Outbreak? AIDS, Africa, and the Medicalization of Poverty

The World Bank predicts that historians will mark the second half of the twentieth century as a time of unprecedented medical triumph and of terrifying medical tragedy. In both the triumph and the tragedy, Africa is center stage. On October 26, 1977, a man with smallpox was quarantined in a small village in southern Somalia. He survived; and as health specialists waited anxiously, no new cases of the disease emerged anywhere else. Smallpox transmission had been entirely interrupted. For the first time, humans had eradicated a disease. Just a few years later, the medical community identified (acquired immunodeficiency syndrome). The justification for clustering together such heterogeneous diseases as Kaposi's sarcoma, lymphoma, and dementia as AIDS was their sudden appearance among gay men and an epidemiological profile that suggested a virus. There was an active effort to unify this disparate group of diseases by finding a singular etiological agent. A series of likely agents was proposed: cytomegalovirus (CMV), human T-cell leukemia virus (HTLV-1, then HTLV-3), and lymphadenopathy-associated virus (LAV). None of these agents had much institutional support until April 1984, when Robert Gallo of the National Institutes of Health and Margaret Heckler, the United States Secretary for Health and Human Services, announced that was caused by a newly discovered retrovirus called HIV (human immunodeficiency virus), which all sufferers were thought to carry in their blood. Since Kaposi's sarcoma, a leading AIDS-indicator disease, was known to occur in East and central Africa, scientists speculated that HIV had originated there. Since then, the association of and Africa has become almost reflexive;