And the Band Played On

by Randy Shilts

  “That’s what happens to you older men,” he joked.

  Bill looked only mildly relieved. Cleve wondered to himself if they all were going to spend the rest of their days like this. His lymph nodes had been slightly swollen for months, and he had taken to examining every visible square inch of his body during his morning showers. Half his friends were doing the same thing; the other half were going to the baths as they always had.

  March 22

  901 MISSION STREET, SAN FRANCISCO

  The San Francisco Chronicle is housed in a building with a tower and a big clock at Fifth and Mission streets. Not far from the financial district, the neighborhood had become a refuge of winos and derelicts who petitioned passing reporters to spare change. Having run that gauntlet, on this morning, a young reporter approached an assistant city editor with the copy of a study leaked to him by a “congressional source.” The bold “CONFIDENTIAL” stamp piqued the editor’s curiosity, as did the reporter’s confirmation from an official “high in the health department” that the study was accurate. It wasn’t Merv Silverman, of course, and a feminine pronoun strategically slipped out along the way, leading the editor to accurately assume that the high official was the no-nonsense Selma Dritz who, in news circles, was considered only slightly less credible than God. Reporters don’t have to tell editors their sources, but it doesn’t hurt to hint during lobbying for a story. The Chronicle was running more AIDS stories than any newspaper in the United States. This, however, wasn’t saying very much. AIDS stories still needed a careful marshaling of editorial support to clear the various hurdles toward publication.

  “It’s definitely a story,” the editor agreed, casting a calculative eye toward the news editors to whom he needed to sell the piece. “Let’s go.”

  “We don’t want the data released,” said Dr. Michael Gorman, the study’s co-author, when contacted about the study. “You have no right to release it. It’s marked confidential.”

  At the SF Department of Public Health, Pat Norman was upset when she was told the Chronicle was going to publish the study. “I’ve only known about it for two weeks,” she said abruptly. She was on the verge of announcing her candidacy for the board of supervisors, and it wouldn’t pay to look like part of a coverup. She obviously was unaware that the reporter had seen the letter, dated two weeks before, in which Dr. Andrew Moss alluded that Pat Norman was already opposed to the data’s release.

  It wasn’t her job to release medical studies, Norman reasoned. It was the job of the director of the Bureau of Communicable Disease Control, and he hadn’t let the information out either. “There was never a question of whether we were going to release this information,” she said. “We wanted to release it in a reasonable way. Appropriately, so as not to cause panic.”

  Back in the newsroom, the reporter had written two paragraphs of his story when the phone rang. It was Randy Stallings, who was president of the Alice B. Toklas Memorial Democratic Club and co-chair, with Pat Norman, of the Coalition for Human Rights, the umbrella group of all the city’s gay organizations.

  “I’d never ask a reporter not to do a story,” he said, adding that there were many reasons not to publish the information. Instead, he said, it should come out in an…appropriate way.

  “They’ll put barbed wire up around the Castro,” said Stallings. “It will create panic. People won’t go to gay businesses in the Castro. It will be used to defeat the gay rights bill in Sacramento.”

  After the reporter had written three more paragraphs, Dr. Moss called from London, pleading that the study not be printed. He clearly was worried that gays would not cooperate with future studies if their leaders denounced his research.

  “This already has gone out to the appropriate channels,” said Moss, referring to gay leaders and the Bay Area Physicians for Human Rights. The reporter needed to give “very serious thought” to whether to write the story.

  Two paragraphs later, Selma Dritz called the reporter, chuckling over an appearance that Pat Norman had made in her office. Stop the Chronicle from running the story, Norman had requested. “I don’t know what she’s worried about,” said Dritz. “It’s true.” Dritz then went on the record confirming the study’s accuracy.

