AIDS study spurs Haitian outrage
BY FRED TASKER and JACQUELINE CHARLES, ftasker@miamiherald.com
A new scientific finding that AIDS came to the United States from Africa via Haiti, probably arriving in Miami as early as 1969, stoked controversy among researchers and Haitians on Tuesday -- reopening deep wounds over the medical community's role in perpetuating a stigma against people from the island.
Published in this week's Proceedings of the National Academy of Sciences, the study aims to better explain the origin of AIDS, whose history involves a virus with a sketchy story line that began in Africa in the 1930s and emerged in Los Angeles in 1981.
The findings were based, in part, on blood samples taken from about 20 Haitian patients at Jackson Memorial Hospital as early as 1979. The samples were frozen, stored at the Centers for Disease Control and Prevention in Atlanta, and reanalyzed by the study's authors, including a researcher at the University of Miami.
''We were seeing patients at Jackson Memorial with what we now call AIDS, and at the time we didn't even know it,'' said Dr. Arthur Pitchenik, co-author of the study and a professor of medicine at the University of Miami Medical School. ``I started seeing Haitian immigrant patients with TB. They would get better from the TB only to die three to six months later from what we now call AIDS.''
Dr. Michael Gottlieb, an assistant clinical professor of medicine at the University of California, Los Angeles, and one of the original discoverers of AIDS, said the analysis placed the HIV virus that causes it in the United States nearly a decade earlier than previously believed.
''It's pretty clear evidence for Haiti as a stepping-stone,'' he said. ``The suggestion that the infection was further below our radar than I'd previously suspected is kind of unnerving.''
''This is very credible work,'' added Dr. Margaret Fischl, a pioneering UM AIDS researcher. ``Their approach is the way it should be done. Some of my colleagues think this is really remarkable work.''
The findings drew immediate anger from Miami's Haitian community and raised concerns among some AIDS scientists, as well.
''People are going crazy,'' said Dr. Laurinus Pierre, executive director of the Center for Haitian Studies in Little Haiti. Pierre said he has fought stigmas against Haitians from the first days of AIDS, in which researchers blamed the epidemic on the ''Four Hs'' -- homosexuals, Haitians, hemophiliacs and heroin addicts.
In February 1990, the Food and Drug Administration barred Haitians from donating blood in the United States, a policy that ignited scores of protests and highly publicized boycotts of blood drives. By December 1990, the FDA had scrapped its policy and developed a more rigorous screening of all blood donors.
To many, the policy pushed an already taboo subject in the Haitian community deeper in the shadows and discouraged many from seeking treatment, a phenomenon some say the latest findings could cause to happen again.
''This does a disservice to the Haitian community, who feel like they already went through this 20 years ago,'' said Dr. Paul Farmer, professor of medical anthropology at Harvard University and a founder of Partners in Health, an international research and aid organization active in fighting AIDS in Haiti. ``This is very slender evidence on which to base such a grand claim.''
''I don't think this is very helpful,'' said Dr. Jeffrey Laurence, a professor of medicine at the Weill Medical College of Cornell University in New York. ``People love to play history, and it would be great to figure out who Patient Zero was. But there are doubts.''
The study's lead author, Michael Worobey, a University of Arizona evolutionary biologist, defended his methodology Tuesday and denied any disservice to the Haitian community.
Worobey and his co-authors analyzed the frozen blood samples from about 20 of Pitchenik's Haitian patients at Jackson from the late '70s and early '80s. They set up a medical timeline that they say indicates the HIV virus arrived in Haiti in 1966 and in Miami by 1969.
Worobey said he estimated the timing of the virus' arrival by taking samples of the virus from the late 1970s to 2000. By knowing the rate at which the viruses mutate, he said he was able to create a picture of what the virus looked like in 1969. And by comparing viruses from the United States and Haiti during this time, he could deduce when the virus arrived in the States.
''It's a common technique used in genetic analysis and human evolution,'' Worobey said Tuesday.
