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

by Randy Shilts

collective concern fueled the most dramatic shift in behavior since the contemporary gay movement was forged in the Stonewall riots of 1969. Nonsexual social alternatives thrived.

Rates of anal gonorrhea, an indicator of the prevalence of passive anal intercourse, plummeted that year. This new toned-down gay life-style had started as a vogue in early 1983; by the end of that year, it was a trend; in the year that followed, it would turn into a full-scale sociological phenomenon.

Psychologists studying the gay community compared the contradictory trends to the reactions men typically have when facing their mid-life crisis.

The gay community’s confused response marked the start of its own collective redefinition, a process that, for all its early silliness, would become one of the more profound effects of the AIDS epidemic in the coming years.

In October 1982, about three-fourths of the nation’s AIDS caseload had lived in one of the four cities hardest hit by the epidemic: New York, San Francisco, Los Angeles, and Miami. By now, however, fewer than two-thirds of the people with AIDS lived in these cities.

the coverage of the Chronicle focused on public policy aspects of the epidemic, while the Times covered AIDS almost exclusively as a medical event, with little emphasis on social impact or policy. The study concluded, “The extensive nature of coverage by the Chronicle, aside from providing a degree of health education not found in New York, helped sustain a level of political pressure on local government and health officials to respond to the AIDS crisis.”

It was November 1983, and science at last was closing in on the viral culprit that bred international death. Unfortunately, the scientific intrigue that would surround the discovery had only begun.

With 27 cases now reported in Great Britain, doctors were clamoring for research money from a conservative prime minister who did not include the epidemic on her list of health priorities.

The disease was obviously widespread in Africa, although it had not been noticed because of the lack of sophisticated medical care. Searching through hospital records and death certificates, the epidemiologists made an even more disconcerting finding. The disease had killed nearly as many women as men, leading researchers to believe that in these poor Equatorial nations, AIDS was spreading as a heterosexually transmitted disease.

initial routes of the epidemic’s spread became clear by virtue of the link between Haiti and Zaire in the early 1970s, when the African nation imported many better-educated Haitians who, as French-speaking blacks, could take the role of the Belgian colonial administrators who had been expelled.

The extraordinary charity efforts were an aspect of the gay community that didn’t get much press. On this cold drizzly night, Sharon McKnight had rolled her own piano in to sing “Stand By Your Man” to men who would probably never get to a nightclub again, because they all were going to

Morrison announced the new 5B policy: that all patients designate their significant others who would have visiting privileges. As far as Morrison was concerned, the definition of the American family had changed. It should be the right of patients themselves to define their families, not the right of the hospital.

changing definition of family

Deotis smiled as a photographer took a photograph of him holding his gown up. The photo never made it into the paper because an editor thought he’d throw up when he saw it.

the will to live was not fantasy but was probably the single most influential factor in determining how long patients survived. People who decided it was time to die, very often did; the young men who fought the disease, often lived longer.

The only education program in New York City was still that of the Gay Men’s Health Crisis, which had coordinated $3 million worth of volunteer time and services for AIDS in calendar year 1983 on a budget of only $120,000.

By Christmas, Dr. Robert Gallo had told the director of the National Cancer Institute that he had discovered the retrovirus that caused AIDS.

the statistician gave Lawrence the results. Lawrence was horrified. According to the analysis, the mean incubation period for the disease was 5.5 years. It appeared that some cases would take more than 11 years to incubate, based on the mathematical projections, although some people would come down with AIDS in as little as six months.

He had believed that tens of thousands would die in the AIDS epidemic. This long incubation period, however, meant that the genetic machinations of the still-unknown virus had permitted it to spread for years before anyone even knew it existed.

If you guys had been married to women, this never would have happened.” The comment, from one of the CDC’s top AIDS people, gave Larry insight into why, nearly three years into the epidemic, the CDC still did not include even one openly gay person on their burgeoning staff at the AIDS office.

