The New York Times - August 16, 1983
Lawrence K. Altman, M.D.

The sensitivity of the issue was apparent here last week as researchers and health officials from 12 countries met at the Pan American Health Organization, the regional office of the World Health Organization. The meeting was the first to discuss the spread of AIDS in the Americas.

One participant was Dr. Ary Bordes, the health minister of Haiti, who was perplexed by the reputation his country has acquired since the Centers for Disease Control in Atlanta named Haitians among the groups that had high "risk factors" for contracting AIDS. The other groups so far identified are male homosexuals, intravenous drug users, hemophiliacs and some recipients of blood transfusions. Of the 2,008 cases of AIDS reported in the United States, 105 victims, or about 5 percent, were Haitian-born people who said they did not belong to any of the other risk factor groups.

Many Haitians have expressed anger over being included in the list. They have charged that most of the cases among Haitians and Haitian- Americans should have been included in the homosexual category, even though the patients have denied such activity. The denials, they contend, stem from cultural differences that make it extremely shameful to acknowledge homosexuality.

Dr. Bordes, who trained in public health at Johns Hopkins in Baltimore, said that normally the main concerns of his job were with common conditions such as diarrhea and tuberculosis. But he said that AIDS, which kills far fewer people than do common infections, had become a priority health issue because of its economic impact on his impoverished country. AIDS has thrust Haiti into the international limelight as epidemics sometimes can do and it has choked off the dollars from tourism. Two spokesmen for the Haitian Government have cited widely discrepant figures on the decline in tourism in the last year. Three weeks ago, one said the decline was 20 percent. Last week, another said it was 75 percent.

Now, as Dr. Bordes tries to persuade the world that his Caribbean country is safe for tourists, his message is that the public has a vastly different understanding of the phrase "risk factor" than do scientists.

Risk factor is a phrase that epidemiologists use to describe the various conditions that can put people at risk of getting a disease. It has come into the everyday American vocabulary in recent years to help people understand that cigarette smoking increases the chances of developing lung cancer and heart disease.

AIDS seems to be spread only by intimate sexual contact or through contaminated blood. But Dr. Bordes contends that many people believe that declaring Haitian nationality as a risk factor has conveyed the false impression others are at risk of getting AIDS from Haitians.

Officials at the Centers for Disease Control say they have offered to publish data on AIDS in Haiti in the center's widely distributed weekly report, as well as a statement from the Haitians about their views on unacknowledged homosexuality in Haiti But the Haitians have to supply their data first. Dr. Ronald St. John, the head epidemiologist for the pan- American organization, confirmed that such a message had been forwarded to the Haitian health ministry on July 6.

However, Dr. Bordes said he had not received the request.

Dr. Harold Jaffe of the AIDS task force at the Atlanta disease center repeated the request at the meeting but drew no affirmative response from the Haitian officials present.

What will Dr. Bordes do when he receives the formal request? "Scientifically I have no reluctance" to provide the information, Dr. Bordes said. "But if those data will destroy my country, I will not do it because my main duty is to my country."

A perplexing question is why AIDS has appeared in Haitians but not in people from the Dominican Republic, which shares the same island of Hispaniola and even some of the same work force.

Each representative was queried about the existence of AIDS in his country. The Dominican representative, Dr. Humberto Bogaert Diaz, said he knew of no reported cases of AIDS in his country. He rejected a challenge from Dr. Fritz Daguillard, a Haitian-born immunologist now working in Paris, who said he had heard reports of at least three cases in the Dominican Republic.

Most epidemiologists find it difficult to understand how a disease could be confined to one side of an island. Perhaps it isn't and more investigation is required.

"Probably we have some cases, but we haven't found them - yet," Dr. Bogaert Diaz, who heads the Dermatology Institute in Santo Domingo, said in an interview. AIDS can lead to an unusual type of cancer called Kaposi's sarcoma that shows up on the skin as well as elsewhere in the body. AIDS also causes a wide spectrum of unusual infections, and Dr. Bogaert Diaz said that after returning home he would discuss the issue with other physicians in the Dominican Republic who would be more likely to see such manifestations. "We will look harder" for AIDS, Dr. Bogaert Diaz said.

Some epidemiologists have speculated that in the tropics, mosquitoes or other insects might spread AIDS. But Dr. Robert Gordon, an official of the National Institutes of Health in Bethesda, Md., said the pattern of reported cases made mosquitoes an unlikely vector. Malaria, which is spread by mosquitoes, is most common in Haiti's rural regions, while AIDS has been reported much less often in rural than in urban areas.

Dr. Alastair J. Clayton, who heads the Canadian Center for Disease Control in Ottawa, said that for unknown reasons the 33 AIDS cases reported in his country were far fewer than might be expected by proportion with the United States. With one-tenth the population of the United States, Canada would be expected to have about 200 cases of AIDS. Of the 33 cases reported, 12 - more than one- third - involve Haitian-born people. This number is disproportionately large, since at most 60,000 Haitian- born people live in Canada.

Two of the 12 Haitian-connected cases in Canada were in women and a third in a infant girl, in contrast to only one case in a non-Haitian woman. The higher percentage in the Haitian-born women reflects similar findings in the United States and Haiti.

Dr. St. John said the Pan-American Health Organization had erred in an earlier statement that the transmission of AIDS was confined to only three countries in the world - Haiti, the United States and Canada. These are the only countries in the Americas where transmission is known to be occurring, Dr. St. John said. Cases have been reported in 14 European countries, although it remains unclear how many of those cases were transmitted within the country or were imported into it.
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