Newly published research is rewriting the earliest chapter of the historical account of how the AIDS epidemic began in the United States.

The work, detailed in a study released Wednesday, discounts the long-held notion that a French-Canadian flight attendant, whose story was highlighted in the seminal book “And the Band Played On,” brought the virus to the United States.

“This individual was simply one of thousands infected before HIV/AIDS was recognized,” said Richard McKay, one of the authors and a professor in the department of the history and philosophy of science at the University of Cambridge, in Britain.


The study, which was published in the journal Nature, found that attention for years focused on the flight attendant, Gaetan Dugas, because of a typographical mistake. Through a labeling error on Dugas’s case file, Patient O (the letter) became Patient 0 (zero) — and the characterization that he was the source of the US outbreak stuck in the popular press.

The “O” was meant to indicate that Dugas was from “outside of California,” where his case came to light when he was interviewed by public health officials studying the spread of the new disease among gay men in San Francisco.

Despite the fact the investigators never suggested Dugas had been the source of the outbreak, a mythology evolved, in part through the book and film version of “And the Band Played On,” which was written by journalist Randy Shilts, who contracted HIV and died in 1994. Those works and others depicted Dugas as having been cavalier about the spread of the new disease and painted him as a villain.

“Unlike the initial reports of the [San Francisco] cluster, media coverage of Shilts’s book strongly insinuated that this individual was the source of the North American epidemic and an exemplar of dangerous disease,” the authors of the new study wrote.

“However, we found that the HIV-1 genome from this individual appeared typical of US strains of the time…. In short, we found no evidence that Patient 0 was the first person infected by this lineage of HIV-1.”

Dr. Jacques Pepin, who has also written about the origins of the AIDS epidemic, called the study “excellent work,” saying it is amazing the team was able to find relevant blood samples from the late 1970s and harvest genetic sequences of HIV viruses from them.

He was not, however, surprised to learn Dugas was wrongly accused of starting the AIDS epidemic in the US.

“Nobody in the scientific world really believed that the Air Canada steward was really ‘Patient Zero’ for the epidemic in the USA, but that is the definitive proof that he was not Patient Zero,” said Pepin, an infectious diseases professor at the University of Sherbrooke, in Quebec, whose book “The Origins of AIDS,” was published in 2011.

“Hopefully, his family may find some relief when they hear about that study,” he said.

McKay, who is writing a book about Dugas that is slated for publication next fall, contacted Dugas’s surviving family to let them know about the study. In a previous interaction with them, they consented to let him quote from a letter Dugas wrote to a friend — in an earlier exploration of Shilts’ treatment of the Patient 0 character in his book — if McKay promised to include a note that they did not wish to speak to the media. Dugas died in 1984. Both of his parents have since died.

The findings from the new study were earlier reported at a scientific conference in Boston in March.

Gaetan Dugas
Gaetan Dugas Creative Commons

The first official word of a new and terrifying disease that was infecting men who had sex with men came in a dispatch from the Centers for Disease Control and Prevention in 1981.

The virus that become known as HIV — human immunodeficiency virus — was later recognized to have evolved from a virus that infected primates in sub-Sarahan African. The jump from primates to people is believed to have happened in the early 1900s.

Along with others, Michael Worobey, a University of Arizona professor who led the new study, has been working for years to retrace the path the virus took as it emerged from its source to fan out across the globe.

Worobey and colleagues tested blood samples taken in 1978 and 1979 from gay men in New York City and San Francisco as part of studies looking at the spread of hepatitis B in these populations.

The scientists tested the samples — drawn before the existence of HIV was known — for evidence of HIV antibodies.

Even then, 6.6 percent of the New York samples and 3.7 percent of the San Francisco samples were positive for HIV infection, suggesting the virus had been spreading for a while in these communities.

Video: A CBS report from 1987 on how epidemiologists identified Gaetan Dugas.

