Odette Ferreira, HIV-2 and the blood sample carried in a coat

On 26 September 1985, in Luc Montagnier's laboratories at the Institut Pasteur in Paris, a Portuguese visitor wrote a number in her notebook. A liquid scintillation counter had read 75,000 counts of reverse transcriptase activity, the enzyme retroviruses use to copy their genes into DNA, in a culture grown from the blood of a patient in a Lisbon hospital. The isolate was nicknamed MIR, after the patient's name.2 sources

Maria Odette Santos-Ferreira was 60, a professor at the Faculty of Pharmacy of the University of Lisbon, and on the last day of a stay in Paris that had begun on 16 September. The blood came from a 28-year-old man admitted to the Hospital de Egas Moniz, one of several patients from Guinea-Bissau with all the signs of AIDS whose blood kept testing negative, or almost negative, for the AIDS virus.2 sources

Ten months later the virus was described in Science as LAV-II. It is now called HIV-2, the second human immunodeficiency virus. Odette Ferreira, as she was known, died 33 years after that entry, on 7 October 2018, aged 93.3 sources

She was born in Lisbon on 4 June 1925 into a family of pharmacists. Her grandfather owned the first pharmacy on the island of Bolama, in what was then Portuguese Guinea; her father was a civil servant. She was taken to Bolama at three months old, visited Portugal every four years, and came back to Lisbon at ten to attend the Colégio Moderno.2 sources

She chose pharmacy and completed the first part of the course, but the Lisbon pharmacy school had been closed since 1932 and the only place to finish the degree was Porto. Her father would not let her live there alone, so her studies stopped for more than two decades. The Lisbon school reopened in 1968, and she graduated in 1970, in her mid-forties.2 sources

She became an assistant in microbiology and won a three-month scholarship from the French embassy to train at the Institut Pasteur. That became a doctorate from the Université Paris-Sud in 1977 on tracing hospital infections in Portugal caused by the bacterium Pseudomonas aeruginosa. The work gave her two things she would need later: a place at the Pasteur, and contacts with the infectious-disease doctors of Lisbon's hospitals.3 sources

AIDS was first reported in the United States in June 1981. In May 1983 Montagnier's team at the Pasteur isolated a virus it called LAV, and in 1984 Robert Gallo's American team published its own virus, HTLV-III. The two turned out to be the same virus, written as LAV/HTLV-III by 1986 and now called HIV-1, but in 1984 the French and American teams were still competing to prove which had found the cause of AIDS.3 sources

In September 1984 Santos-Ferreira joined Montagnier's viral oncology unit to learn how to detect LAV. She came home to run a survey of the infection among people living in Portugal and set up the Pasteur's immunofluorescence test at the Faculty of Pharmacy. Until September 1985 hers was the only laboratory in Portugal doing these tests, and she asked the main Lisbon hospitals to send her blood from suspected AIDS cases.2 sources

The doctors at Egas Moniz, led by José Luís Champalimaud with Jaime Nina and Kamal Mansinho, had a group of men and women from Guinea-Bissau with chronic diarrhoea, wasting, tuberculosis and other infections typical of a broken immune system. None was in the groups then linked to AIDS in Europe and America: they were not gay men, haemophiliacs or people who injected drugs. From August 1984 the hospital sent their blood to laboratories abroad, and the answers came back positive one time and negative the next.1 source

In Lisbon the same sera always gave the same odd picture under the microscope: a faint fluorescence, neither clearly positive nor clearly negative. The team marked them with a question mark as weak positives. On 11 and 13 September 1985 two of the patients were retested, with the same result: weak in immunofluorescence, positive in a second test and negative in a third.1 source

In the first days of September 1985 she presented her survey of Portuguese patients at a European microbiology congress in Brighton, on a poster signed with Montagnier and two of his staff. A stay at the Pasteur had already been agreed for the following weeks, and she decided to take blood from the Egas Moniz patients with her.1 source

How it travelled is the part of the story people remember. According to an account based on Sandra Nobre's biography of her, Kamal Mansinho, then a junior doctor at Egas Moniz, brought the samples to her at Lisbon airport, and she flew to Paris with them hidden inside her coat. The blood had to be kept at about 37 degrees Celsius, and the coat kept it at body heat.2 sources

The coat itself was shown in the February 2019 exhibition on her life at the Museu da Farmácia. The detail comes from her own retelling and her friends', not from a document of 1985, but her notebook confirms the rest: she was at the Pasteur from 16 to 26 September 1985 with blood from the Egas Moniz patients.3 sources

On 19 September she noted that one culture was contaminated with bacteria and could not continue; two others went on. Paula Basso, curator at the Museu da Farmácia, who has studied the notebooks, writes that the Portuguese team kept its suspicion of a new virus to itself. The French staff, and Montagnier, seem to have thought she was simply running routine LAV tests for Portuguese doctors.1 source

The isolate from Lisbon was not the only sign of something new. In December 1985 a team led by Francis Barin and Max Essex reported in The Lancet that blood from some healthy people in Senegal reacted more strongly with a monkey virus, STLV-III, than with the AIDS virus. That pointed to a related virus in West Africa, but the virus itself had not yet been isolated.2 sources

On 18 July 1986 Science published “Isolation of a new human retrovirus from West African patients with AIDS”. Its first author was François Clavel; Santos-Ferreira was sixth, and José Luís Champalimaud and Montagnier were among the other authors. It reported a virus isolated from two West African AIDS patients that looked and behaved much like LAV but differed in the proteins of its outer envelope.2 sources

