DEATH WATCH: The Global Response to AIDS in Africa

McCormick, Piot's CDC colleague on the Kinshasa trip, asked the Reagan administration for funding to return to Zaire to conduct a larger study. According to Laurie Garrett, author of "The Coming Plague," political appointees turned McCormick down, refusing to believe his finding that "AIDS can be, and is, a heterosexual disease."

The Fears of the Rich

Projet SIDA, after the French acronym for AIDS, went forward in Kinshasa without White House help, despite McCormick's plea. Leading it, fresh from a public health surveillance post in New Mexico, came a young American doctor who would transform the global AIDS campaign.

Jonathan Mann, then 37, brought passion and meticulous energy to the job. From 1984 to 1986, his small team traced widening circles of infection, without apparent social boundaries, in Zaire. "The harder Jon and his team looked for identifiable risk factors, the more they came to realize the worst," Robert W. Ryder, who took over the project from Mann, wrote later. "The risk factors for HIV infection in Kinshasa were being young and sexually active and living in Kinshasa."

One unknown variable stood out when scientists gathered in Bilthoven, Netherlands, in 1986. "You need to know who is having sex with whom," but few human interactions are so bound up in concealment and taboo, said Bernhard Schwartlander, now chief of epidemiology at UNAIDS. "The big problem is that we had no idea of the mixing patterns."

This much was clear: With heterosexual transmission established, AIDS might go anywhere. Mann became convinced the disease had "transcendental importance" and compared it to tectonic forces shaping a continent. He was a persuasive salesman, and two years of evidence gathered in Zaire pierced the complacency of many governments.

Early in 1986, the World Health Organization in Geneva still regarded AIDS as an ailment of the promiscuous few. Halfdan Mahler, the organization's Danish-born director general, enraged Piot with a casual suggestion in one early meeting that other diseases were far more important than AIDS.

Fakhry Assaad, Mahler's chief of infectious diseases, was beginning to disagree. He knew Mann's research, and the two men made common cause at a conference that year in Bangui, Central African Republic, where the din of a tropical downpour on a sheet iron roof broke up the proceedings and gave them time to talk. Assaad brought Mann to Geneva in November. In a two-hour conversation, the charismatic American upended Mahler's view of the world.

AIDS was not merely another infectious disease, Mann argued. It seemed to flourish in--and reinforce--conditions of poverty, oppression, urban migration and social violence. It therefore could not be solved as a biomedical problem. Women who feared a beating would not ask their husbands to use condoms. Street children and widows without rights of inheritance could not reduce the number of their sexual partners if they depended on sex for subsistence.

In an interview with filmmaker Robert Bilheimer before Mann's Sept. 3, 1998, death in the crash of Swissair Flight 111, Mann said discrimination "isn't just an effect, it's actually a root cause of the epidemic itself."

Mahler later described himself as transformed by Mann's analysis. On Nov. 20, 1986, less than three weeks after meeting Mann, the WHO leader flew with him to New York for a news conference. A few minutes before 1 p.m., they walked together into Room S-0226 at U.N. headquarters.

"We stand nakedly in front of a pandemic as mortal as any pandemic there has ever been," Mahler declared. "In the same spirit that WHO addressed smallpox eradication, WHO will dedicate its energy, commitment and creativity to the even more urgent, difficult and complex task of global AIDS prevention and control."