And the Band Played On

by Randy Shilts

  “And what’s the most important issue today?” Burton asked Bill.

  “Gay cancer,” Bill said.

  The fact that the response came almost as a reflex stunned Bill. He hadn’t really taken GRID that seriously in recent months. Like everybody else, he was eying his pimples more suspiciously, but fundamentally, he saw gay cancer as something that happened to other people, sleazy people with 1,100 sexual contacts. That’s what he had read in the paper.

  Self-conscious that he had pounced on the issue so hard, Bill laid out the political terms for the Godfather of San Francisco politics in a conversation that would have far-reaching implications for the epidemic.

  He couldn’t believe that the government wasn’t ringing alarms and pledging tons of money to this disease, Bill explained. It didn’t make sense. Look at all the hoopla they made about Legionnaire’s and toxic shock. Bill didn’t have the proof yet, but he suspected they weren’t talking about it because they didn’t want to spend money. They wanted to save their bucks so they could finance death squads in Central America.

  When placed so sharply in the partisan terms with which Burton was most comfortable, Burton began to see Bill’s point. Bill could work on this gay cancer stuff, he promised, reminding him not very gently that there was an election to win first.

  Bill Kraus was ecstatic about his new congressional staff job. His relationship with Kico Govantes wasn’t going well. He had shown Kico everything about the gay scene and defended the liberating sexuality so much that Kico was now intrigued with exploring it himself. In hopes of rekindling their fading passion, Bill had taken to escorting Kico to local baths.

  Kico was always uncomfortable in those places, feeling they were dirty, even evil. And he had begun a romance with a handsome older architect, so he didn’t need the release. Bill was fiercely jealous, although he and Kico remained part-time lovers, ensnared in a partnership that would never dissolve. In a corner of his mind, Bill welcomed the staff job because it would give him an escape. He never was much into alcohol or pot. Although he occasionally sniffed a line of coke, he preferred to use work to pull himself away from personal problems. The job also positioned him to work in Congress, the only elected job he felt mattered.

  At night, when Kico was with his architect, Bill drove his Datsun to a desolate windswept hilltop set above the Castro District. From a craggy outcropping of Corona Heights, he could see the small, busy, gay enclave below and the tall skyscrapers of downtown set against a porcelain-blue sky. As the fog crept from the ocean and wound lazily through the high rises, a fear sometimes tugged at him. He couldn’t define it, so his thoughts would drift away again to the speeches that would need to be written.

  HARVARD SCHOOL OF PUBLIC HEALTH, CAMBRIDGE, MASSACHUSETTS

  Dr. Max Essex eagerly took the blood samples that arrived from a Japanese infectious disease ward to his lab. The experiments to detect antibodies to the Human T-cell Leukemia virus, or HTLV, were performed easily with reagents sent from Dr. Bob Gallo’s lab at the Division of Tumor Cell Biology of the National Cancer Institute. They yielded the expected results. Patients with infectious diseases in the ward, such as pneumonias and bacterial maladies, were three times more likely to be infected with HTLV than noninfected people. Essex was far less interested in what this meant for the Japanese than its implications for GRID. It proved that an infectious agent, particularly a retrovirus, was capable of engendering diseases by crippling the human immune system. The retrovirus itself could be transmitted, providing for an infectious disease of the immune system. HTLV, for example, could be transmitted in sex, through semen, or through contaminated blood products. Essex also hypothesized that some strains of this virus were more likely to induce immune suppression than others. Perhaps it was HTLV itself that was causing GRID.

  Essex called Don Francis with the news. Bob Gallo’s lab, Francis knew, was already poking around the lymphocytes of GRID patients in search of retroviruses. Essex decided to spend the summer testing GRID patients’ blood for evidence of HTLV infection.

  June 18

  CENTERS FOR DISEASE CONTROL, ATLANTA

  Although just about every scientist at the CDC was convinced that the cluster study gave them precisely the evidence they needed to show that GRID was an infectious disease, its release came with a deluge of qualifiers and maybes from CDC officials.

