February 20, 1953|
Quebec City, Quebec
|Died||March 30, 1984
Quebec City, Quebec
|Known for||Widely reported as patient zero for AIDS|
Gaëtan Dugas (French: [ɡaetɑ̃ dyˈɡa]; February 20, 1953 – March 30, 1984) was a Canadian who worked for Air Canada as a flight attendant. In March 1984, a Centers for Disease Control and Prevention (CDC) study tracking the sexual liaisons and practices of gay, and bisexual men in California, New York, and some other states found Dugas to be the center of a network of sexual partners, and he was mistakenly dubbed "patient 0". After the study, mistaken assertions claimed he brought the HIV virus to the U.S., but Dugas was not the initial carrier of the infection to North America. He is used as an example in epidemiology of an index case.
A gay man, Dugas traveled the world and had many sexual liaisons with men. At the time, gay culture was largely illegal, underground, and clandestine. Gay bars and gay bath houses were social settings for gay and closeted men to meet. The extent to which gay cancer was known about in the early 1980s, how it was spread, or when Dugas was diagnosed are disputed.
Dugas died in Quebec City on March 30, 1984, as a result of kidney failure caused by AIDS-related infections. Robert Rayford was the first documented victim of HIV/AIDS in North America, and died at age sixteen in May 1969. He reported having experienced symptoms since 1966.
"Patient Zero" hypothesis
A study published in the American Journal of Medicine in 1984 traced many of New York City's early HIV infections, at the time called 'gay cancer', to an unnamed infected gay male flight attendant. Epidemiologists hypothesized that Dugas had carried the virus out of Africa and introduced it into the Western gay community.
Dugas is featured prominently in Randy Shilts's book And the Band Played On, which documents the outbreak of the AIDS pandemic in the United States. Shilts portrays Gaëtan Dugas as having almost sociopathic behavior by allegedly intentionally infecting, or at least recklessly endangering, others with the virus. Dugas is described as being a charming, handsome sexual athlete who, according to his own estimation, averaged hundreds of sex partners a year. He claimed to have had over 2,500 sexual partners across North America since becoming sexually active in 1972.
Genetic analysis of HIV provides some support for the Patient Zero theory. Dugas is now believed to be part of a cluster of homosexual men who traveled frequently, were extremely sexually active, and died of AIDS at a very early stage in the epidemic.
However, a number of authorities have since voiced reservations about the implications of the CDC's Patient Zero study and characterizations of Dugas as being responsible for bringing HIV to cities like Los Angeles and San Francisco. In the Patient Zero study, the average length of time between sexual contact and the onset of symptoms was 10.5 months. While Shilts's book does not make such an allegation, the rumor that Dugas was the principal disseminator of the virus became widespread. In 1988, Andrew R. Moss published an opposing view in the New York Review of Books.
A November 2007 article in the Proceedings of the National Academy of Sciences dismisses the Patient Zero hypothesis, and instead claims that HIV was transmitted from Africa to Haiti in 1966, and from Haiti to the United States in 1969.
Earlier cases and virus origins
In 2014, Radiolab compiled a report showing that although Dugas had been widely reported as "Patient Zero," he was preceded by many other cases later attributed to HIV/AIDS, and could not be the first case. In 1983, scientists isolated HIV—the virus that leads to AIDS—and noted that the virus, when duplicating itself, made replicating errors, that could be tracked to detect variations in infected individuals over time. Scientists eventually used this information to trace the detection of the virus entering the United States in 1966, when Dugas was still a "virginal adolescent," before entering the U.S., the virus came from the Caribbean country Haiti. Scientists trace the origins of HIV from Haiti to West Africa where a subspecies of chimpanzees native to west equatorial Africa had been identified as the original source of the virus.
Human blood samples from 1959 and 1960 from Kinshasa, the capital and the largest city of the Democratic Republic of the Congo on the Congo River, led scientists to extrapolate the virus back to the early 1900s, likely 1908 in Africa. Around that time the virus may have been transmitted from another species. Paralleling the HIV discoveries, primate researches found Simian immunodeficiency virus (SIV), which was widespread among many species of chimpanzees.
