Worst case scenario of HIV pandemy?

Insider

Banned
Wait a moment, Jared has AIDS developing earlier in "Decades of Darkness". Check for it - it's called "Asperger", because it's discovered by that very Dr. Asperger.
Is it an alternative history? Is it on these forums? There is one TL called Decisive Darkness, but as for exact phrase the search engine gives back useless references. Except I learned that Brits called their post IIWW austerity a Decade of Darkness.
 

BlondieBC

Banned
Does HIV have to emerge at roughly the same time as OTL? Because the virus was clearly around for a few decades before it gained a much wider spread in the late 70s. Having HIV emerge in the early 20th century (keeping this to the After 1900 forum) would be pretty devastating for both Africa and the rest of the world.

Even if we still have HIV emerging in the late 1950s, then potentially we could have HIV both spread both within Africa and outside of Africa to a much greater extent. We could have HIV appearing throughout the most vulnerable populations by the late 1960s. We could have HIV having a much wider spread in Africa as well at an earlier date.

This is OTL. Aids did emerge in the early 1900's. It was suppressed by diseases such as smallpox, malaria, and sleeping sickness. An immune suppression disease will have a hard time thriving in a world of smallpox, measles and the like.
 

BlondieBC

Banned
Worst case is it goes airborne in the seventies.
By (say) 1978 mysterious cases of an immune deficiency disease are being detected around the world and statistical analysis indicates it's an airborne virus with a very long incubation period. No test, no cure. no treatment and apparently no survivors. By 1979 half-a-million people in the USA are dead, and two million are visibly infected and about forty million asymptomatically infected.

The CID (Communicable Immune Deficiency) plague looks like ending human civilisation...

Airborne mutations of a what a bodily fluid disease is unlikely.
 

BlondieBC

Banned
Quite. But I'd envisaged more of a sneeze/spray droplet vector, unlikely but not impossible.

I'd imagine a virus that got better at its primary transmission vector. It get a little bit better at crossing via sexual fluids or mother milk. Seems like the odds of transmission with a single sex act is around 1 in 100. Make that 1 in 20, and it can explode even faster on to the world scene
 
Wait a moment, Jared has AIDS developing earlier in "Decades of Darkness". Check for it - it's called "Asperger", because it's discovered by that very Dr. Asperger.

There's also earlier AIDS in the Africa-centric timeline Malê Rising (called "Congo Fever"). I think it realistically portrays the results of things, especially in the context of that universe.

This is OTL. Aids did emerge in the early 1900's. It was suppressed by diseases such as smallpox, malaria, and sleeping sickness. An immune suppression disease will have a hard time thriving in a world of smallpox, measles and the like.

But if there's less people dying from those diseases, like in the West if AIDS spreads there earlier, wouldn't the usual causes of death for AIDS patients appear? The diseases which typically only appear in immunosuppressed individuals? Wouldn't the medical field notice a sharp increase in those diseases in the West?
 
If the "Virgin Cleansing Myth" becomes more widespread before society begins to limit the spread of the disease, then a whole new generation might be infected.
 

BlondieBC

Banned
But if there's less people dying from those diseases, like in the West if AIDS spreads there earlier, wouldn't the usual causes of death for AIDS patients appear? The diseases which typically only appear in immunosuppressed individuals? Wouldn't the medical field notice a sharp increase in those diseases in the West?


I am going from memory here, and the research changes over the years.

HIV has jumped to humans at least twice. Once directly from a monkey. The second time from monkey to chimp to human. The route is probably butchering/eating raw meat. So we have two major strains of HIV. Of one of these strains, there are about 6 major varieties. We are familiar with the more successful jumps, but there are very limited successes. One strain has under a dozen infected in Africa. And this difficulty spreading in a new host species is not uncommon. Measles appears to have taken hundreds of years to get so well adapted to humans (500 AD to 1200 AD according to last source I read).

Probably sometime a little before WW1, HIV jumped to humans in either what was Kamerun or the French Congo. The areas it jump are absolutely remote. They are malaria filled. And there was major issues with West African Sleeping sickness epidemic in that time frame. Aids is spreading, but not in an area that Westerners are likely to document or care about. In the 1920's, Kinshasa was likely the first major urban area for Aids to get established. It probably traveled to the city via truckers and brothels. Aids thrived in this environment, but no one noticed. The Belgians did not want to educate the local but need non-European high skill workers such as Doctors. The Belgians imported Haitians. When the Congo became free, these Haitians returned to Haiti and established the disease there. Again, no one notice despite a major vector Haiti being medical doctors. Aids then spread to the USA via Haiti, probably just in workers going back and forth. Since it appears to be deeply established in Haitian communities in the USA, it probably was not primarily moved by the sex vacation route. No one picked it up in ethnic communities in the USA. Years later, then we get to "Patient Zero" who is only important because of the political decisions made based on this information. He was a airline employee who was gay. He probably got the disease in Africa, but my memory is a bit vague on this one. He then infected three or four people. About 6 years later, they all come down with the same illnesses in short order and the same doctor treats them. We are lucky that these guys did not move to different cities in the half decade or more from infection to sickness. We are also lucky all three of these guys had sex with the same man about 3-6 months before getting sick. And that they fell ill in the order they had sex with this man. Originially, the doctors thought AIDS had a incubation period of months, and the evidence used to determine the cause was false. Then later they figure out that "slims" in Africa was AIDS