  Ironically, it was Jim Curran and the CDC Task Force who were most terrified at the implications of the cluster study. For public consumption, however, Curran and Harold Jaffe reassured reporters that no evidence existed that GRID was an infectious disease. “The existence of a cluster provides evidence for a hypothesis that people are not randomly associated with each other, and the cluster is a sexual cluster,” Curran said. “It doesn’t say we have evidence of one person giving to another person, certainly. The alternative hypothesis on the cluster would be that it isn’t transmissible from one person to another. It’s just that these people are really members of a very small subgroup among whom it might not be unusual to have sex. This is the less likely of the two hypotheses. Yet I don’t think either should be discarded. We need to focus research into this. We’re not prematurely releasing information that’s not validated. On the other hand, we’re not holding back information that might have some important health benefits.”

  Scientists accepted the information in the spirit that it was given. Most wanted to see more convincing evidence. Clinicians worried that such small clusterings among sexual contacts could lend credence to the toxic exposure theory because it was possible that one batch of bad drugs could have gotten into one crowd. Paraquat on one shipment of marijuana, for example, might have caused all these mens’ immune disorders if the pot made it across the gay air bridges between New York, Los Angeles, and San Francisco. Of course, this argument belied the random way gay men, particularly the bathhouse-oriented men who made up most of those in the clusters, chose their sexual partners. It wasn’t as though they were going to bed with each other because they were all friends. But the clinicians tended not to be sociologists, and the intricacies of the sexual 7-Elevens were lost on some of them.

  Other research-oriented scientists told CDC Task Force members that they found the cluster stories intriguing, although somewhat anecdotal, and that a case-control cluster study would be necessary to prove the hypothesis of sexual transmissibility. Of course, such a study would take a few years to construct, but nobody said science worked fast.

  In any event, the cluster study failed to resolve the transmissibility question as Bill Darrow and the CDC researchers originally had hoped it would. A handful of scientists and public health officials clearly saw the implications, but nobody rushed into action because the science wasn’t then set in concrete. Although the study attracted a brief flurry of national media attention, it faded fast.

  VANCOUVER, BRITISH COLUMBIA

  Gaetan Dugas confided to only a few friends that he was the “Orange County connection,” as the study became known because of Gaetan’s role in linking the New York, Los Angeles, and Orange County cases. Though on leave from Air Canada, the thirty-year-old flight attendant still had the passes that allowed him to fly all over the world for virtually nothing. He loved the travel, but he had decided to settle in San Francisco. They had an interferon program at their GRID clinic, and besides, he’d always wanted to live there.

  It was around this time that rumors began on Castro Street about a strange guy at the Eighth and Howard bathhouse, a blond with a French accent. He would have sex with you, turn up the lights in the cubicle, and point out his Kaposi’s sarcoma lesions.

  “I’ve got gay cancer,” he’d say. “I’m going to die and so are you.”

  July 2

  ATLANTA

  Bruce Evatt heard of still another case of immune suppression in a hemophiliac in Canton, Ohio, and now he saw clearly what was ahead. GRID was an infectious disease caused by a virus that could be spread through the blood. The nation’s blood supply was already conta
minated with the virus. A meeting of blood-industry officials would be needed soon; emergency measures would be needed to save lives.

  July 6

  CASTRO STREET, SAN FRANCISCO

  Cleve Jones had spent all afternoon passing out leaflets on Castro Street for the Kaposi’s Sarcoma Foundation’s first public forum the next night. When he arrived at the home of his old boyfriend, attorney Felix Velarde-Munoz, he was still buzzing with talk of GRID and the new organization he was forming. Cleve couldn’t believe how apathetic other gay leaders were about it. He had begged Pat Norman for a list of doctors to whom he could refer the scores of worried callers; she said she’d have to check about the right process for releasing such information.

