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Higher Education Modules

Patient Zero and the Early North American HIV/AIDS Epidemic

Chart depicting sexual contacts among homosexual men with AIDS in a study.

The search for a “Patient Zero”—popularly understood to be the first infected case of an epidemic—has been an important feature of the news media’s coverage of disease outbreaks from the late 20th century onward, including HIV/AIDS, Ebola, SARS, and H1N1. Yet despite its widespread use, the term is a recent invention, drawing its origins from epidemiological studies investigating the etiology of AIDS in the United States in 1982. How did the idea of an epidemic’s “Patient Zero” so swiftly come to exert a strong grip on the scientific, media, and popular consciousness?

Patient Zero and the Early North American HIV/AIDS Epidemic explores the historical precedents and emergence of this phenomenon. It also traces the closely interlinked development of one enduring popular origin tale for the North American HIV/AIDS epidemic: namely, that AIDS could be traced to a single, gay, French-Canadian flight attendant named Gaétan Dugas. What factors gave rise to the widely disseminated and disturbing depiction of this individual as the original “Patient Zero” of the American AIDS epidemic? Upon what historical precedents did this tale draw? How did this tale affect how people understood HIV/AIDS and subsequent disease epidemics? Students will have the opportunity to discover the answers to these questions and reflect on the historical and present-day challenges raised by outbreaks of infectious disease.

There are six one-hour classes in this module, grouped into three units. Unit 1 encourages students to draw comparisons between the challenges faced by earlier Western societies dealing with epidemics and responses to HIV/AIDS in the late twentieth century. Unit 2 focuses on the role of epidemiology in the first years of the recognized American epidemic, and on one investigation in particular that coined the term “patient 0” and shaped the way journalist Randy Shilts wrote his best-selling history, And the Band Played On. Unit 3 explores the varied responses to Shilts’s book and its promotional focus on the role of the flight attendant, Gaétan Dugas, whom it identified as “Patient Zero.” It also considers the impact of these responses on both media coverage and scientific investigations of subsequent disease outbreaks. Information about the module's author, suggested use, and academic objectives is also available online at About the Module.

  • Unit 1: Historical Precedents
  • Unit 2: Infectious Disease Epidemiology and Narrative
    • Class 3: AIDS and Infectious Disease Epidemiology explores the early work of American epidemiologists who investigated the newly recognized syndrome. The class pays particular attention to the Los Angeles cluster study which, in its attempt to provide evidence to support the idea that AIDS was caused by a sexually transmissible agent, introduced the term “patient 0.”

    • Class 4: And the Band Played On: Randy Shilts’s History of the American AIDS Epidemic focuses on the writing, promotion, and responses to the best-selling history of the American epidemic written by a gay San Francisco journalist, a good deal of which focused on his identification, characterization, and rechristening of the individual at the center of the CDC’s cluster study as “Patient Zero.”

  • Unit 3: Social, Cultural, and Medical Responses to Epidemics
    • Class 5: Responses to “Patient Zero” investigates the widely diverging responses to Shilts’s characterization of Gaétan Dugas as “Patient Zero.”

    • Class 6: New Patient Zeroes evaluates the idea’s legacy for the investigation of subsequent epidemics and its potential to obscure important determinants of health and sickness.