CHUS, Department of Microbiology and Infectious Diseases, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, Québec J1H 5N4, Canada.
Sex Transm Infect. 2012 Jun;88(4):307-12. doi: 10.1136/sextrans-2011-050277. Epub 2012 Feb 11.
To understand the factors that drove the exponential spread of HIV-1 in Léopoldville (Kinshasa) in the 1950s.
A review of colonial and post-colonial health service reports, medical publications, and demographic and social science research in Léopoldville.
Sex work appeared early in the history of Léopoldville, driven by a strong gender imbalance. Throughout the colonial era, sex work was of a low-risk type, with 'free women' having a few regular clients. This sufficed for the persistence of HIV-1, but probably not for the dramatic expansion that occurred in the 1950s. During that decade, genital ulcerative diseases were uncommon and their effect on HIV-1 transmission must have been modest. Circumstantial evidence indicates that this expansion may have been related to parenteral transmission of HIV-1 in the city's sexually transmitted disease clinic, where up to 500 injections were administered daily using syringes and needles that were merely rinsed between patients. Most intravenous injections were given to treat syphilis in patients who never had any clinical evidence of this disease but only had a positive non-treponemal serology, often because of prior yaws infection. An outbreak of 'inoculation hepatitis' was reported among these patients in 1951-1952. It is only after the Congo's independence (1960) that, in a context of pauperisation, a pattern of sex work appeared in Léopoldville wherein women had sex with more than 1000 clients each year, allowing the sexual amplification of the virus.
It is plausible that the exponential amplification of HIV-1 in Léopoldville occurred mostly parenterally in the 1950s and sexually in the 1960s.
了解 20 世纪 50 年代利奥波德维尔（金沙萨）HIV-1 呈指数级传播的驱动因素。
对殖民地和后殖民时期卫生服务报告、医学出版物以及利奥波德维尔的人口和社会科学研究进行回顾。
性工作在利奥波德维尔的历史早期就出现了，这是由强烈的性别失衡驱动的。在整个殖民时期，性工作的风险较低，“自由女性”有几个常客。这足以维持 HIV-1 的持续存在，但可能不足以解释 20 世纪 50 年代发生的戏剧性扩张。在那个十年里，生殖器溃疡性疾病并不常见，它们对 HIV-1 传播的影响一定是适度的。间接证据表明，这种扩张可能与城市性传播疾病诊所中 HIV-1 的注射传播有关，在那里，每天使用注射器和针头为多达 500 名患者注射，这些注射器和针头在患者之间只是冲洗一下。大多数静脉注射是为了治疗梅毒患者，这些患者从未有过任何这种疾病的临床证据，只有非梅毒螺旋体血清学阳性，这通常是因为以前感染过雅司病。1951-1952 年，这些患者中报告了一起“接种性肝炎”爆发。只有在刚果独立（1960 年）之后，在贫困化的背景下，利奥波德维尔出现了一种性工作模式，即女性每年与 1000 多名客户发生性行为，从而使病毒得到性放大。
HIV-1 在利奥波德维尔的指数级扩增很可能主要是在 20 世纪 50 年代通过注射传播，而在 20 世纪 60 年代则主要是通过性传播。
