Sunday, June 24, 2012


I have been reading The Origins of AIDS by Jacques Pepin (Cambridge, 2011, not to be confused with Jacques Pépin, the celebrity chef). This is a wholly engrossing work that elides with more than one aspect of the writing of my Edwardian Opulence exhibition catalogue—we open next February 28—because it necessarily casts a ray of bright and chilling light upon the very worst features of the colonial enterprise, especially in Equatorial Africa. Was anything as incomparably beautiful as a diamond ever extracted from the earth amid more or worse human suffering? Was ever something as completely unnecessary as a second railway line from the pool of the Congo River to the Atlantic coast built with such appalling disregard for the rights and dignity of man? If, as seems likely, the global pandemic of HIV/AIDS came into being as an indirect result of the latter, we the heirs of the colonizers—direct or collateral, as the case may behave certainly had our comeuppance.

The miracle is that modern medical science has been able to trace the origins of HIV/AIDS at all. The virus is recklessly wasteful, reproducing itself in every host (if permitted to do so) millions, even billions of times a day. Indeed it exists simply for the purpose of its own replication, an infinitesimally small strand of DNA whose innate character is destructively to invade other peoples cells for that sole purpose. Beyond this rather forlorn mystery, the frighteningly explosive rate at which the virus multiplies means that the processes of spontaneous mutation by which it naturally divides itself into the equivalent of substrains or subspecies are exceedingly rapid. The steps in evolution that divided us humans and our chimpanzee cousins from our common ancestor between four and six millions of years ago are for the various strains of HIV/AIDS compressed into mere decades, and will no doubt continue in this vein—to our continuing and collective peril. 

So the first basic principle is that the locality where the virus exists in the greatest diversity of strains is therefore likely to be the place where it first passed from chimp to person—and that place is Central Africa: the two desperately benighted Congos, Cameroon, Gabon, the Central African Republic, Equitorial Guinea, Rwanda, and Burundi. In other words, a great swathe of former French, Belgian, German, British, and Portuguese colonial possessions. 

Why chimps, and why the species Pan troglodytes troglodytes? Because the study of phylogenetics—the analysis of the DNA of different sorts of microbial pathogens to construct of a kind of family tree that accounts for their evolution, and also to plot the relationships that therefore exist between certain pathogens that are similar, even closely related to each other—told us in 1989 that there existed among that particular species of chimpanzee a simian immunodeficiency virus that was closely related to HIV. There have been other theories, relating to (1) the development of a polio vaccine in Philadelphia using genetic material extracted from green monkeys; (2) the injection by French scientists of small quantities of the blood of infected monkeys into psychiatric patients to see if they would contract malaria—definitely one for the ethics committee; and (3) the merrily optimistic but ultimately unsuccessful pursuit of the transplantation into men of monkeys’ testicles. However, the inference, since then confirmed beyond reasonable doubt, was that HIV came into being as a consequence of some sort of human exposure to the simian immunodeficiency virus in P.t. troglodytes: one chimp, one person (maybe a handful of people)—that subsequently exploded into a global pandemic which by 2009 claimed the lives of 29 millions, and insured that another 33 millions are now living with HIV.

When did this crossover from chimp to man happen? Pepin’s book argues convincingly that the crossover must have taken place in about 1921, or shortly afterwards. The epidemiology of HIV/AIDS is now sufficiently well understood that we can be fairly certain that across whole populations the virus develops its destructive hold over the human immune system in a period of roughly eight years (if unimpeded), though of course it can work a lot faster in some cases, and a lot slower in others. 

In 1921 the Chemin de Fer Congo-Océan, an entity that must go down in the annals of history as among the very worst corporate criminals—and think of the competition—started building a railway between Brazzaville and Pointe Noire on the Atlantic Coast in what is now Republic of the Congo or Congo-Brazzaville, formerly French Moyen-Congo. The terrible irony was that this railway was not really necessary, because it ran roughly parallel with an existing one that was built earlier and a little way farther to the south, on the other side of the Congo, by the neighboring Belgians. However, it suited the French to build their own, in the lively but, as it turned out, wholly misguided spirit of competition and free enterprise, much assisted by a small army of grotesquely mistreated slave laborers. Parts of the new railway traversed impossibly difficult terrain and dense jungle, and it has been estimated that between 15,000 and 23,000 construction workers perished there in conditions of unimaginable privation, squalor, and brutality—no better than slavery, and in certain respects rather worse even than that. 