So not only did we miss AIDS many times, we got lucky to catch it when we did in the USA. I don't think anyone looked for infectious diseases where there was a 7 year infectious period with no symptoms. Blinded by our knowledge of diseases, so to speak. So a lot of words to get to.

We could have easily missed a more infectious AIDS or an earlier jump of AIDS to humans. Personally, I suspect that AIDS jump to humans many times well before 1900. Eating monkeys is not uncommon, and if you have butcher wild animals, you will know how much blood is involved and how you can easily have small cuts on your hands. And I suspect that when it became common enough, the more deadly infectious diseases wiped out the small communities with AIDS. By small, I mean a few hundred here or there.

Europeans caused a big spike in disease with railroads and forced labor conditions that resemble slavery. In some pretty large areas, it looks like populations declined as Europeans did the typical colonial stuff. To give you an example, the Serengeti went into its wild state with the last 100 years. People used to live there until Eastern African Sleeping sickness became stronger. Besides enriching a very few whites, African colonization is a testament to inept governance.
 
I am going from memory here, and the research changes over the years.

HIV has jumped to humans at least twice. Once directly from a monkey. The second time from monkey to chimp to human. The route is probably butchering/eating raw meat. So we have two major strains of HIV. Of one of these strains, there are about 6 major varieties. We are familiar with the more successful jumps, but there are very limited successes. One strain has under a dozen infected in Africa. And this difficulty spreading in a new host species is not uncommon. Measles appears to have taken hundreds of years to get so well adapted to humans (500 AD to 1200 AD according to last source I read).

Probably sometime a little before WW1, HIV jumped to humans in either what was Kamerun or the French Congo. The areas it jump are absolutely remote. They are malaria filled. And there was major issues with West African Sleeping sickness epidemic in that time frame. Aids is spreading, but not in an area that Westerners are likely to document or care about. In the 1920's, Kinshasa was likely the first major urban area for Aids to get established. It probably traveled to the city via truckers and brothels. Aids thrived in this environment, but no one noticed. The Belgians did not want to educate the local but need non-European high skill workers such as Doctors. The Belgians imported Haitians. When the Congo became free, these Haitians returned to Haiti and established the disease there. Again, no one notice despite a major vector Haiti being medical doctors. Aids then spread to the USA via Haiti, probably just in workers going back and forth. Since it appears to be deeply established in Haitian communities in the USA, it probably was not primarily moved by the sex vacation route. No one picked it up in ethnic communities in the USA. Years later, then we get to "Patient Zero" who is only important because of the political decisions made based on this information. He was a airline employee who was gay. He probably got the disease in Africa, but my memory is a bit vague on this one. He then infected three or four people. About 6 years later, they all come down with the same illnesses in short order and the same doctor treats them. We are lucky that these guys did not move to different cities in the half decade or more from infection to sickness. We are also lucky all three of these guys had sex with the same man about 3-6 months before getting sick. And that they fell ill in the order they had sex with this man. Originially, the doctors thought AIDS had a incubation period of months, and the evidence used to determine the cause was false. Then later they figure out that "slims" in Africa was AIDS

So not only did we miss AIDS many times, we got lucky to catch it when we did in the USA. I don't think anyone looked for infectious diseases where there was a 7 year infectious period with no symptoms. Blinded by our knowledge of diseases, so to speak. So a lot of words to get to.

We could have easily missed a more infectious AIDS or an earlier jump of AIDS to humans. Personally, I suspect that AIDS jump to humans many times well before 1900. Eating monkeys is not uncommon, and if you have butcher wild animals, you will know how much blood is involved and how you can easily have small cuts on your hands. And I suspect that when it became common enough, the more deadly infectious diseases wiped out the small communities with AIDS. By small, I mean a few hundred here or there.

Europeans caused a big spike in disease with railroads and forced labor conditions that resemble slavery. In some pretty large areas, it looks like populations declined as Europeans did the typical colonial stuff. To give you an example, the Serengeti went into its wild state with the last 100 years. People used to live there until Eastern African Sleeping sickness became stronger. Besides enriching a very few whites, African colonization is a testament to inept governance.
And with per-WWI POD we would see a major drop in life expectancy and populations as diseases that Europeans had, like smallpox, were the death rate was low, would bounce back to epidemic levels on par with what happened to the Americas and Oceania.
 
