A study published this October in Nature has exonerated Gaetan Dugas, also known as "Patient Zero," or the Canadian flight attendant accused of bringing HIV to the United States.
"I would not myself use the word 'exonerate,'" says the study's co-author Michael Worobey, "because I don't like the idea of equating having an early case of the virus with blame in any way."
But people did blame Dugas, especially after the publication and press tour of Randy Shilts' AIDS history, And the Band Played On. In his book, Shilts portrayed Dugas as a predatory sociopath, deliberately infecting hundreds with "gay cancer," as it was known at the time. The New York Post called Dugas "The Man Who Gave Us AIDS." But recent research indicates that HIV had been in the US for several years before Dugas ever entered the country.
Worobey and his team looked for evidence of HIV in blood samples taken in 1978 and 1979, in New York and San Francisco, for a study on hepatitis B. Their goal was to map the HIV genome at a time before the disease had been discovered. Viruses change as they're passed from person to person, so the genome had mutated significantly by the time the AIDS epidemic officially began in 1981. "It's hard to get RNA from such old samples, so we had to devise a new technique where we stitched little fragments together," says Worobey. "We were able to complete the HIV genome from eight samples from the 1970s." Worobey's team also examined a sample from Dugas "and found neither biological nor historical evidence that he was the primary case in the US," according to the report in Nature.
So how did we come to believe that this one man was responsible for bringing HIV to America?
Before Gaetan Dugas, "Patient Zero" wasn't even a term. In a study conducted by the CDC, Dugas had been referred to as "Patient O," standing for "Outside California," which was then misread as "Patient 0." The CDC study, which was attempting to prove that AIDS was sexually transmitted, gathered the recent sexual histories of several men in California. Four of the men had had sex with Dugas, who was contacted. Dugas provided an extensive list of his sexual contacts; the information he volunteered helped to solidify the theory that HIV was sexually transmitted.
This guy got unfairly labeled, in large part because he was really helpful in the early research.
"This guy got unfairly labeled, in large part because he was really helpful in the early research," says Worobey. Dugas seemed central to the study because he provided the most names, not because he had infected the most people. "If other people had been able to share more names, he wouldn't have been very special, and we wouldn't be talking about him today."
Shilts described his first encounter with the term in a 1993 Advocate interview: "When I went to the CDC, they started talking about Patient Zero. I thought, 'Ooh, that's catchy.'" Shilts' contacts at the CDC wouldn't out Dugas as "Patient Outside California," so Shilts began asking around. According to an article in the Bulletin of the History of Medicine, it was Gay Men's Health Crisis president Paul Popham who identified Dugas as Patient Zero. Popham's boyfriend had dated Dugas, and later died of AIDS. "I realized that Paul, who had visible lesions on his face, was dying from a virus from this guy. It was like I was seeing the legacy of this person and his virus," Shilts told The Advocate in 1987.
When Shilts started covering the AIDS epidemic for the San Francisco Chronicle, he was appalled by the lack of funding and attention paid by the national press, government, and medical industrial complex. The Reagan administration has been criticized for its callousness during the early years of the outbreak, and at a press conference in 1982, presidential spokesman Larry Speakes implied that any newsman asking about AIDS had to be gay.
At an awards banquet in 1983, Shilts heard TV journalist (and current announcer for Wait Wait… Don't Tell Me!) Bill Kurtis deliver the joke, "What's the hardest part about having AIDS? Trying to convince your wife that you're Haitian." Slights like these motivated Shilts to write a book about the heroes and villains of the AIDS epidemic. One of the villains, according to his account, was Dugas, whom Shilts believed to be an unrepentant spreader of the disease.
Shilts interviewed Selma Dritz, a public health worker in San Francisco, who tried to get Dugas to stop having sex because of his diagnosis. Dugas reportedly told Dritz he planned to continue having unprotected sex regardless of what she said. From a modern-day perspective, this attitude can seem extremely irresponsible, but in 1982, when Dritz and Dugas had butted heads, it still wasn't proven that HIV was sexually transmitted. Many theories as to what caused AIDS were still circulating in both the medical and gay communities. Dritz even admitted to exaggerating the truth to plead her case. "I told him, 'Look, we've got proof now.' I didn't tell him how scientifically accurate the information was. It wasn't inaccurate, but it wasn't actually scientifically proven. I said, 'We've got proof that you've been infecting these other people. You've got AIDS, you know. We know it's transmissible now, because you're transmitting it,'" she told medical historian Sally Smith Hughes in the early 90s. It's also unclear as to whether Dritz urged Dugas to practice safe sex with condoms or to forgo sex altogether.
According to Nature study co-author Richard McKay, there's evidence that Dugas subscribed to the "immune overload" theory of the disease. It was believed by some that gay men's immune systems were being compromised by "repeated exposure to viruses, infections, sperm, and recreational drugs," McKay writes in the Bulletin of the History of Medicine. It was only in 1973 that homosexuality was taken off the books as a mental illness, and many gay men of the time thought the sexual transmission theory of AIDS was yet another way for the medical community to police gay men.
Shilts wrote And the Band Played On with an omniscient narrator voice—creating the inner monologues of the people he wrote about from his own imagination. Inspired by James Michener, Shilts wanted to sweep people up into the drama of the disease by placing them in the minds of its heroes and villains. But Shilts couldn't have known what went on in Dugas' mind, as he died two years before the book came out. Friends of Dugas were interviewed by Shilts and gave a rounded portrait of a caring man who tried to help others fighting the same disease. But Shilts ignored these testimonies in favor of the sociopathic angle. And Shilts' publisher, St. Martin's Press, ran with it. The publishing house made Patient Zero the main angle of their publicity campaign for And the Band Played On. "[P]ublications drew upon the frequently rehearsed narrative of a disease introduced from abroad by a foreigner. 'Canadian Said to Have Had Key Role in Spread of AIDS,' wrote the New York Times, while the National Review nicknamed Dugas 'the Columbus of AIDS,'" writes McKay.
In the media, Dugas was juxtaposed with Ryan White, the teenage boy who had contracted AIDS from a blood transfusion. Outlets portrayed White as the innocent victim who had contracted the disease through no fault of his own, whereas Dugas had contracted HIV because of his deviant lifestyle. Not only was he gay, Dugas was described as both promiscuous and foreign. Art critic Douglas Crimp believes that Shilts, who was gay and died of AIDS in 1994, demonized Dugas as a sort of internalized homophobia. Crimp wrote that Shilts offered Dugas up as a "scapegoat for his heterosexual colleagues."
While this new study serves as a cautionary tale on villainization and blaming, it also indicates that AIDS was in America well before "Patient Zero," giving us clues to how to fight the disease today. "It's telling us something important about HIV," says Worobey. "For all its scariness and seeming invulnerability, it actually has a hard time moving from subject to subject." HIV is a clunky virus. It has a hard time bonding to host cells. "It has lower concentration in bodily fluids. Part of it is just the receptors they happen to use, and the number of cells that are susceptible." The more work that is done to prevent the spread of HIV in its early stages—with early detection, more transparency and dialogue between sexual partners, and symptomatic care—Worobey says "can plausibly drive HIV/AIDS to very low levels, even if we don't have a vaccine."