Gaëtan Dugas was a QuébécoisCanadianflight attendant and a relatively early HIV patient who once was widely regarded as "Patient Zero" or the primary case for AIDS in the United States. In March 1984, a Centers for Disease Control and Prevention study tracked the sexual liaisons and practices of gay and bisexual men, especially in California and New York. Dugas was code-named as "Patient 0" to indicate his role as the index patient in a cluster of 40 AIDS cases in the United States. Popular media later extrapolated this information to mean that he was the original carrier of AIDS in the country, although the report itself made no such claim. His case was later found to have been only one of many that began in the 1970s, according to a September 2016 study published in Nature. Dugas worked as a flight attendant for Air Canada and died in Quebec City in March 1984 as a result of kidney failure caused by AIDS-related infections.
1984 Cluster Study
A study published in The American Journal of Medicine in 1984 titled Cluster of Cases of the Acquired Immune Deficiency Syndrome examined the sexual contacts of gay men infected with AIDS to determine if their histories were consistent with the hypothesis that AIDS was caused by an infectious agent. A graph included with the paper traced the sequence of infection among 40 men and labeled one of the nodes as "Patient 0". The paper later stated: The researchers later stated they had originally intended to designate Dugas as "Patient O", with "O" standing for "Out-of-California" but at some point it was changed to a "0".
"Patient Zero" designation
Dugas is featured prominently in Randy Shilts's 1987 book , which documents the outbreak of the AIDS epidemic in the United States. Shilts refers to Dugas as "Patient Zero" and portrays him as having almost sociopathic behavior by allegedly intentionally infecting, or at least recklessly endangering, others with the virus. Dugas is described as being a charming, handsome sexual athlete who, according to his own estimation, averaged hundreds of sex partners per year. He claimed to have had over 2,500 sexual partners across North America since becoming sexually active in 1972. In David France's 2016 book How to Survive a Plague, Shilts's editor expressed his regret for having "made a conscious decision to vilify Dugas in the book and publicity campaign in order to spur sales." Genetic analysis historically provided some support for the Patient Zero theory, in which Dugas was believed to be part of a cluster of homosexual men who traveled frequently, were extremely sexually active, and died of AIDS at a very early stage in the epidemic.
Re-examination of "Patient Zero" designation
A number of authorities have since voiced reservations about the implications of the CDC's Patient Zero study and characterizations of Dugas as being responsible for bringing HIV to cities such as Los Angeles and San Francisco. In the Patient Zero study, the average length of time between sexual contact and the onset of symptoms was months. While Shilts's book does not make such an allegation, the rumor that Dugas was the principal disseminator of the virus became widespread. In 1988, Andrew R. Moss published an opposing view in The New York Review of Books. In 2016, a group of researchers led by evolutionary biologist Dr. Michael Worobey conducted a genetic study that looked at blood samples taken from gay and bisexual men in 1978 and 1979 as part of a hepatitis B study, and based on the results of the data, concluded that Dugas was not the source of the virus in the U.S. "On the family tree of the virus, Dugas fell in the middle, not at the beginning." "Beliefs about Patient Zero," Worobey concludes, "are unsupported by scientific data." Worobey's paper, published in Nature in October 2016, finds "neither biological nor historical evidence that he was the primary case in the US or for subtype B as a whole." A study by historian Richard McKay of Cambridge and others identified several causes for the Patient Zero myth. During early CDC analysis of cases in California, patient 057 was nicknamed patient "O" for "Out-of-California", but this was interpreted by others as Patient Zero. Dugas was particularly helpful in tracing his network of partners, providing names and addresses for many of them, which was further expanded because others remembered his distinctive name. Although many of the patients analyzed reported in excess of 1000 sexual partners, most remembered "only a handful" of names, making their contacts to other cases more difficult to trace. Dr. Robert M. Grant, an AIDS researcher at the University of California, has stated: "No one wants to be the Patient Zero of their village. But this may be helpful because it says, 'Just because you are the first to be diagnosed doesn't mean you started the epidemic.'" Two films, John Greyson's musical comedy filmZero Patience and Laurie Lynd's documentary Killing Patient Zero, have also debunked the Patient Zero myth around Dugas.
