And the Band Played On: Politics, People, and the AIDS Epidemic

by Randy Shilts

Playing Politics with a capital “p” meant using the political system to establish the long-term social change you’re seeking.

New York gay leaders, led by lesbian Carter delegate Virginia Apuzzo, thought the Californians were far too militant for mainstream America. Not everybody could live like the out-of-the-closet types who were always rioting in San Francisco.

A Democratic Congress could probably hold back the anti-gay legislation of the New Right. Although the other points on the agenda they held dear would suffer from spending cuts,

the agricultural engineer was the first to die,

United States, unexplained maladies from a mysterious new syndrome would be traced back to 1979.

1914, Kaposi’s sarcoma, or KS, was first reported in Africa, where subsequent studies discovered that it was the most common tumor found among the Bantus, the disease generally remaining within distinct geographic boundaries in the open savannah of central Africa.

Gay doctors had long recognized that parasitic diseases like amebiasis, giardiasis, and shigellosis were simply a health hazard of being gay. The problems grew with the new popularity of anal sex, in the late 1960s and early 1970s, because it was nearly impossible to avoid contact with fecal matter during that act.

Easy treatment had imbued them with such a cavalier attitude toward venereal diseases that many gay men saved their waiting-line numbers, like little tokens of desirability, and the clinic was considered an easy place to pick up both a shot and a date.

Jerry Falwell and his Moral Majority became household words, and analysts heralded the fundamentalists as the most important new political force to emerge in America in decades.

Most analysts, however, pinned the conservative landslide on the sheer unpopularity of incumbent Carter and the fact that people seemed ready for a frugal government that pledged cuts in domestic spending.

Voters had just thrown out the city’s method of electing supervisors by district. Gays had fought hard for district elections in the 1970s, largely because it seemed that no gay candidate could ever be elected citywide; there just wasn’t that kind of power then.

gay neighborhoods, again, were showing the highest voter registration, feeding the highest voter turnouts in the city. Gay precincts were also proving to be the city’s most liberal, churning out ten-to-one majorities for incumbent Democratic Senator Alan Cranston.

Some of the largest Carter voting blocs in Manhattan, New Orleans, and Houston were from homosexual neighborhoods.

Back then, it had been so clear what they were fighting for. There were visible foes, like Anita Bryant and John Briggs’s anti-gay school-teachers referendum. Now, in such a short time, they had already won much of what they wanted, at least in San Francisco. The votes were still there, but the fire had left the politics of Castro Street. What were they fighting for now?

the trap that had snared so many beautiful gay men. In his twenties, he had searched for a husband instead of a career. When he did not find a husband, he took the next best thing—sex—and

The warehouse district alleys of both Manhattan and San Francisco had throughout the 1970s grown increasingly crowded with bars for the burgeoning numbers of leathermen like Ken Horne. By 1980, it was a regular industry.

New studies were showing that 93 percent of gay men were infected with cytomegalovirus, a herpes virus that had been linked to cancer. The gay sexual revolution had also made the Epstein-Barr virus, a microbe also linked to cancers, pandemic among homosexual men.

the strange mix of taboos and newfound freedom had created a social climate that was wonderfully tailored for aggressive little viruses.

a new virus was now well-entrenched on three continents, having moved easily from Africa to Europe and then to North America.

Mildvan went quickly to the point. This was all connected, she was convinced, and in the early weeks of 1981 she became one of the first doctors to begin conceiving a larger picture.

New discoveries are constantly being made and many of these discoveries have important political or social overtones.

The Carter administration had held a tight line on health spending. Under Reagan, Westmoreland could see, it would be worse.

President Reagan had gone into office promising that federal programs would be turned over to the states.

Two cases was something to be concerned about. Three cases, he felt, were a big deal, a harbinger of more to come.

gay politics, the importance of coalitions, and his new plan to foster gay clout by placing key gay activists in the offices of various political leaders.

Bill was having a more difficult time reconciling the gay community’s sexual Disneyland with the political aspirations he wanted his minority to achieve.

The gay sexual scene became progressively depersonalized:

Bill’s leftist inclinations blamed it on corruption of money and businessmen. These places were created because there was money in them. Bill personally appreciated the convenience of the sex,

The first diagnosis of Kaposi’s sarcoma in San Francisco arrived in Jim Ground-water’s office on April 9,1981, from a pathologist at the University of California at San Francisco.

But in the last eight weeks, she had filled five orders for adult male patients with unexplained Pneumocystis. All but one of them lived in New York.

he didn’t have the luxury to collect data for the next two years before writing up an august article for a medical journal. People had to find out about this, Gottlieb thought frantically. He’d only been in L.A. since July, but he had one key contact.

