Interesting TED Talk with economist Emily Oster, on that hoariest of topics, “Everything You Know About AIDS in Africa is Wrong.”

Now, much of what people know about AIDS in Africa is wrong, and Oster makes some fine points. But she loses a lot of credibility with me when she repeats one of the most longstanding (though long-ago debunked) myths of AIDS lore. At the 11:34 mark, when talking about the (very real) role that transport networks and trade can play in spreading the disease, she says:

The epidemic was introduced to the U.S. by, actually, one male steward on an airline flight who got the disease in Africa and brought it back — and that’s the genesis of the entire epidemic in the U.S.

She’s referring to Gaetan Dugas, a Quebecois flight attendant for Air Canada. Randy Shilts’ 1987 book And the Band Played On labeled Dugas as “Patient Zero,” the center of the epidemic’s start in North America. (Dugas died in 1984.) I remember, as a kid, watching a 60 Minutes episode on this “Patient Zero” and how he was reponsible for all the AIDS in America, sodomizing his way from coast to coast and intentionally spreading the disease. He was vilified as a monster for years.

Except it isn’t true, and that’s been clear for almost two decades. This 1988 piece from NYRB shows that the study that put Dugas at the center of things used a flawed model of the disease — blaming Dugas for infections that started showing symptoms at the same time as the intercourse allegedly to blame. You don’t develop full-blown AIDS three days after infection — it takes years. (Quote the researcher: “The cluster is in fact a textbook example of constructing your empirical evidence to fit your theory.”)

Now, Dugas certainly had sex with a whole lot of people. But he got lots of attention from people like Shilts because, in a way, he was the most cooperative early AIDS victim in North America. He kept detailed records of all the people he had sex with and was happy to cooperate with CDC officials in their efforts to figure out what was causing the disease. (Remember, at the time, it wasn’t known that AIDS was fatal — or even that it was spread sexually. The popular image of Dugas as some crazed serial killer is based on faulty assumptions about how the disease was viewed back then.)

In any event, Dugas wasn’t diagnosed with anything until 1980. (It was called “gay cancer” or GRID until 1982.) And there’s plenty of evidence AIDS in America predated Dugas. A study of blood samples taken from NYC men given a hepatitis vaccine in 1978-89 found 6.6% of them already had HIV antibodies in their blood. The first confirmed U.S. case of AIDS was from 1969, with cases among gay men in California in 1978.

(Side note: Check out this National Review article on Shilts’ book from 1987. Not because of the content, but because of this sentence: “…according to an impressively researched new book by Randy Shilts, himself a gay…” Yes, back in the day, people called people like Shilts “a gay.”)

Anyway, here’s hoping the rest of Oster’s talk is more accurate. Her basic thesis is that the strongest correlate to HIV infection rates in Africa is trade — more trade equals more infections. Which would put a damper on globalization thoughts, wouldn’t it? (I’m not sure I buy it, since I don’t believe there was a stunning spike in export value in southern Africa in the 1990s, when infection rates skyrocketed. But I haven’t looked at the data and Oster has.)

Her evidence is in part based on data from Uganda, the one African nation that has seen a real reduction in infection rates. Every AIDS researcher, it seems, has his/her own ways to read the Ugandan tea leaves. Oster argues the decline was caused by decreased trade, caused by a decline in coffee prices. Others credit an increase in condom use. Sunday’s NYT said it was an outbreak of monogamy. Who’s right? Who knows? I wish someone would decide.

29 July 2007

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