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We got there, went to the main hospital, Mama Yemo Hospital, and interviewed the chief of medicine there. He showed us all his AIDS cases. We went on rounds and I kept saying, “AIDS, AIDS, AIDS, AIDS.” The cases were just lined up. It overwhelmed what I had seen in Haiti. It was far, far more devastating, with people just wasting away completely.
I had brought some laboratory equipment along, and we tried to set it up. We had some problems with the monoclonal antibodies because African blood types are different than American blood types, and so no one had any CD4 cells, initially, because the monoclonals were not picking them up. That got corrected eventually. The patients did have CD4 cells, and the cells were not zero.
Hannaway: Was that what you thought initially?
Quinn: At first we were thinking, “My gosh.” But even the healthy people had no CD4 cells, so we knew we had a reagent problem. But that got taken care of. We stored all the blood, and we tied it together. Peter and I and Joe became the leaders of the team, each one of us taking on a different responsibility.
Hannaway: How was that division organized?
Quinn: Joe had never seen a case of AIDS before, nor had Peter had much experience, so I clearly was the “AIDS person.” Peter, again, was the Belgian-Zairian connection, playing those politics; and Joe was the American-Zairian politics, which are very important in doing a foreign investigation–very, very important. I stayed out of the politics part because I did not even know how to speak French. I was in the dark whereas those two were negotiating left and right through the Belgians and through the Americans and the Zairians to allow us to do our work, because Africans did not want to be labeled as a risk group like Haitians, which was what was happening in Europe. There was a lot of sensitivity.
So the two of them handled the politics. Joe was good at setting up the repository and helping me with the laboratory part, whereas Peter was very good at interviewing different doctors down there and finding out what had they been seeing, and trying to track how many cases there had been in the past. Because, from my perspective, Peter was the original instigator of this investigation, and, as we built our clinical description of what we were seeing and how many cases we were seeing and so forth, I think it was pretty unanimous among the three of us that Peter should write the first paper and that it should be in the Lancet. He did that, and that was our first paper on the epidemic in Africa.
Hannaway: Laurie Garrett claims that the team that visited Zaire in 1983 had difficulty in getting a paper published in the Lancet. It was only after rejection by a number of other journals that it was published in the Lancet. She claims specifically the New England Journal of Medicine rejected it, but she also mentions another journal. We wondered if this was accurate, and, if so, why do you think the paper was rejected? But from what you are saying, it does not sound as though the paper was rejected.
Quinn: We had decided it should go to Lancet. We might have said the New England Journal. But my understanding is it got published fairly quickly.
Hannaway: You were in Zaire in September 1983 and then this paper was published in July 1984?
Quinn: It came out, yes. So it was published in July. We were there. But the paper did not get written until probably close to January, because of all the tabulation and data. Normally, it is a six-month delay anyway with one journal, never mind going to three journals. The New England Journal takes two months for review at the least. It might have gone to the New England Journal, but again, I think the only person who could answer that is Piot, if you ever get to interview him. He will tell you.
Hannaway: All right. We will try and add that to our list.
Hannaway: Let us come back to this trip to Zaire. What were the chief differences clinically of the Zairian patients that you saw in the Kinshasa hospitals compared to the American patients, and also the Haitian patients, if you like?
Quinn: I have to say what the similarities were first. Since I was already oriented towards the intestine and the gut, what I saw was diarrhea wasting syndromes in both fulminant diarrhea and so on. That was why I was still focused on it as some sort of unusual intestinal parasite or organism that was causing this overwhelming diarrhea. And they called it “Slims” disease. That is what it was called at the time in Africa. They did not know what was causing it, and they did not call it AIDS. It was called “Slims” disease.
Hannaway: They called it that in Zaire? I thought that was primarily in Kenya.
Quinn: It was. They had some French term for it, but they also called it “Slims” disease. I do not know what the French translation was at this point. But Peter was my translator, so he would say, “They’re saying 'Slims' disease.”
The patients in Zaire had an unusual rash that was different, and we did not know how to describe it. We took a bunch of skin biopsies, gave them to dermatologists, and it was nonspecific. No one has ever really figured out what it was due to. Some say it was insect bites that the patients got super-reactions to.
But I did not find that the patients in Zaire had different symptoms. In fact, I was looking for similarities, not differences. The only difference was the appearance of both equal numbers of men and women as patients.
Hannaway: Did you see Kaposi’s sarcoma?
Quinn: Yes. We saw the classic Kaposi’s. I saw the same type that we saw in the U.S., and it was in the intestine as well as on the skin surface. My impression was it was the same disease. I had no doubts in my mind. What I saw in Haiti, I was seeing in Africa, and I was seeing in the U.S. The color of the skin might be a little different in that I tended to see more white men in my practice here at Hopkins, and I was seeing black Haitians and black Africans. But other than that, and seeing more women, it was essentially the same.
Hannaway: You were already, in a sense, inclined to accept that there was a heterosexual transmission?
