FEU-NRMF

INSTITUTE OF MEDICINE • But, one thing is for sure, Dugas was not the source of HIV in
Bioethics 2 United States and was never Patient Zero. Dugas was a
scapegoat for HIV.
CASE: GAETAN DUGAS
Ethical Issued Raised
Historical Background • Micro-Ethical Concern (Patient-Oriented)
• Born: April 20, 1953 in Quebec ü Obligation not to spread the disease
• Started out as hairdresser in Toronto - Dugas refused to give up sex despite the strong
• Moved to Vancouver later on and later joined Air Canada to evidence of sexual transmissibility. It would be a
begin his dream career of being a Flight Attendant grave injustice to deliberately and knowingly
• His travels included trips to United States, Europe, and communicate the disease to someone else. The
Caribbean infected person must use every reasonable means to
• He was particularly fond of San Francisco and made the yearly avoid this.
trip to partake in the annual gay parade and week-end long • Discrimination
partying - In 1983, when so little information had been disseminated
• His good looks and charm ensured a steady stream of sexual locally about AIDS and Dugas represented the first person
partners and in a typical year his exploits amounted to with Kaposi Sarcoma most gay Vancouverites met, the
approximately 250 encounters flight attendant endured significant fear and resentment
• 1979: HIV ordeal began when he developed swollen lymph in that city.
nodes - Tivey noted of Dugas’s appearances in public. “People
• 1980: Brown spot appeared on his face and biopsy revealed knew who he was by this time, and they were afraid of him,
Kaposi’s Sarcoma people were afraid, they just got out of his way. These were
• March 1984: The so – called “Cluster Study” was published in other gay men moving when they saw him coming.”
the American Journal of Medicine - While it is understandable to fear a deadly illness that one
- Interviewers asked the patients to name all their sexual does not fully comprehend, this ignorance does not justify
contacts and after a few dozen interviews, they noticed violent or discriminatory behavior against those infected.
that multiple patients mentioned a certain Canadian air Such behavior denies a fellow human being the basic
steward dignity, the fundamental respect that is that individual’s
- The paper included a diagram illustrating links between due as a creature made in God’s image.
patients with each person represented by place and
number and within this cluster of circles was Patient O. Developments
®
Directly emanating from Patient O were 8 individuals and • March 1987 - AZT (zidovudine, Retrovir ) -- Glaxo Wellcome
from there, further links to other AIDS patients. was licensed after trials showed that a dose of 1200mg per day
• The Centers for Disease Control (CDC) did interview Dugas and reduced opportunistic infections and increased CD4 counts and
when it is becoming evident that AIDS was an infectious survival among people with AIDS.
disease, doctors advised him to stop having sex. • Zidovudine - it is the first anti-HIV drug approved by the US
• Dugas refused the advice of the doctors. He was stubbornly Food and Drug Administration (FDA)
unconvinced that he could transmit his disease and remained • Over the years, multiple drug therapies proved to be more
sexually active. effective than single-drug therapies
• He moved to San Francisco, gained a significant notoriety at the • 1988 – US bans discrimination against federal workers with HIV
bathhouses to the point that some members of the gay • 1991 – According to WHO, there are 10 million HIV patient
community hatched a conspiracy to force him out of town worldwide. More than a million are in the US (CDC).
• Eventually, he did move back to Vancouver. His disease • 1993 - AIDS patients start to show signs of resistance to AZT.
advanced and suffered through multiple bouts of Pneumocystis • 1995 - The New York Times reports that AIDS has become the
pneumonia. March 30, 1984 he passed away in Quebec. leading cause of death among all Americans ages 25 to 44.
• Three years later, Randy Schilts hoped that the book “And The • 1995 - The number of yearly deaths in the U.S. jumped from
Band Played On” would expose what he described as 4,135 in 1987 to 48,371 in 1995
‘institutional indifference’ that was confounding a major health • 1997- AIDS deaths had dropped to 21,399 as additional anti-HIV
crisis. drugs were approved by the FDA
• Shilts later on revealed Dugas as the Cluster Study’s Patient • 1997 - Approximate number of HIV-positive people worldwide
Zero and was said to be the cause of AIDS epidemics. -- 22,000,000. To put this number in perspective, it is larger than
• In an interview made with Michael Denneny (Shilts’ publisher) the total population of the continent of Australia.
he described the initial dismal prospects for the book which • 1997 - Approximate total worldwide death count -- 6,400,000.
motivated them to find a more creative way to promote the • 2011 - More than 1.1 million people are living with HIV/AIDS in
book and the solution: the United States, and more than 33 million people are living
- Use Patient Zero and present him as the handsome, with HIV/AIDS around the world.
promiscuous French-Canadian Airline steward who may • 2013 - UNAIDS reported that AIDS-related deaths had fallen
have brought AIDS to America. 30% since their peak in 2005. An estimated 35 million people
• It was the pathway to the bestseller list and it worked. are living with HIV.
• Denneny’s rationalization was once the book gained its • Many epidemiologists admit a cure for HIV/AIDS is still years
publicity, Shilts could use the platform to denounce the Reagan away.
Administration’s indifference to the AIDS problem.

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