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Patient Zero Vindicated: A Canadian Flight Attendant and the HIV Epidemic

Writer: Thomas Wang ‘26

Editor: Helen Chow

Wikipedia; Gaëtan Dugas (1)

In June of 1981, news reports of a deadly virus spread around the US. Panic would spread and certain groups, especially the burgeoning gay community, would be targeted above all else. This was the beginning of the HIV/AIDS epidemic in the US.

In 1987, a few years after the virus was first officially identified (2), one Randy Shilts, an openly gay man (3), had seen the virulent discussion surrounding the virus and took it upon himself to break the mold. Shilts, a reporter working in San Francisco, gained prominence for his reporting on the AIDS epidemic in the years prior. His work culminated in the publishing of an award-winning book, And the Band Played On. Heavily critical of political infighting over the AIDS epidemic in the early years, Shilts blamed the government for their indifference, arguing that it was their neglect that worsened the spread of the virus (4)

However, while his work actively challenged the stereotypes surrounding the gay community, it proved harmful in that it singled out a particular character: Gaëtan Dugas, a gay Canadian flight attendant labeled “Patient Zero”.

Shilts implicated Dugas as the bad actor. He claimed that it was Dugas who contracted HIV in his travels and brought it to North America. In addition, he portrayed Dugas as a “sociopath” (5) who knowingly engaged in sexual acts with other men while infected with HIV. While there is some debate as to whether Shilts claimed explicitly that Dugas was patient zero, the result was the same. The media parroted the headline, and soon everyone in the country knew who Patient Zero was. The “Columbus of AIDS” (5), among other titles, was bestowed upon Dugas who by this point had passed away 3 years ago due to AIDS-related complications (1).

For the past few decades, this narrative remained unchallenged. It festered as a popular myth that propagated stigma and stereotypes surrounding HIV/AIDS. By defining a name that the public could latch their hate on to, Shilts made Dugas, and the gay community at large, a subject of scorn. By singling out Dugas, Shilts, instead of breaking down the system in which the gay community is persecuted, propagated the narrative that Dugas simply wasn’t “one of the good ones”. It proved far easier for the general public to blame one person than to blame the system that let the disease run rampant.

But all of it was based on a lie. 

In 2016, researchers at the University of Arizona sought to find the truth behind HIV’s emergence in the US. The researchers gathered archived blood samples from MSM (men who have sex with men) dating back to 1978-1979, a few years before the virus was first identified, that were originally collected for hepatitis B studies. They selected 53 of these samples that tested positive for HIV to sequence the genome of the virus. However, the samples were difficult to work with. Naturally, after decades of storage, the samples had degraded to a point where the amount of viral RNA that could be recovered was too low for sequencing. In order to circumvent this, the researchers used a technique they called “jackhammering”(6)

From each of their samples, they used a panel of primers, molecules used to identify specific sequences of the viral RNA, containing a range of different primers wide enough to cover each specific snippet of the viral genome. In this way, the entire genome could be obtained from the mess of fragments in the samples. 

Using this technique, they ended up with 8 samples that provided enough to fully sequence the genome, effectively the ID tag of the virus. They found that although these were the oldest samples found outside of Africa, they were actually most likely ancestors of an older strain of an epidemic in the Caribbean. 

Maximum clade credibility (MCC) tree summary of the Bayesian spatiotemporal reconstruction based on complete HIV-1 genome data (6)

The figure above, called a phylogenetic tree, traces the lineage of HIV using a concept called the molecular clock: a hypothesis that DNA and protein sequences evolve at a rate that is relatively constant over time. The researchers could then reasonably estimate that the strains in the United States (CA for California, GA for Georgia, and NY for New York) were ancestors of a strain from the Caribbean (CB).

The researchers then compared the genome to that of patient 0’s, and found, as can be seen above, that the particular strain Dugas had was nested deep within the track of the virus in the US. They concluded that there was zero evidence to support the idea that Dugas was the first case of HIV in the US, but rather one of many. The researchers posited the identity of the real patient zero, ultimately concluding that it was likely an individual who migrated from the Caribbean to the US around 1971. But crucially, they named no names.

The very first study that identified a so-called patient 0 (it was actually Patient O for “out of California”) made no claim that he was the first HIV case in the US (1). It was only Shilts’ book and subsequent news coverage that spread this claim.

Shilts’ act of naming Dugas as patient zero of the epidemic, gave the world a target. Dugas became the face of this deadly disease, thereby making him, and the community that surrounded him, an easy target of hate and marginalization. The power of a name cannot be understated. It took over 32 years after his death for Dugas’ own to be vindicated.

Works Cited

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