  NEWARK, CALIFORNIA

  Rick Walsh always remembered his Uncle Gary as a wonderful storyteller. In the basement of the Walsh home in Sioux City, Gary would talk on and on, making up his stories as he went along. Ever since then, Gary had been Rick’s favorite uncle. He was never condescending to Rick and had always treated him as an equal. During the four years that Gary didn’t talk to his parents because of Grandma Walsh’s unfortunate comment about going to heaven, Rick was the conduit for family news. Rick and Gary had remained close, even after Rick married and settled into a quiet cul de sac in suburban Newark, California.

  On that March evening, Rick was happy to hear Gary’s voice, although he could tell his uncle wasn’t going to share jokes.

  “Have you heard about AIDS?” Gary asked.

  “I think so,” said Rick, not liking the drift of the conversation.

  “I’ve got it,” said Gary. “I could die in two years or less. Nobody has ever been cured.”

  “Awesome,” said Rick.

  Rick couldn’t believe Uncle Gary would have something so serious. He didn’t know what to say. After a long pause, he blurted out the first thing that came to his mind.

  “I don’t know what to say except that I love you.”

  Gary’s parents in Sioux City were another matter.

  “That’s what you get from all that,” his mom said, not bringing herself to utter the words she meant. “Why don’t you leave that city?”

  Gary hung up shortly after she suggested he go to confession.

  March 25

  FEDERAL BUILDING, SAN FRANCISCO

  Making a difference was the raison d’être of Bill Kraus’s politics and his life. His arm-twisting with the Social Security Administration was yielding results, and Bill looked forward to the call he was about to make to the sister of an AIDS patient. She had called months before, telling Bill about the Social Security case workers who had denied her brother disability payments. Yes, he had Pneumocystis carinii pneumonia, but he looked well enough to work. He did not fit the Social Security requirements for disability, they said. He had appealed his case but lost.

  Bill Kraus had been calling bureaucrats for months on the case. Again, he felt fortunate to be working for Phil Burton, who signed any letter Bill put in front of him when it concerned AIDS. In Congress, Bill knew, Burton was the only representative who didn’t blanch at the gay jokes that inevitably came up during any cajoling on the epidemic. He had become the leader on the issue, and at Bill’s request, fired off letters to top Social Security administrators to make an AIDS diagnosis presumptive evidence of disability. The bureaucrats were not so recalcitrant as they were slow.

  Concentrating on the specific case of the ailing San Francisco man, Bill first secured cooperation from a local official who then referred the matter for approval in Sacramento. Now, months later, the man finally was qualified for disability.

  The sister’s voice was hollow when Bill called with the good news.

  “Thanks,” she said, “but my brother died last night.”

  Eventually, Bill’s lobbying secured a national directive declaring AIDS a presumptive disability. Even years later, however, Bill could not manage to tell the story about the man and his sister without crying. It seemed to sum up so much of 1983.

  March 31

  PACIFIC HEIGHTS, SAN FRANCISCO

  “All of you represent different constituencies in the gay community,” said Marcus Conant, scanning the huge room where an anybody-who’s-anybody inventory of the city’s gay politicians were seated. “Things have to change and change fast, or you won’t have any constituents left.”

  The politicos shifted uncomfortably in their chairs. By and large, they were unaccustomed to this kind of talk. They were much more famili
ar with discussions about discrimination and liberation, co-sexuality and heterosexist oppression. Now there were new, disconcerting terms like cytomegalovirus, clusters, incubation periods, the hepatitis B model, and of course, geometric progression. When dealing with AIDS at all, most gay political leaders preferred framing the epidemic in familiar concepts. This is why condemning the federal government had become so popular. One could use the conventional rhetoric, including discrimination and prejudice. Now, however, doctors were tossing the ball squarely into the gay leaders’ court, and most of the activists weren’t sure what they should do, or more accurately, what was the politically correct thing to do.

  This was the mobilizing meeting Marc Conant and Paul Volberding had decided to orchestrate when they were at the AIDS conference at New York University, when Conant read “1,112 and Counting.” These were the leaders who could ring the alarms, Conant thought.