  People were dying and gay bureaucrats were worried about process. There wasn’t time for process, Cleve said. Gay doctors still hadn’t decided whether they’d bother to put together risk-reduction guidelines, and Cleve had spent half the day on the phone pleading with gay lawyers to sit on the board and give the organization some credibility. None of them seemed particularly interested either. They had their own political agenda, and there didn’t seem anything to be gained by associating their names with some downer that was probably a lot of media hype.

  Cleve took a long sip on his second vodka tonic, puffed heavily on a Marlboro, and noticed that Felix wasn’t talking much. Cleve kicked himself for running off at the mouth and asked what the civil rights lawyer had been up to lately. Usually, there was some injustice that Felix was fighting in his new job at the State Bar of California. But the handsome Chicano lawyer offered little comment, complaining that he’d been tired a lot lately, just coming home after work and going straight to bed. Cleve thought it odd. They had spent the romantic summer of 1980 together, dancing hours away in the hot afternoon Tea Dances. Energy had never seemed to be Felix’s problem.

  The memories ended there. Cleve’s peripatetic mind went back to the next day’s KS forum, the new words he was learning, expressions like intubate and interferon, and the intricacies of probate with which he was becoming familiar. Suddenly, Felix excused himself from the table, dashed to the backyard, and threw up. With this, Cleve politely excused himself and headed for a bar.

  Felix admitted it to no one, certainly not to old flames like Cleve Jones and not even to his best friends. Like hundreds of others in San Francisco, however, his doctor had sat him down for a serious talk. The yeast infections in his mouth, the fatigue, and those nightsweats, the doctor warned, might all be part of this new GRID syndrome. They needed to monitor his health carefully because he might come down with something worse. Somewhere, in some compartment separated from the rest of his being, Felix secreted this knowledge. There it stayed, never emerging in words to another person, haunting his sweaty sleep like a nightmare waiting to happen.

  NEW YORK CITY

  Rodger McFarlane and other Gay Men’s Health Crisis members were training scores of hotline counselors, random volunteers collected from the board of directors’ little black books. There was so much for the volunteers to learn, from the intricacies of the immune system to holding hands of healthy men who lay awake at night because a lymph node seemed just a little bigger than normal. One corps of volunteers was needed to finagle their way through the legendary red tape of getting disability and Social Security benefits. Each agency would have one or another social worker who would lend a sympathetic ear to the gay man or drug addict ailing with Pneumocystis, and these people needed to be discerned from among the many more who wouldn’t.

  Just when McFarlane would think he was going to work on long-term care plans, somebody would call and he’d have to change some man’s sheets so he wouldn’t be lying in shit all night. Then he’d have to talk to the guy for a couple of hours because it turned out that the family was coming the next day and they didn’t even know the guy was gay, much less sick with gay cancer.

  The tensions between Larry Kramer and Paul Popham were growing over the nature of what GMHC was supposed to be. Paul realized that a whole network of social services needed to be created for gay men during this epidemic. By now, it was clear that the city wasn’t going to do much for a minority that wielded so little real political power in such a vast metropolis. Larry Kramer, meanwhile, wanted the group to veer into political activism and simply demand these services from the city as its just due.

  Another point of conflict was over what to tell gay men. Larry was adamant that GMHC should tell homosexuals exactly what the doctors were telling board members in private meetings—to stop having sex. Or, if not to stop having sex altogether, at least to stop having the kind of sex that involves putting semen in another person’s body. Most of the board members were themselves fresh from the hot summers in Fire Island bushes and long nights at spacious Manhattan bathhouses, and they had a hard time putting down the activities they had spent most of the past decade pursuing. It seemed prudish to make judgments. In the GMHC newsletter issued in July, the first nonscientific publication issued by any organization in the world on the year-old epidemic, various views of risk reduction were presented.

