Anne Bayley: surgical oncologist who recognised the spread of AIDS in Zambia among heterosexual patients

Abstract

In 1983 surgeons across East Africa began to compare notes about a new disease, known colloquially as “slim,” which was prevalent across the region. At the time, Anne Bayley was running a clinic at the University Teaching Hospital in Lusaka, Zambia, for patients with endemic Kaposi’s sarcoma, a relatively indolent skin tumour, found mainly in older men. In 1983, however, the number of new cases of Kaposi’s sarcoma doubled to 23—and 13 of these patients (including three women) presented with unusual, more aggressive disease. Eight patients died in less than a year.1 There was also a rise in reports of Kaposi’s sarcoma in the literature, reflecting the emergence of HIV/AIDS among mainly gay men in the West. Bayley realised that HIV was the underlying problem in her patients with aggressive Kaposi’s sarcoma, which she thought implied heterosexual transmission. Not everyone agreed, convinced that it was spread by sex between men. Keeping an open mind and with some personal discomfort, she asked her male patients if they ever had sex with men. Most responded with an emphatic no. In 1984, when an HIV antibody test was developed, Bayley sent samples for testing. Nearly all the patients with aggressive Kaposi’s sarcoma were HIV positive. Bayley’s clinical reports resulted in the US Centers for Disease Control sending a team to Lusaka, leading to …