Book Review: The Origins of AIDS by Jacques Pepin

Infectious diseases physician and epidemiologist Jacques Pepin, in his The Origins of AIDS (Cambridge University Press, 2011), tells an illuminating and sobering story of the spread of HIV. This is a scholarly, detailed work written for a general audience..

Dr. Pepin, who has done research in sixteen African countries, knows the continent and its history, and the AIDS pandemic, as he reveals that history, is very much a legacy of colonialism. The colonizers liked to proclaim that they were bringing civilization and Christ to Africa, but, in truth, theirs was a racist mission of military conquest and economic exploitation.

His own story in Africa, the continent where SIV jumped from one subspecies of chimpanzee to become the human pathogen HIV-1, began in the 1980s when he was a medical officer in a bush clinic in Zaire. In years following his service there, he came to realize that patients that had visited the clinic seeking help for various conditions probably left infected with HIV. Because of frequent power outages (sometimes lasting two months), which made the autoclave inoperable, proper sterilization of re-usable syringes and needles had not been guaranteed at the clinic.

In earlier decades, starting in 1920, the approximate year of the origin of HIV-1, use of improperly sterilized syringes and needles would have occurred even more often than in the 1980s. The French and Belgian colonial powers (their territories are where the virus first appeared), in an effort to protect the Europeans who had arrived in Africa, set up aggressive inoculation programs for tropical diseases and STDs. These campaigns went on for years. Medical negligence and public health policy ensured that an extremely pathogenic virus spread exponentially, a virus that otherwise might have died out after infecting a few people.

Other factors also amplified the spread of HIV-1. It was colonial policy to gather men of working age into urban areas that were essentially work camps or to conscript them into work gangs to build a railway. The policy was to separate the men from their families, and that policy encouraged prostitution.

The story continues, with Dr. Pepin offering piece after piece of the puzzle of how and why disease spread across the globe.

Knowledgeable and passionate, Jacques Pepin wrote this book, in good part, out of moral obligation to those who have suffered. And, as he says in his epilogue, he wanted to remind the world that the most dangerous threat to the human species is the human race itself. He goes on: . . . the one new message that the HIV epidemic, as chronicled in this book, should bring home is that well-intentioned human interventions can have unpredictable and disastrous microbiologic consequences.


Very interesting indeed Merry and having spent years in Africa well know the not so honourable history. Can't help agreeing with his epilogue either. Hope he finds a big readership. (Quite magical there - apart from european exploitations the countries must have seemed like that to them too....... little wonder they went with the exception of Dr Pepin who went only to aid).

It's my Uni Anthropology popping up here.
Thanks, Enid.

That is my hope, that people will read the book. An important work. So many interesting details I wanted to include in the review but knew I should keep it short.

Oops. I see I left three words out of that quote at the very end. Corrected now. Sorry.

Yes, I understand the interest outsiders would've had in exploring the continent.
Don't you ever apologise Merry............far too many difficulties of my own when it comes things mechanical or digital.
My detailed information about Africa came from a university course which discussed the Karimojong tribes of upper Uganda. In the 20th century, they were still living in a transhumance culture usually assumed to predate agriculture. (I'm afraid to ask what happened to them during subsequent upheavals in Uganda.) Beyond consumption of unpasteurized milk, they also consumed blood which could be harvested without killing cattle. (A cultural tradition tied wealth to the number of cattle, so slaughtering cattle for food was crazy to their minds.) I have since learned this is not nearly as far in our own past as commonly assumed. In 14th century England blood pudding, derived the same way, was an essential source of protein in peasant diets. This kind of interaction makes it nearly impossible to avoid zoonotic infections.

My own experience in the far east showed me that impoverished medical professionals will reuse needles without proper sterilization. You don't have to go that far. I've heard of several people getting vaccinations in Mexico using the same needle. Graft and corruption often compound the problem at the level of those giving vaccines. Such governmental defects simply carried over from the colonial period, but colonial officials who benefited did not regard these as defects.

I have believed that this was the connection between vaccination campaigns and the spread of AIDS for some time. I do not believe it was responsible for the origin of the pandemic.
anciendaze, I appreciate your input -- always a wealth of information to offer.

But I don't understand your last sentence: "I do not believe it was responsible for the origin of the pandemic." What does "it" refer to?
I was referring to a vaccination campaign. I do not believe the virus originated in vaccine. Evidence from molecular biology and geographic distribution point to an origin in Africa around 1910. There is even evidence in cases from the 1950s that the virus was in humans before the vaccination programs most often blamed. Vaccination spread an existing human disease.
Right ! can we get this all together so we know what's happening for all of us in the world of viruses.
No, not in vaccine. Jacques Pepin certainly does not think that. He spends some time near the beginning of the book arguing that Edward Hooper's theory, that SIV was introduced in polio vaccines, is implausible. He only talks about virus being spread through improperly sterilized syringes and needles (in an early stage of the epidemic).

Because of the high mortality of those infected with HIV, Dr. Pepin has to build his case about the probable spread of HIV-1 indirectly. He examines medical records and literature that shows that during those inoculation campaigns for tropical diseases and STDs, hepatitis viruses, B and C were given to patients. A person would get a shot for syphilis, say, and shortly exhibit jaundice. If hepatitis viruses were passed from patient to patient from contaminated equipment, then HIV certainly could have been, too.

Evidence of how HIV-2 (SIV transmitted from the sooty mangabey) spread in Portuguese Guinea also supports the hypothesis of amplification through public health policy and medical negligence.
Hi, Enid. My comment posted at 3:30 was in response to anciendaze. Thanks again for your interest and also for your generous attitude toward my poor proofreading skills! :D
Jacques book would be good, I suppose, if HIV was actually the cause of AIDS. Not even Luc Montagnier (who won the Nobel Prize for his HIV discovery) believes HIV can do all the things that the US/UK claims it can.
I read Hooper's book The River - years ago - what a fascinating read that was! Apparently the theory has not stood the test of time but I imagine Pepin's book would be fascinating as well. Hopefully I'll have the time to read it at some point...For now thanks for the reminder!
Hi, Cort. Yes, I think you would enjoy this book. I hope you find the time to read it.

cfsboston, ok, well, then this book isn't for you.
Thanks, Merry, really interesting, and the first time I've heard theory that vaccination campaigns played an important role in the spread of HIV. Not sure I'm willing to spend over 40 to read it, though!
oceanblue, I got the book from the public library after learning about it in a magazine review. If you are keen to read it, and your public library doesn't have copy, ask the library to purchase one or you can request the book through interlibrary loan. Uh, but maybe you know all this.

Blog entry information

Last update

More entries in User Blogs

More entries from Merry