In 2006, scientists reported the origin of the HIV virus came from a species of chimpanzees that were "penned in" a little corner of Cameroon. Bracketed by the Boumba River to the west, the Sangha River to the east, "this patch of tropical forest is sealed into an inland peninsula to the south by the Ngoko River." The area is about 100 square miles. The best hypothesis, according to Radiolab, is that a Bantu hunter, while processing a newly killed, and infected, chimpanzee, got cut himself and got the animal's blood into his body. In the early 1900s the area was experiencing an upheaval as the German Empire took over the land in 1884 naming the colony Kamerun. The hypothesis follows that the infected hunter would have visited or moved to one of the larger inhabited areas in the early 1900s where prostitution and sexual contact would have been easily found.
Using the same virus tracing technologies, scientists extrapolate about a "chimp patient zero" who existed within a million years ago, although it is likely impossible to further limit the time frame. This chimp would have had to eat SIV-infected monkeys from two distinct species, a red-capped mangabey, and a spot-nosed guenon. Normally these viruses would have been defeated separately, or never interacted. But in 'chimp zero,' a relatively rare occurrence of pieces of the two viruses combined and thrived, leading to the virus that later was introduced to humans and became the one HIV virus. Scientists have found a dozen HIV virus strains spread from chimps, monkeys, and a gorillas, but one is responsible for the majority of the human infections causing a high percentage of the almost 36 million people who have died as of 2014. The research is being used to study the prevention of other "patient zero" events with other viruses.
- (French) "La découverte de la maladie — Sida, les premières années" (Discovering the illness — AIDS, the first years), Radio-Canada, 17 January 1992.
- Auerbach, D.M.; W.W. Darrow, H.W. Jaffe, and J.W. Curran (1984). "Cluster of cases of the acquired immune deficiency syndrome. Patients linked by sexual contact". The American Journal of Medicine 76 (3): 487–92. doi:10.1016/0002-9343(84)90668-5. PMID 6608269.
- “Patient Zero”: The Absence of a Patient’s View of the Early North American AIDS Epidemic
- Gaétan Dugas and the 'AIDS Mary' myth"Gaétan Dugas, the gorgeous French-Canadian flight attendant who hopped cities as easily as he hopped beds."
- Shilts, Randy (1988). And The Band Played On. Penguin. p. 439. ISBN 0-14-011130-1.
- Kolata, Gina (28 October 1987). "Boy's 1969 Death Suggests AIDS Invaded U.S. Several Times". The New York Times. Retrieved February 11, 2009.
- Gladwell, Malcolm (2000). The Tipping Point. Little Brown. p. 21. ISBN 0-316-34662-4.
- Kuiken, C; Thakallapalli R, Esklid A, de Ronde A (2000-11-01). "Genetic analysis reveals epidemiologic patterns in the spread of human immunodeficiency virus". American Journal of Epidemiology (Los Alamos National Laboratory) 152 (9): 814–22. doi:10.1093/aje/152.9.814. PMID 11085392.
- Moss, Andrew R. "AIDS Without End", The New York Review of Books, December 8, 1988. Retrieved December 2, 2006.
- AIDS virus invaded U.S. from Haiti: study
- The emergence of HIV/AIDS in the Americas and beyond.
- "Patient Zero". Radio Lab. Retrieved July 29, 2014.
- AIDS Has Killed Almost 36 Million People, But I Bet You've Never Heard The Real Origin Story, The Cell That Started a Pandemic, Radiolab.org, with guests and research from: Nathan Wolf author of The Viral Storm; Carl Zimmer, author of A Planet of Viruses; Michael Worobey, MicrobeWorld.org's "Meet the Scientist Podcast"; David Quammen, author of Spillover; Beatrice H. Hahn of Penn Center for AIDS Research.
- Where did HIV come from?
- Out of Africa: The Origins of HIV
- Halifax Rainbow Encyclopedia page for Dugas—he lived in Halifax for several years.
- Gaëtan Dugas at Find a Grave
- AidsVancouver - archive footage of Gaetan Dugas speaking at an Aids Vancouver forum (beginning at ~5:45)