Brought to light by well-meaning French newspapers, the ensuing scandal at home in Paris resulted in certain reforms being pressed upon the at best sleepy but more probably complicit and certainly negligent colonial officials en poste in Brazzaville, according to which improved pay and conditions for railway workers, the guarantee of minimum quantities of better food, including messily butchered bush meat (chimpanzee), and a supply of busy prostitutes, constituted what was then regarded as a partial amelioration of the worst offenses hitherto perpetrated by the railway company. 

The practice of medicine in Equatorial Africa was in any event dreadful, and ill equipped even to deal with the daunting smorgasbord of known tropical diseases, but by 1931 local conditions had generally improved in response to the railway scandal. In that year a clever young French doctor, Léon Pales, took up a two-year post in Brazzaville, just in time to perform what was almost never attempted previously for want of time and resources: a series of careful, detailed autopsies. 

Dr. Pales was struck by the existence of drastically thin patients, mostly young railway workers discharged because of ill health, who were all suffering from chronic non-bloody diarrhoea but in whom he could detect no parasitic agent, which ought to have partly explained their condition. They weighed between 30 and 35 kilograms (roughly 66 to 77 pounds). Pales had access to the Institut Pasteur laboratory, which tested stool samples for known pathogens, above all shigella (dysentery) but they found nothing at all that shed light on this desperate malady. So he called it Cachexie du Mayombe, after the gruesome stretch of the railway whence his patients found their way (and many, many more than them didn’t). It now seems likely that these sufferers, who promptly died, one after the other, were among the first crop of victims of AIDS, though of course Pales was unaware of it at the time. The published results of his autopsies, however, are today powerfully persuasive—having since then slumbered peacefully on the shelves of French medical libraries until the awesome meaning of their contents was lately comprehended

Dr. Pales found in these victims post mortem evidence of a profoundly disturbing array of diseases including but not limited to tuberculosis, occult tuberculosis (tuberculosis of the intestine or the intra-abdominal lymph nodes), lymphadenopathy, including large mesenteric lymph nodes (around the small bowel), but also cerebral atrophy, which is normally very rare among young patients—and now firmly associated with the onset of AIDS. However, he could identify no unifying or underlying pathology that would explain the extreme wasting in cases of this so-called Cachexie du Mayombe. 

Had it been a significant factor, malnutrition or privation ought to have been reversed almost as soon as his patients presented themselves in Brazzaville, were fed properly and treated. Instead they got steadily worse and without exception died, and there the matter lay—while HIV/AIDS quietly spread, insidiously, slowly at first in the rapidly growing colonial centers of Léopoldville (Kinshasa in what is now as described the Democratic Republic of the Congo, formerly Zaire and before that the Belgian Congo) and Brazzaville on the opposite, north bank of the two-mile wide pool of the Congo River in the what is confusingly also called the Republic of the Congo or Congo-Brazzaville, formerly French Moyen-Congo

Between both more or less French-speaking cities, there was much traffic depending upon how much political instability and upheaval took place through the Great Depression, the years of World War II, and onwards through the relatively prosperous 1950s, and continuing into the decade of independence, when many Belgian and French companies simply packed up and left the Congolese to their fate—at the hands, it turned out, of the obscene Mobutu Sese Seko Nkuku Ngbendu Wa Za Banga (which means, in all seriousness, the all-powerful warrior who, because of his endurance and inflexible will to win, goes from conquest to conquest, leaving fire in his wake). However, throughout their rapid growth during these decades: (1) young Congolese men consistently far outnumbered women and prostitution therefore thrived; (2) prostitution was actually embraced with enthusiasm by so-called free women for whom it represented the chance of a better life beyond the oppressive clan control of the traditional rural village (in which forms of prostitution existed anyway), and moreover (3) prostitution proliferated in steadily higher and higher-risk forms within a flourishing culture of hundreds of little bars, alcohol, and western popular music, while (4) colonial doctors and nurses thinly spread all over both regions routinely used and re-used glass hypodermic syringes with inadequate methods of sterilization (and often none at all). 

Thus, having crossed cover from chimp to cut hunter or butcher in about 1921, HIV accelerated dizzyingly in the midst of this perfect storm of mutually intensifying conditions for sexual and blood-to-blood transmission, quantum leaping onwards, and almost inevitably then breaking out of the Congo (by road, rail, ship, and latterly air—and to the Americas via one solitary Haitian soldier returning to Port-au-Prince from a tour of duty in Zaire in about 1964, a classical case of what is known to epidemiologists as a foundation event), until...

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