The AIDS virus attacks the mind. About 40% of AIDS patients develop neurological and associated psychological symptoms. They begin with a slowing of speech and thought, short term memory failure, and difficulty in concentrating. These deficits become more pronounced and new ones appear: deteriorated motor coordination, apathy, confusional states; then irritability, hyperactivity, incontinence, and delirium or mania, or both. As death approaches, the patient lies immobile, staring vacantly ahead, silent and unresponsive. The mind has been destroyed. These symptoms are indistinguishable from those caused by encephalopathic or cerebral atrophy conditions. Yet they are special because they terrify friends and lovers who know that HIV did it.
The virus assaults the minds of about half those who are diagnosed to be HIV+. Although they may be otherwise healthy, they experience feelings of powerlessness, shock, isolation, anger, denial, guilt, anxiety, apathy, and suicidal thoughts. Depression and malaise disrupt work and social relations. These symptoms are indistinguishable from garden-variety panic and depression, but for one thing: HIV did it.
The virus terrorises the minds of some people so much that they believe that they are infected even though they test negative. They mimic the mononucleosis-like symptoms of initial HIV infection. The syndrome is called AFRAIDS. It's indistinguishable from ordinary hysteria but for one thing: HIV did it.
The virus brutalises the minds of carers, family and friends of AIDS patients. They experience grief, social withdrawal, and are at risk of chronic psychological disorders. Carers have recorded their anguish in witnessing the slow death:
"He looked pathetically decrepit, his face almost unrecognisable from the skin lesions of Kaposi's sarcoma;
There are simply no words in human language to express the suffering of any one person with AIDS;
You could literally see every function in his body closing down one by one".
Descriptions of this kind have been recorded for many diseases. The tertiary syphilis patient, for example, is ghastly. Large ulcers disfigure the face, scalp, trunk, and legs. The mouth and nose are eaten away; mind and brain are gone. This spectrum of wounds endured by carers of AIDS patients is indistinguishable from disturbances experienced by others who care for the dying, except for one thing: the patients in their care suffer from AIDS.
The virus attacked the minds of Sydney morticians so violently that they got up a law to prohibit viewing the remains of those who died of AIDS or of any unexplained infection. If the next-of-kin choose not to have the corpse cremated, it is placed in a sealed plastic bag by apprentices wearing disposable infection-control clothing.
Politicians are at high risk from HIV mental attacks. During the 1984 general election, the Queensland Heath Minister startled the government by announcing that three infants were dead and a fourth was dying from contaminated transfused blood. It was the signal for the Opposition to pummel Labor's initiative to extend human rights protection to homosexual acts. A National Party leader blamed the deaths on Labor's "promotion of homosexuality as a norm". The Queensland legislature needed but one day to pass a law banning blood donation by anyone in a risk group. Hair-trigger though this response was, it did not satisfy a Sydney clergyman, who demanded that gay men be quarantined. The Prime Minister, thrown from his horse by the uproar, huddled with minders. The outcome was to call an emergency meeting of health ministers to consider strict guidelines for blood donation. It was much the same elsewhere. When the AIDS panic was at full tide in the US, state legislators introduced, in just one year, 450 bills relating to AIDS.
No doubt about it, HIV drives people bananas. Those who suffer from the Acquired Anxiety Syndrome must number in the millions. It drives you crazy because you can't see the damned thing. Neither can scientists. The electron microscope lets them see virus particle concentrations in excess of 1 million per millilitre. But those concentrations of HIV haven't been found. Thus, as Donald Francis states, direct visualisation of viruses is often "difficult". So there's no telling where it will strike next. Innocent babes, the all-American idol Rock Hudson, a romper-stomper type right-wing activist, a sports superstar. God help us!
Or does God side with the bug? Is the plague Jehovah's way of bringing corrupt, luxuriant nations back to the path of righteousness? Health bureaucrats easily refuted the quarantine proposal; rounding up millions, pinning them in special facilities for the duration of their lives, isn't the sort of empire Australians like to build. It's nuts. HIV doesn't spare clergymen.
AIDS scientists have no credible answer to the Jehovah hypothesis. Suddenly, from out of the blue, the wretched microbe struck in Kinshasa, Haiti, New York, Rio, Sydney. Virologists classify microbes into phyla and orders and try to date their evolutionary origin. All the viruses, bacteria, fungi, and parasites that pester us and livestock have been around for a long time; some protozoans for maybe a billion years. So AIDS must have been around for a long time. Yet there was nary a sign of it until 1981.
