How Urbanization and Mass Transit Sparked the AIDS Epidemic

A new report on how AIDS began reveals striking similarities to today’s Ebola outbreak.

Scientists have identified Kishasa as the epicenter of the AIDS epidemic. (Photo by AP / John Bompengo)

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There’s a reason movies about pandemics are always set in some crazy Hong Kong-ish neighborhood where 200 people are squished onto a bus built for 80 — disease loves a crowd. So when scientists revealed last week that they’d found the origin of AIDS, it came as little surprise that the outbreak began in a rapidly urbanizing part of the Congo nearly a century ago.

Reporting in the journal Science, the researchers traced the origins of the epidemic that has infected over 75 million people to the African boomtown of 1920s Kinshasa. At the time, the city was becoming a major point of trade, and a transit hub with railroads running outward from it to several other cities in the region.

The city’s growth drew hoards of male laborers, and, in turn, a rampant sex trade. So when the virus made the jump from primates to people, it quickly spread here, and soon made its way to nearby Brazzaville and Katanga. By the end of the 1940s a million people were coming and going on Kinshasa’s railways, taking the virus with them as they left.

“It was a very large and very rapidly growing area,” Prof. Oliver Pybus from the University of Oxford told the BBC, adding that “the… really interesting aspect is the transport networks that enabled people to move round a huge country.”

With both the current Ebola outbreak and the outbreak of AIDS 90 years ago, the parallels — the growth of cities, new forms of travel — are unmistakable. “The path of Kinshasa’s HIV hinted at how modern travel could midwife a global pandemic,” wrote the Washington Post. Even today, urban density is directly correlated with HIV prevalence. Citylab recently reported that nearly half of all American AIDS cases are found in just 12 metro areas, and the accompanying maps paint a stark picture: it’s most often the densest parts of these cities that see the highest rates of infection.

With cities growing so quickly, it’s tempting to indulge in doomsday predictions about the health consequences of urbanization. But in many ways, cities provide our best chance for beating such epidemics. One of the reasons Ebola has spiraled out of control in Africa is specifically rural: officials can’t convince West African villagers to stop eating bat meat, as is their tradition, which is one of the ways the virus spreads. And not all African cities have cultivated the contagion — Lagos, where there’s a density of decent health care services, quickly contained Ebola when it showed up there.

A recent research paper titled “City Epidemics Matter” tackled this topic, emphasizing the paradox that urbanization presents to the spread of contagious disease. “Cities hence provide many opportunities to mobilize financial, human and technical resources, to coordinate and deliver services more efficiently and cost-effectively,” write the authors. The problems arise when you get density without these improved services — lots of people but not enough resources. When that happens, an epidemic is only one of urbanization’s many problems.

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Will Doig was formerly Next City’s international editor. He's worked as a columnist at Salon, an editor at The Daily Beast, a lecturer at the New School, and a communications staffer at the Open Society Foundations. He is the author of High-Speed Empire: Chinese Expansion and the Future of Southeast Asia, published by Columbia Global Reports.

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Tags: health

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