with a few regular clients, and then, after 1960, with a large number of men, a process which amplified the transmission of sexually transmitted pathogens, both the traditional ones (gonorrhoea, syphilis, etc.) and the emerging one, HIV-1. This is just another example of the complex relationships between social changes and diseases.Tuberculosis emerged as an important cause of adult mortality in nineteenth-century Europe, when the industrial revolution brought many poor peasants to the cities where they lived in crowded, unhealthy conditions conducive to the transmission of this respiratory pathogen. More recently, in the last decades of the twentieth century, an unprecedented epidemic of obesity has developed in industrialised countries as a consequence of our sedentarisation, itself driven by the ever-increasing availability of motor vehicles, televisions, video games, the Internet, and so on. Upcoming changes in the lifestyle of future generations will impact on the incidence of various diseases, in a way which is hard to predict and which cannot be avoided. Some of these changes could be detrimental to the human race, while others will represent progress. For instance, the progressive reduction in the use of fossil fuels and their replacement by greener sources of energy should eventually lower the incidence of the respiratory diseases associated with air pollution.
The second factor in the emergence of SIV cpz into HIV-1 was its parenteral amplification through poorly sterilised syringes and needles, re-used on many patients. In central Africa, this may have jump-started the epidemic by increasing the number of infected humans to a level where sexual transmission could thrive. In retrospect, this iatrogenic amplification resulted from a lag of only about fifty years between the development of therapeutic agents that required their IV administration and the realisation that infectious agents, especially viruses, could be transmitted by this route. When humans manipulate nature in a way that they do not fully understand, there is always a possibility that something unpredictable will occur.
This is a reminder that the most dangerous threat to the long-term survival of the human species is the human race itself. Of course, this has been obvious for some time. My generation and the one before us grew up with the fear of a nuclear holocaust. Even though the number of nuclear missiles has been reduced, the list of countries possessing this technology has grown, and with it the probability that one day somebody will push the button. My children’s generation has grown up with the threat of global warming, a process whose consequences could be as destructive, albeit much slower. The human race is not very quick to understand novel threats. Just a few years ago, the president of the United States refused to ratify the Kyoto protocol on the basis that the ‘American way of life is not negotiable’, as if the core of American civilisation and values were the four-wheel drive vehicles produced by three large corporations that barely survived the end of this president’s term in office.
In this context, 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. Mankind has emerged through a process of natural selection over billions of years. Apart from ourselves, there is probably no other living organism on earth that could destroy us completely, because if such organisms had existed, we would not have managed to reach our current status in the first place. But as I write these lines, there is renewed interest in sending humans on a wonderful voyage to Mars and back. The kids who watched Neil Armstrong’s small steps on the moon are now engineers, pilots, administrators and politicians. They think that their own generation also needs to push back a new frontier, that this is part of the
The second factor in the emergence of SIV cpz into HIV-1 was its parenteral amplification through poorly sterilised syringes and needles, re-used on many patients. In central Africa, this may have jump-started the epidemic by increasing the number of infected humans to a level where sexual transmission could thrive. In retrospect, this iatrogenic amplification resulted from a lag of only about fifty years between the development of therapeutic agents that required their IV administration and the realisation that infectious agents, especially viruses, could be transmitted by this route. When humans manipulate nature in a way that they do not fully understand, there is always a possibility that something unpredictable will occur.
This is a reminder that the most dangerous threat to the long-term survival of the human species is the human race itself. Of course, this has been obvious for some time. My generation and the one before us grew up with the fear of a nuclear holocaust. Even though the number of nuclear missiles has been reduced, the list of countries possessing this technology has grown, and with it the probability that one day somebody will push the button. My children’s generation has grown up with the threat of global warming, a process whose consequences could be as destructive, albeit much slower. The human race is not very quick to understand novel threats. Just a few years ago, the president of the United States refused to ratify the Kyoto protocol on the basis that the ‘American way of life is not negotiable’, as if the core of American civilisation and values were the four-wheel drive vehicles produced by three large corporations that barely survived the end of this president’s term in office.
In this context, 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. Mankind has emerged through a process of natural selection over billions of years. Apart from ourselves, there is probably no other living organism on earth that could destroy us completely, because if such organisms had existed, we would not have managed to reach our current status in the first place. But as I write these lines, there is renewed interest in sending humans on a wonderful voyage to Mars and back. The kids who watched Neil Armstrong’s small steps on the moon are now engineers, pilots, administrators and politicians. They think that their own generation also needs to push back a new frontier, that this is part of the
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