The public had to be given a plausible scientific story about origins; otherwise evangelists would sweep the field with the Jehovah hypothesis. There was also the KGB to worry about.
Using East German conduits, the KGB put out the story that the virus was a weapon devised in the US biological warfare program. This sensational notion was endorsed by a few reputable scientists and by British anti-vivisectionists, who said that HIV is a recombinant animal-human hybrid. The Strangeloves who allegedly masterminded this devil's work at the Fort Detrick biological weapons facility were named in some publications. They were scientists in leading universities. If the dark forces behind the scenes could assassinate President Kennedy, would they scruple about devising an unstoppable killer to use on the Reds, or Africans, or homosexuals? Here again the virus showed its incredible power to induce delusional states. The CIA and the State Department were frantic for the bug boffins to come up with a plausible story.
The boffins obliged. Government scientist Robert Gallo had what he touted as invincible proof that the virus was transmitted from monkeys to humans at least 400 years ago. If you are a virologist, chopping millions of years down to a few centuries is pretty neat. You need only a few more strides to bring you up to the epidemic. Here are the steps. For four centuries HIV was doing its work in an isolated African population that doctors never reached. This secures the key dogma that the virus is an inexorable killer: it was killing, but no MD attended the isolate. The virus spread when maidens left the forests for Kinshasa, where the flesh trade was brisk. Bisexual Belgian businessmen collected the virus from these girls and gave it to male prostitutes in Haiti. A Canadian airline steward picked it up in Haiti and spread it to thousands of his contacts in San Francisco, New York, and Los Angeles.
This incredible story was actually believed. It is reported with a straight face in AIDS literature, but with no explanation of why scientists think it plausible. The reason is that infections of their technicians by laboratory animals is a standing hazard. The story was told to me in all sincerity by a scientist in Myron Essex's lab shortly after he discovered that simian immunovirus (SIV) had about 70% of its genes in common with HIV; stir in a couple of lucky mutations, and, Presto! SIV became HIV. This was his Eureka. He was on a high; he had found the key that fits all locks.
Gallo's monkey story was meant to be the last word about origins, but the virus outsmarted him. HIV used his story to start a new cycle of stories. Here's one of them.
Keep the monkey, discard the bites and the prostitutes. Add scientists in a Philadelphia lab circa 1957. The scientists are growing the poliomyelitis virus in a culture of African green monkey kidney cells. They need lots of polio virus because they are making polio vaccine. The bug boffins don't know that the kidneys of healthy green monkeys are the ancestral home of SIV. So SIV contaminates the vaccine unnoticed. The vaccine is ready for trial. Naturally it will be trialed in the Third World because that's where the greatest need is. A benevolent drug company provides 300,000 doses of this latest pride of humanitarian science. It is administered by compassionate disease conquerors to children and young adults in Zaire, Rwanda and Uganda. But an invisible tragedy has struck. The vaccine is contaminated. SIV mutates to HIV. Add sex holidays decades later. Voilà the African AIDS Belt and an epidemic down the middle of the international fastlane.
This story was told by Julian Cribb in the Weekend Australian in 1992. It won him the Walkley Prize for investigative journalism. It's wild. Sixty million doses of possibly contaminated polio vaccine were administered over the years, yet it seeded only one AIDS epicentre. Still Julian won the prize because people are so keen to know where the virus came from. Cribb collected no bouquets from our AIDS scientists. They hate the story. They will not even reply to it. They hate it with the same fervour that the US State Department hates the Fort Detrick story.
No doubt about it, HIV sends minds into spins. It has defeated AIDS science, which threw in the towel on the origin of the AIDS virus some years ago.
The CDC's official epitaph was written by Donald P. Francis in 1989. He said:
"From the moment AIDS was recognised as a strange and frightening phenomenon, speculation about its origin was irresistible. Growing just beneath the fear and speculation was the xenophobia that has often accompanied transcontinental propagation of epidemics".
(Francis knows about Africa. He served humanity, on secondment from the CDC to the WHO team that staunched African haemorrhagic fever and smallpox.) He goes on to discuss theories of simian origin and mutation origin. He rejects both and tosses it in: "It is doubtful that the origins of the virus will ever be fully known". He means it will never be known at all. Don Francis, MD, DSc, is unduly modest. He knows the origin of the AIDS virus because he led the CDC virologists who postulated a viral cause of AIDS. That moment of creativity is what we today know with certainty about the origin of the virus. Indeed, it exhausts what we know about its origin. Let's have a look.
