AIDS STUDY SPURS HAITIAN OUTRAGE

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