We've all heard the myths and hypotheses about the origins of the epidemic caused by the HI virus, but a new book, “Tinderbox: How the West Sparked the AIDS Epidemic and How the World Can Finally Overcome It”, sheds more light on where it all began. It is a fascinating account of the medical detective work that traced the disease to Cameroon a century ago.
“AIDS is not a new disease. With ‘Tinderbox’ we wanted to write a defining AIDS book for this generation that will get people excited to talk about AIDS again. We were able to apply new discoveries on the origin of AIDS,” said Daniel Halperin, who co-wrote the book with American journalist Craig Timberg.
Scientists have long known that a blood sample preserved in a hospital in Kinshasa, capital of the Democratic Republic of Congo, dating from 1959, indicated that HIV had been around decades before it was recognized in the 1980s. In 2008, Michael Worobey of the University of Arizona reported on a second sample of the virus, from a lymph node biopsy taken in Kinshasa in 1960, which helped establish the virus’ evolutionary timeline.
"By comparing these two historic pieces of virus and mapping out the differences in their genetic structures in his lab at the University of Arizona, Worobey determined that HIV-1 group M was much older than anyone had thought. Both samples of the virus appeared to have descended from a single ancestor at some time between 1884 and 1924. The most likely date was 1908," the book recounted.
Meanwhile, a research team led by microbiologist Beatrice Hahn of the University of Alabama pinpointed the geographic location of the virus. An SIV (simian immunodeficiency virus) infecting chimpanzees in Cameroon proved to be an identical match to HIV-1 group M.
“This SIV was likely around for centuries and may very well have been passed on to a hunter or someone handling the carcass of an infected chimp. The chimp’s blood could have infected the person through an open wound," said Halperin.
The authors add a dimension that has received little attention: colonialism and how it helped spread the HIV epidemic. “Once the virus made the jump from chimp to human, a single infected person could have carried HIV down the Sangha [River], on to the Congo River and into Kinshasa. The Belgians had founded the city in 1881; by the early 20th century, Kinshasa, then called Leopoldville, was the biggest city in central Africa, fuelled by the dizzying growth of trade with the outside world.”
The epidemic was born between 1881 and 1924. A few decades later, the virus had migrated far from its point of origin, mutating into new but equally deadly subtypes.
“Scientists studying HIV-1 group M already had found many related varieties - what scientists call subtypes - each with slightly different genetic structures and paths through the world. One, scientists discovered, had travelled east from Kinshasa toward Lake Victoria. One went south to Zambia, Botswana and South Africa. One hopped all the way across the ocean to Haiti, then to the United States and Europe,” Halperin and Timberg wrote.
They are not complimentary about efforts to combat the spread of HIV. “On the prevention side, the United States and other donors have fallen short. Part of the problem has been the polarized nature of AIDS politics, with its battles over condoms versus abstinence. Few outsiders - not the US government, the United Nations, religiously based charities, or even the Bill & Melinda Gates Foundation - have made impressive gains in preventing the spread of HIV among adults, despite massive investments of money and political will," Timberg told IRIN/PlusNews.
The book notes that the steepest drop in HIV infection rates in the past 15 years occurred in Zimbabwe, a country that received less foreign aid than its neighbours during this period.
“When debating how to prevent HIV, liberals like to talk about condoms, while conservatives often talk about abstinence. Yet the track record for both ideas has been disappointing,” said Timberg.
Halperin, an epidemiologist who has worked on AIDS policies for several southern African countries in the past decade while Timberg was covering AIDS in the region for the Washington Post, told IRIN/PlusNews that engaging in sex with multiple partners was also a root cause of the epidemic’s origin more than a century ago.
One goal of “Tinderbox” is to change public perceptions about AIDS. No longer a great mystery, HIV has been identified as a mutable virus with a documented history. The second popular perception the book addresses is that AIDS prevention and treatment can be “one size fits all”.
The authors believe that the key ingredient in bringing the epidemic under control - the “behaviour change” that has eluded so many AIDS prevention initiatives - can best be achieved through internal rather than external actors.
“The evidence is abundant that if you have more than one partner, the chance of HIV infection is increased. It is sometimes difficult for Africans to talk about sexual things in a one-on-one setting. What we found effective is when people talk collectively. If you take a look at the places where HIV went down dramatically, it was where members of society talked to one another: Zimbabwe, Uganda and elsewhere… We saw musicians, leaders, politicians leading the discussions. It is harder if this information comes from foreigners, or anyone outside the community or social group or even family,” said Timberg.