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uncomfortable about not having the same rapport with him that I had with the others, but medically, at least, he was not getting worse. In fact, he remained as I have described him for several months.

Despite our patients’ marginal health, I was optimistic. It was exciting. The veil of ignorance had been partially lifted. Patients who would have previously died were surviving and leaving the hospital. Many did reasonably well between relapses, despite their blood tests, which showed that they were still immune deficient. We had effective treatments for many but not all of the infections and hoped that if we could buy enough time either we would find a cure or the patients would recover spontaneously.

We also knew something that hardly anyone else knew: This terrible disease did not affect homosexual men exclusively. The speculations in the letters section of the New England Journal of Medicine—amyl nitrates, proctofoam cream, the immunosuppressive properties of sperm in the bloodstream—were fanciful but wrong. But what was the connection between these Haitians and gay men with the same illness? Was this something new, or had it been there all along but in our ignorance we had missed? We speculated among ourselves. New virus? Mutant virus? Combination of viruses in sequence? Genetic predisposition? Old virus behaving in a new manner? Perhaps it was exposure to malaria or some other parasitic organism endemic to Haiti? There certainly were enough possibilities to choose from—leishmaniasis, schistosomiasis, strongyloidiasis. Rifampin, a drug used to treat tuberculosis, was reported to have immune-suppressant properties. Each of these theories was considered, but there were no hard facts to support any of them.

Mary Jo in obstetrics delivered the baby of a pregnant mother dying of tuberculosis. Gwen and Wade in pediatrics followed this child and soon others, some born of seemingly healthy mothers. All eventually succumbed to bizarre infections. So now we had infected men, women, and children in growing numbers. Their only link? They were all Haitians.



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