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Higher Education Modules

Patient Zero and the Early North American HIV/AIDS Epidemic

Class 1: Explaining Disease Origins and Causation

When a new and deadly immune deficiency disorder was first recognized in the United States in 1981, fear, rumour, and speculation abounded. It was not until 1984 that scientists approached a consensus view that a newly discovered retrovirus was the likely causative agent for the condition, which had become known as Acquired Immune Deficiency Syndrome (AIDS). Effective antiretroviral therapy would elude researchers and patients in resource-rich countries until the mid-1990s, and this life-saving therapy remains unavailable to millions worldwide to this day. Hundreds of thousands of individuals died from the condition in the United States during the first fifteen years of the recognized epidemic, and many thousands more struggled to live with dignity whilst facing disability, discrimination, and neglect. During the 1980s, it became increasingly apparent that the Human Immunodeficiency Virus (HIV), the causative retrovirus for AIDS, had been spreading silently and unnoticed across the globe for several decades, infecting and killing millions worldwide. After nearly a century of successful biomedical interventions against infectious disease in North America, the fifteen-year period between 1981 and 1996 represented a traumatic rupture in a widespread and often unquestioned confidence in medical progress.

The first week’s readings explore the historical parallels between the emergence of AIDS and initial reactions to the condition, with responses to earlier outbreaks of pestilence in Western Europe—a history to which many Americans turned for lessons. The appearance of devastating disease epidemics have long been accompanied by attempts to understand why they occurred, with the explanations of the social elite—including physicians, city authorities, and religious officials—intermingling with those of the general public. Often, public officials under pressure to act decisively have undertaken measures that both reinforced existing cultural stereotypes and focused on social minorities.

Arrizabalaga, Henderson, and French explore what people thought and how they acted when the “French Disease” arrived in early modern Europe at the end of the 15th century. Their work highlights how individuals’ interpretation of a new disease—and their prognosis if infected—depended significantly on their level of education, social position, and ability to pay for appropriate treatment and care. The authors also describe the universal response of locating the origins of this seemingly new and sexually transmitted disease in a foreign culture. The authors’ refusal to treat the late 15th-century “French Disease” as what we might today think of as syphilis underlines their commitment to understanding the condition as it appeared to observers in early modern Italy, and not translated through the confident lens of 20th-century biomedical successes.

Hewlett examines how religious and political factors converged in the response to the ‘French Disease” in the early modern Italian city-state of Lucca. There, city authorities viewed those suspected of sodomy—and, within this broad category of non-procreative sexual activity, those suspected of anal sex between males in particular—as bearing responsibility for the “French Disease.” In his chapter, Pullan articulates the overlapping explanatory models of contagion and miasma for the appearance and transmission of plague in early modern Italy. He explores the multiple and sometimes contradictory roles the poor were seen to take on in times of epidemic—bearers, victims, and beneficiaries of the plague. They were, in turn, considered deserving of isolation, charity, and suspicion from the social elite.

Epstein argues that a combination of factors led to the powerful and long-standing construction of AIDS as a “gay disease.” These included the better access to medical treatment of the middle-class gay men who were among the first to fall ill with the new disorder, medical scientists’ lack of familiarity and over-generalization of a homosexual “lifestyle,” and a committed, organized response by gay and lesbian activists in the face of disaster. He points out that the word “cause” has a complex set of meanings in different contexts, a factor which would lead many to believe that homosexuality had “caused” AIDS, facilitating the bestowal of blame on gay men.


Arrizabalaga, Jon, John Henderson, and Roger French. “Preface,” “Syphilis and the French Disease,” and “The Arrival of the French Disease in Renaissance Italy: Initial Impact and Lay Reactions.” In The Great Pox: The French Disease in Renaissance Europe. New Haven and London: Yale University Press, 1997, pp. xiii-xv, 1-19, and 20-37.

Epstein, Steven. “The Nature of a New Threat.” In Impure Science: AIDS, Activism, and the Politics of Knowledge. Berkeley, Los Angeles and London: University of California Press, 1996, pp. 45-78.

Hewlett, Mary. “The French Connection: Syphilis and Sodomy in Late-Renaissance Lucca.” In Sins of the Flesh: Responding to Sexual Disease in Early Modern Europe. Edited by Kevin Patrick Siena. Toronto: Centre for Reformation and Renaissance Studies, 2005, pp. 239-60.

Pullan, Brian. “Plague and Perceptions of the Poor in Early Modern Italy.” In Epidemics and Ideas: Essays on the Historical Perception of Pestilence. Edited by Terence Ranger and Paul Slack. Cambridge: Cambridge University Press, 1992, pp. 101-24.

Discussion Questions
  1. Which themes appear to repeat themselves across the readings?
  2. What does “causation” mean in the context of an epidemic? What were some of the suggested causes of the AIDS epidemic? In what ways do they resemble attempts to explain disease outbreaks in earlier times? How do they differ?
  3. How have attempts to explain an epidemic’s appearance been linked to blame?
  4. How were the responses of gay communities to the threat of AIDS similar to those adopted by other minority groups affected by the immune disorder? Or to affected minorities in other historical epidemics? How were they different?
  5. Arrizabalaga, Henderson, and French insist on treating the “French Disease” as “strange” and not easily translatable to our modern understanding of infectious disease. How might this historical approach to understanding past disease outbreaks be applied to HIV/AIDS, particularly if we consider the period before the arrival of highly active antiretroviral therapy in 1996? Or the period prior to 1984, the point when the evidence produced by French and American scientists strongly suggested that the retrovirus later known as HIV caused AIDS?