Can someone tell me what the actual probability of contracting HIV from sexual intercourse is? And I do assume it varies slightly between man-to-woman; woman-to-man; man-to-man; and woman-to-woman. Probability in contracting through sharing a needle with an infected person. Probability of contracting through blood transfusion.
 
The rate of HIV from male/female vaginal intercourse is variable - poor hygiene, open sores/other venereal disease (think genital warts or herpes) makes it higher. For anal intercourse it is higher, because that area is not "designed" for intercourse. Infected needle and blood transfusion much higher because there is direct transfer of virus with zero protection.

Prior to the 1920s blood transfusion was rare if ever done, not like today. Heroin or other drug addiction with SHARED needles was rare because restrictions on getting needles/syringes really did not exist, and in any case at that point syringes were glass and they and needles were routinely reused AFTER sterilization, which in the proper medical setting would mean no transmission (the reason this is a problem now is that in third world countries needles and syringes are reused absent adequate sterilization because buying more disposables is unaffordable).

Noticing an uptick in "normal" infectious diseases due to the immune system effects will be difficult as even in "first world" countries prior to the 1950s while they collected medical statistical data this was spotty. In colonial areas, very very limited. As far as the diseases that you see with compromised immune systems such as some with unusual fungi, etc and Kaposi's Sarcoma, the odds are a "routine" disease will kill the HIV infected before these show up.
 
Is the theory that mass vaccination campaigns in Africa helped spread HIV credible? In that the needles used tended to be unsafe and used multiple times?


But wouldn't there be a higher rate of these formerly very rare diseases, and found in healthier individuals? I think in the post-WWII era, we could notice that, and by "we", I suppose a brilliant medical mind (working in the West) could devise some theory as to why this is and thus discover AIDS. But this would require AIDS spreading more extensively a decade or two earlier.

Can someone tell me what the actual probability of contracting HIV from sexual intercourse is? And I do assume it varies slightly between man-to-woman; woman-to-man; man-to-man; and woman-to-woman. Probability in contracting through sharing a needle with an infected person. Probability of contracting through blood transfusion.

Mostly minute but very present, except for blood transfusions. But there's many other factors that increase the risk.
 

BlondieBC

Banned
Is the theory that mass vaccination campaigns in Africa helped spread HIV credible? In that the needles used tended to be unsafe and used multiple times?



But wouldn't there be a higher rate of these formerly very rare diseases, and found in healthier individuals? I think in the post-WWII era, we could notice that, and by "we", I suppose a brilliant medical mind (working in the West) could devise some theory as to why this is and thus discover AIDS. But this would require AIDS spreading more extensively a decade or two earlier.

Yes, reusage of needles did help spread AIDS, and some of the vaccination involved reusing needles. I can't really quantify the effect.

Sure AIDS could have been spotted earlier. And sure, a wider spreading AIDS might well be caught much earlier than OTL.
 
Is the theory that mass vaccination campaigns in Africa helped spread HIV credible? In that the needles used tended to be unsafe and used multiple times?



But wouldn't there be a higher rate of these formerly very rare diseases, and found in healthier individuals? I think in the post-WWII era, we could notice that, and by "we", I suppose a brilliant medical mind (working in the West) could devise some theory as to why this is and thus discover AIDS. But this would require AIDS spreading more extensively a decade or two earlier.



Mostly minute but very present, except for blood transfusions. But there's many other factors that increase the risk.
So, if I'm reading that article correctly it is actually a low risk to contract HIV through sexual intercourse of any kind.... if somehow you had eliminated other ways of contraction (ASB I know) HIV would have spread slower...?
 
I am going from memory here, and the research changes over the years.

HIV has jumped to humans at least twice. Once directly from a monkey. The second time from monkey to chimp to human. The route is probably butchering/eating raw meat. So we have two major strains of HIV. Of one of these strains, there are about 6 major varieties. We are familiar with the more successful jumps, but there are very limited successes. One strain has under a dozen infected in Africa. And this difficulty spreading in a new host species is not uncommon. Measles appears to have taken hundreds of years to get so well adapted to humans (500 AD to 1200 AD according to last source I read).

HIV has been very good at making the jump to infect people, although not so good at then spreading between people. The total number of confirmed jumps from other primates to humans stands at 11, probably more. (The last time I checked the stats was about a year ago). HIV-1 has spread from primates to humans on at least 4 occasions, three times from chimpanzees, once from gorillas. HIV-2 has made the transition at least 7 times, probably 8. Of those HIV-2 jumps, six known HIV-2 subtypes have been found in people on only one occasion; in other words, six independent jumps of HIV-2 which spread no further than one person, or perhaps no further than a small cluster of people without becoming more widespread.