Atlanta, May 1981. The CDC's hypersensitive sentinel system receives a message from its Los Angeles listening post. A cluster of five homosexual men with Pneumocystis pneumonia (PCP) and candidiasis (thrush), three of whom had abnormalities of cell-mediated immunity. The next CDC surveillance report (5 June) described the cluster and postulated a
'cellular immune dysfunction related to a common exposure that predisposes individuals to opportunistic infections such as pneumonia and candidiasis'.
The definition will be used as a surveillance criterion by doctors all over the country. It is the first step in the definition of AIDS.
July. Doctors attending gay men are eagle-eyed. They report 26 cases of Kaposi's sarcoma (KS) accompanied by immune dysfunction. KS is a puzzle. Some doctors call it an inflammation; others a cancer. Among Europeans, it is rare, and prefers older men of Mediterranean origin. But in Africa it prefers children of both sexes, its prevalence is significant, and it kills like cancer. Now KS is going for gay men ranging from 26 to 51 years of age, in Los Angeles and New York. Very odd.
August. The CDC switches the epidemic vigilance light to amber. An unusual incidence of disease associated with unexplained immunosuppression has been flagged. The concept of opportunistic infection, accompanied by a deficit of cell-mediated immunity, is bedded down as the revised surveillance definition of a disease called informally Gay Related Immune Deficiency (GRID). With it is bedded down the concept of an underlying common cause. Another foundation stone of AIDS science is set in place.
September. The CDC switches the epidemic light to green. In Washington the National Cancer Institute (NCI) convened a KS workshop on the 15th. Fewer than 20 cases are available for study. Not many as populations go, but the Public Health Service lives by the motto that you should shut the door before the horse bolts.
Medical scientists study the data. The common immunodeficiency factor is that most of the patients have significantly elevated CD8+ and significantly lower CD4+ T lymphocytes and lower ratios of CD4 to CD8 cells in peripheral blood. Thus, in only three months, the basic pathology-immunosuppression-had been identified and the probable mode of transmission by sexual contact had been established. Lowered counts of T4 helper cells but elevated counts of T8 suppressor cells. The workshop debates what, if anything, this means. The technology for counting T lymphocytes is new; there is little clinical experience to go on. The immune system is composed of a wide variety of differentiated cells that interact in a complex and patchily understood manner to provide protection against infectious diseases. While acknowledging that the distinction between T4 and T8 cells is oversimplified, the workshop fastened on it as a reasonably sensitive measure. So it is added to the surveillance definition of GRID. Another foundation stone of AIDS science had been laid.
The workshop moved on to discuss the cause of this "strange and frightening phenomenon". Strange, because doctors had not encountered KS and PCP of this virulence. The PCP bacterium is carried by 95% of us. When on rare occasion it does act up, the sickness is mild. The KS story is similar. Since it was identified in 1872, doctors have debated whether KS is a cancer or an unusual inflammation. Since the cells that cause the condition have never been identified, no rational therapy has been devised. Some patients may live with KS for years. So the puzzle before the workshop was that two usually mild diseases were taking a new and aggressive course. The men in whom they appeared were apparently healthy at the time of onset. They worked, jogged, travelled. Suddenly they were ill. This aspect of the clinical signs was captured in the surveillance definition, "no known cause for diminished resistance". Here opinion divided.
The NCI thought that there were plenty of known causes of diminished resistance among these men. The cardiovascular patient can also look healthy shortly before a fatal coronary, but autopsy will show extensive vascular damage. So it was with the gay patients under study. They were calamities waiting to happen.
They all had numerous sexual partners. They had infestations common among fastlane gay men: Epstein-Barr virus (mononucleosis), cytomegalovirus (CMV) and several other herpes viruses, varicella zoster virus, adenovirus, chlamydia, toxoplasma gondii, respiratory syncytial virus, hepatitis A and B virus, gonorrhoea, candida albicans (thrush), syphilis, plus a variety of enteric and protozoan infections. Each of these viruses, particularly CMV, could cause immune suppression, and CMV had been implicated as a cofactor for KS. Could not the novelty of the syndrome be due to interaction between these viruses, bacteria, and protozoans? This was the "viral overload" hypothesis.
It was also observed that all patients used nitrite inhalants. Poppers became fashionable among gay men in 1972. By 1981, legal sales had reached $250 million annually and National Institute of Drug Abuse reported that more than 5 million people were using them at least once a week. Drug manufacturers extensively promoted them in gay publications as "better living through chemistry". Gay men used them heavily as relaxants to facilitate anal intercourse. But heavy use of nitrites was known to cause severe symptoms and immunosuppression, and there was evidence that they were also mutagenic and carcinogenic.
