Miami Herald - Sunday, August 11, 1985
Ellyn Ferguson and Randy Loftis, Herald Staff Writers

But MacLeod, 32, a frank woman with a direct gaze, and Whiteside, 35, a bespectacled, quiet man whose words flow in a calm, steady stream, are tracking a medical mystery of frightening proportions: why little Belle Glade, population 19,000, has the nation's highest rate of acquired immune deficiency syndrome.

AIDS -- the latest disease to emerge in an area where tuberculosis, malnutrition, venereal disease and other illnesses are common -- is grim news for the sugar cane- and vegetable-growing town deep in the Glades, western Palm Beach County's farming belt.

And researchers have written an even more disturbing footnote for the usually fatal disease.

In Belle Glade, AIDS has crossed the line that had divided the public from those considered most at risk -- homosexual men, intravenous drug abusers, blood transfusion recipients and hemophiliacs. AIDS is believed to be passed through blood or semen.

More than half the Glades' cases don't fit those usual high-risk profiles -- far more than in the national experience. Nationally, only 6 percent of the 12,256 AIDS cases fall outside the usual high-risk categories.

Both those categories include Haitians with AIDS, but the figure is much higher in Belle Glade. Thirty-two percent of its AIDS patients are Haitian, while nationally only 2.7 percent of the AIDS patients are Haitian.

Belle Glade had 37 cases in April -- a small number, but that's 18.75 cases per 10,000 residents, a rate four times higher than second-place New York City, with its 3,993 reported cases.

So far, scientists can't explain why the disease, which breaks down the body's ability to fight infections, has hit the Glades so hard, or why so many nonrisk people have gotten it.

"I really don't know what to make of it," says Dr. Dale Tavris, epidemiologist for the Palm Beach County Health Department.

Theories abound. Researchers at the federal Centers for Disease Control and the University of Miami have evidence that heterosexual contact can transmit AIDS. The National Institutes of Health and the CDC are tracking possible transmission from AIDS victims in Africa to their wives, husbands or children through normal household contact.

Environmental theory

MacLeod and Whiteside, physicians who treat the Glades' AIDS victims, have their own theory. They say the blame could lie with the Third World filth in which many of their impoverished patients live, and with repeated mosquito bites over a lifetime.

"Perhaps (an) environmental factor may contribute to AIDS, especially when you consider that we don't have a good explanation for half of our cases of AIDS in Belle Glade," Whiteside said.

Since Whiteside and MacLeod aired their theories at an international AIDS conference in Atlanta in April, they have attracted attention from all three national networks, The New York Times, Newsweek, Time and newspapers from across the country.

Most of the nation's top AIDS researchers say MacLeod and Whiteside are way off base with their mosquito theory. There's virtually no chance that mosquitoes are spreading AIDS, they say.

But they concede that environmental factors -- poor sanitation, crowded housing and other illnesses that often afflict the poor -- could be among the missing pieces to Belle Glade's tragic puzzle.

"Environmental factors cannot be ignored," said Dr. Margaret Fischl of the University of Miami, one of South Florida's leading AIDS investigators. "I think there is a problem in Belle Glade. It has to be evaluated."

Further scrutiny

Dr. Harold Jaffe, chief epidemiologist for CDC's AIDS Activities Section in Atlanta, voiced a similar opinion at a conference in Miami. Mosquitoes aren't an AIDS factor, but "the question of environment deserves further scrutiny," Jaffe said.

Whiteside, who with MacLeod travels from North Miami Beach to Belle Glade twice a month to see AIDS patients, says proving that squalid living conditions might play a role in AIDS would have "huge implications."

It means, he said, the same might apply anyplace with crowded conditions associated with poverty -- such as Miami's Little Haiti, Liberty City or Overtown.

Other researchers use more measured language, but they acknowledge that the theory is worth exploring.

This month, state health officials will start a three- to six-week research project that could shed light on the mystery. First, they will test the blood of consenting patients at the county's health clinic near Belle Glade to get an idea of how many people have been exposed to HTLV-III, the virus linked to AIDS.

