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

by Randy Shilts

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.

The odious biological realities of a deadly epidemic encouraged paradox. At a dinner party one night, Cliff Morrison, the nursing coordinator for the AIDS Ward at San Francisco General Hospital, was introduced to a man who later scolded his host, “You should have told me who he was. I never would have shaken his hand if I knew where he worked.” After dinner, the anxious guest left the party for an evening at the baths. In line at the Club Baths at Eighth and Howard streets, patrons jokingly called the facility “AIDS and Howard,” even while they fished membership cards and locker fees from their wallets.

In a local gay newspaper, writer Paul Reed summarized the various styles of gay response to the epidemic. There were the “What Crisis?” types, who denied there was an epidemic at all, as opposed to the “Nervous Nellies,” who were paralyzed with dread. The “Ozzie and Harriets” had settled into monogamous relationships, while the “Superman” types tricked on, convinced they were somehow immune to AIDS. The “Doris Day” types invoked fatalism to rationalize their continued cruising, singing, “Que sera, sera.” Reed counted himself in the last category: “The Utterly Confused.”

In late August, a second Debbie Reynolds fund-raiser in Los Angeles flopped when local AIDS groups refused to cooperate. Demoralized by the constant criticism and bickering from other gay leaders, board members began resigning. One attorney bitterly told Marc Conant, “Let them all die if that’s what they want to do.”

When the Institute for Health Policy Studies at the University of California in San Francisco later analyzed the differences between the municipal responses to AIDS in New York City and San Francisco, it concluded that the disparate quality rested in part on the vast difference in news coverage by the two cities’ major newspapers. Between June 1982 and June 1985, the San Francisco Chronicle printed 442 staff-written AIDS stories, of which 67 made the front page. In the same period, The New York Times ran 226 stories, only 7 of which were on page one. From mid-1983 on, 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.”

Despite all their evidence, the Parisian doctors found that the American scientific establishment was reluctant to take their work seriously. Their research papers were subjected to lengthy delays. In rejecting one paper, an American reviewer took a nationalistic tact when he dismissed LAV as “the French virus.”

Behind the scenes, Robert Gallo at the NCI continued to spread the word that LAV was nothing more than a laboratory contaminant. Repeatedly, Pasteur researchers heard from their American counterparts that, yes, the Pasteur work was interesting, but they would wait to see what Gallo came up with.

On the eve of the conference, Japan had reported its first two AIDS cases, making it the first Asian nation to be touched by the epidemic. The brothels, Turkish baths, and sex parlors in Tokyo’s famed Yushiwara District were refusing entry to foreign visitors for fear that they might spread AIDS. Baths posted signs reading: “Japanese Men Only.”

The 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.

“We will not have any of these cases in the Soviet Union,” said a Soviet delegate confidently. Don Francis couldn’t resist saying to Marc Conant in his loudest stage whisper, “And they won’t, all right.” In a stern Russian accent, Francis continued: “You have AIDS—bang, bang, bang.” The Soviets were not amused.

Such stories helped convince the nurses on the AIDS Ward that 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 strategy of both state and city health officials continued to minimize the severity of the AIDS problem, lending credence to their contention that they were doing enough to fight it.

The CDC wasn’t impressed with the complacent outlook of health officials, given the fact that it was common knowledge that Manhattan gay doctors weren’t reporting many of their cases because of the confidentiality dispute with the CDC. Dr. Richard Selik of the AIDS Activities Office responded to the reports of New York AIDS decreases by ordering an investigation on local reporting practices. In the end, it turned out that the rate of AIDS cases wasn’t decreasing in New York but was increasing there as fast as elsewhere in the country. This did not deter the state and city health officials from continuing to announce, at virtually every juncture of the epidemic, that the rate of new AIDS cases was “leveling.”

Again and again, this sad sequence of self-hatred and policy paralysis played out in the AIDS epidemic, just as it did in Bethesda.

