We have just seen how HIV and other blood-borne viruses can be transmitted through injections. Here we will examine the history of colonial medicine in the French territories of central Africa, where remarkable public health interventions ultimately proved successful in reducing the burden of tropical diseases, but at the same time caused the parenteral transmission of HCV, the HTLV-1 retrovirus and presumably SIVcpz/HIV-1 as well. The core of the problem was that since the early drugs against infectious diseases were not very effective, they all had to be administered by injections, often IV, so as to maximise the drug concentration in the blood and in other tissues. As we will see now, tens of millions of IV injections were administered within the crucible of HIV-1, at exactly the right time.

The system

A remarkable peculiarity of French colonial history is the way medicine was organised: as part of the military. Young Frenchmen interested in a medical career in the colonies would usually get their degree at a medical school run by the armed forces in Bordeaux, before moving on to the tropical medicine institute in Marseilles, known as Le Pharo, after the name of the park where it is located near the old port. Overseas, they would start as a médecin-lieutenant and progressively, for the more talented, patient or motivated, move up the ladder to become perhaps a médecin-colonel or médecin-général at the end of their careers. Very few of them would be posted to the barracks to provide care for the colonial armed forces. Instead, they were posted to the hospitals and disease control units, working among civilians but remaining military doctors so that a strict hierarchy was maintained. Disease control interventions and modes of healthcare delivery would be decided at the top of the pyramid, by the médecin-général, and implemented in a similar fashion throughout the colony following detailed protocols. There were precise definitions of what had to be reported and in what form, and the reports from each hospital or district would be merged into an annual report for the colony, containing an extraordinary number of tables, maps and graphs about the diseases of interest, their distribution, the treatments administered, the exact number of injections for each drug, and so on. Some of these annual reports contained 800 pages. Their format was the same for all colonies, so that they could be consolidated into an annual summary of the health status of overseas France.