The study concludes that AIDS arrived in Haiti after Haitians went to the Democratic Republic of Congo as workers after that country won independence in 1960.
It debunks the original ''Patient Zero'' theory that said the HIV virus came to Los Angeles via a gay Canadian flight attendant named Gaetan Dugas. That theory was created by Dr. William Darrow and others at the CDC and turned into the 1987 book And the Band Played On, by journalist Randy Shilts. Darrow later repudiated his own study.
Pitchenik said he realized this week's study would be controversial in the Haitian community.
''I want to stress that this has nothing to do with race or sex or color of skin, and we should not stigmatize any particular group,'' he said.
``It's not whether you're Haitian or homosexual. It's the high-risk behavior you engage in. Whether you have unprotected sex, whether you're a drug user sharing needles.''
In Haiti, where 6 percent of the population was HIV-infected in 2003, the situation has improved, with HIV rates dropping to 2 percent by 2006, the CDC says.
This report was supplemented with material from Miami Herald wire services
Source: http://miamiherald.typepad.com/gaysouthflorida/2007/10/aids-study-spur.html
The Association of Haitian Physicians Abroad (AMHE) responds to Worobey study, November 7, 2006
ReplyDeleteThe Association of Haitian Physicians Abroad (Association des Médecins Haitiens à l'Etranger or AMHE) has reviewed the recent article by Thomas Gilbert and colleagues, reporting a phylogenetic analysis of archival blood samples collected from five early recognized AIDS patients at Jackson Memorial Hospital in 1982-1983.
The study authors identify these five patients as Haitians who left Haiti after 1975. This article has several important limitations and does not provide any scientific breakthrough. Before a detailed critique of this paper, AMHE would like to point at the following remarks in methodological biases that may explain some of the study findings. First, the bias in selection of early samples of HIV among Haitians is quite obvious. The investigators chose a convenient sample under the unproven assumption that all these Haitian immigrants acquired HIV infection in Haiti. They obviously ignore that the clinical course of these patients perfectly fits the natural history of HIV/AIDS. No culturally-sensitive epidemiological investigation has ever been conducted of these initial Haitian immigrants presenting with HIV infection at Jackson Memorial Hospital in Miami. Therefore, the assertion that they contracted HIV in Haiti is presumptuous and not based on facts. Moreover, no archival samples from Haiti are included in the phylogenetic analysis and this constitutes a serious flaw. We do not know either how many samples of the pandemic clade B might have come from Haitian subjects, which raises the prospect of misclassification.
Second, the authors do not adequately report on some of their methods and results. For example, they do not specify clearly the number of sequences for which there was uncertainty as to which subtype they belonged to; neither do they try to replicate their results by sequencing other HIV genes. While computer simulation techniques and phylogenetic analyses are important to our understanding of biological evolution, the application of these methods with such serious methodological limitations does not prove unequivocally the origin of the pandemic clade B subtype in the United States.
Because these findings lack scientific validation, we need to raise questions about the motives of the authors; their paper not only does not advance our knowledge of the HIV epidemic but it continues with a dangerous precedent of victimizing an ethnic group with flimsy data. Needless to say that such half truths have been very harmful to the country and its people. The hasty classification of Haitians as a group at risk for HIV more than 20 years ago can be considered as a cloud hanging over good scientific practice. It destroyed the tourist industry in Haiti; its citizens have since been suffering from the social stigmata of presumed carriers of dangerous germs even though that classification was finally removed by the CDC.
We are also afraid that such mishandling of data can have the unintended consequence of the refusal of Haitian patients to participate in research studies at American Universities for the fear that they will be used as guinea pigs in the furtherance of biased scientific protocols and conclusions. That would be the saddest of ironies for we all need good science to help us all against this calamity.
La Science sans conscience n'est que ruine de l'âme.
Christian Lauriston, MD
President of the Central Executive Committee of AMHE.
www.solutionshaiti.blogspot.com
Vous savez la verite, mon frere!
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