Quinn: Yes, I was. Even though I had worked solely with gay men and gay transmitted diseases for two and a half years in Seattle, and then coming to Baltimore, and then recognizing this disease, seeing these equal numbers. How were these women getting it? Then, we heard about the prostitution that goes on and the multiple sexually transmitted diseases. As far as I was concerned, after my trip to Haiti, I was convinced this disease was heterosexually transmitted. In fact, it left such a mark on me that when I came back from Africa, although I was still involved with the African project and getting it to be a much longer prospective cohort study, the first thing I did was I said, “We have got to start looking for this in our clinics at Hopkins and looking at women.” I said, “Let’s start saving blood away,” and you will see where that comes in, because that was the source of the real battles with the press that I had at the time.
Hannaway: Please continue.
Quinn: All right. Well, this skips a couple of years, so I did not want to jump to that yet. But let us just leave that as “see footnote.”
Harden: I wanted to have a few more specifics on Projet SIDA as a project in terms of how it was developed, the personnel who were involved, the goals, how successful it was by the time it was shut down.
Quinn: But first, before I do that, because you have heard all about the early development of my career, what I wanted to say was, when I was asked to go to Haiti and to Africa, I could not have been more excited in the sense that that was what I had trained for, to do international tropical medicine, and here I was going into the tropics. In fact, one of the reasons why I left the Laboratory of Parasitic Diseases at the NIH was that I did not see any career from there going off into Africa to study malaria. It was all laboratory and mice. Maybe it would have eventually led to that. But when Dick asked me to go to Africa, I was, “Wow, this would be great!” This was what I, from my early days in undergraduate school, wanted to do. I said to myself that I would continue the international part as well as setting up a domestic research program of my own.
But now to approach Projet SIDA. I left [Zaire] early, actually. I flew directly from Zaire to Aarhus, Denmark. Aarhus was having an AIDS meeting and they asked me to report. So I left Peter and Joe and the rest of the team down in Zaire, and they continued doing their work. I was the first one to leave. They said I could go ahead and give a preliminary report, and I told the people in Denmark what I had been seeing. Everyone got all excited. There was no credibility problem that we were seeing what we thought was a heterosexually transmitted disease or a disease that affected both men and women.
Then I flew from Denmark to Las Vegas to the infectious disease meetings and again gave a very preliminary report on the findings of Projet SIDA. That seemed to be fairly exciting. None of it was published, so it was not in any literature yet. But I did not have any negative feedback.
Joe and Peter had finished by the time I finished going to these meetings, and we got on a conference call and we said, “We have got to do something. We have got, one, to write the paper up, so we are talking like November; and, two, we have got to set up a prospective program.” And it was the three of us. For some reason, I do not know why, I guess because we wanted one person to represent each of the institutes, the Institute of Tropical Medicine, the National Institutes of Health, and the CDC. So it was Joe, me, and Peter, and in reverse order for each of those institutes. We each said, “Okay, here’s how we have to do it. We will go to our respective people, find out who can get the most money, set the thing up, and we each assign a person.” That was how it was left.
About a month later, there was a new conference call. Joe was no longer on the team. He was out. Jim Curran was in. I cannot tell you the politics that went on. I do not know. I was not privy to that. All I know is that Jim said, “This is within our purview; this is an AIDS-related issue. I am in charge of the task force. I agree with Joe that there should be a team there.” He said, “I have already identified someone whom I want to send there. His name is Jonathan Mann.” I said, “Send me his CV so I can see what he’s done.” And Peter said the same thing.
I identified an American to go by the name of Skip Francis or [Dr.] Henry Francis, who had been working in the Laboratory of Parasitic Diseases, seemed to be very knowledgeable, and who had worked in Africa once before. I wanted someone who knew what he was getting into, and whose task was to set up the immunology part of the project. The CDC was to set up the epidemiology part. Peter Piot was to set up the clinical part, and he identified a man named [Dr. Robert] Colebunders. But Peter said, “Tom, you have more clinical experience. Can I send him over and you train him?” and so Colebunders came over and trained with me, and Skip was transferred to me. So I trained the two of them as to what these patients looked like, what we should be doing, and we designed research protocols and so on like that.
I got–this is a funny story–the CV of this Jonathan Mann, who was a health officer from the CDC in New Mexico studying, I think, it was rabies at the time. Wasn’t it rabies?
Harden: Amongst several things he did.
Quinn: I said, “He does not have any AIDS experience. Why is Jim doing this?” So I said that to Jim Curran, and Jim said, “He is great. He’s a very good epidemiologist. He’ll do a good job.” So I said, “Fine. He’s your selection. Here’s my selection. Here’s Peter’s selection.” And off it went.
So it was decided that they should start. It was, as I recall, around June or July of 1984, the same time that the paper came out, that the three of them went over. Jonathan got there first, then Skip came, and Colebunders came. Colebunders was a very nice gentleman. I really liked him. I had not met Jonathan Mann yet.
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