Pathogens May Change, but the Fear Is the Same

Published: August 15, 2011

In “House on Fire: The Fight to Eradicate Smallpox,” Dr. William H. Foege, one of the conquerors of the virus, describes a grotesque moment in the war: The last victim in Benin, in West Africa, is visited by several “fetisheurs” — witch doctors — seeking to harvest his scabs.

For a fee, fetisheurs performed inoculations, a medical practice common in Africa for centuries. Into a small cut in the arm of a healthy person, they would rub in a victim’s powdered scabs. (The inoculee had about a 2 percent risk of dying, but a typical African epidemic was about 25 percent lethal.)

But when business was slow, fetisheurs would drum some up by starting outbreaks. Coating thorn branches with a paste of scabs and tucking them in doorways to scratch passers-by would do the trick.

One is reminded of a conspiracy theory that still haunts another fatal disease, AIDS: the notion that a top-secret cure exists but is kept suppressed by pharmaceutical companies because there is more profit in drugs taken for life.

To a doctor, all epidemics are objectively different. Viruses are not bacteria are not parasites. Transmission by sex is not transmission by sneeze or mosquito. But to the mortals they mow down, all epidemics are emotionally alike — an onslaught of fear, awe, repulsion, stigma, denial, rage and blame — and doctors would be foolish to forget that.

Three works circulating now — Dr. Foege’s book, Larry Kramer’s autobiographical play “The Normal Heart” and a movie, “Life, Above All,” set in South Africa — remind us how fragile life looks when the miasma is still swirling around our nostrils.

That is, before our fear ebbs and we tumble back into indifference, as we have about swine flu, SARS and even AIDS.
One of the first things we forget is epidemics’ power to alter history.

Many Americans know AIDS killed Rock Hudson, Arthur Ashe, Freddie Mercury and Rudolf Nureyev. Sad deaths, but not earth-shaking.

Most probably do not know that, as he delivered his Gettysburg Address in 1863, Abraham Lincoln was just coming down with smallpox, which in the next week nearly killed him in midwar.

Or that George Washington’s most important tactical decision may have been to inoculate his army in 1777, knowing his British foes, already protected, might prevail if an epidemic in Boston kept spreading. Two years earlier, American troops weakened by the pox had lost the Battle of Quebec.

The autobiographical work by Dr. Foege, a former director of the Centers for Disease Control and Prevention and now an adviser to the Bill and Melinda Gates Foundation, describes the last days of the only human disease ever eradicated.

The others are about AIDS, first detected in 1981, the year after smallpox died. It has now killed more than 30 million people, and the toll grows yearly — except in the minds of average middle-class heterosexual white Americans, a group that has lost its fear of the disease, according to a recent survey by the Kaiser Family Foundation.

A revival of “The Normal Heart,” by Mr. Kramer, an early AIDS activist, is now on a national tour. It opens in Greenwich Village in 1981, as it dawns on a few American doctors that something mysterious and terrible is afoot. The play is really a vehicle for Mr. Kramer’s anger, a series of tirades by his stand-in, whose message is that gay men should stop defining their struggle for equal rights chiefly as the right to have promiscuous sex. It makes him unpopular, but as medical advice it is sound: Avoid vectors of fatal illnesses, no matter how cute they are.

“Life, Above All,” by contrast, is set in rural South Africa in 2010. It opens with a 12-year-old girl meeting an older man. Once you realize he is kindly, you are horrified to grasp why she is there: Her mother, paralyzed by grief, has sent her to buy a coffin for her baby sister.

The word “AIDS” is almost never said aloud in the film. Instead there are sidelong accusations, the bluntest being the baby’s drunken father snarling at his wife, “You poisoned her with your milk.”

Like “The Normal Heart,” it exploits the shock value of symptoms American doctors rarely see anymore: the purple blooms of Kaposi’s sarcoma, the white foam of oral thrush, the meningitis stare.

Everyone dies miserably, pushed down holes or abandoned under trees. One scene recalls an event I covered in 1998: the death of Gugu Dlamini, a South African woman beaten to death by her neighbors for admitting on a Zulu radio station on World AIDS Day that she was infected.

However, unlike Mr. Kramer’s play, it takes place in a time when AIDS tests and antiretroviral drugs are available, even in the small town where it is set. People ought to be embracing hope, but stigma and fatalism force them to die rather than get tested.

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