Interagency rivalry between the CDC and the National Cancer Institute was frequently alluded to during the Atlanta trip. One CDC official candidly admitted, “We don’t even talk to them.”

The closeted homosexual is far less likely to demand fair or just treatment for his kind, because to do so would call attention to himself.

“The efforts of the Public Health Department have been ineffective in influencing sexual activity at the bathhouses.”

Collectively, the gay community was going through the phase in the grief process known as bargaining.

bargaining is an attempt to postpone. So gay men bargained. Safe sex had come to mean eliminating your least favorite sexual activity and hedging on the rest. Maybe if I give up getting fucked, I can still have oral sex, many reasoned.

the bathhouse issue for gays continued to play like the blood banking issue for heterosexuals. There was denial and then bargaining. The gay response to the bathhouse problem was not a homosexual reaction; it was a human reaction.

Dritz was stunned that the disease—which could only be contracted through unprotected, passive anal intercourse—should increase at a time when gay men were being told that passive anal intercourse was a ticket to oblivion.

The bathhouses weren’t open because the owners didn’t understand they were spreading death. They understood that. The bathhouses were open because they were still making money.

A year before, Gary Walsh had been among the thirty-five AIDS sufferers to sign a letter asking that Bay Area Reporter editor Paul Lorch be fired. Lorch pulled out the letter when he heard that Gary had died and drew a line through Gary’s name.

Fresh blood samples from AIDS patients were flown in from Los Angeles and San Francisco, and the results were the same. These people were infected with LAV. The French had discovered the cause of AIDS.

sex. In the years since then, Larry Littlejohn had served two terms as president of the Society of Individual Rights and was widely recognized as one of the city’s first gay activists.

He assumed somebody would act. After all, lives were at stake. A city health department that would yank a restaurant license for cockroach infestation certainly would pull a bathhouse license for fostering a far more lethal activity. Yet, by the first months of 1984, it was clear that nobody would do anything. Most recently, Dr. Silverman had written Littlejohn that bathhouses were valuable sites for AIDS education. That was what had brought Littlejohn to the city’s largest bathhouse in early March. He wanted to see what kind of education patrons got.

He couldn’t stand all the screaming and hatred; he wanted out of the whole controversy. When Cleve called Pabich, he said that his boss, Assemblyman Art Agnos, had demanded that he not add his name to the list. Neither Dick Pabich nor Bill Kraus believed this. Bill swore he would never forgive Cleve for deserting him at this most crucial juncture. But Cleve couldn’t focus on that. Two years of gay fratricide over AIDS had thoroughly exhausted him. As he slumped into his bed after calling Pabich, Cleve just wished it would all be over.

He believed that the Mafia, who maintained strong links to bathhouses in other cities, was behind the quick change in the health director’s thinking.

Bill Kraus was devastated by the criticism. He had spent the past decade doing little else than promoting gay rights. Now he was chastised as a “traitor” for his efforts to ensure the biological survival of gay men. He felt that a homosexual McCarthyism had descended on the gay community.

With such logic, the heroes had become the bathhouse owners, who had assured doctors at the AIDS Clinic that bathhouses were fine because “we both make money off” the people who were killing themselves there.

Therefore, by April 1984, isolates of the AIDS virus had been made at the Pasteur, NCI, CDC, and UCSF, all of which were discovered after substantially less than a year of research. What delayed the NCI, therefore, was not the difficulty in finding the virus but their reluctance to even look.

had made its vast penetration into American life. Although all the scientists who made the viral isolations certainly deserved applause, the discovery of the AIDS agent ultimately was not a contest for accolades but a race against time. Once again, time, the true adversary, had won.

Long-term planning for the epidemic would require a long-term commitment of resources, and that was something that both the Deukmejian and the Reagan administration wanted to avoid.

With the announcement of HTLV-III, Brandt quickly identified the four paths on which research should proceed. Top priority was the development of a blood test. Federal researchers also had to start seeking an AIDS vaccine and effective AIDS treatments while nailing down HTLV-III as the cause of AIDS.

