On June 5, 1981, the Centers for Disease Control and Prevention (CDC) published a report in their Morbidity and Mortality Weekly Report (MMWR) entitled “Pneumocystis Pneumonia—Los Angeles,” describing five cases of a rare lung infection, Pneumocystis carinii pneumonia (PCP), in five young, previously healthy gay men in Los Angeles. Two of the men had died. Click here for the actual report. Though unknown at the time, what they were describing was AIDS, caused by Human immunodeficiency virus (HIV). As of the end of 2022, the World Health Organization (WHO) estimates that 39 million people were living with HIV globally, an astronomical number which includes 1.5 million children aged 0–14, and 0.7% of adults aged 15–49. And it began in Los Angeles, with five. But how did they get it? The blame landed on the shoulders of one man, Gaëtan Dugas, who became known as “Patient 0.”
A “patient 0” is a medical term meaning a person identified as the first to become infected with an illness or disease in an outbreak. Let me tell you the story of Mary Mallon before we go any further. Mary was born in Ireland in 1869, emigrated to America in 1884, and supported herself by working as a maid and eventually as a cook for wealthy families in New York City. In 1906, she was hired by Charles Henry Warren, a wealthy New York banker, to cook for him and his family at their summer home on Long Island. 6 of the 11 people present in the house came down with typhoid fever caused by the bacterium Salmonella typhi, though Mary herself appeared to be unaffected. Public health officials initially concluded that freshwater clams were the source of the outbreak, though one investigator, aware that in 1906 about 3,000 people in and around New York City had been infected by Salmonella typhi, was unconvinced. He noted that of Mary’s 8 previous employers, 7 of the families had cases of typhoid fever, and concluded that it was Mary herself that was transmitting the disease from household to household. On June 15, 1907, he published what he described as the “healthy carrier” conclusion in the Journal of the American Medical Association.
Mary’s job might bring her into contact with 4 or 5 members of a family she was cooking for, but of those, the father would go to his job and be in contact with his coworkers (who would in turn go home and be in contact with their families), the children would go to school and be in contact with their classmates (who would in turn go home and be in contact with their families), and grandmother might go to daily rosary and Mass and be in contact with Fr. O’Flanagan (who would in turn go back to the rectory and be in contact with the other priests who would in turn be in contact with many more parishioners). Mary may only have physically touched 4 or 5 people, but her reach (when you consider who those 4 or 5 touched, and who the ones they touched in turn touched, and so on, and so on…) was far greater! Multiply that by the number of families she worked for.
Mary Mallon became known as “Typhoid Mary” and was blamed for the 1906 outbreak of typhoid fever.
Randy Shilts’ 1987 book on the early days of the AIDS epidemic, And The Band Played On, chronicles governmental incompetence and societal indifference toward what was, at the time, perceived as a disease resulting from the supposedly morally dubious “choices” made by gay men. It outlines how AIDS was initially allowed to happen for ideological reasons — namely that god sought to punish gay men for engaging in homosexual sex acts. Today, AIDS affects millions of people in the United States, including children and heterosexuals; it is only natural for us to want something that big and that devastating to have a cause to which we can point. We need there to be a Typhoid Mary of AIDS, and Shilts gives us Gaëtan Dugas.
Beginning in California, the CDC eventually connected more than 40 men in 10 American cities to a network (for lack of a better term) of men who had sexual contact with each other during the late 70’s. Gaëtan Dugas, a French-Canadian flight attendant, was one of the men, but he was not from California; given his job (flight attendant), he travelled extensively, so the CDC researchers placed an ‘oh’ (O) next to his name standing for “outside” (California).
As the hysteria and the fear grew, AIDS needed a villain, a monster. Poor Gaëtan’s ‘oh’ (O) was read by the media and the public as a ‘zero’ (0) and “the myth of Patient 0” was born. Shilts’ book wrongly portrayed Gaëtan as a sociopath who knowingly spread the disease, but how could he “knowingly spread the disease” when he died before there was conclusive evidence as to how the disease was spread?
Moreover, “the disease” was just that (often referred to as GRID for “gay-related immune deficiency” as a convenient shorthand) until 8 months AFTER he was showing serious, life-threatening symptoms and the CDC named it AIDS (acquired immune deficiency syndrome) when they rightly noted nearly half of the people infected with the disease were not homosexual men (so the disease, while prevalent amongst homosexuals, was not exclusive to homosexuals, and therefore NOT “gay related”)! The same “syndrome” was found in hemophiliacs, users of intravenous drugs such as heroin, and Haitian immigrants. AIDS was the name the CDC chose, but the second choice at the time was 4H (for homosexuals, hemophiliacs, heroin, and Haitians).
By 1983, the CDC concluded that 40 of the 248 people known to be infected with HIV had sex with Gaëtan, or with someone who had previously had sex with him, so anecdotally Randy Shilts’ perpetuation of the Patient 0 myth worked, even though we now know HIV arrived in New York City around 1971 and Gaëtan did not start working at Air Canada until 1974.
Let me be clear: Shilts never states in And the Band Played On that Gaëtan was the first to bring the virus to North America. He does, however, blame him, based on the debunked Patient 0 myth, for spreading it, making of him a kindof “gay Typhoid Mary.”
In the November 2016 issue of the journal Nature, an international team of scientists published groundbreaking research tracing the HIV virus from its origins in Africa to North America by way of the Caribbean in the 1970’s. Dr. Michael Worobey, co-author of the study and professor of ecology and evolutionary biology at the University of Arizona said of their findings:
No one should be blamed for the spread of a virus that no one even knew about, and how the virus moved from the Caribbean to the US in New York City in the 1970’s is an open question. It could have been a person of any nationality. It could have even been blood products. A lot of blood products used in the United States in the 1970’s actually came from Haiti. What we’ve done here is try to get at the origins of the first cases of AIDS that were ever noticed. … When you step back in time, you see a very interesting pattern.
An article at the US National Institutes of Health website argues that Shilts accuses Gaëtan (right) of ignoring evidence (of transmissibility via homosexual activity) that Gaëtan simply would not have been aware of given how early in the history of the disease he succumbed to it:
I oppose the assertion that Dugas, the so-called Patient Zero, ignored incontrovertible information about the condition and was intent on spreading his infection. Instead I argue that scientific ideas in 1982 and 1983 about AIDS and the transmissibility of a causative agent were later portrayed to be more self-evident than they were at the time.
Gaëtan’s story, or rather the plausible yet unsupported by the science story of Gaëtan, is a cautionary tale about leaping to conclusions without a firm grasp of the facts, about allowing emotions (like fear) or prejudices (like homophobia or bigotry) to overrule our intellect, and about kowtowing to the tyranny of hysteria.
Gaëtan Dugas died on March 30, 1984. He was 31.