In the 2006 article Hepatitis C Infection in African Americans Brian Perlman writes “Although African Americans represent only 12% of the US population, they represent ∼22% of the estimated Americans with chronic HCV infection;” and “The African American population in the United States has a dominant ancestry from sub-Saharan West Africa.”  This map from the Trans-Atlantic Slave Trade Database shows the regions in the America’s where many captive humans from Africa disembarked to slave markets.  The Gulf Coast, the Carolina’s, Georgia, Chesapeake (Tidewater) region were important slaving ports. If HCV originated in Africa (and/or Asia) these ports were probably where HCV was first introduced into North America.

Introductory Map 9

Epidemiologists who study the genetic diversity of old viruses that have been moving around the globe for hundreds of years (like HCV) also study historical migration routes.   (The Africa-to-Asian slave trade took place over eleven centuries;  The Africa-to- the-Americas slave trade, about four centuries.  (Source-Google Book preview:  A History of Sub-Saharan Africa, page 229, by Collins and Burns)

Interestingly, the VHA has produced a map that shows that the VISN’s (6,7,8, 16) with the greatest burden of HCV are in many of these old slave market areas. Census Bureau maps show the states with the the largest populations of African Americans are in the South.  The Hepatitis C Index (registration required) provides another tool to explore HCV prevalence in  African Americans with geography.

The virus maintained itself inefficiently in the African American community for generations (Ex. vertical mother-to-child transmission, household contact, rags, occupational blood exposures, tattoos, scarification) and spread to slave owners who administered crude health care:

“Masters and mistresses performed a variety of health care needs for their slaves prior to summoning a physician. Southern families often possessed their own medicine chest filled with popular remedies of bleeding, vomiting, and purging.”

Rough sexual assault and bloody punishments can’t be ignored.  The ancient methods of smallpox inoculations called variolation may have played a role.  Plantation owners like Thomas Jefferson made sure that his slaves, employees, and family were inoculated (last paragraph).

Because African Americans (often Genotypes 1) have a harder time clearing the virus, some infected patients have not always been offered treatment or have been excluded from clinical trials.  The VA has recenlty updated their management policies and we hope that previously untreated patients with genotype 1 are now given an equal choice in treatment options.  Any suggestion that the higher prevalence of  HCV in African American veterans is due to misconduct, and not historical and natural events, must be rejected.

We’ll save the topics of blood-letting and variolation for another day.