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How would the medical community have responded? All of us that are investigative types were going to do the same thing that was done in 1980. We would immediately try to identify how it was spreading, how it was going from one person to the other, just as you would with tuberculosis or you would have with syphilis or gonorrhea. There was a certain amount of medical training that was available to describe the basic epidemiology of this disease.
Immunologically, could we have picked it up? Yes. Those afflicted were developing diseases that were uncharacteristic in normally healthy people, and that would have been identified. Would we have found the infectious cause? No. We did not have the technology or the background knowledge. The building blocks were not yet there for our knowledge of retroviruses and so on.
I do not think we would have identified the virus within two to three years. It would have taken 10 or 15 years. I think we would have struggled for a long time, and we would always have called it a syndrome of unknown etiology the way we call multiple sclerosis a syndrome whose etiology we do not know. For how long did we call peptic ulcers stress-related and not related to Helicobacter, until we found Helicobacter, and then everything changed. In that instance the bug was found first and then associated with the disease. It would have been a little different, but not the recognition of it.
How it would have been perceived by the public? Probably in the same way. The public was not very supportive of this disease or this segment of the population. There was a lot of outcry and criticism, people saying that this was God’s way of saying gays should not be doing this. I can remember articles in the lay press, and many criticisms about the way of life. Even the Haitians were getting the same kind of treatment. Here were these foreigners, they were getting this disease, and what were they doing here? Maybe this was God’s way of saying they should not be here. And the hemophiliacs, the Ryan Whites out there and how they were treated and shunned–that would have been the same in 1955 as it was in 1980. I do not think our society was any more receptive in the early 1980s than it would have been in the early 1950s. I just do not think it would have been as big an epidemic in the 1950s. I think there was a real social change from the norm in the free-love format that was occurring in the 1970s in the gay community. It started earlier in the heterosexual community, but eventually opened up with gays.
Harden: Now we want to turn to the international situation because, in that context, there is much more heterosexual transmission, and so physicians encountered a different picture. I want to return to Haiti. This will be another long question. Let me set it up.
We had a two-hour interview with Dr. Richard Krause, and he described the 10-day trip to Haiti in the spring of 1983, on which you and Cliff Lane accompanied him. He talked about the difficulties that you had getting cooperation from the Haitian physicians in seeing patients. He noted that the first three patients you saw were women and that three or four of the first 10 had tuberculosis. The two-part question is: Was this the first time, or was there some other time, when you realized that AIDS was an international problem? Then, would you begin to talk about the Haiti trip?
Quinn: There were reports coming out of Europe of this syndrome, and we knew the Haitians were getting it. It was pretty obvious to me that if Haitians were getting it, they had to be getting it in Haiti as well as in New York and other places in the U.S. But how did the Europeans link into it? With gays going back and forth, maybe it was transmitted that way; the shipment of blood products and things like that, because we are now talking about 1982 and 1983, and the recognition of it in the blood supply was occurring around that time as well.
But then it was Dick [Krause] who called me and said, “We have been asked to go to Haiti.” I guess the Haitians first came up to the NIH, to the Fogarty [International Center], is my recollection.
Harden: I believe so.
Quinn: And the Haitians objected to this. And the CDC came to the meeting. The NIH was there. I do not know who sponsored it. The Haitians came and they basically said, “We do not want the CDC. They are the ones who have labeled us. But we will allow a team of investigators from the NIH to come down and invite them to find out what is going on.” However, the CDC said, “We have to have at least one person on the team.” It was, I think, either [Dr. Albert] Al Saah or [Dr.] Harry Haverkos, or maybe both. Both of them were at the CDC at the time. Neither is there now, but back then they may have been part of the AIDS Task Force. So Dick accepted the invitation to go to Haiti. I think PAHO [Pan American Health Organization] was somehow involved. Dick asked me to join him.
I was being asked, I think, because I had the most clinical experience of anyone in the NIH group. Yes, [Dr. Anthony S.] Fauci and Cliff Lane and others had seen patients, but I had quite a big practice by that time. Not that I intended to. It was just that Hopkins was a nice place to go if you had this disease. So I had seen quite a bit. I was in the thick of it in terms of the investigation, so it made sense that Cliff and Dick and I, as members of the one institute, go to Haiti. But I vaguely remember that there was either Harry Haverkos and Al Saah who I think were both CDC [personnel]. That was the team that went down.
Dick is absolutely right. The first thing that we saw were these women, who were just wasted away, coughing, probably having Pneumocystis or tuberculosis or whatever, and we were told that they had tuberculosis. They showed us the X-rays. I never actually saw definitive proof of that, but it was suspected. I think Dick is absolutely right on that account. But, boom, it hit me that there was a comparison with the first woman with the disease that I had seen.
It brought home to me that, number one, this disease was not affecting just one gender; it was probably going to hit both. It looked like it was still sexually transmitted because the woman’s husband was usually also sick or had died, so I could link it back to that. We asked them lots of questions: Why were these women getting the disease if it was only supposed to be in gay men? Yet there were millions of other Haitians, who were not infected, who were not showing signs of the disease. Again, we did not know what the cause was at this point. So, as we were sitting back at the hotel, we talked about how this really looks like a sexually transmitted organism or an organism that heterosexuals are getting and homosexuals are getting that somehow gets into the blood supply through blood donation. Now, we were not talking about needles at that point, even though dirty needles are used in Haiti for medicinal purposes. But I think as we went around those clinics, it was clear to us that there was some evidence of heterosexual spread. Although we did not set up an investigation to pursue that, we laid the groundwork for future studies to develop and to investigate that.