That pilot project could lead to a broader, federally financed study that might include "a preliminary review" of a possible mosquito connection, said Spencer Lieb, chief of Florida's communicable disease section.

No 'position change'

That doesn't mean state officials accept the mosquito theory, Lieb said.

"This is not a position change," he said. "This is a statement of research that needs to be done. I don't think any research in AIDS is totally close-minded, but (follows) a logical sequence."

Research chiefs from the federal CDC in Atlanta will come to Palm Beach County to double-check the results.

The demographics of the Glades' AIDS sufferers have helped to pique the scientists' interest:

* More than 90 percent of Belle Glade's victims live within a two-block area of the city's southwest section, a nearly all-black ghetto. Most are close neighbors; two live in a single rooming house.

* With a large population of recent Haitian immigrants, researchers expected to find a high number of Haitian AIDS patients, but not one-third of Belle Glades' cases.

* The AIDS profiles in the Glades don't match those elsewhere in Palm Beach County. Along the more populous Atlantic Coast, the people with AIDS fit the national high-risk categories more closely.

* The secondary diseases that AIDS patients in the Glades usually get also differ from the national norm.

"We tend to have the more unusual opportunistic infections (in AIDS patients) in our county," said Tavris, the county epidemiologist. "We have a lot of tuberculosis in our AIDS patients." TB is known to spread more readily in crowded housing with poor sanitation.

"In Belle Glade, there does seem to be some correlation in that respect," Tavris said.

A map showing where Belle Glade's TB patients lived got Whiteside and MacLeod thinking about a possible link with AIDS.

"The majority of cases of active tuberculosis come from the same neighborhoods . . . sometimes the same house," Whiteside said. "Because all the AIDS (patients) are in the same neighborhood, there may be a parallel."

TB link 'possible'

Fischl, the University of Miami researcher, said a TB link might be possible. TB or other illnesses might reduce a person's ability to fight off the AIDS virus, she said. Still, Fischl cautioned that no one has proved an environmental link.

Whiteside and MacLeod think further research will prove the connection. They contend that a lifetime of malnutrition, poor sanitation and deplorable housing exposes people to wave after wave of infections, weakening the immune system and making them more susceptible to the AIDS virus.

Noting the common history of tropical diseases between Florida and the Caribbean, they also say constant, repeated mosquito bites over years could spread the virus.

The mosquito theory probably has gotten them in more trouble with other scientists than anything else.

"I think honestly, one thing we did (at the Atlanta conference) is we broke a taboo: We mentioned mosquitoes as one of the environmental factors," Whiteside, half-joking, said during a recent interview.

It's not a taboo, but bad science, other researchers say. Even those who support the general theory of an environmental link say mosquitoes aren't involved.

Theory disputed

Dr. John Seale, a London physician who has written several articles in English research journals comparing AIDS in different countries, says there's no mosquito connection.

But Seale does think squalid, crowded housing has contributed to AIDS in Africa, and he says it would be "most odd" if the same thing weren't happening in Belle Glade.

Dr. C. L. Brumback, the county Health Department's nationally respected director, disputes Whiteside and MacLeod on both counts.

"At the present time, there is no evidence of mosquito transmission and there has been no support of environmental factors," he said.

As Whiteside and MacLeod have presented their theories in dozens of national news accounts, sometimes comparing Belle Glade to a developing nation, they haven't won too many friends among Glades businessmen and civic leaders.

Some local people question the pair's credentials as researchers. Their colleagues say they're competent.

"I consider them credible," said Gus Sermos, the CDC's chief investigator in Florida. "They don't claim to have proven their theory."

Challenges welcomed

Sermos said the pair, especially MacLeod, is better at doctoring than at handling intense scrutiny from reporters and the egos of other scientists. "I wish I could act as her press agent sometimes," he said.

Whiteside said he and MacLeod welcome the scientific challenges to their theories.

"I'm glad to have people who will make a constructive criticism because that's how I learn. But my position is this: For God's sake, keep an open mind and let's look at the different possibilities."

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