Ground Sero: when the world saw AIDS for the first time

Did I ever tell you that I like infectious diseases? No matter how horrible they are sometimes. The beauty of an infection is that one day it’s the deadliest in the world, like a bacterial pneumonia, the next moment you have penicillin, and everything is different again. Horrible diseases get chronic almost overnight.
The scary thing is: you don’t know from the start what the disease is and if it will ever be treatable. The most notorious diseases in this case is the ultimate queen of infections: HIV, AIDS, SIDA, Kimi. The story is like a movie. Better said: the story is used in many movies. And there’s a reason. It has a spectacular start, a thriller like chase and a (sort of) happy ending. Let’s look at the start and how the world seroconverted.

1981
Reagan has just started his powerplay with the cold Russians, in Tanzania president Nyerere is working his fourth term and the Netherlands are recovering from the inauguration of Queen Beatrix. Three places in the world, miles apart that don’t have anything in common. Or so it seems. This year, all three of them and many more, will be confronted with a disease that nobody knows. Oh, and 13 year old Lisa Lopez has no idea yet that she will be conquering the world a couple of years later with TLC and their hit song “Waterfalls”. Why is that related? Just continue reading.

California, US of A
Out of the blue, hundreds of young men start dying. Young, gay men. It’s a disease nobody had seen before and gets referred to as Gay cancer. The first reports suggest that the disease is spread through inhalation of a substance (like the inhalation of poppers), and really, definitely not an infectious disease. It leads to an immunodeficiency in men with a “particular lifestyle”. Vegans have a particular lifestyle, as do priests and the Eskimo, but in this case they were referring to male patients that, in the year prior to the symptoms, had sex with many different men. Beware, this was before Grindr and the Gay pride. A new term is made to describe the illness: GRID – Gay Related Immuno Deficiency.

Moshi, Tanzania
On a completely different continent, Dr William Howlett also gets introduced to this new disease. However, the case definition is definitely different than the USA one. Here, they look out for flying testosterony hunks, the primary affected group seems to be travelling men and stewards, who can easily transfer the disease from one country to the next. And whatever you may think about business men and stewards, in the definition of Tanzania’s dictionary the word “gay” is absent.

Haarlem, the Netherlands
Closer to my home, my currently retired supervisor (then a flaming thirty-year old) Reinier ten Kate saw a great denial. Most specialists that get in contact with the disease, don’t recognize the disease and can’t evaluate the risks properly. They see regular infections, but then all at the same time. So, they are categorized as many diseases, instead of being this special one. Specialists that never had to deal with acute situations all of a sudden found themselves in the Emergency Room and doctors whose medical fields seemed miles apart suddenly had to sit together and discuss. Could it be? The Gay thingy from the USA? In the small country of the Netherlands, surely we wouldn’t get this disease, right?! But unfortunately, denial is not always the answer.

Moshi, Tanzania
In the meantime, Dr Howlett identified 200 female prostitutes as potentially infected. The idea that a disease could have preference for a sexual orientation is classified as ridiculous. Still today the biggest infected group in this country is women.

California, United States of America
Back to our American friends. It appears to be difficult to get political attention and money to conduct decent research. Since the disease is primarily seen in Homosexuals in this country, the Christians call it the Wrath of the Jedi Khan, wait, no sorry, a wrath of God (I always confuse the two).
However, other patient groups start to get infected. Hemophilia patients, that receive blood transfusions very often, get infected. This proves that the disease is blood transmittable and is not per se related to having sex with men. Regardless, the rule is started that gay men are excluded from being a blood donor. A personal frustration of mine seeing that I have female friends that are at more risk of becoming HIV infected than my best friend that spend years spooning his long-term partner.

1983, World
Apparent is that the term GRID didn’t quite cover the problem and a new abbreviation is introduced to the world: CD (Compact Disc). Oh, and; AIDS: Acquired Immuno Deficiency Syndrome, caused by the Human Immunodeficiency Virus (HIV).

1994, TLC
The newly formed girl group TLC try to help the world with their “Waterfalls” by singing about dangerous lives and the consequences of this, including HIV. In an attempt to cast of the stigma around the disease, they sing about a girl infecting a boy.

