"Patient Zero" Cleared of Starting the U.S. AIDS Epidemic

Debunked Myth Helped Fuel Gay Stigma Worldwide

From the earliest days of the AIDS epidemic, gay men were regularly implicated in the spread of the disease to the larger U.S. population. This belief was only strengthened by reports in 1980s that a French-Canadian flight attendant named Gaëtan Dugas had been identified as the disease's "Patient Zero."

Activists calling for increased AIDS research
Barbara Alper / Getty Images

While evidence over the past 20 years had largely dispelled the myth that Dugas was the source of the North American outbreak, it was only in 2016 that a group of genetic scientists offered definitive proof.

A research team from the University of Arizona conducted a screening of over 2,000 blood samples collected from gay men in San Francisco during the 1970s. Their analysis provided a genetic footprint of the virus as it spread throughout this population of men, changing and mutating as it was passed from one individual to the next.

The researchers were able to conclude that the disease had likely leaped from the Caribbean well before Dugas was even infected. They also showed that the virus found in his blood had a high genetic variability compared to samples taken from other men in the study group.

This proved that Dugas had, in fact, been infected with a virus that had been circulating in the population for some time. Had Dugas been the source of the outbreak, his virus would not have had the genetic imprint of an otherwise well-disseminated pathogen.

How Public Bias (and a Typo) Created the "Patient Zero" Myth

At the time when the "Patient Zero" myth first started circulating, public fears about the disease were high. Not only were people coming to grips with the fact that the "gay cancer" was now being seen in other populations, they were faced with almost daily reports that linked the disease to not only gay men but to other stigmatized groups, such as immigrant Haitians and injecting drug users.

Blame for the spread of infection was rampant, with public opinion often split between who were the "innocent" victims of HIV (children, hemophiliacs) and those who were not. Against this social backdrop, reports that a gay man had been confirmed as the "source of AIDS" fueled a narrative that many were only too eager to embrace.

What made the myth all the more frustrating was the fact that it was never actually based on science; it was based on a typo.

In 1984, when officials with the U.S. Centers for Disease Control and Prevention first began tracing the sexual network of 40 gay men confirmed to have HIV, Dugas was notated as "patient O," with the letter "O" simply indicating "(from) Out(side) of California"

However, when the chart was finally laid out, Dugas' name happened to be at the center of the cluster of infections. This apparently led to a transcription error in which Dugas was incorrectly identified as "patient 0" (zero), and not "patient O" as was intended.

The fallout from the error was only amplified with the release of the novel And the Band Played On by Randy Shilts, which recounted the early AIDS epidemic and portrayed Dugas as a nihilistic sexual predator only too happy to spread the disease:

"Club Baths, San Francisco, November 1982 . . . When the moaning stopped, the young man rolled over on his back for a cigarette. Gaëtan Dugas reached up for the lights, turning up the rheostat slowly so his partner's eyes would have time to adjust. He then made a point of eyeing the purple lesions on his chest. 'Gay cancer,' he said, almost as if he were talking to himself. 'Maybe you'll get it too.'"

Shilts went even further to proclaim that Dugas had "played a key role in spreading the new virus from one end of the United States to the other."

The critical praise received for both the book and subsequent film only solidified Dugas as the archetypal villain of the crisis, while tacitly placing blame on the sexual excesses of the gay community itself. In their review of the book, the National Review dubbed Dugas "the Columbus of AIDS," while the New York Post went so far as to declare him "The Man Who Gave Us AIDS."

In both instances, the media highlighted the "omnipresent carnality" of the gay community as described by Shilts (who himself only disclosed his HIV status shortly before his death in 1994).

The Enduring Impact of the "Patient Zero" Myth

So strongly was the "Patient Zero" myth embraced that its impact has been felt well beyond the U.S. borders. In parts of Africa, where both infection rates and anti-gay sentiments run high, "Patient Zero" has long been used as a means by which to blame and even punish homosexuals for the rising epidemic.

As recently as 2011, Dr. Sam Okuonzi of Uganda's Health Services Committee declared that "very first AIDS patient… called Gaetan Dugus (sic)… referred to as Patient Zero" was proof that HIV spread from the U.S. to Africa as a result of homosexual sex.

Similar anti-gay claims were made in Zimbabwe, when in 2015 Health Minister David Parirenyatwa insisted that homosexuality was the cause for the 28% infection rate in prisons, despite denying inmates condoms to better protect themselves.

Even in the U.S., the assignation of blame has given rise to anti-gay bias, including the long-held belief that bisexual men act as a "bridge of infection" to heterosexual women. While these and other myths have largely been disproved, they continue to fuel a defamatory view of gay sexuality as being either unclean, irresponsible, or inherently promiscuous.

Blame and stigma continue to inform the public perception of HIV. The very fact that the U.S. only officially altered its gay blood ban in December 2015 demonstrates that even science can be displaced by unwarranted fears and the perpetuation of negative stereotypes in the "interest of public health." Such views pay further evidence to HIV stigma. About 15% of the 1.1 million people living with HIV in the United States today are not aware they are infected. High infection rates continue to plague the gay community (particularly gay men of color).

Whether the exoneration of Gaëtan Dugas will alter these negative perceptions is unclear. What is clear is that the scapegoating of "Patient Zero" serves as yet another dark reminder of how closely prejudice and infection are linked, establishing those "had it coming" in order to justify the inaction of a government or of us as individuals.

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  1. Worobey M, Watts TD, McKay RA, et al. 1970s and 'Patient 0' HIV-1 genomes illuminate early HIV/AIDS history in North AmericaNature. 2016;539(7627):98-101. doi:10.1038/nature19827

  2. How researchers cleared the name of HIV Patient ZeroNature. 2016;538(7626):428. doi:10.1038/538428a

  3. Okunonzi SA. Uganda: origin of HIV – myth and reality. The Independent (Kampala). Published July 9, 2011.

  4. Mochone T. Minister: homosexuality fueling HIV infections in Zimbabwe Prisons. Voice of Africa. August 14, 2015. 

  5. HIV.gov. Too many people living with HIV in the U.S. don’t know it. Published June 10, 2019. 

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