And the Band Played On

by Randy Shilts

  The blood banking industry was insisting that because only one or two blood-transfusion recipients with AIDS could be linked to donors who had full-blown AIDS, the chance of contracting AIDS from a blood transfusion was one in a million. After all, three million Americans are transfused with blood each year, they said. But Dr. Engleman calculated the odds differently. First, the blood bankers weren’t counting the growing number of transfusion recipients who came down with AIDS from blood donated by someone with lymphadenopathy cr pre-AIDS symptoms. Clearly, these people were also infected with the virus; the blood banks were playing semantics by not including them in the calculations. Moreover, there may be three million blood units donated every year, but a typical patient is transfused with three, not one unit, increasing the odds further. Nor was it fair to figure in the transfusions of areas with no incidence of AIDS. The honest way to figure the odds was to use numbers from the major urban areas where the AIDS virus was prevalent. At San Francisco’s Irwin Memorial Blood Bank, for example, officials figured they were losing between 7 and 15 percent of their blood for the lack of gay donors. If these people were donating in 1981 and 1982, this translates into a lot of blood potentially infected with AIDS years before anybody even knew the epidemic existed.

  No, this one-in-a-million rhetoric was bullshit, Engleman thought. Instead, he figured that a person’s chance of contracting AIDS from a San Francisco transfusion was more on the order of 1 in 10,000, maybe 1 in 5,000.

  People play the California lottery with hopes of winning $100 on precisely those odds, which weren’t a good enough margin of safety for Engleman.

  From the start, Engleman had thought that the federal government’s guidelines requiring only the questioning of donors were inadequate. Nearly three months after they went into effect, he could see that some people in high-risk groups still were donating blood. Not everybody bothered to read the little pamphlets handed out at the desk for self-deferral. For some, it appeared that donating blood was an act that could overcome their personal fears about having AIDS. Thus, blood banks occasionally became the stages for gay men living out the psychodramas of denial.

  Stanford needed a blood test, Engleman decided. As a specialist in the new field of helper and suppressor lymphocytes, Engleman quickly opted for putting each blood donation through the university’s new Flourescent Activated Cell Sorter machine to run helper-suppressor ratios. The tests were expensive, increasing the price of each blood unit by $6, or about 10 percent. But how do you define “expensive” when you’re talking about saving lives?

  By the end of May, Stanford University Hospital became the only major medical center in the United States to decide to start testing blood for evidence of AIDS infection. The rest of the blood industry was stunned that Engleman would conduct tests that the industry had rebuffed. Some said it was a gimmick to draw AIDS-hysteric patients to Stanford from San Francisco hospitals.

  The anger ran deeper, Engleman noted even then. It was as if the blood bankers themselves were caught in the psychological web of denial. They wanted proof of the existence of an AIDS virus; they wanted extraordinary evidence that transfusion AIDS existed; they fundamentally wanted to deny that they could be part of something so horrible. Engleman had broken rank just when it was time to pull the wagons together.

  Engleman could comprehend the psychological processes at work. Blood bankers were good people, he knew; they just weren’t using their full intellectual facilities on this issue. Stanford made no great fanfare when the testing began and issued no press releases. Engleman, however, was firm on one point. He didn’t want any nontested blood in his hospital. In a tense meeting with officials of the Peninsula Blood Bank, which supplied additional blood to the Stanford Medical Center, Engleman ordered them to begin having their blood tested within thirty days or Stanford would stop buying from them. Reluctantly, the blood bankers complied. San Francisco’s Irwin Memorial Blood Bank did not follow suit, however, telling the press that testing was unnecessary. They had self-deferral guidelines, they said, and there was only a one-in-a-million chance that somebody would get AIDS from a blood transfusion.

  CENTERS FOR DISEASE CONTROL, ATLANTA

  Dale Lawrence met with blood bankers again in early May to present ten more cases of transfusion-associated AIDS. His job was to convince them that this was real, a problem they should be doing something about. And he was failing. The blood bankers wanted to pick apart each case study and talk about this or that detail, rather than what, taken together, the whole phenomenon meant: AIDS still was spreading, unabated, in blood.

