The Association of Haitian Physicians Abroad (Association des Médecins Haïtiens à l'Etranger or AMHE) has reviewed the recent article by Thomas Gilbert and colleagues, reporting a phylogenetic analysis of archival blood samples collected from five early recognized AIDS patients at Jackson Memorial Hospital in 1982-1983. The study authors identify these five patients as Haitians who left Haiti after 1975. This article has several important limitations and does not provide any scientific breakthrough. Before a detailed critique of this paper, AMHE would like to point at the following remarks in methodological biases that may explain some of the study findings. First, the bias in selection of early samples of HIV among Haitians is quite obvious. The investigators chose a convenient sample under the assumption that all these Haitian immigrants acquired HIV infection in Haiti. They obviously ignore that the clinical course of these patients perfectly fits the natural history of HIV/AIDS. No culturally-sensitive epidemiological investigation has ever been conducted of these initial Haitian immigrants presenting with HIV infection at Jackson Memorial Hospital in Miami. Therefore, the contention that they contracted HIV in Haiti is presumptuous and not based on facts. Moreover, no archival samples from Haiti are included in the phylogenetic analysis and this constitutes a serious flaw. We do not know either how many samples of the pandemic clade B might have come from Haitian subjects, which raises the prospect of misclassification.

Second, the authors do not adequately report on some of their methods and results. For example, they do not specify clearly the number of sequences for which there was uncertainty as to which subtype they belonged to; neither do they try to replicate their results by sequencing other HIV genes. While computer simulation techniques and phylogenetic analyses are important to our understanding of biological evolution, the application of these methods with such serious methodological limitations does not prove unequivocally the origin of the pandemic clade B subtype in the United States.

Because these findings lack scientific validation, we need to raise questions about the motives of the authors; their paper not only does not advance our knowledge of the HIV epidemic but it continues with a dangerous precedent of victimizing an ethnic group with flimsy data. Needless to say those half truths have been very harmful to the country and its people. The hasty classification of Haitians as a group at risk for HIV more than 20 years ago can be considered as a cloud hanging over good scientific practice. It destroyed the tourist industry in Haiti; its citizens have since been suffering from the social stigmata of presumed carriers of dangerous germs even though that classification was finally removed by the CDC.

We are also afraid that such mishandling of data can have the unintended consequence of the refusal of Haitian patients to participate in research studies at American Universities for the fear that they will be used as guinea pigs in the furtherance of biased scientific protocols and conclusions. That would be the saddest of ironies for we all need good science to help us all against this calamity.

"Science sans conscience n'est que ruine de l'âme".

Christian Lauriston, MD

President

Central Executive Committee

Association of Haitian Physicians Abroad (AMHE)

RELATED TEXT: When blame is again unjustly assigned to Haitians for the pandemic, AIDS / UN's 2007 HIV/AIDS Epidemic Update