The Marx/Drucker theory of iatrogenic spread through unsterile needles, and the recent intervention by Professor David Gisselquist, who claims that most HIV infections in Africa are caused through this same route
by Edward Hooper
The most interesting counter-argument against the OPV theory of origin of AIDS has been put forward by two American scientists, Preston Marx and Ernest Drucker. [See: “Serial human passage of simian immunodeficiency virus by unsterile injections and the emergence of epidemic human immunodeficiency virus in Africa”, by P.A. Marx, P.G. Alcabes and E. Drucker, Phil. Trans. Roy. Soc. Lond. B; 2001; 356; 911-920.] They take the cut hunter/natural transfer scenario (which theoretically could have occurred at any time in the last few million years, since chimps and humans became separate species), and invest it with a necessary time-frame. They do this by proposing that there was an amplification factor, this being the arrival in Africa of disposable needles (which were none the less reused). Apparently needle deliveries to Africa experienced an exponential rise in the 1950s.
Marx and Drucker propose that the SIV-infected hunter or bushmeat-seller (or someone infected therefrom) went to a clinic and was injected with a needle that was then reused on somebody else. This process would then have been repeated a few more times, which potentially might have allowed the human-adapted SIV to become more pathogenic or transmissible. Theirs is a theory not of iatrogenic (physician-caused) origin, but of iatrogenic spread. It is the only version of “cut hunter” that seems even reasonably plausible, for otherwise cut hunter supporters have to rely on urbanisation as the factor that allowed a primate virus that had recently passed to humans suddenly to explode, and begin its awful global march. In fact, they would require this to happen not just once, but four times, and almost simultaneously, because of the four different HIVs that have emerged and become established in Africa within the last several decades. (Phylogeneticists identify four separate outbreaks of HIV infection, relating to at least four transfers of primate SIV to humans. First there is the pandemic strain, HIV-1 Group M, with the “M” standing for “Main” group. Then come the minor outbreaks, which have infected between a few hundred thousand and a few dozen persons, and which are caused by HIV-2, HIV-1 Group O (for “Outlier Group”), and HIV-1 Group N (for “New Group”). HIV-2 is similar to the SIV of the sooty mangabey, a West African monkey, whereas all the HIV-1s are closely related to chimpanzee SIV.)
In fact, the minor HIV outbreaks fit rather well with the OPV theory, for it is known that experimental French-made polio vaccines were tested in the fifties in both French Equatorial Africa and French West Africa, which represent the epicentres of the three minor outbreaks. Among the primates the French were using for their research were chimps and sooty mangabeys.
The Marx/Drucker theory has been embraced with rather unseemly passion by the scientific establishment, even though it involves the medical profession playing a key role. This may be because the theory is non-specific, so no individual physicians or institutions can be held responsible. And there is also an unspoken subtext – that the physicians in question were probably not western ones. However, the reuse of unsterilised needles did not happen only in the Belgian Congo, so this theory is unable to explain the strong correlation between early HIV/AIDS, and the 27 known CHAT vaccination sites.
In short, the Marx theory is based on a temporal, but not a geographical, coincidence. One might, with just as much merit, propose that rock-and-roll, which emerged in the fifties, prompted more sex, more HIV spread, and thus an Elvisogenic epidemic.
In recent days, there has been a new spin on the needles debate, sparked by Professor David Gisselquist, who has been variously described as an anthropologist, an independent consultant, and an HIV specialist. He heads a group of American academics who conducted a survey of various epidemiological studies of HIV, which they combined with the rather contentious proposal that levels of sexual activity in Africa can be roughly equated with those in America and Europe. And they came up with three papers, and a remarkable claim, which elicited much press coverage. [Three papers by Gisselquist et al.; Int. J. STD AIDS; 2003; 14; 144-147, 148-161 and 162-173.] In marked contrast to previous analyses, they concluded that 60% of all HIV spread in Africa was caused by unsterilised needles and unscreened transfusions, and only about 30% by sex. (The accepted ball-park figures were 10% for parenteral – or blood-borne – transmission and 80% for sexual, so this represented a sea-change.) Gisselquist has been quoted by Reuters as saying: “For the last 15 years, the AIDS establishment somehow got on to the notion that we need to scare people about sex to prevent HIV transmission”.
In reality, however, it seems to be Gisselquist who is scaring people, including some of his co-authors. I phoned one of them, whom I happened to have interviewed several years before, and was told that there had been disagreements about the final published versions of the articles, and that some of the authors had had to withdraw their names from certain papers. There was also, I was told, concern about Gisselquist’s press statements. My informant told me that Gisselquist had “only moved across to the medical field two years ago”. Later, I checked on the Web, and discovered that before that he had been a “consultant at the World Bank”, an economist who wrote papers about how to save the Russian economy.
The Gisselquist group provides a long list of surveys they have examined, and impressive pages of mathematical formulae, but their research smacks of ivory tower theorising, and a lack of experience of the African epidemic on the ground. They highlight early HIV surveys conducted during 1984-8, but the conclusions of most persons who worked on AIDS in Africa during that period are very different. In Uganda, which was probably the first country in the world to experience a visible community-wide AIDS epidemic, almost every survey from 1985 onwards revealed an age-prevalence pattern comprising intermediate levels of HIV-1 infection for 0-to-4-year-olds (presumably largely caused by perinatal spread), which plummeted to virtually zero for 5-to-14-year-olds, and then rose steeply for the ages of 15 to 45 for women, and 20 to 55 for men, before tailing off to zero for older individuals. Yet all age groups and both sexes would have experienced comparable levels of unsterile injections and unsafe transfusions. This “Christmas tree” pattern, which was recognised right across the continent in the 1980s, is strongly suggestive of a pathogen that is spread largely by the sexual route, with only minor roles played by perinatal and parenteral spread. Another powerful clue is the fact that HIV infection levels among Ugandan teenage girls were often many times higher than among teenage boys, which parallels the earlier onset of sexual activity among African females.
The Gisselquist co-author with whom I spoke told me his personal belief was that 20% to 30% (not 60%) of African HIV might be transmitted through unsafe medical practices. My own belief (based on many years of studying African epidemiological surveys) is that parenteral spread may have increased in importance since the start of the epidemic, and that nowadays it might cause between 10% and 20% of new infections. I would certainly defend the principle of debating such issues, for public health decisions must be based on sound information and data. And by all means let us fight to improve the quality of medical care and condom provision in Africa and elsewhere, and thereby hopefully reduce the transmission of HIV and other pathogens (whether by dirty needles, or unprotected sex). But most of those who have studied the African epidemic at close range believe that it is Gisselquist’s estimates that are speculative, and that some of his public utterances are simply irresponsible, given how many people are eager to hear, dying to hear, that unprotected sex is not that dangerous.
Of course, the more publicity that is given to claims that dirty needles are responsible for most of the HIV spread in Africa, the easier it becomes to promote the idea that dirty needles might also have sparked the epidemic. And there is clearly some linkage between the two theories, for one of Gisselquist’s co-authors is Ernest Drucker.
What is undeniable is that over the last two or three years a substantial body of scientists and medics, many from the USA, seem to be keen to promote an explanation for the origin of AIDS that, though avowedly iatrogenic, caused by the actions of physicians, involves no specific individuals or governments. No names, no scandal. Nobody held to account. No lawsuits.