To put it another way, HIV has almost certainly been making regular transitions from primates to humans in Central Africa for centuries, probably millennia. As far as is known, it did not spread outside of Central Africa before the twentieth century, but it's not hard to imagine circumstances where it could have done so, the most obvious being increased trade with Central Africa earlier.
 
Five years ago, I did a blog post, Five notes from Jacques Pepin's The Origins of AIDS, that presented a compelling portrait for the central role of colonial medicine in the spread, through mass inoculations of residents of French Equatorial Africa with non-sterile needles.

"In Pepin's account, the French responded to this existential threat to the populations by establishing a fairly thorough compulsory medical program relying heavily on the use of hypodermic needles as delivery mechanisms for medicines. Most unfortunately, the hypodermic needles used were not sterilized, the idea of viral contamination of syringes only becoming known in central Africa until after the Second World War. This, Pepin suggests, may have been the thing that took HIV from being a rare zoonotic infection of chimpanzee hunters to being a plague with the potential for far wider spread. In his 2010 paper "Iatrogenic Transmission of Human T Cell Lymphotropic Virus Type 1 and Hepatitis C Virus through Parenteral Treatment and Chemoprophylaxis of Sleeping Sickness in Colonial Equatorial Africa", Pepin's study of a population in the Central African Republic that had received treatment for trypanosomiasis more than sixty years previously revealed that only a small fraction of the people who had been treated and expected to survive to the present actually did: "From historical data, we predicted that 59% of Mbimous 65 years and older would report treatment for trypanosomiasis before 1951; only 11% did so." Why? Noting that the rapid progression of human beings from infection with HIV to death in the space of a single decade made his hypothesis impossible to confirm, Pepin noted that use of unsterilized needles in the region was quite common--"In 1917–1919, of 89,743 individuals screened in Oubangui-Chair (now Central African Republic), 5347 were diagnosed as having trypanosomiasis and treated (mostly with subcutaneous drugs) using only 6 syringes."--and that other viruses known to be transmitted via the same routes as HIV, including Hepatitis C and HTLV-1, were present among the survivors."

The terrible thing is that this may have been inevitable. Sleeping sickness was a particular killer, but the native populations of central Africa were terribly vulnerable to all sorts of epidemic diseases. Humanitarian concerns aside, if there were not mass inoculations then there was a real risk of central African populations being endangered to the point of creating labour shortages. Almost any colonial power save the most genocidal would have been compelled to intervene to prevent the depopulation of this colonized territory.
 
So, if I'm reading that article correctly it is actually a low risk to contract HIV through sexual intercourse of any kind.... if somehow you had eliminated other ways of contraction (ASB I know) HIV would have spread slower...?

Going to what Pepin argues, the use of unsterilized needles in transmitting all sorts of viruses throughout populations was critical. A minor zoonosis involving dozens of people had much less chance of spreading than a pandemic involving thousands, especially something sexually transmitted and effectively invisible, especially in the open-ended sexual networks that prevailed in the region at the time. Once the virus got to the future Kinshasa, a global epidemic was inevitable.

I've written elsewhere that the shape of the virus could have been very different. The "Haitian connection", the idea that a Haitian was infected with HIV while working in post-colonial Congo and that the subsequent North Atlantic epidemic spread from this one man sometime in the 1960s, does seem to have been confirmed. Genomic diversity among HIV viruses in this epidemic suggests that only a single transmission occurred. If this person was luckier and not infected (or, perhaps more likely, if this person did not transmit the virus on), then the state of HIV would have been much different. There would have been no spread in Haiti (accelerated, Pepin argues, by a blood bank on Port-au-Prince that did drastically unsafe things to its donors) and consequently no forward spread into North America in the 1970s.

In this scenario, HIV/AIDS would not have been discovered among MSM and IV drug users in North America in the early 1980s. Instead, North America (and Haiti) would have had an experience much like that of contemporary western Europe, where the first reports of HIV were concentrated among Africans and people with sexual connections to Africans. There may well have been a later stage of HIV spread to at-risk demographics late in the 1980s, or there might not have been. Maybe the advance warning would have allowed for safer sex to take root in time.

OTL, the enormous progress made in treating and controlling HIV was achieved substantially because at-risk demographics in the high-income countries where the disease was most visible were large enough that the epidemic could not be ignored. With hundreds of thousands if not millions of people infected, eventually humanitarianism and pragmatism was able to overcome prejudice.

What would happen in an ATL without these political incentives, where an unstoppable plague was concentrated among Africans and people with connections to Africans?
 
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