So far, sixteen hemophiliacs were suffering from AIDS. In just two years, the disease had emerged as the leading cause of death among hemophiliacs in the United States, even surpassing uncontrolled bleeding.

Bathhouse owners, some of whom had spent much of the last decade barring racial minorities from their businesses, themselves had become new champions of civil liberties.

Privately, Silverman felt that if people like Bill Kraus were so goddamned opposed to the bathhouses, they should take picket signs and stand outside the doors, warning people away. That would draw more media coverage of the issue and give him a demonstration of community support that, in turn, could justify his closing the baths. Without such support, Silverman did not feel that closure would serve a constructive end. Gay leaders lauded Silverman for taking the most appropriate action. The foes of the Milk Club could barely restrain a smirk at Bill Kraus. Everybody figured he was behind this burst of attention on the bathhouses, as he had been last year. Once again, he had lost.

Through 1983, Larry Littlejohn wrote various letters to San Francisco Public Health Director Mervyn Silverman, the board of supervisors, and the AIDS organizations, pointing out what he considered to be a rather logical argument for stopping bathhouse sex. 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.

What disturbed Bill Kraus more than the charges themselves was the fact that there was no one in the gay community who would censure this verbal terrorism. Not one gay politico, writer, or thinker would step forward and say, simply, “This is madness.” Insanity triumphed because sane people were silent.

“Today we add another miracle to the long honor roll of American medicine and science,” she declared. “Today’s discovery represents the triumph of science over a dreaded disease. Those who have disparaged this scientific search—those who have said we weren’t doing enough—have not understood how sound, solid, significant medical research proceeds. From the first day that AIDS was identified in 1981, HHS scientists and their medical allies have never stopped searching for the answers to the AIDS mystery. Without a day of procrastination, the resources of the Public Health Service have been effectively mobilized.” The doctors who accompanied Heckler to the podium blanched visibly when she proclaimed that a blood test would be available within six months and a vaccine would be ready for testing within two years. None of the doctors with Heckler on the stage believed this claim, and nobody could determine where she had conceived such deadlines, which they knew would never be met.

By the summer of 1984, of course, Francis’s lab technicians were working with large quantities of the deadly LAV as well as large amounts of tissue from AIDS patients. His antiquated laboratories, however, did not have an autoclave to sterilize pans and instruments. Instead, technicians carried their contaminated trays and instruments down a hallway to another lab for cleaning. Doing this required the workers to precariously balance their materials in one hand while they turned the doorknob with their contaminated lab gloves. In the summer of 1984, Francis’s problems with doorknobs came to summarize his despair over adequate resources.

For all the behind-the-scenes talk, however, AIDS remained a largely unspoken subtext in the election. When the issue was considered at all, it was generally in the context of what each political party thought was wrong with the other.

Of course, nobody spoke the A-word aloud from the podium of either convention. The entire subject continued to be embarrassing for most people in the mainstream of society; this uneasiness was something that Republicans and Democrats shared.

The Pasteur team remained dispirited by their inability to gain recognition for their achievements. As they plodded from conference to conference, they continued to see their work slighted and the viral discovery they had made attributed to others. By the end of the year, Montagnier sighed, “I have learned more of politics than of science during all this. I never thought I would have to be a good salesman in order to be heard.”

The uproar illuminated the profoundly heterosexual male bias that dominates the news business. After all, thousands of gay men had been infecting each other for years, but attempts to interest news organizations to pressure the city for an aggressive AIDS education campaign had yielded minimal interest. A single female heterosexual prostitute, however, was a different matter. She might infect a heterosexual man. That was someone who mattered; that was news.

As battle lines hardened, the conflict became a classic confrontation of public health and civil liberties. The Lambda Legal Defense Fund, a New York–based gay legal group, threatened to block release of the test in court. How could the government release a test that could have such devastating impact on so many American lives, without any safeguards? they asked. At the CDC, doctors who had worked on transfusion-AIDS research were dumbfounded. How could these people threaten to halt a test that could clearly save lives? By mid-February, the two sides had reached a standoff.

