The syringes were rinsed and reused. This in a city where HIV-1 had arrived.
Six years later came the blood sample that yielded the HIV-1 sequence now known as ZR59. One year after that, DRC60. The virus had spread and diversified. It was at large. No one can say whether either of those two patients had ever visited the Dispensaire Antivénérien for a shot. But if they hadn’t, they probably knew someone who had.
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From this point the story gets huge and various, literally going off in all directions. It explodes out of Léopoldville like an infectious starburst. I won’t try to trace those diverging trajectories—a task for ten other books, with purposes different from mine—but I’ll sketch the pattern, and then focus briefly on one that’s especially notorious.
During its decades of inconspicuous transmission in Léopoldville, the virus continued to mutate (and probably also to recombine, mixing larger sections of genome from one virion to another), and those copying errors drove its diversification. Most mutations are fatal mistakes, bringing the mutant to a dead end, but with so many billions of virions replicating, chance did provide a small, rich supply of viable new variants. The campaigns of injectable drug treatments, at the Dispensaire Antivénérien and elsewhere, may have helped foster this process by transmitting the virus quickly into more human hosts and increasing its total population. The more virions, the more mutations; the more mutations, the more diversity.
The HIV-1 group M lineage became split into nine major subdivisions, now known as subtypes and labeled with letters: A, B, C, D, F, G, H, J, K. (Don’t confuse those, if you can help it, with the eight groups of HIV-2, designated A through H. And why are E and I missing? Never mind why. Such edifices of labeling get built piecemeal, like slums of cardboard and tin, not with architectural forethought.) As time passed, as the human population of Léopoldville grew, as travel increased, viruses of those nine subtypes emerged from the city, radiating outward across Africa and the world. Some of them went by airplane and others by more mundane means of transport: bus, boat, train, bicycle, hitchhiking on a transcontinental truck. Foot. Subtype A got to East Africa, probably via the city of Kisangani, halfway between Léopoldville and Nairobi. Subtype C spread to southern Africa, probably via Lubumbashi, way down in the Congolese southeast. Seeping across Zambia, achieving rapid transmission in mining towns full of workers and prostitutes, subtype C proliferated catastrophically throughout South Africa, Mozambique, Lesotho, and Swaziland. It went on to India, which is linked to South Africa by channels of exchange as old as the British empire, and to East Africa. Subtype D established itself alongside subtypes A and C in the countries of East Africa, except for Ethiopia, which for some reason became afflicted early and almost exclusively with subtype C. Subtype G got up into West Africa. Subtypes H, J, and K remained mostly in Central Africa, from Angola to the Central African Republic. In all these places, after the usual lag of years between infection and full-blown AIDS, people began dying. And then there’s subtype B.
Sometime around 1966, subtype B crossed from Léopoldville to Haiti.
How it did that is unknown, and can probably never be known, but Jacques Pepin’s archival burrowing provides new support for one plausible old scenario. When the Belgian government abruptly relinquished its African colony, on June 30, 1960, under the stern encouragement of Patrice Lumumba and his movement, tens of thousands of Belgian expatriates—almost an entire middle class of civil servants, teachers, doctors, nurses, technical experts, and business managers—found themselves unwelcome and uncomfortable in the new republic, and they began flooding homeward. Crowding the planes for Brussels. Their departure created a vacuum, since the Belgian regime had pointedly avoided educating its colonial subjects. There wasn’t a single Congolese medical doctor, for instance. Few teachers. The country suddenly needed help. The World Health Organization responded, sending physicians, and the United Nations (through its Educational, Scientific, and Cultural Organization, UNESCO) also began enlisting skilled people to work in the Congo: teachers, lawyers, agronomists, postal administrators, and other bureaucrats, technicians, and professionals. Many of those recruits came from Haiti. It was a natural fit: The Haitians spoke French as did the Congolese; they came from African roots; they had education but very little opportunity at home under the dictatorship of Papa Doc Duvalier.
During the first year of independence, half the teachers sent by UNESCO to the Congo were Haitians. By 1963, according to one