  Blood issues continued to dominate the AIDS Activities Office’s concerns. Dr. James Allen had taken over transfusion work and had become increasingly convinced that donor-deferral guidelines would bring disaster. The questions would have to be asked by blood bank volunteers, Allen knew, who tended to be sweet retired ladies out to do something civic minded. Asking about homosexuality and intravenous drugs was not the same as asking for an address and social security number. CDC anxieties were not calmed when one sociopathic gay rights attorney in Texas suggested gays should threaten “blood terrorism” and say they would donate blood en masse if the government didn’t launch serious AIDS research programs. The issue had international ramifications as well. France had banned the import of American blood in mid-May. Dutch and British health authorities were considering similar proposals.

  Ideally, the CDC could nail down the blood question by tracking down every recipient of a transfusion donated by someone who later came down with AIDS. Dale Lawrence had proposed such a project, but there wasn’t enough money to support it.

  May 23

  UNCLE CHARLIE’S BAR, NEW YORK CITY

  “Has he finally gone completely and utterly crazy?” wondered Paul Popham as he watched Larry Kramer barge into the deejay’s booth at the popular bar. Paul had been hosting the party for the new volunteers of Gay Men’s Health Crisis. Everybody still was gossiping about how angry Larry remained at his departure from the board, but Paul had never expected this. He wasn’t sure whether he should shout or laugh.

  “This is Larry Kramer,” Larry yelled into the microphone to the stunned volunteers and GMHC staff. “We’re poised at a crucial point. I think this organization was founded to fight. I think the board of directors is very, very timid.”

  He’s really gone off the deep end this time, thought Paul.

  Larry felt he had been driven to this. In the weeks since the meeting with the mayor, nothing had changed. At a recent AIDS hearing, New York City Health Commissioner Dr. David Sencer had blandly stated that AIDS was not “an emergency” in New York City. The city needed no education programs because gays were doing such a good job of educating themselves. There needed to be no planning for even the most basic health needs, such as hospital beds. The city’s gay health coordinator, Dr. Roger Enlow, also had turned aside the idea that the city begin education programs with the libertarian argument that the “city should not tell people how to have sex.”

  Both city and state officials were responding to growing alarm by having meetings. Indeed, David Sencer frequently joked that the epidemic of AIDS had spawned an epidemic of conferences. A week before, Governor Mario Cuomo had announced at a political gay fund-raising dinner at the Plaza hotel that he would establish an AIDS task force. The next day, the state government announced a $100,000 grant to GMHC for education. It would never be clear whether the grant reflected genuine concern on the part of the state or the resumption of the longtime feuding between the governor and the mayor. Mario Cuomo rarely let pass an opportunity to embarrass his nemesis, Ed Koch, and the release of this token amount of money did little but highlight the city’s own inaction on the issue.

  The city also had its own Interagency AIDS Task Force, meeting under the authority of David Sencer. At virtually every meeting, representatives from various AIDS groups talked about the need for education programs, hospice beds, home health-care nurses, and planning for future hospital needs. Th
is or that city bureaucrat would promise to look into the problem. The task force would meet again, and the city officials would talk of this or that obstacle. They’d have more reports at the next task force meeting. And the next meeting brought still new obstacles and rarely any resolution. Every task force meeting became a recitation of problems and official procrastination. Everybody got to vent steam but little was actually accomplished. The city of New York had yet to devote one penny to any AIDS education or services, despite being home to 45 percent of the nation’s AIDS victims.

  Nothing was happening, Larry Kramer thought.

  “We need fighters,” he exhorted the crowd at Uncle Charlie’s. “We need a board of directors that will get confrontational and slug things out.”