In New York City, gay leaders remained flatly opposed to gay men taking the test for fear of civil liberties violations. Rather than enact laws protecting civil rights, a much more difficult task in New York than California, the strategy was simply to make it impossible for gay men to be tested. Without any public comment, Health Commissioner David Sencer filed a public order declaring that no laboratory in New York City would be permitted to conduct antibody tests except for scientific research. The order did not apply to blood banks. While the New York City testing ban eliminated the possibility of abuses, it also denied the test to people who might want to take it for a personal reason. A number of gay doctors were stunned. They had looked forward to the test for its possible use on ailing patients who appeared to have bizarre manifestations of ARC. An antibody test would steer them toward immune dysfunctions, while a negative result might guide them toward other non-AIDS diagnoses. There was also the question of women with a history of drug abuse considering having children. A child born to an infected woman would most likely be infected with the AIDS virus and suffer the fate of those lonely infants who were born to die. The value of the test was incalculable in such cases, but doctors were denied its use for their patients because a handful of gay AIDS activists and political leaders had persuaded the health commissioner to ban the test for political reasons.

After spending four years listening to polite public health officials chatter in the intransitive lingo of AIDSpeak, AIDS activists were unaccustomed to hearing people suggest that they might actually have to do something. So far, most gay action against the disease had consisted of holding sophisticated AIDS education forums in Manhattan auditoriums and handing out condoms at the San Francisco Gay Freedom Day Parade.

Although the gay AIDS activists were fond of lecturing people that “AIDS is not a gay disease,” they had in fact treated the epidemic almost solely as a gay disease, the private property of a community that would base public health policy on its own political terms.

To Francis, the Hudson episode was not a celebration of one man’s courage but an indictment of our era. A lot of good, decent Americans had perished in this epidemic, but it was the diagnosis of one movie star, who had demonstrated no previous inclination to disclose his plight, that was going to make all the difference.

When Liberace was on his deathbed, a spokesman maintained the pianist was suffering the ill effects of a watermelon diet.

Dr. C. Everett Koop had come to President Reagan’s attention because of his leading role in the anti-abortion movement. His conservative religious fundamentalism horrified liberal, feminist, and gay leaders who had fiercely opposed his nomination as surgeon general in 1981.

Koop spent much of 1986 interviewing scientists, health officials, and even suspicious gay community leaders. Once the text was prepared, he took the unusual step of having tens of thousands of copies printed—without letting the White House see it in advance. When Koop went public with the report, it was clear why. The “Surgeon General’s Report on Acquired Immune Deficiency Syndrome” was a call to arms against the epidemic, complete with marching orders. For one of the first times, the problem of AIDS was addressed in purely public health terms, stripped of politics. AIDS education, Koop wrote, “should start at the earliest grade possible” for children. He bluntly advocated widespread use of condoms. Compulsory identification of virus carriers and any form of quarantine would be useless in fighting the disease, Koop concluded.

The report proved an immediate media sensation. The calls for sex education and condom use at last gave journalists something titillating on which to hang their stories.

Uncorrupted by the language of AIDSpeak, Koop was able to talk in a way that made sense; at last, there was a public health official who sounded like a public health official. Not only that, he was able to utter words like “gay” without visibly flinching.

Unwittingly, the Reagan administration had produced a certifiable AIDS hero. From one corner of the country to the other, AIDS researchers, public health experts, and even the most militant of gay leaders hailed the surgeon general. Koop quickly became so in demand for speeches that he was called a “scientific Bruce Springsteen.”

The public was used to hearing health officials sound like politicians, so it didn’t sound jarring when politicians started talking like they were health officials.

Ultimately, it had taken an international committee to rule that, no, this was not a leukemia virus and, no, Dr. Gallo did not have the right to name it. To smooth ruffled feathers, however, the committee arrived at a compromise name: Human Immunodeficiency virus, or HIV.