The team wanted to study the genetic sequences of the viruses in the blood. Plotting them against the sequences of the other HIV viruses can help to generate a timeline for an outbreak because scientists know the rate at which the virus mutates.

But viral RNA degrades over time and initially Worobey and his team could not extract enough genetic material to generate full genetic sequences from the RNA in the blood samples. After developing a new technique they describe as “jackhammering,” they managed to come up with full sequences for eight patients — five from New York and three from San Francisco.

There is only one HIV virus sequence older than these in the viral genetic databases. The information that can be gleaned from this trove of sequence information suggests the virus arrived in the US around 1971 — before Dugas became a flight attendant and began his travels.

The evidence suggests the virus came to the United States from the Caribbean. The amount of differences among the sequences indicates the virus had been spreading for several years by the late 1970s when the blood samples were taken, the authors said.

Worobey and his coauthors studied the genetic sequence of the virus that infected Dugas and compared it to the stored blood samples.

“We found no evidence that Patient 0 was the first person infected by this lineage of HIV-1,” they wrote in the paper.

Worobey cautioned that efforts to try to trace the origins of an outbreak shouldn’t be used to target blame.

“No one should be blamed for the spread of a virus that no one even knew about,” he insisted.

Leave a Comment

Please enter your name.
Please enter a comment.

  • I’ve studied this subject for years with another person “RN ” we learned that CDC had this virus in there labs ..I strongly believe that it was government to control humans race ..two race’s Blacks and Homosexual that was the two most Hated human beings at that time period..We have over come and through and still fight ..Look at the beginning of what the doctors and pharmaceutical companies,,now look at our debt in health care , backfired in there face .I lived with HIV since 1988 I’m 49 yrs old .?

  • I do not believe that it was indicated that he was patient zero. It was just noted that he was in some manner sexually connected with dozens of the first few cases in the early 1980’s. He traveled the world and had sex with Any hundreds of different men. Even after he knew he was sick he continued his sexual activity. It is thought that he had a considerable role in the early spreading of the disease.

  • And the the authors continue spreading the notion of Mr. Dugas as Patient 0 (zero) when they say “We found no evidence that Patient 0 was the first person infected by this lineage of HIV-1,” they wrote in the paper.

  • I always thought it was around much longer than it was thought to be. I always think of others who died, ie Montgomery Clift, who from what I have read, wasted away before he died in 1966…..but not just him…..

  • This is typical for human mind to deal with unknown, especially a scary things or situation which they can not contain. Always they search for scapegoat to calm their untamed anxieties. This is how Xenophobia work in the developed countries, and other traditional communities believes in “witchcrafts. It is sad indeed…

  • If I remember the movie correctly, they didn’t imply that the flight attendant was the one cause of HIV in the US; but that, because of his constant travels and very active sex life, he probably inadvertently, more than any other single individual, ended up having helped to spread the virus as fast as it did in the US.

    • That’s correct. While I have read the book, it has been a loooong time ago. But my recollection from the film adaptation is a lot more recent. In no way does the film imply or even suggest that Dugas was the source of the epidemic in the U.S. It only indicated that he was “patient zero” in a particular cluster that Will Darrow was investigating for the purposes of proving that the disease was sexually transmitted.

  • I believe Radiolab did a show on this very subject about two years ago. Not to discourage the author of this article because I know Radiolab is not equivalent to a scientific study, but the episode “Patient Zero” was quite informative. I believe they tracked the virus back to the Congo around 1910.

  • I always thought it was a plausible theory that the events in New York surrounding the bicentennial in 1976, with the arrival of Tall Ships and thousands of visitors from far and wide, is what led to launching the AIDS epidemic in America.

  • That there was ever a search and report trying to pin an epidemic as tragic as AIDS on one person makes me sad–sadder still that it turns out to have identified the wrong person. Epidemics require lots of sources and lots of viable hosts.

A roundup of STAT’s top stories of the day in science and medicine

Privacy Policy