  Paul Popham watched Larry Kramer as he joined the volunteers after his impromptu stump. You can’t go around telling people how to have sex, Paul thought, which is what Larry wanted GMHC to do. You gave them the information. You didn’t scold and you didn’t act moralistic. And Paul was tired of hearing Larry bitch about Mayor Koch and The New York Times. There were problems, but you worked within the system to solve them. If Larry didn’t like the way GMHC was doing things, Paul thought, why didn’t he go off and form his own organization? He’s out of step with the way New York gay men are, Paul figured, or they’d be out joining a Larry Kramer Club. Instead, they’re here.

  Enno Poersch’s assessment was more succinct. “The guy has gone absolutely bonkers,” he said.

  Larry was pleased that his speech had generated some applause. A number of volunteers came over and told him they had volunteered because of “1,112 and Counting.” Larry saw Paul across the dance floor and wished Paul would come up and ask him to be on the board again. But Paul stayed put.

  On the night that Larry Kramer lectured GMHC about confronting the city government over the lack of AIDS services, the San Francisco Board of Supervisors passed $2.1 million for the city’s growing AIDS programs. Of the funds, $1 million went toward equipping the outpatient clinic and planned inpatient ward designed specifically for AIDS patients at San Francisco General Hospital. The board also gave enough money to establish residences to house forty-eight homeless AIDS patients under the auspices of the Shanti Project. Funds also were released to fund the support staff from the vast network of volunteers at the Shanti Project and KS Foundation. With the $1 million enacted for AIDS in 1982, the level of city spending on AIDS in San Francisco now exceeded the funds released to the entire country by the National Institutes of Health for extramural AIDS research.

  May 24

  “The sexual revolution has begun to devour its children. And among the revolutionary vanguard, the Gay Rights activists, the mortality rate is highest and climbing.”

  The commentary that appeared in newspapers across the United States that day was the dropped shoe so many gay politicians had awaited. A speech writer for former President Nixon, Patrick J. Buchanan had served in recent years, as a right-winger without portfolio, making his most dashing appearances on editorial pages where editors were constantly searching for conservative columnists to compensate for the media’s liberal bias. Buchanan was said to hold much favor with the more conservative of White House aides, and so his first column on AIDS was viewed with much interest. Where would President Reagan, who had somehow managed to make it through two years of the epidemic without whispering a word about it, end up on AIDS? Conservatives thus far had stayed away from talk of the disease; even Jerry Falwell wasn’t saying much. Now, with AIDS in the headlines, those days were coming to an end and the first signs of potential backlash came with this column.

  “The poor homosexuals—they have declared war upon nature, and now nature is exacting an awful retribution,” Buchanan wrote.

  Like most extremists, Buchanan did not strive for any particular consistency in his arguments. He drew on Kevin Cahill’s assertion of a “conspiracy of silence” about AIDS among doctors to support the contention that liberals were covering up the horrible threat to Americans posed by AIDS arrying homosexuals. He conjured the image of San Francisco’s police officers putting on their masks and gloves to establish the danger of AIDS. After citing many irrelevant medical statistics, Buchanan concluded by saying no homosexual should be permitted to handle food and that the Democratic party’s decision to hold their next convention in San Francisco would leave delegates’ spouses and children at the mercy of “homosexuals who belong to a community that is a common carrier of dangerous, communicable and sometimes fatal diseases.”

  Days later, Buchanan followed this with a second column quoting from The New York Times’ unfortunate coverage of the “routine close contact” study. Gays not only were slaughtering hemophiliacs and blood-transfusion recipients, Buchanan said, but now they threatened to kill children by working as pediatricians and custodians in day-care centers. “It has long been the defiant slogan of the gay rights movement that, so long as we don’t injure anyone, what we do is our own business,” he concluded. “If promiscuous homosexuals in the urban centers of New York and San Francisco are capable of transmitting death with a casual sexual contact, their slogan, to put it mildly, would no longer seem to apply.”

  May 26

  CASTRO STREET, SAN FRANCISCO

  “You’re a sexual Nazi.”

