The epidemiology of AIDS in Haiti refutes the claims of Gilbert et al

Abstract

In 1982, scientists at the Centers for Disease Control and Prevention (CDC) incorrectly inferred that Haitians were at increased risk for acquiring HIV (1), a generalization that resulted in unprecedented national stigmatization. The association was later dropped, but Haiti's economy never recovered. Gilbert et al. (2) again link HIV's origins and Haiti, stating that “subtype B likely moved from Africa to Haiti in or around 1966” and then on to the United States. They base this hypothesis on viral sequences from only five Haitian–Americans with AIDS in 1981 who had arrived in the United States “after 1975.” Without treatment, the average time from seroconversion to AIDS is 5.2 years in Haiti (3); it is thus debatable where and when these patients acquired HIV.

The epidemiology of AIDS in Haiti also refutes the authors' claims. In the early 1980s, the epidemic was predominantly male and urban, suggestive of its origins in sex tourism. The epidemic became generalized within 3 years as men spread the virus to their female partners, to rural areas, and through the blood supply (4, 5). Retrospective testing of Haitian blood samples from the 1970s failed to identify a single case of HIV, and no cases were traced back to the thousands of Haitians paid to donate blood to Americans during that era. Furthermore, skilled clinicians and thousands of autopsies did not identify an AIDS-defining illness in Haiti until 1978 (5, 6).

Haiti has overcome enormous obstacles and mounted one of the world's most successful responses to the AIDS epidemic. Scientists need to carefully consider the great harm that can result from asserting dubious claims of causality.

Full text

LETTER
The epidemiology of AIDS in Haiti
refutes the claims of Gilbert et al.
In 1982, scientists at the Centers for Disease Control and
Prevention (CDC) inc orrectly inferred that Haitians were at
increased risk for acquiring HIV (1), a generalization that
resulted in unprecedented national stigmatization. The associ-
ation was later dropped, but Haiti’s ec onomy never recovered.
Gilbert et al . (2) again link HIV’s origins and Haiti, stating
that ‘‘subt ype B likely moved from Africa to Haiti in or
around 1966’’ and then on to the Un ited States. They base
this hypothesis on viral sequences f rom only five Haitian–
Americans with AIDS in 1981 who had arrived in the United
St ates ‘‘after 1975.’’ Without treatment, the average time
f rom seroconversion to AIDS is 5.2 years in Haiti (3); it is
thus debat able where and when these patients acquired HIV.
The epidemiology of AIDS in Haiti also refutes the au-
thors’ claims. In the early 1980s, the epidemic was predomi-
nantly male and urban, suggestive of its origins in sex tourism.
The epidemic became generalized within 3 years as men
spread the virus to their female partners, to rural areas, and
through the blood supply (4, 5). Retrospective testing of Hai-
tian blood samples from the 1970s failed to identify a single
case of HIV, and no cases were traced back to the thousands
of Haitians paid to donate blood to Americans during that
era. Further more, skilled clinicians and thousands of autop-
sies did not identify an AIDS-defining illness in Haiti until
1978 (5, 6).
Haiti has overc ome enormous obstacles and mounted one
of the world’s most suc cessful responses to the AIDS epi-
demic. Scientists need to carefully c onsider the great harm
that can result from asserting dubious claims of causality.
Jean William Pape*
†
, Paul Far mer
द
, Serena Koenig
‡§¶储
, Daniel
Fitzgerald*, Peter Wr ight**, and Warren Johnson*
*Centres GHESKIO, Port-au-Prince, Haiti;
†
Weill Medical College
of Cornell University, New York, NY 10021;
‡
Par tners In Health,
Boston, MA 02115;
§
Br igham and Women’s Hospital , Boston, MA
02115;
¶
Harvard Medical School, Boston, MA 02115; and
**Vanderbilt Univer sit y, Nashville, TN 37235
1. Centers for Disease Control (1982) Opportunistic infections and Kaposi’s
sarcoma among Haitians in the United States. Morb Mortal Wkly Rep 31:353–
354, 360–361.
2. Gilbert MTP, et al. (2007) The emergence of HIV/AIDS in the Americas and
beyond. P roc Natl Acad Sci USA 104:18566–18570.
3. Deschamps MM, Fitzgerald DW, Pape JW, Johnson WD (2000) HIV infection
in Haiti: Natural history and disease progression. AIDS 14:2515–2521.
4. Pape JW, et al. (1983) Characteristics of the acquired immunodeficiency
syndrome (AIDS) in Haiti. N Engl J Med 309:945–950.
5. Farmer P (1992) AIDS and Accusation: Haiti and the Geography of Blame (Univ
of Californ ia Press, Berkeley, CA).
6. Liautaud B, Laroche C, Duvivier J, Pean-Guichard C (1983) Kaposi’s sarcoma
in Haiti: Unknown reservoir or recent appearance? Ann Dermatol Venereol
110:213–219.
The authors declare no conflict of interest.
储
E-mail: skoenig@partners.org.
© 2008 by The National Academy of Sciences of the USA
www.pnas.org兾cgi兾doi兾10.1073兾pnas.0711141105 PNAS
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March 11, 2008
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vol. 105
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no. 10
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