Read for yourself:
Little precious has a natural obsession for temptation
But he just can’t see
She give him loving that his body can’t handle
But all he can say is, “Baby, it’s good to me”
One day he goes and takes a glimpse in the mirror
But he doesn’t recognize his own face
His health is fading and he doesn’t know why
Three letters took him to his final resting place 

Other songs about HIV/AIDS:
Madonna – In this life
Elton John – The last song
Bruce Springsteen – Streets of Philidelphia
U2 – One
Acda en de Munnink – Niemand sterft aan liefde
Janet Jackson – Together again
And many more.

That’s the history, this is how we as a species got in contact with this new virus that changed many lives forever. But stay tuned, the story continues next blog!

IMAGE: APAP PHOTO/RICK MAIMAN

 

One dog bite away from death; Rabies and why life is unfair

A couple of weeks ago I witnessed the most terrible infection I have ever seen. It also reminded me, in a hardcore fashion, of the difference between living in a Western country or being raised in a low resource environment. What was it about? Dogs, bites, rabies. The bottom-line of this blog? Sometimes life is unfair.

A young boy was brought to the clinic on the Thai/Myanmar border one month after he had been bitten by a street dog. The father had killed the dog immediately, but they hadn’t come to the clinic for care. 

I’ve worked for seven years in Dutch hospitals dealing with patients. Some severely ill, some having a hard time accepting they weren’t (frustratingly big group). All these patients have one thing in common; they never worried about costs of diagnostics and treatment. They live in a country where all necessary (and sometimes unnecessary) tests can be done and almost all therapies are paid for.

On the Thai/Myanmar border things are different. Not all the tests and treatments are available, and those that are cost money. Might not be a lot of money in the eyes of the Westerners, but here many families don’t have money. People don’t come to the hospitals because they are afraid of what it will cost, or they wait too long to come.

When the family did come, it was too late. The boy suffered from rabies. A disease that you can’t diagnose until you have symptoms and once you have symptoms, death is inevitable.

Rabies is transmitted from mammals. Usually dogs or cats but also bats and monkeys. They bite you or lick you and the virus goes into your nerve-system, starting its travels towards the brain. When it reaches the brain, it’s over. The whole travel is asymptomatic for the patient and no blood test is helpful. When it reaches the brain, most of the time the patients become highly agitated, raging and the jaw muscles stop functioning causing patients to drool. But the most interesting feature is that they become afraid of water. Yes, really.

When I offered a bottle of water to the small boy after he didn’t drink for two days he turned his head away. The boy was captivated by fear.  It was a terrible sight.

Prevention
There are two ways of preventing rabies; Pre-exposure and Post-exposure. With Pre-exposure you get three vaccines now and if you ever get bitten, go to a clinic/hospital within 48 hours and get Post-exposure vaccinations, no special immunoglobulins injection needed. Post-exposure means you go to a clinic within 24 hours after a bite to get a special immunoglobulins injection, followed by a series of vaccinations. Then you’re ok.
I used to think that the only advantage of the Pre-exposure was that you gain some time. And you can always reach a hospital within 24 hours nowadays, right? So, go Post-exposure… Well, my opinion changed.
Working first in Africa and now here, I see that the immunoglobulines that you absolutely need are very expensive and not available in most clinics. Time is scarce. This means that you have to travel to one of the bigger cities to get your treatment or even fly to a different country. Most of the tourists will be able to do that, albeit with effort and money (and probably nagging about the healthcare system). For locals this is not an option. Immunoglobulins already cost about a month salary here, just like the needed other vaccines. Add the travel costs and the hospitalization costs and families are bankrupted. Families with maybe five or more children. So not only time, also money is scarce. On the Thai/Myanmar border that is a dark and unfair combination.

The boy died the same night that he came to our clinic. A different and conflicting emotion rose, it was a sad feeling of being glad. Glad that the small young boy didn’t have to suffer much longer. That the family didn’t have to suffer much longer. The family didn’t complain, they were calm in the whole situation and they appreciated everything we tried to do, knowing what the outcome was going to be.

What a privilege to get vaccines easily, to get tests done if needed, to be able to get a diagnosis and a treatment  within 24 hours if needed. Appreciate what you have, because some don’t have the same privileges. They are one dog bite away from death. And yes, that’s life and it is unfair.