couple of chapters justice by reading them closely, but I still feel like I can give some impressions based on the large majority that I did read closely.
Again, this is a very well-written book. It's very technical, with lots of hard-science in it, so it's not a good book to start with if you're just delving into the subject for the first time. However, if you've got a bit of background knowledge, the science-heavy sections are actually surprisingly readable and interesting. He makes a very compelling case for his origin explanation, and the way he ties it all together is very satisfying.
Again, this is a very well-written book. It's very technical, with lots of hard-science in it, so it's not a good book to start with if you're just delving into the subject for the first time. However, if you've got a bit of background knowledge, the science-heavy sections are actually surprisingly readable and interesting. He makes a very compelling case for his origin explanation, and the way he ties it all together is very satisfying.
October 28, 2014
Such a well written book for any hungry knowledge readers. The arguments about dissemination of HIV are solid. The good intention of treating diseases by drug IV injection with reusable syringe and needle had turned into an amplification of 'unknown new virus'. Colonisation and country exploitation benefited the spreading of this virus. Profit driven plasmapharesis also add to its pandemic dissemination.
I hope every health providers and policy makers will read this book, so that every decision they make in the future will consider any possible threat for human race. Is there any other species as good as human in endangering their own survival?
I hope every health providers and policy makers will read this book, so that every decision they make in the future will consider any possible threat for human race. Is there any other species as good as human in endangering their own survival?
January 16, 2016
A very good read, with a TON of information on how the AIDS epidemic was tracked to its source and bearded in its lair. If just one or two of these mistakes could have been avoided, millions of people who died in misery might be alive and well today. The book is full of technical information but the author never lost me -- he explains things very well and does a great job at the end of fitting all the pieces together into a pretty clear, pretty complete picture. Along the way he does an even better job than the author of THE TINDERBOX of condemning colonialism and the destruction of multiple African cultures, and draws an even clearer picture of where that has led all of us.
February 25, 2012
A very interesting book chronicling the social and biological origins of HIV in Africa and its spread around the world. The science is explained well and the writing is engaging. What I liked the most is he explored the medical, sociological, political history of this disease.. It would be an excellent read for anyone involved in novel health interventions or officials involved in policy decisions. The book's overarching message is that well intended medical interventions sometimes have unintended consequences.
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