drew little notice at the time. No one yet realized how devastating blood-product contamination could be. Nor did the CDC’s Morbidity and Mortality Weekly Report mention it, a decade later, when breaking the news that Haitians seemed especially at risk for the mysterious new immune-deficiency syndrome. Randy Shilts didn’t mention it in And the Band Played On. The only allusion to Haitian blood plasma that I recall, from the years before Jacques Pepin’s book, came during my conversation with Michael Worobey in Tucson.
Shortly before publishing on DRC60 and ZR59, Worobey coauthored another notable paper, dating the emergence of HIV-1 in the Americas. The first author was a postdoc named Tom Gilbert, in Worobey’s lab, and in the anchor position was Worobey himself. This was the work, based on analyses of viral fragments from archived blood cells, that placed the arrival of HIV-1 in Haiti to about 1966, give or take a few years. It appeared in the Proceedings of the National Academy of Sciences. Soon afterward, Worobey got a peculiar email from a stranger. Not a scientist, just someone who had caught wind of the subject. A reader of newspaper coverage, a listener to radio. “I think he was from Miami,” Worobey told me. “He said he worked in an airport that dealt with the blood trade.” The man had certain memories. Maybe they haunted him. He wanted to share them. He wanted to tell Worobey about cargo planes arriving full of blood.
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The next leap of the virus was small in distance and large in consequence. Port-au-Prince is just seven hundred miles from Miami. A ninety-minute flight. Part of the project that Tom Gilbert undertook, in Worobey’s lab, was to date when HIV-1 had arrived in the United States. To do that he needed samples of old blood. Whether the blood had reached America in bottles, in bags, or in immigrant Haitians didn’t much matter for this purpose.
Worobey, serving as Gilbert’s adviser, remembered a study of immunodeficient Haitian immigrants that had been published twenty years earlier. It had been led by a physician named Arthur E. Pitchenik, working at Jackson Memorial Hospital in Miami. Pitchenik was an expert on tuberculosis, and beginning in 1980 he noticed an unusual incidence of that disease, as well as Pneumocystis pneumonia, among Haitian patients. He sounded the first alarm about Haitians as a risk group for the new immunodeficiency syndrome, alerting the CDC. In the course of clinical work and research, Pitchenik and his colleagues drew blood from patients and centrifuged it, separating serum from cells, so they could look at certain types of lymphocyte. They also froze some samples, on the assumption those might be useful to other researchers later. They were right. But for a long time no one seemed interested. Then, after two decades, Arthur Pitchenik got a call from Michael Worobey in Tucson. Yes, Pitchenik said, he would be glad to send some material.
Worobey’s lab received six tubes of frozen blood cells, and Tom Gilbert managed to amplify viral fragments from five. Those fragments, after genetic sequencing, could be placed into context as limbs on another family tree—just as Worobey himself would later do with DRC60 and ZR59, and as Beatrice Hahn’s group was doing with SIVcpz. It was molecular phylogenetics at work. In this case, the tree represented the diversified lineage of HIV-1 group M subtype B. Its major limbs represented the virus as known from Haiti. One of those limbs encompassed a branch from which grew too many small twigs to portray. So in the figure as eventually published, that branch and its twigs were blurred—depicted simply as a solid cone of brown, like a sepia shadow, within which appeared a list of names. The names told where subtype B had gone, after passing through Haiti: the United States, Canada, Argentina, Colombia, Brazil, Ecuador, the Netherlands, France, the United Kingdom, Germany, Estonia, South Korea, Japan, Thailand, and Australia. It had also bounced back to Africa. It was HIV globalized.
This study by Gilbert and Worobey and their colleagues delivered one other piquant finding. Their data and analysis indicated that just a single migration of the virus—one infected person or one container of plasma—accounted for bringing AIDS to America. That sorry advent occurred in 1969, give or take about three years.
So it lurked here for more than a decade before anyone noticed. For more than a decade, it infiltrated networks of contact and exposure. In particular, it followed certain paths of chance and opportunity into certain subcategories of the American