Chapter 10 reviews the history of colonial medicine in the Belgian Congo. In this huge colony, Belgium established arguably the best healthcare system in tropical Africa, with more than 2,500 institutions of all kinds. As in the French colonies, there were large-scale disease control interventions using injectable drugs. A network of public health laboratories, including those in Léopoldville and Stanleyville, are ruled out as being instrumental in the early propagation of HIV. The brilliant career of Lucien Van Hoof, the colony’s chief medical officer for twelve years who also did cutting-edge research on the control of sleeping sickness, is highlighted. The rather debatable medical practices in Léopoldville’s STD clinics are examined; ‘free women’ were forced to undergo a long series of intravenous injections if they were thought, often wrongly, to have had syphilis previously. An outbreak among these women of ‘inoculation hepatitis’ was recognised in the early 1950s. An analysis of changes in the incidence of tuberculosis in various parts of the Belgian Congo in the 1950s suggests that HIV was already driving this increasing incidence in Léopoldville. A recent study identified several routes for the iatrogenic transmission of blood-borne viruses during the colonial and early post-colonial era.

Chapter 9 looks at the history of colonial medicine in French Africa. Eugène Jamot, the most famous French military doctor, spearheaded efforts in the 1920s to control sleeping sickness. These interventions were later extended to other endemic diseases such as yaws, syphilis and leprosy. Case-finding activities in every village, with on-the-spot treatment of infected patients with injectable drugs administered using unsterilised syringes and needles, led to massive infection with the hepatitis C virus of as many as half of some birth cohorts. Obviously, this could have resulted in the concurrent iatrogenic transmission of HIV, in the very parts of central Africa inhabited by the chimpanzee source of the virus.