  “A number of physicians, many of them gay as well, have advised their gay patients to moderate their sexual activity, to have fewer partners, and to have partners who are in good health,” went the toughest advice. “It is the number of sexual partners, not sex itself, that increases risk.”

  Another story, by sociologist Marty Levine, however, sneered at such suggestions as “fallacious reasoning” and such advice as “panic…still washing over us.” Levine wrote that “278 cases out of a possible 11 million (gay men in America) hardly constitutes an epidemic.”

  For its part, GMHC as a group decided that its job would be to give gay men the most up-to-date information about the epidemic and let them make their own decisions. This policy engendered another fierce debate between Larry Kramer and the other board members. “We don’t want to get into the business of telling people what to do in bed,” came the chorus against Larry. During an epidemic of a sexually transmitted disease, Larry thought, this was exactly what you did to save lives. He lost the arguments but remained convinced that the board ultimately would shift its position. The only question in his mind was how many people would die first.

  July 13

  MT. SINAI HOSPITAL, NEW YORK CITY

  Even before Dr. Jim Curran from the Centers for Disease Control started to speak, the symposium was buzzing about the MMWR that had just been issued a few days before from Atlanta. The report finally confirmed what doctors in New York City and Miami had known since last year—that this so-called gay cancer was all over the Haitian refugee communities in their cities. The MMWR documented thirty-four Haitian cases of opportunistic infections, like those striking gay men and intravenous drug users. Most Haitians suffered from either Pneumocystis or toxoplasmosis, although some contracted the deadly cryptococcus brain infection or disseminated tuberculosis. Unlike the stricken gay men, few of the Haitians seemed to be getting Kaposi’s sarcoma. However, their blood showed the same deficiencies in T-helper lymphocytes that marked all the various risk groups.

  “The occurrence of opportunistic infections among adult Haitians with no history of underlying immunosuppressive therapy or disease has not been reported, previously,” the report stated dryly. In plain talk, the CDC was saying that this had never happened before and they’d be damned if they could figure out why it was happening now. The Haitians presented a new enigma in which to wrap the mystery of the growing epidemic. The worst news of the day, however, was yet to come.

  When Curran started talking, a discernible chill crept through the room. There was still another new risk group, Curran said. That week, the CDC would release the case histories of three hemophiliacs who apparently contracted the immune suppression from their Factor VIII. The three cases, Curran knew, were the hemophiliacs in Canton and Denver whom Dale Lawrence had just researched, as well as the elderly Florida man who had been reported to the CDC back in January. A stunned silence greeted
Curran’s report.

  After the lecture, somebody whispered something in the corridor to Curran about a rumored transfusion-related GRID case in Montreal. Curran’s normally cool face looked plainly disturbed at the news.

  Meanwhile, the doctors fell into little groups, seizing on the implications of GRID in hemophiliacs. First gays, then intravenous drug users, and now hemophiliacs. Those were the major risk groups for hepatitis B. They also knew that there was another risk group for hepatitis B: doctors, nurses, and health care workers. Hospitals were now vaccinating their entire staffs with the new hepatitis B vaccine in the first move toward eliminating that dreaded disease from the profession. Would GRID be the encore? Many doctors wondered aloud that afternoon whether the next risk group to be described in the MMWR would include themselves.

  As of July 15, 471 cases of GRID had been reported to the Centers for Disease Control, of whom 184 had died. The victims now spanned twenty-four states; the pace of their diagnoses was quickening. One-third of the cases had been reported in the past twelve weeks alone. New diagnoses, which had been coming in at a rate of 1.5 a day in February, were being reported at a rate of 2.5 a day in July. Finally, the CDC was publicly calling the outbreak of immune suppression an epidemic.

  “The pressure is on” to find the cause, said Jim Curran in a Washington Post interview published on July 18. “There may be additional groups that get it, and, in the other groups, people are going to keep on dying…. Somebody’s got to find this thing.”

  17

  ENTROPY

  July 1982

  PARIS