AIDS may have been the number-one priority of the Department of Health and Human Services, he later observed, but it certainly was not a priority for the Office of Management and Budget.

Even the pleading of the Assistant Secretary for Health would not make much of a difference. What did make a difference began on June 5,1984, when a man went to his doctor’s office to learn the results of a biopsy. The biopsy had been performed on a pesky purple spot on the fifty-eight-year-old’s neck. The doctor suspected what the spot signified as soon as he saw it. Nevertheless, he waited until the biopsy confirmed the diagnosis before he told Rock Hudson that he was suffering from Kaposi’s sarcoma.

This indicated an exponential increase in future transfusion cases as late-arriving runners from these AIDS marathons approached the finish lines.

1 person in the 1978 study had LAV antibodies, while 25 percent of the group studied two years later were infected. Since then, the infection rate had more than doubled. The retrospective testing bolstered the hypothesis that a new viral agent had appeared among San Francisco gay men in 1976 or 1977 and spread rapidly through the city

Dr. Max Essex was at liberty to hypothesize openly about how AIDS started. His own studies on outbreaks of an AIDS-like disease among research monkeys in both Massachusetts and California had led him into research on Simian AIDS, or SAIDS, and the discovery of STLV-III, or Simian T-lymphotrophic virus. The similarities in proteins between STLV-III and HTLV-III led Essex to believe that AIDS may have been lying dormant in some primate population for thousands of years before being transferred to humans.

Given the abrupt sociological dislocation in equatorial Africa in recent years, the rest of the story was fairly easy to piece together. A remote tribe may have harbored the virus. With the rapid urbanization of this region after colonization, the virus may have only recently reached the major cities, such as Kinshasa. From Africa, the virus jumped to Europe, where AIDS cases were appearing regularly by the late 1970s, and to Haiti, through administrators imported from that island to work in Zaire throughout the 1970s. From Europe and Haiti, the virus quickly made its debut in the United States, returning to Europe in the early 1980s through gay tourists.

Dale Lawrence’s research into AIDS incubation gained a more pressing import. With an average incubation period of 5.5 years, there didn’t have to be many cases in 1984 to substantiate the fatality of the AIDS virus. According to his calculations, because the virus had not invaded the bodies of very many Americans until 1980, the huge number of AIDS cases would not start appearing until late 1985. Still, throughout 1984, the CDC made no effort to reveal Lawrence’s disquieting research.

As far as Don Francis was concerned, the reward for government work rested in impact. You didn’t get a hefty salary, a fancy office, or elaborate perks as a government scientist, but you could make a difference. Francis had beaten every virus he had fought; that was impact. He had helped wiped out smallpox and the dreadful Ebola Fever virus. But he couldn’t beat the system when it conspired to help the viral enemies of humankind. By the summer of 1984, Francis was beginning to feel thoroughly beaten down.

“If we can’t pass them out, we might as well burn them,” reasoned Sutro’s owner. The logic was abstruse for most people, however, and the sight of the bathhouse employees publicly burning AIDS-prevention guidelines became one of the most enduring images of the AIDS-stricken gay community in San Francisco that summer.

At City Hall, an environmentalist named Ponderosa Pine, who frequently dressed up as a tree, was leading an “All Species Rally” of fellow ecologists who had donned plant, bird, and fish costumes to call attention to the “fate of other species.”

The reluctance of prominent people to publicly acknowledge their AIDS diagnoses left obituary columns strangely empty of actual flesh-and-blood people who were dying of the syndrome. Only the most knowledgeable of obituary readers could detect the presence of this epidemic in the death notices. A thirty-eight-year-old fashion designer dying of “cancer and pneumonia,” for example, was a sure giveaway, as was the man in his thirties who left no surviving widow after succumbing to a “lingering” or “lengthy” illness.