Empire State Medical Association Denounces Incomplete Research Claims made by Dr. Gilbert and Dr. Worobey on "HIV Coming from Haiti"

(www.nyesma.org)

The Empire State Medical Association is highly concerned about the claims by Michael Worobey that "AIDS virus invaded the United States in about 1969 from Haiti, carried most likely by a single infected immigrant who set the stage for it to sweep the world in a tragic epidemic".

We reject the comments that "researchers think an unknown single infected Haitian immigrant arrived in a large city like Miami or New York, and the
virus circulated for years -- first in the U.S. population and then to other nations."

Gilbert and Worobey, analyzed samples from only five of these Haitian immigrants dating from 1982 and 1983. They also looked at genetic data from 117 more early AIDS patients from around the world. This genetic analysis allowed them to calibrate the molecular clock of the strain of HIV that has
spread most widely, and calculated when it arrived first in Haiti from Africa and then in the United States. The researchers virtually ruled out
the possibility that HIV had come directly to the United States from Africa, setting a 99.8 percent probability that Haiti was the steppingstone.

For Haiti, the history of HIV/AIDS represents stigma, discrimination, and racism. In 1982, scientists at the Centers for Disease Control (CDC)
incorrectly inferred that Haitians were at increased for acquiring HIV as a racial group (1). HIV/AIDS therefore became known as the "4H Disease",
affecting homosexuals, heroin addicts, hemophiliacs, and Haitians.

This resulted in unprecedented national stigmatization and devastating economic,
social, and psychological consequences, decimating the tourist industry in this island nation. As reported at the time: "Haiti has been made an
international pariah by AIDS. Boycotted by tourists and investors, it has lost millions of dollars and thousands of jobs at a time when half the work
force is jobless. Even exports are being shunned by some (2)."

In 1985,when it became clear that Haitians share the same risk factors as other groups, the CDC dropped the Haitian association, but it was too late. HIV
and Haiti were inextricably linked in the minds of the general public. Haiti's economy has never recovered.

Gilbert et al once again link HIV and Haiti, stating: "Subtype B likely moved from Africa to Haiti in or around 1966" and then on to the U.S. Their entire hypothesis is based on virus isolated from five Haitian-Americans who were living in Miami in 1982-83. No other information is provided except
that they "entered the U.S. after 1975 and progressed to AIDS by 1981 and hence were presumably infected with HIV-1 before entering the U.S."

A host of questions remain. What were their risk activities? Where had they traveled? Did they have sex with Americans in Haiti? We do know that the
average time of progression of HIV infection to AIDS and to death in the pre-ART era was 4.5 and 7.4 years, respectively - these intervals are consistent with the five subjects acquiring the infection in the U.S, which limits the validity of their findings (3).

The authors go on to state: "The HIV-1 epidemic in Haiti exhibits a greater range of viral genetic diversity that the rest of the world's subtype B combined". The authors have not studied the virus in Haiti. Where are the data to support this claim?
They also state that their aim is to combine phylogenetic, molecular evolutionary, historical, and epidemiological perspectives in an attempt to
reconstruct the history of the subtype B pandemic. However, epidemiology studies conducted in Haiti do not support the author's hypothesis.

If the virus was in circulation in Haiti since 1966, there would not have been a much higher male: female ratio in the early years of the epidemic (80% of
the first Haitian patients were male in the early 1980's) which rapidly generalized as they spread the virus to their female partners (4,5). In addition, reviews of large samples of banked blood from the 1970's failed to yield a single case of HIV and thousands of autopsies did not diagnose an AIDS defining illness until 1978 (6).

Furthermore, only one case of Kaposi's sarcoma (KS) was noted by Haitian dermatologists prior to 1979 (7). KS is easily recognizable and it would not have been missed by Haitian dermatologists for over a decade. Haiti has overcome enormous obstacles and mounted one of the world's most successful responses to the HIV/AIDS epidemic.

Yet, the authors restate prejudices advanced two decades ago in the publication of Pitchenik et al
(8): "Haitians in Haiti and elsewhere are at risk of AIDS". People of all ethnicities in every country are at risk. Scientists need to be very responsible in their assertions, lest they do great harm.