The expansion of HIV-1 in colonial Leopoldville, 1950s: driven by STDs or STD control?
Pépin, J.
Sexually Transmitted Infections 88(4): 307-312
2012
ISSN/ISBN: 1368-4973 PMID: 22328643 DOI: 10.1136/sextrans-2011-050277Document Number: 552788
To understand the factors that drove the exponential spread of HIV-1 in Léopoldville (Kinshasa) in the 195s. A review of colonial and post-colonial health service reports, medical publications, and demographic and social science research in Léopoldville. Sex work appeared early in the history of Léopoldville, driven by a strong gender imbalance. Throughout the colonial era, sex work was of a low-risk type, with ‘free women’ having a few regular clients. This sufficed for the persistence of HIV-1, but probably not for the dramatic expansion that occurred in the 195s. During that decade, genital ulcerative diseases were uncommon and their effect on HIV-1 transmission must have been modest. Circumstantial evidence indicates that this expansion may have been related to parenteral transmission of HIV-1 in the city's sexually transmitted disease clinic, where up to 5 injections were administered daily using syringes and needles that were merely rinsed between patients. Most intravenous injections were given to treat syphilis in patients who never had any clinical evidence of this disease but only had a positive non-treponemal serology, often because of prior yaws infection. An outbreak of ‘inoculation hepatitis’ was reported among these patients in 1951–1952. It is only after the Congo's independence (196) that, in a context of pauperisation, a pattern of sex work appeared in Léopoldville wherein women had sex with more than 1 clients each year, allowing the sexual amplification of the virus. It is plausible that the exponential amplification of HIV-1 in Léopoldville occurred mostly parenterally in the 195s and sexually in the 196s.