The KS cohort of men had yet another factor in common , anorectal mucosal trauma. Trauma arises from various ways that gay men mobilise the anus for sex. Enemas are used prior to intercourse and intercourse is usually vigorous. The anorectal damage caused by these activities can be extensive. Trauma allows semen to enter the bloodstream. But semen is an antigen when it enters the blood of another, and is immunosuppressive.
Most fast-lane gay men are on heavy antibiotic medication to contain their infectious diseases. Much of this is self-administered because medical lore among gay men states that dosages in excess of prescription maximums are required. These medicines are purchased on the black market and they are not necessarily from a reliable pharmaceuticals source. Thus gay men are pouring large doses of antibiotics into their systems unaware that antibiotics are immunosuppressive.
Such was the NCI case. Its central idea was that the cause of the novel syndrome was to be sought amidst this thicket of potential causes. There was no need to postulate a new infectious agent. This was to become known as the multi-factorial model of AIDS.
The CDC felt confident of its case. It knew the clinical diseases of gay men thoroughly from the 7000-man cohort of its hepatitis study. Nitrites, they believed, could be dismissed. Nitrites had been in use for over a century. Viral overload was no use either. The hepatitis cohort answered to this description, but the novel KS and PCP symptoms had not been found among them. No, there had to be a new infectious agent, a point source of immune cell destruction. This is the single-virus, single-disease model that came to dominate AIDS science.
The architect of the CDC position was Don Francis. He had taken his PhD at Harvard under the supervision of Myron Essex, who was a colleague of Robert Gallo. His thesis had been a study of feline leukaemia virus — a retrovirus. His study of 134 cats claimed that infection with the retrovirus caused immune suppression that led in turn to cancers and other diseases. Francis' thesis was a seminal study because it supported the concept of a viral cause of cancer. The Grail of a cancer virus had been sought since about 1970. It was indeed this Grail that launched the study of retroviruses by Duesberg, Essex, and Gallo. But the aching expectation of a breakthrough had been disappointed until 1980, when Gallo discovered a human leukaemia virus (HTLV-I). (Duesberg, we noticed, challenged this claim in 1987.)
It was only weeks after the CDC received the initial notification of five cases in San Francisco that Don Francis, at age 39, experienced his first AIDS Eureka. His training as a viral epidemiologist made him impatient of the fuzzy causality of the multi-factorial model. Viral causality by contrast is clean and geometrical: one virus, one disease. His doctoral thesis had provided a distinctive viral causality. Now he had found the human clinical application that virologists had vainly sought. The syndrome looked ever so much like the leukaemia syndrome in his cats. In an inspired moment it was vouchsafed to him that the cause of GRID was a virus; specifically, a retrovirus. Gallo had just discovered human T-cell leukaemia virus. It made sense.
A second Eureka occurred in March 1982 after numerous discussions with Essex, Gallo, and his colleagues at the CDC. All the pieces came together. Francis presented a lecture to NCI scientists in which he outlined his doctoral work, the data on the hepatitis cohort, and IV drug users. He argued that the risk factors for GRID and hepatitis were virtually identical. "Combine these two diseases, feline leukaemia and hepatitis, and you have immune deficiency," he said. Feline leukaemia modelled the latency period, while hepatitis modelled the risk factor.
The NCI was not convinced. Apart from the fact that a new virus was a speculation, Francis' sketchy model did not connect immunosuppression with the specific opportunistic infections, nor with their virulence. Why these diseases and why their virulence? How could a virus infect and kill not only T4 cells, but macrophages, B cells and other elements of the immune system?
There was no answer. The indications today are that no answer will be forthcoming from the standard model. In May 1994, the National Institute of Drug Abuse (NIDA) held a conference on AIDS and drugs. Some of the outcomes of this conference were:
The NIDA conference reveals retrospectively the diagnostic blunder of the clause crucial to the definition of AIDS—"no known cause for diminished resistance". It now seems that the CDC engaged in the "unprincipled actions" that Dr Wecht detected in its handling of the swine flu epidemic. The nitrite evidence was ignored. The same story can also be told of the second AIDS diagnostic disease, PCP. This disease is developed by intravenous drug users, who inject opioids.
When AIDS was defined as a sexually transmissible disease, KS and PCP were significantly related to drug abuse. There was no good reason to postulate an infectious agent and every reason to investigate further the toxic effects of these drugs. At the Royal Perth Hospital, medical physicist Eleni Eleopulos had developed a model for these effects. When it came to the attention of AIDS scientists, they called her "an agent of the AIDS virus". Such is AIDS science.