  Lia Belli, a longtime proponent of gay causes and wife of the city’s most prominent and bellicose lawyer Mel Belli, had offered the playroom of her Pacific Heights mansion for the event. The playroom, it turned out, was the entire top floor of the palatial home; a lot of the activists privately conceded they had come just to see what the house, at one of the most fashionable addresses in the city, looked like. When she introduced Marc Conant, Lia Belli pleaded that the epidemic demanded the gay community’s “immediate action” and that it was “an issue that’s above politics.” Conant had assembled every major AIDS researcher in town to recite a litany of horror about the years that lay ahead.

  By current estimates, the incubation period was as long as eighteen months, Conant said, meaning the AIDS cases of tomorrow were out there spreading the virus around today. “The 1984 AIDS victims have already contracted the disease,” said Conant. “Even if we had a vaccine today, there is nothing we could do to prevent these cases.”

  Selma Dritz gave the latest update on numbers, reporting 207 Bay Area cases, “as of today,” and the probability of hundreds more by the end of the year. Andrew Moss showed his census tract charts that identified Castro Street as ground zero of the local epidemic. Moss’s line graphs showed a near-vertical curve of cases that wouldn’t begin to level off, he noted, until well after gay men started changing their sexual activity.

  Paul Volberding talked about the Los Angeles cluster study and Patient Zero. The study indicated that you didn’t need 1,100 sexual contacts to get AIDS anymore, he said. It was just a matter of luck. Sex as a lottery. “When the disease first started, it probably took more contacts in order to get it, because there was less incidence of the disease,” he said. “That’s not the case anymore.”

  Questions focused largely on one issue: Did the doctors really know how AIDS was transmitted? Anal intercourse could be a major problem, the scientists said, given the hepatitis B model of transmission. The virus, obviously present in semen, could be injected directly into the bloodstream through fissures in the rectal lining. Nobody, however, seemed particularly enthralled with Conant’s suggestion that gay men start wearing condoms. The CDC case-control study had indicted promiscuity, a word quickly denounced by gay leaders as “judgmental,” but the doctors could offer little direct advice on which practices spread the disease. Because of federal funding shortages, no subsequent epidemiological studies had been undertaken to investigate this issue, even though they were precisely the inquiries that could most directly have saved lives. Now doctors, who were trying to urge a reluctant gay community to change, were bearing the burden of the shortfall.

  “Bodily fluids,” suggested Dr. Robert Bolan of the Bay Area Physicians for Human Rights.

  It was the first time the gay community had heard the expression; and it wouldn’t be the last.

  “You have to avoid contact with bodily fluids,” said Bolan, who had emerged as the most militant AIDS fighter in the gay doctors’ group. “That would include semen, urine, saliva, and blood. And I mean avoid them. This is the big enchilada, guys. You don’t get a second chance once you get this.”

  Hearing this, San Francisco Supervisor Carol Ruth Silver, a close, longtime ally of the gay community, made what she considered a logical suggestion: “If you’re saying that this can be spread through sexual contact, it makes sense to me to have the public health department get a court order to shut down the gay bathhouses. That would probably save lives.”

  A chorus of boos and hisses greeted Silver’s recommendation. The gay leaders were prepared to, perhaps, think of AIDS as a big enchilada, but they were not ready to swallow a combination plate. Such action would have profound political ramifications, they warned. The sheer volume of the heckling cowed Silver into silence, as it would every other civic leader. Not only was closing the bathhouses something that could not be done, it was something that could not even be discussed.

  As the leaders slowly filed out, they invariably told Marc Conant or Paul Volberding what fine work they were doing. Keep it up, they said. Conant had a sinking feeling as he walked down the mansion’s twisting, baronial staircase to leave. He had hoped the leaders would agree on a call to arms to fight the epidemic within the gay community. Instead, they seemed preoccupied with the politically correct thing to do. Conant feared that people were going to die because of it.

