had sexual contact with. Of these cases, 168 people had at least two
contacts who were also infected. This suggested they were
disproportionately important in the outbreak. ‘Who were those 168
people?’ Gladwell asked. ‘They aren’t like you or me. They are
people who go out every night, people who have vastly more sexual
partners than the norm, people whose lives and behaviour are well
outside of the ordinary.’
Were these people really so promiscuous and unusual? Not
particularly, in my view: the researchers found that, on average, these
cases reported sexual encounters with 2.3 other infected people. This
implies they caught the infection from one person and typically gave it
to one or two others. Cases tended to be black or Hispanic, young,
and associated with the military; almost half had known their sexual
partners for more than two months.[72] During the 1970s, Potterat
had begun to notice that promiscuity wasn’t a good explanation for
gonorrhea outbreaks in Colorado Springs. ‘Especially striking was the
difference in gonorrhea test outcome between sexually adventurous
white women from a local upper middle class college and similarly
aged black women with modest sexual histories and educational
backgrounds,’ he noted.[73] ‘The former were seldom diagnosed with
gonorrhea, unlike the latter.’ A closer look at the Colorado Springs
data suggested that transmission was likely to be the result of delays
in getting treatment among certain social groups, rather than an
unusually high level of sexual activity.
Viewing at-risk people as special or different can encourage a
‘them and us’ attitude, leading to segregation and stigma. In turn, this
can make epidemics harder to control. From / to Ebola, blame
- and fear of blame – has pushed many outbreaks out of view.
Suspicion around disease can result in many patients and their
families being shunned by the local community.[74] This makes
people reluctant to report the disease, which in turn amplifies
transmission, by making the most important individuals harder to
reach.
Blaming certain groups for outbreaks is not a new phenom enon. In
the sixteenth century, the English believed syphilis came from France,
so referred to it as the ‘French pox’. The French, believing it to be