“Wayne,” Gottlieb said, “there’s something going on with Pneumocystis carinii pneumonia and CMV in homosexual men. Can you look into it?” Gottlieb was relieved Shandera was his friend,

This was important, Shandera knew, and the very reason he had volunteered for work in the medical world’s version of the Peace Corps. He would have preferred to be in some underdeveloped nation helping the truly disadvantaged, but, as he relayed his findings to Gottlieb, he sensed that what he was doing now was significant.

With five cases of Pneumocystis diagnosed in five gay men over the past few months in just one city, the phenomenon Gottlieb and Shandera were studying fit the necessary criteria for an epidemic. One man was already dead. Gottlieb had the queasy feeling that there was something bigger, something catastrophic lurking behind this.

there’s no way we can guarantee that it will be published.” But this is an emergency, Gottlieb thought as he hung up the phone in frustration. You don’t just run business as usual in an emergency. It was an observation Gottlieb would recite almost daily in the difficult years ahead. For this young doctor, about to be credited with the discovery of the public health threat of the century, the thought became a grim mantra for the AIDS epidemic.

African KS had been linked to a herpes virus, CMV. This research was intriguing in that it might establish one of the first links between a virus and cancer, something scientists had sought for years.

Dr. A. Bernard Ackerman, who added with surprising prescience, “We have recently seen numerous cases of Kaposi’s sarcoma in young homosexual men and, it is our opinion, that these lesions may well be induced by an infectious agent.”

five cases of bone sarcoma in homosexuals they’re investigating at State University of New York?”

The unknowns went against the methodical streak in her attentive nature, so on that Tuesday afternoon, Sandy wrote a memo to her boss, the deputy director of parasitic diseases, and told him about the nine drug orders and the gossip about the bone sarcoma. That was how the thorough GS-7 drug technician in Room 161 of the Centers for Disease Control’s Building 6 alerted the federal government to the new epidemic.

Don’t offend the gays and don’t inflame the homophobes. These were the twin horns on which the handling of this epidemic would be torn from the first day of the epidemic. Inspired by the best intentions, such arguments paved the road toward the destination good intentions inevitably lead.

Curran was also struck by how identifiably gay all the patients seemed to be. After years of working with the gay community, he knew that you couldn’t tell homosexuals by looking at them. These clearly must be patients who put a high personal stake in their identification as gay people, living in the thick of the urban gay subculture. They hadn’t just peeked out of the closet yesterday.

With all the overlapping infections, the mysterious immune defects, and the unprecedented sociological issues, nothing about this epidemic fit into any neat category. About a dozen staffers from all the disciplines potentially involved with the diseases volunteered for the working group. They included specialists in immunology, venereology, virology, cancer epidemiology, toxicology, and sociology. Because the outbreak might be linked to the Gay Bowel Syndrome, parasitologists were called in. With Curran, Harold Jaffe, and Mary Guinan, the task force was weighted with people from venereal disease studies.

First, there could be some substance common to the environment of these patients causing their immune problems. The leading candidate was poppers, or nitrite inhalants, though almost any bad batch of drugs might be to blame. The second explanation, of course, was that this was the effect of some infectious agent, either one new virus or some combination of old microbes working together in a new way.

Whatever was happening to the PCP cases in Los Angeles was somehow related to these KS patients in New York.

Most gay papers across the country carried the item well off the front pages since it seemed, at best, to be some medical oddity that was probably blown out of proportion by homophobes in both the scientific establishment and the media. It was in the gay press, however, that the complicated phraseology of Pneumocystis carinii pneumonia was first simplified to a term that fit better into headlines. Gay pneumonia, it was called.

Cancer and immune suppression, Francis said. Both feline leukemia and this new gay disease were marked by a trail of opportunistic infections that seemed to take advantage of an immune system weakened by a primary infection. In cats, the infection was a leukemia virus that knocked out the cats’ immune systems and left them open to a number of cancers. Clearly, some similar virus was doing the same thing to these homosexual men,

this new disease must have long latency too, which is the only way it was killing people in three cities on both coasts before anybody even knew it existed.

viruses were crafty little creatures constantly trying to outsmart humans in their bid for survival. Long latency periods were one of the most clever ways to thwart detection and extermination.

Francis didn’t think the gay health problems were being caused by cytomegalovirus or the other familiar viruses under discussion. They had been around for years and hadn’t killed anybody. It was something new; it could even be a retrovirus, Francis said.

Francis was already convinced. He quickly became the leading CDC proponent of the notion that a new virus that could be spread sexually was causing immune deficiencies in gay men.