  Bill Kraus preferred long yellow legal pads for writing, jotting down his ideas carefully in longhand with no punctuation other than dashes. He had hoped some kind of consensus might emerge from the Belli meeting on what to do, but instead the conflicts had become clearer. AIDS could not be fought effectively if gay people continued to think in terms of the old gay community, Bill thought. The rhetoric of the old gay movement—the sexual liberation movement—also needed to be revised. It was not anti-gay to be pro-life, he thought. Bill Kraus began writing his manifesto, one that drew the battle lines on which he would wage his fiercest political fight.

  “We believe it is time to speak the simple truth—and to care enough about one another to act on it. Unsafe sex is—quite literally—killing us…. Unsafe sex with a number of partners in San Francisco today carries a high risk of contracting AIDS and of death. So does having unsafe sex with others who have unsafe sex with a large number of partners. For this reason, unsafe sex at bathhouses and sex clubs is particularly dangerous….

  “If the gay movement means anything, it means learning self-respect and respect for one another. When a terrible disease means that we purchase our sexual freedom at the price of thousands of our lives, self-respect dictates it is time to stop until it once again is safe….”

  Cleve Jones and Ron Huberman—Bill Kraus’s best friend and the vice-president of the Milk Club—both signed the letter with Bill. When Huberman took the letter to the Bay Area Reporter, publisher Bob Ross joked that a lot of his advertisers wouldn’t like its tone. And it was six weeks before it was published.

  Meanwhile, three Castro-based psychologists—Leon McKusick, Thomas Coates, and William Horstman—were tabulating results from a sample of 600 gay men surveyed in mid-March as to their sexual behavior. Although it did not draw on a randomly selected population, the study was the most extensive ever attempted. The results were culled from questionnaires handed out in the early evening at gay bars and to men leaving gay bathhouses and sex clubs late at night. Another 200 respondents were gay couples, filling in the surveys mailed to them. The sampling revealed how vast the task would be for public health educators.

  Only 15 percent of the respondents said they had stopped passive anal intercourse, one-third said their level of that activity had remained the same, and 28 percent said they were doing less. About 20 percent of respondents said they were rimming less often, while one in nine were rimming new partners at the same level as the previous year. Twenty-eight percent had stopped rimming altogether. The most difficult behavior to change, it turned out, was oral sex. Although one in three men said they were sucking less, only 5 percent had stopped altogether, while 55 percent were partaking at the same rate as before the epidemic.

 
Even worse, bathhouses and sex clubs clearly remained a major center of gay sexual activity. One in four gay men went to bathhouses at least once a week, while one in five others went once a month. The popularity of the sex palaces was ironic given how health conscious gay men had become. Two-thirds of the respondents had visited their physician in the ten weeks before the sampling. Only one in twelve had not seen their doctor in the past year.

  Also disconcerting was the survey’s finding that one in six men agreed with the following statement: “Since I found out about AIDS, sometimes I get so frustrated that I have sex that I know I shouldn’t be having.”

  Altogether, the study was alarming on a number of points. First, it showed that gay men knew what put them at risk for AIDS. That message had gotten out. However, 62 percent still engaged in high-risk sex at the same frequency—or more often—than before they found out about AIDS. Only 30 percent had reduced their risk behaviors, although not even all of these men had eliminated all activities likely to put them in the path of the AIDS virus. Secondly, the study showed the dangerous role bathhouses played in the spreading epidemic. Men who went to bathhouses were far less likely to have changed their sexual behavior than the other groups sampled in the survey and were far more likely to be infected with a sexually transmitted disease. Sterner messages needed to be delivered to prevent more deaths, the doctors concluded.

  “As the rate of infection is climbing exponentially while this report is being submitted, it is evident that measures gay men are currently taking to avoid infection have begun but are still inadequate,” the authors wrote. “As the survey indicates, the gay men surveyed are still poorly informed about disease transmission or are unwilling or unable to change sexual patterns in a manner that will place them at lower risk.”