front cover of Patient Zero and the Making of the AIDS Epidemic
Patient Zero and the Making of the AIDS Epidemic
Richard A. McKay
University of Chicago Press, 2017
Now an award-winning documentary feature film

The search for a “patient zero”—popularly understood to be the first person infected in an epidemic—has been key to media coverage of major infectious disease outbreaks for more than three decades. Yet the term itself did not exist before the emergence of the HIV/AIDS epidemic in the 1980s. How did this idea so swiftly come to exert such a strong grip on the scientific, media, and popular consciousness? In Patient Zero, Richard A. McKay interprets a wealth of archival sources and interviews to demonstrate how this seemingly new concept drew upon centuries-old ideas—and fears—about contagion and social disorder.

McKay presents a carefully documented and sensitively written account of the life of Gaétan Dugas, a gay man whose skin cancer diagnosis in 1980 took on very different meanings as the HIV/AIDS epidemic developed—and who received widespread posthumous infamy when he was incorrectly identified as patient zero of the North American outbreak. McKay shows how investigators from the US Centers for Disease Control inadvertently created the term amid their early research into the emerging health crisis; how an ambitious journalist dramatically amplified the idea in his determination to reframe national debates about AIDS; and how many individuals grappled with the notion of patient zero—adopting, challenging and redirecting its powerful meanings—as they tried to make sense of and respond to the first fifteen years of an unfolding epidemic. With important insights for our interconnected age, Patient Zero untangles the complex process by which individuals and groups create meaning and allocate blame when faced with new disease threats. What McKay gives us here is myth-smashing revisionist history at its best.
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Private Choices and Public Health
The AIDS Epidemic in an Economic Perspective
Tomas Philipson and Richard A. Posner
Harvard University Press, 1993

Like other dangerous but pleasurable activities, such as downhill skiing and mountain climbing, engaging in unprotected sex implicitly involves the weighing of costs and benefits. Recognizing that the transmission of the AIDS virus is a consequence of private choices—rational and often informed—to engage in risky conduct, the authors employ tools of economic analysis to reassess the orthodox approach to AIDS by the public health community.

Standard predictions of the spread of AIDS, the authors argue, are questionable because they ignore rational behavioral response to the risk of infection. For the same reason, customary recommended public health measures, such as extensive testing for the AIDS virus, not only may be ineffective in controlling the spread of the disease but may actually cause it to spread more rapidly. The authors examine regulatory measures and proposals such as mandatory testing, criminal punishments, and immigration controls, as well as the subsidization of AIDS education and medical research, the social and fiscal costs of AIDS, the political economy of the government's response, and the interrelation of AIDS and fertility risk.

Neither liberal nor conservative, yet on the whole skeptical about governmental involvement in the epidemic, this book is certain to be controversial, but its injection of hard-headed economic thinking into the AIDS debate is long overdue. Although Private Choices and Public Health is accessible to the interested general reader, it will also capture the attention of economists—especially those involved in health issues—epidemiologists, public health workers, lawyers, and specialists in sexual behavior and drug addiction.

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