MICROBIOLOGY AND IMMUNOLOGY ON-LINE

In 1981, it was clear that AIDS was present in the homosexual male communities of several major metropolitan areas in the United States and was spread by sexual contact. By 1982, another mode of transmission was apparent - infected blood and blood products. As a result, the disease arose in hemophiliacs, blood transfusion recipients and intravenous drug users; and in this case there was no sexual bias. In addition, the disease was spread sexually to the partners, male or female, of people with the disease.

In 1982, CDC described another risk factor for AIDS infection: being of Haitian origin, particularly having recently arrived in the United States from Haiti. Not surprisingly, this caused consternation among Haitian immigrants into the United States who feared discrimination and in Haiti, where it was feared that the presence of this mysterious infectious disease might discourage tourism and investment, which it did. Thus, in 1983, people were talking of the 4H club for the likelihood of getting AIDS:

Since 1982, AIDS has been a particular problem in Haiti with a higher incidence of infection than other Caribbean countries; today, this island still has a greater adult prevalence of HIV infection and total number of cases even though the number of infections and AIDS cases has fallen. Haiti and The Dominican Republic, the country with which Haiti shares the island of Hispaniola, have very similar populations, between 8 and 9 million. Haiti’s adult prevalence of HIV infection is 1.9% (2014) while that of The Dominican Republic is 1.0%.

So why Haiti? First, there is clearly nothing special about AIDS in Haitians since today they have the same risk factors for acquiring the disease: male homosexuality and intravenous drug use. Thus, Haitians are not at higher risk for getting the disease because of some genetic characteristic. It should be noted, however, that in the cases that were reported in 1982, most of the New York and Miami Haitian patients were males (but so were the majority of Haitian immigrants) who were heterosexual and most denied intravenous drug use. This was in contrast to the AIDS epidemic among Caucasian males at that time.

We do not know for sure whether HIV entered the United States from Haiti or vice versa but the former now seems more likely since the HIV that initiated the Haitian epidemic is related to strains found in central Africa. Moreover, computer analyses of early Haitian and United States HIV isolates suggest that HIV arrived in the mid 1960’s with Haiti experiencing the disease a year or so earlier.

In support of the idea that AIDS spread from Haiti to the United States is the fact that, prior to the emergence of AIDS, Haiti was a prime destination for American gay tourists. This fact might be the single reason why AIDS was initially a gay disease in North America.

We know that HIV migrated from chimpanzees to humans in central Africa, probably in the Congo. It remained isolated in rural communities until major migrations to the metropolitan areas occurred around the time of independence in 1960. At this time, AIDS was a heterosexual disease as it still is in Africa. Many Haitians found employment in the newly independent Congo since one of its major languages is French, having been a Belgian colony, and Haitians also speak French, since Haiti was, until 1804, a French colony. Most of the Haitian migrants to central Africa were male and they probably caught the virus from interactions with Congolese prostitutes and brought the virus back home with them. The apparent date of arrival of HIV in Haiti would fit with the migrations of Haitians to and from the Congo and the subsequent spread of the disease to the United States.