  Bill Kraus heard variations on this theme from the moment he stepped onto Castro Street that afternoon. His essay calling on gay men to change their life-styles and redefine gay liberation had been printed in the Bay Area Reporter that hit the streets that afternoon. Bill had tried to be positive in the article, advancing the idea that “we gay men can transform this epidemic into our finest hour.” Nevertheless, the reaction was swift and nasty. Bill was called an “anti-sex” brownshirt, out to destroy the gay community with his talk about not going to bathhouses. Bill’s critics in the Toklas Club were ecstatic that he had handed them such explosive ammunition to use against the Milk Club.

  The right wing was beginning to draw battle lines around issues of promiscuity and bathhouses. Rather than define their own battle lines, many gays adopted these issues as their front line of defense. By acknowledging defects in the old gay life-style, Bill had strayed to the enemy camp, as far as many of his critics were concerned. They started whispering the ultimate psychological insult, that he hated himself because he was gay, that he suffered from “internalized homophobia.”

  Bill Kraus was crushed at the criticism, especially coming at a time when his own work on AIDS had accelerated into hyperdrive. He was working sixty-hour weeks at the congressional office, monitoring national AIDS legislation and funding. Days before, he had been elected to the board of directors of the National KS/AIDS Foundation that Marc Conant was organizing as an American Cancer Society-type group for AIDS. Bill was also working with Dana Van Gorder to devise a local public education campaign for AIDS risk reduction to try to bolster the long-stalled efforts of the San Francisco Department of Public Health.

  “Don’t they see I want to save their lives?” Bill moaned to Kico Govantes.

  Although the two weren’t lovers, Kico remained Bill’s confidant. Kico ran his fingers through Bill’s thick curly hair and hugged him. He couldn’t understand how gay politicians, people who said their cause was to promote love, could be so cruel to each other. He could also see that the rejection stung Bill deeply, far more acutely than something merely political should.

  “If I get AIDS,” Bill said, “it’s going to be those people’s fault.”

  31

  AIDSPEAK SPOKEN HERE

  In San Francisco, plague met politics. Instead of being confronted by a united authority with intelligent plans for defense, it found divided forces among which the question of its presence became the subject of factional dispute. There was open popular hostility to the work of the sanitarians, and war among the City, State and Federal Health authorities…For a while the people were in the gravest danger and it seemed impossible to convey any adequate warnings to them.

 
; —Eradicating Bubonic Plague from San Francisco, 1907,

  The Report of the Citizens’ Health Committee

  June 2, 1983

  SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH

  “Dr. Silverman, this poster says people should have fewer sexual partners. Does that mean that if somebody had ten sexual partners a week last year that they can cut down to five sexual partners a week now and they won’t get AIDS?”

  Merv Silverman looked uncomfortable. He had taken Barbara Taylor, a no-nonsense reporter for the all-news KCBS radio, and a Chronicle newsman to proudly unveil the health department’s AIDS poster, the one everybody was talking about.

  “We’re trying to give a message that people will pay attention to,” said Silverman.

  For five years Merv Silverman had served as a popular public health director. The media loved him; the gay community adored him. He wasn’t accustomed to such sharp questioning. Barbara Taylor, who had spent the last seven years listening to politicians, pressed on.

  “Dr. Silverman, it says on this poster that people should limit their use of recreational drugs. Does that mean that if somebody was shooting up, say, three times a week, that they’d be safe from AIDS if they shot up just once a month? You’re not saying not to use recreational drugs; you say limit your use of drugs.”

  “We’re trying not to lecture people,” answered Silverman. “It doesn’t do any good if you give people a message they don’t listen to.”

  “I thought we were trying to tell people how not to get AIDS,” said Taylor. “Why aren’t we telling them that?”

  Merv Silverman thought Barbara Taylor was taking an old-fashioned, textbook kind of approach to public health. The health director understood this approach; after all, his master’s in public health came from Harvard. The silver-haired forty-five-year-old had spent his life in the field. But AIDS was not a classical public health problem. It was sensitive. It required messages that were…appropriate.