Jacques Pepin isn't a big name in AIDS research and he toils not in a scientific world capital but in the Quebec regional city of Sherbrooke. Yet this self-effacing professor is getting international buzz for a new book that traces the improbable voyage of the AIDS virus to a single bush hunter in central Africa in 1921.
Like a scientific detective, Dr. Pepin unearths clues to solve the lingering mystery about the genesis of AIDS – stalking the disease when it silently spread in Africa, decades before it entered the public's consciousness in the early '80s.
"Very little was written about that period," he said in an interview, "and I found it fascinating."
Dr. Pepin's book, The Origin of AIDS, is gaining attention for some of its surprising conclusions. He collects evidence that the virus spread not only through sexual activity but, crucially, through well-meaning European doctors and nurses fighting tropical diseases in pre-independence Africa.
They used syringes and needles to inject hundreds of patients a day in medical campaigns against diseases such as sleeping sickness, tuberculosis and leprosy. In the process, Dr. Pepin believes, they helped turn a virus infecting a lone ape hunter in Africa into a global epidemic with some 32 million victims.
"The chances that this hunter alone could launch an epidemic are very low," Dr. Pepin said. "But there are all the chances in the world that he went to be treated for a tropical disease and a little HIV stayed in the syringe. Then the next patient was injected with it intravenously."
Dr. Pepin got an inkling about the subject from personal experience.
He spent many years working and living in Africa, first landing there as a 22-year-old Quebec med-school graduate in 1980. During a later stint treating sleeping sickness on a Canadian-funded program in Zaire (now the Democratic Republic of Congo), he believes he may have inadvertently passed along the AIDS virus himself.
Electricity failures meant the machines that sterilized syringes didn't always work; nurses boiled the instruments instead. Dr. Pepin isn't sure the syringes were properly sterilized, or whether they may have inadvertently passed the AIDS virus from one patient to the next.
"Honestly, I have no memory of asking myself the question at the time," he said. "But afterwards, I reflected on what I did in good faith. I realized that maybe I had transmitted a bit of the AIDS virus." The thought, he said, left him with a sense of "humility."
Dr. Pepin's research over the years also involved testing the blood of older Africans; and he spent years sifting through historical documents on the colonial period – newspapers, records, academic studies – in capitals across Europe. His turning point, he said, came one day in the southern French city of Marseilles. He was poring over medical archives and found a motherlode of original records crammed with painstaking charts and entries outlining the massive use of injections in colonial Africa.
"That day was a revelation. I realized that these reports probably contained a big part of the explanation of what happened behind the emergence of AIDS," he said. "If there hadn't been those medical campaigns, in my opinion, there probably wouldn't have been an AIDS epidemic."
Being French-speaking helped him to tackle the mounds of records from the French and Belgian colonial powers, he added.
His work led him to connect the dots between that first bush hunter, who probably got infected with HIV while manipulating chimpanzee meat, to the sex trade in fast-growing African cities decades later. Then, in a more speculative turn, he believes the virus bridged the Atlantic with a single Haitian teacher returning home in the 1960s after working in Zaire, before spreading through a Haitian plasma centre, sex tourism and finally surfacing among gay men in California.
Published this month by Cambridge University Press, the book is being praised by AIDS experts, even as some admit they had never previously heard of Dr. Pepin. His home is in Sherbrooke, 150 kilometres east of Montreal, where he heads the University of Sherbrooke's infectious-diseases department.
Max Essex, chairman of the Harvard School of Public Health's AIDS Initiative, describes the book as more scholarly and "substantial" than previous works that try to trace the path of AIDS before the 1980s.
"This was the first thing I've seen that tried to explain the origin of HIV … with all the phases of the emergence, through to the larger epidemic," Dr. Essex said in an interview.
Oliver Pybus of the University of Oxford, an evolutionary biologist and AIDS researcher, said Dr. Pepin's study of historical records from central Africa "makes his work new and insightful."
Prof. Pepin said that even if his book focuses on the historical trail of the AIDS epidemic, it also contains the seeds of a cautionary tale for the medical world today.
"Doctors and scientists can draw a lesson in prudence and humility from this," he said. "When you manipulate nature in a way you don't completely understand, the consequences can be unpredictable and absolutely disastrous."