I met [Dr.] Jean Pape, who was affiliated with Cornell and was doing studies there; [Dr.] Warren Johnson, who was his mentor; and [Dr.] Neil Halsey, who was doing a measles study in Haiti. So right in those early times I started to meet the other people, the Americans, who were working in Haiti on other related diseases. Jean Pape and Warren knew of my work of intestinal infections right away, and so we headed off and were starting to exchange information.
Then I returned to the U.S. with this impression in my mind that, yes, this disease was prevalent in Haiti. The way it was described was that gay men went to Haiti for vacations, and they went to these poor Haitians, who would do anything for some money, and would engage in homosexual acts even though the Haitian men might be heterosexual. Then the Haitian men would go back to their wives and infect them. The scenario, as I recall it, that the popular press and others got at the end was that this was still not “really a heterosexual disease.” Women were not spreading it to men. This was solely male to male and male to bisexual male, if you will, who then gave it to the woman. But the woman never gives it to the man. No one in 1983 thought that could happen that I can recall.
Harden: In the United States?
Quinn: In the United States or in Europe. After being in Haiti, we thought it was very possible, so we were calling it a heterosexual disease and maybe one that went both ways, because we saw equal numbers of men and women. Eventually, the longer we stayed down there, the more equally divided were the numbers of patients, male and female. We were saying, “This can’t all be going that way.” But that is what the lay press tended to think.
Then there was a report in Europe of Africans with the same disease who had come from Zaire and other places to Belgium, and France, and the patients were both men and women. That was all I needed to see. It was, I think, just one report, but that was enough for me. I felt this was not just a gay disease, and I doubted that this was dirty needles. But the only way we were ever going to find out was to go to Africa or go back to Haiti and set up good prospective long-term epidemiologic studies.
This was at the same time that people were talking about doing that anyway with gays, here in the U.S. and in Europe, that is setting up prospective cohorts and finding out how this was spread, what was causing it, and so forth. I think 1983 was a very instrumental year, early 1983, for setting up cohorts to investigate the epidemiologic as well as the clinical natural history of this disease.
Then I guess Dr. Krause probably filled you in, but this is an interesting story. [Dr.] Peter Piot had trained in Seattle, and our paths crossed. We met there, but we did not really share any particular research. But I had met him, he had met me, so we knew each other. I know a few other things from reading Laurie Garrett’s and other people’s books, as to what might have happened, but I was not privy to that. When he came to me–this is the way I remember it– everyone has their slightly different stories, but they are all very close.
My recollection is that Piot and I were talking about this spread of the disease, and that I had been in Haiti. I told him what I had seen, he told me what he was seeing in Belgium, and we were saying, “We really should set up a project in Africa.” He said, “I have been trying to do that. I can’t get funding for it. Do you know a way that I can?” I said, “I work for this man, Dr. Krause, who is interested in setting up projects overseas to help internationally to try and figure out what is going on. We were just in Haiti together and we talked about Africa, because many of these Haitians had lived in Africa.” I said, “Do you want to meet him?” He said, “Sure. If he’ll fund a trip, that would be great.” So I introduced Piot to Dick. Now, whether he went to Dick first and then they brought me in, I cannot remember–my recollection is that I introduced him to Dick, but it could have been the other way round. It was a long time ago. But it seems that Garrett thought that it went that way. Piot went to Dick and then Dick called me like he had called me for Haiti. Whatever. I do remember that we sat at a sidewalk cafe. Has Dick told you about this one?
Harden: I do not think so.
Quinn: It is really interesting. I was talking to Peter, and Dick was walking by with [Dr.] Jack Whitescarver, and we pulled them aside. We sat down and we planned the project to go into Zaire, to Kinshasa, and find out what was going on. [Dr.] Karl Western got involved in that. It was planned that we would all go to Antwerp first, meet with Peter in the Institute of Tropical Medicine, since I and my colleague, who had been appointed–[Dr. Frederick] Fred Feinsod, I think it was–was to join me. He was also new with the institute. We would get educated about what life was like in Zaire–that it was the former Belgian Congo, We got a real history education–what the diseases were there, and things like that. Then we would fly down to Kinshasa two days later.
Dick set up the funding for it; Ken Sell set aside some funding for equipment. I was to go as the clinician because I had seen all these AIDS cases in Haiti and in the U.S. Piot would go as the epidemiologist and as the person who had previously been in Zaire. Feinsod was another epidemiologist along to help with some of that work. There was a man named [Dr.] Henri Talman, who was also a clinician and who had seen a couple of Africans in Europe, and he was going to join me. So we had this team to go to Zaire.
Then, before we left, we got a phone call from HHS [Health and Human Services], [Secretary Edward] Brandt, saying, “We have your foreign travel notification in the office here. It is approved. But we have another one from the CDC–they are going to Zaire–from a man named Joseph McCormick. Do you know him?” “No, I do not know him.” “I do not want two agencies, the CDC and the NIH, tripping over each other. This has to be a joint thing. Please call him up and invite him.” I said, “Okay.” So I called Joe up and I said, “I know you are going. We are going. Why don’t we go together. Why don’t you join us in Antwerp.” He said, “Fine. Who are you working with?” I said, “Peter Piot. He’s the organizer.” He said, “Peter? I worked with him a long time ago. We worked on Lhasa fever and on Ebola fever. I know him fine.” “Okay, you guys know each other.” In fact, they did. They had worked together previously, in 1976, I think it was. So McCormick joined us and we flew to Zaire together.continued on Page 05
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