a vein, not just a muscle), the most direct method of drug delivery and also the best for unintentionally transmitting a blood-borne virus.
All those injections, according to Pepin, might account for boosting the incidence of HIV infection beyond a critical threshold. Once the reusable needles and syringes put the virus into enough people—say, several hundred—it wouldn’t come to a dead end, it wouldn’t burn out, and sexual transmission could do the rest. Some experts, including Michael Worobey and Beatrice Hahn, doubt that needles were necessary in any such way to the establishment of HIV in humans—that is, to its early transmission from one person to another. But even they agree that injection campaigns could have played a role later, spreading the virus in Africa once it was established.
This needle theory didn’t originate with Jacques Pepin. It dates back more than a decade to work by an earlier team of researchers, including Preston Marx of the Rockefeller University, who proposed it in 2000 at the same Royal Society meeting on AIDS origins at which Edward Hooper spoke for his oral polio vaccine theory. Marx’s group even argued that serial passage of HIV through people, by means of such injection campaigns, might have accelerated the evolution of the virus and its adaptation to humans as a host, just as passaging malarial parasites through 170 syphilis patients (remember the crazed Romanian researcher, Mihai Ciuca?) could increase the virulence of Plasmodium knowlesi. Jacques Pepin picked up where Preston Marx left off, though with less emphasis on the evolutionary effect of serial passage. Pepin’s main point was simply that dirty needles, used so widely, must have increased the prevalence of the virus among people in Central Africa. Unlike the OPV theory, this one hasn’t been discredited by further research, and Pepin’s new archival evidence suggests that it’s highly plausible, if unprovable.
Most of those injections for trypanosomiasis occurred in the countryside. City dwellers were less exposed to trypanosomiasis, partly because the tsetse fly doesn’t thrive in urban jungles as well as it does in green ones. One question that needed answering, therefore, was whether any such mania for injecting had also gripped Léopoldville, where HIV met its most crucial test. Pepin’s answer is unexpected, interesting, and persuasive. Never mind trypanosomiasis. He discovered a different but equally aggressive campaign of injections, aimed at limiting syphilis and gonorrhea in the city’s population.
In 1929, the Congolese Red Cross established a clinic known as the Dispensaire Antivénérien, open to women and men for the treatment of what we used to call venereal diseases. Located in a neighborhood on the east side of Léopoldville, near the river, it was a private facility providing a public service. Male migrants, arriving to seek work, were required by city regulations to report to the Dispensaire for an exam. Anyone experiencing symptoms could visit the place voluntarily, and there was no charge for treatment. But the bulk of the caseload, according to Pepin, “consisted of thousands of asymptomatic free women who came for screening because they were required to do so by law, in theory every month.” The colonial government accepted prostitution as an ineradicable fact but evidently hoped to keep the trade hygienic—so les femmes libres were obliged to get checked.
If a person tested positive for syphilis or gonorrhea, he or she would be treated. But the diagnostic testing was imprecise. Any free woman or male migrant who had once been exposed to yaws (caused by a bacterium very similar to the syphilis bacterium, but not sexually transmissible) might flunk the blood test, be classed as syphilitic, and receive a long course of drugs containing arsenic or bismuth. Harmless vaginal flora could be mistaken for gonococcus, the agent of gonorrhea. A woman diagnosed gonorrheic might be injected with typhoid vaccine, or a drug called Gono-yatren, or (even Jacques Pepin seems puzzled by this one) milk. During the 1930s and 1940s, the Dispensaire Antivénérien administered more than forty-seven thousand injections annually. Most were intravenous. Straight into the blood. With increased migration to the city following World War II, the numbers rose. In the early 1950s, the quackier remedies (intravenous milk?) and the metallic poisons gave way to penicillin and streptomycin, which had longer-lasting effects and therefore meant fewer shots. The campaign peaked in 1953, at about 146,800 injections, or roughly 400 per day. Many if not most of those injections were administered to femme libres, sex workers, ladies of hospitality, however you want to describe them, who had multiple male clients. They came and went.