The authors found that the envelope of the new virus was recognised by serum from a macaque infected with a simian virus, suggesting it was closer to that monkey virus than to LAV. Hybridisation tests showed it was only distantly related to LAV. They called it LAV-II. Montagnier announced the discovery in Lisbon in 1986 with his Portuguese collaborators, and a follow-up paper in The New England Journal of Medicine in May 1987 found HIV-2 in 30 patients, almost all from West Africa, 17 of them with AIDS.3 sources

The two viruses came into humans separately. HIV-1 is closest to a virus of chimpanzees in Central Africa. HIV-2 descends from a virus of the sooty mangabey, a West African monkey, and probably crossed into people in Guinea-Bissau in the 1940s or 1950s. Basso cites research suggesting that injections and other blood exposure during the independence war of 1963 to 1974 helped it spread there.2 sources

HIV-2 is harder to pass on, by sex and especially from mother to child, probably because infected people carry less virus in their blood. Infection usually stays silent longer and destroys the immune system more slowly. Estimates of how many untreated people ever reach AIDS vary, even within one source. A 2021 review says in its summary that most eventually do, but its main text cites studies suggesting that only 15 to 25 per cent progress to AIDS without treatment, after an estimated 15 to 20 years on average.2 sources

It has also stayed local. Guinea-Bissau once had the highest rate, with about 8 per cent of adults infected. The latest figures in the 2021 review put Guinea-Bissau, Senegal, the Gambia, Sierra Leone and Côte d'Ivoire at 1 to 5 per cent, and Cape Verde and the rest of West Africa below 1 per cent. Prevalence is falling. In Europe, Portugal and France have the most cases, through their old colonial links with West Africa.2 sources

In 1992 the health minister appointed her coordinator of the Comissão Nacional de Luta Contra a SIDA, the national commission against AIDS. She held the post until 2000, the first pharmacist to do so in a job usually held by doctors. By then heroin had spread through Portugal, and HIV infections among people who injected drugs were rising steeply.5 sources

She went to them. Lisbon's Casal Ventoso neighbourhood was then Europe's biggest open-air drug market, and she gave away clean syringes there, with donated clothes, soap, razors, condoms, fruit and sandwiches. Dealers sent her death threats. The Guardian, which interviewed her in 2017, reported her answer.2 sources

On 1 October 1993 the commission, the Ministry of Health and the Associação Nacional das Farmácias launched “Diz Não a Uma Seringa em Segunda Mão”, “Say no to a second-hand syringe”. Users could swap a used syringe at a pharmacy for a kit with sterile syringes, condoms and disinfectant wipes. Because about 2,500 pharmacies took part, it reached the whole country at once, and the European Commission rated it the best project presented by a member state.3 sources

The National Association of Pharmacies counted more than 43 million syringes collected between 1993 and 2008. An external evaluation in 2002 estimated that the programme's first eight years had saved the state between €400 million and €1.7 billion. In 2022 the programme handed out 1.1 million syringes, 80 per cent of them through harm-reduction teams and 19 per cent through pharmacies.2 sources

The commission did more than syringes. Under her it opened free, anonymous testing centres, a drop-in centre for sex workers in the Intendente district of Lisbon, district AIDS commissions and the first palliative care home for people with AIDS in Lisbon, and it reopened the AIDS helpline.2 sources

Portugal's national register counts 66,421 HIV infections diagnosed in the country from 1983 to 2024. New diagnoses rose through the 1990s to a peak of 3,338 in 1999 and have broadly fallen since. In 2024 there were 951, fewer than a third of the 1999 figure.1 source

The sharpest change was among people who inject drugs. They account for 19,573 of all infections recorded, 29.5 per cent of the total, and the DGS and INSA describe a very steep rise in the 1990s to 1999, then a fast and continuous fall. In 2024 only 19 new diagnoses were linked to injecting.1 source

The register shows when infections fell, not why. Needle exchange began in 1993. In 2001 Portugal decriminalised the possession of drugs for personal use: people caught with a personal supply could be sent to a local panel of a doctor, a lawyer and a social worker instead of being arrested. Treatment centres and harm-reduction services were also growing through those years. The Guardian's 2017 investigation warned that it is misleading to credit Portugal's results entirely to the change in law.2 sources

France made her a knight of the Légion d'honneur in 1987 for the HIV-2 work. In Portugal she became a Commander of the Order of Sant'Iago da Espada on 6 April 1988, won the Ministry of Health's Prémio Nacional de Saúde for 2012 (announced that October and presented in 2013), and in 2016 received the science ministry's Medal of Scientific Merit. The Ordem dos Farmacêuticos named a research prize after her in 2010.4 sources

On 19 December 2017 the Faculty of Pharmacy gave her name to its auditorium, which she had helped to build. “Today is one of the happiest days of my life,” she said. The same month the President, Marcelo Rebelo de Sousa, made her a Grand Cross of the Order of Public Instruction, the highest grade of the order for services to education; she received it in a private ceremony in February 2018.4 sources

She still went to the faculty every day in her nineties and sat in the front row at HIV conferences. She died on Sunday 7 October 2018. Her funeral ceremonies were held at the Igreja do Campo Grande in Lisbon, and the funeral went from there to the Alto de São João cemetery. Her papers are at the Museu da Farmácia, which opened an exhibition on her life in February 2019.5 sources