“It was like a massive puzzle. But I
knew then that I finally had all the pieces
I needed to complete the picture.
It just took time to put it together.”
Once home, Dr. Pépin and his wife relished the stability for raising
their two young children. Continuing to work with various infectious
disease projects in Africa, Dr. Pépin also made a name for himself in
Canada when, after conducting two epidemiological studies on C. difficile
colitis, he helped to identify a virulent strain that was causing dozens of
deaths in hospitals across Quebec and in other provinces. The second
study, published in the Canadian Medical Association Journal, was named
the best article of 2005 by the Infectious Diseases Society of America.
It was another epidemic – a massive outbreak of African sleeping
sickness in the early 1980s – that led Dr. Pépin to Marseilles in 2006. The
trip was part of a painstaking pursuit that he had been carrying on part-
time for three years to find evidence to prove his theory – or rather, a gut
feeling – that the use of intravenous drugs to treat the disease was at least
partly responsible for the transmission of HIV.
The trip came on the heels of an article he had published in AIDS, the
official journal of the International AIDS Society. It used the results of a
study involving 1,600 people in Guinea-Bissau – together with historical
information about medical campaigns in the former Portuguese colony
that Dr. Pépin found by poring over old newspapers and records in medi-
cal archives in Ottawa, Boston and London – to suggest that both ritual
clitoris excision and multiple injections to treat sleeping sickness and
tuberculosis were responsible for the spread of HIV- 2.
He hoped to find similar proof about another outbreak of sleeping
sickness in the former French colony of the Central African Republic by
going through medical archives at the Institut de Médecine Tropicale de
Santé des Armées, a military-run facility in Marseille. He soon realized,
on the first day of his visit, that he had stumbled onto a goldmine of in-
formation about widespread intravenous treatment of not only sleeping
sickness but also a half-dozen other major diseases including leprosy and
yaws. “When I saw all the material there, like one 800-page report with a
hundred tables of data on numbers of injections given and the drugs used,
I was literally speechless,” recalls Dr. Pépin. “I realized I could expand my
research to other countries and other diseases.”
He spent the next two weeks frantically photocopying and scanning
reports. “I just grabbed everything I could and took it all home with me.”
After digesting that material, he returned to Marseilles a few months lat-
er – this time armed with a digital camera – and took photos of thousands
more pages of material about medical campaigns in French colonial Africa.
It was during that second trip that Dr. Pépin says he experienced the
dizzying eureka moment: the realization that he had very likely discovered
the smoking gun – the mechanism that led to the widespread transmission
of HIV. That became clearer, he adds, when he began writing up his find-
ings and linking them with the information he had already uncovered, as
well as his own first-hand experience. “It was like a massive puzzle,” he says.
“But I knew then that I finally had all the pieces I needed to complete the
picture. It just took time to put it together.”
The information he found in Marseilles has helped Dr. Pépin to write, in
addition to his acclaimed book, two major scientific articles, with more in the
pipeline, on the transmission of other major diseases in equatorial Africa.
“Jacques is the recruit I’m most proud of,” says microbiologist Raymond
Duperval, who hired Dr. Pépin in 1990 when he was head of the department
of infectious diseases at U de Sherbrooke (he retired last year and the
position is now held by Dr. Pépin). “He is a tireless worker, a real research
machine. But he is also an extremely modest person, very approachable.
To meet him you’d never guess he was a scientific superstar.”
True to form, Dr. Pépin smiles sheepishly when asked about the high
praise he has received for his book. “It was a labour of love,” he says of the
project, which took him four years to complete and cost him thousands
of dollars of his own money. “Being able to tell a coherent story of AIDS
was my goal. I’m happy that I was able to put all the bits and pieces of
the puzzle together.”
Mark Cardwell is a freelance journalist based in Quebec City whose specialties include
medicine and health.