And the Band Played On

by Randy Shilts

  When Mayor George Moscone tapped him to be San Francisco health director in 1977, Merv Silverman knew he was moving into a highly politicized job. Unlike homogeneous Wichita, San Francisco was teeming with various constituencies, most of which were highly vocal. No fewer than thirty-four advisory committees advanced various special interests there. In San Francisco more than anywhere else in the United States, he learned, there was no separating politics from public health.

  This thought recurred to Silverman in Denver when Mayor Dianne Feinstein took him aside to talk about the bathhouses. The mayor had first broached the subject in late 1982. Both her father and her second husband were doctors, giving her some definite opinions on medical matters. “If you have a problem, you get rid of it,” she said. Silverman hadn’t considered promiscuity to be some isolated tumor that you could separate from the body; but with AIDS, the entire gay community was the patient, he argued. Scaring the patient away from the doctor wasn’t the route toward a cure.

  Feinstein’s concerns weren’t so easily allayed now that the epidemic had moved to the front pages. She still didn’t understand why Merv Silverman didn’t take action against the baths. Silverman went over his logic again: A more sweeping behavior change was needed in the community, he argued. Closing the baths might merely move the sexual activity elsewhere.

  Feinstein remained unconvinced, but she did not press the point in Denver. She had no authority to order Silverman to do anything, she knew, since he reported not to her but to a city manager. For his part, Silverman thought Feinstein just wanted to clean up the town for the 1984 Democratic National Convention. It didn’t seem likely that the issue would go away.

  June 16

  CAPITOL, WASHINGTON, D.C.

  The U.S. Senate passed the $12 million AIDS supplemental appropriations bill overwhelmingly and with little debate. Although the White House threatened a veto of the larger supplemental appropriations bill in which the AIDS money was included, overpowering bipartisan support for AIDS research money was enough to ensure that it would be allocated. The sums under consideration were, after all, barely nickels and dimes out of a federal budget approaching $1 trillion.

  Nevertheless, religious conservatives began to come alive on the AIDS issue. The right-wing magazine Human Events denounced the Senate vote. “The [appropriations of $12 million] represents a response to a massive lobbying campaign by militant homosexuals,” the magazine editorialized.

  It was a truism for AIDS budgets in Washington that no sooner was one proposal run through the necessary channels than scientific breakthroughs rendered it obsolete. Already circulating in the Public Health Service was a confidential memorandum indicating that the $17.6 million the Reagan administration had proposed spending on AIDS for the fiscal year beginning October 1983 was woefully inadequate for the work the CDC, NIH, and FDA wanted to undertake. To seriously tackle the burgeoning AIDS problem, the Public Health Service would need to triple AIDS funding to $52.3 million, the agency directors believed. Despite these calculations from the agency chiefs of the federal research centers, the Reagan administration put forward no new initiatives for AIDS funding. The administration’s course was firm: The scientists already had all the money for AIDS research they needed.

  As of June 20, 1983, AIDS had stricken 1,641 Americans, killing 644, according to a special update on AIDS that the Centers for Disease Control had prepared for the weekly MMWR. New York City reported 45 percent of the cases; 10 percent resided in San Francisco; and Los Angeles was home to 6 percent. With the first AIDS diagnoses reported from New Mexico and Alabama, the epidemic had spread to thirty-eight states, as well as the District of Columbia and Puerto Rico. The CDC reported that another twenty-one infants in the United States were suffering from what appeared to be AIDS, although they were not yet to be included as reported cases in the CDC statistics as long as the agency was investigating other possible causes of their immune suppression. The numbers stricken with the deadly disease had precisely doubled over the last six months, and the CDC predicted that the numbers of dead and dying would double again in the last six months of 1983, and double again after that.

  June 21

  WASHINGTON, D.C.

  Marc Conant stared across the big elliptical oak desk in the Hubert H. Humphrey Building, where the U.S. Department of Health and Human Services was headquartered. Conant had chosen his seat so he could look Thomas Donnelly in the eye. Donnelly was the Assistant HHS Secretary for Legislative Affairs. He was the man to whom agency chiefs pled their cases for more AIDS funding; he was the man telling them they could not expect the administration to approve new money for AIDS, and that they should pay for AIDS studies by looting other programs. Judi Buckalew from the White House was there too, but she was merely a special assistant to the Office of Public Liaison, a rather meaningless agency whose job it was to have meetings with people the White House didn’t really want to talk to. Already the White House had distanced itself from this meeting by ordering its site changed from the Old Executive Office Building, located next to the White House, to the HHS headquarters. At the last minute, Buckalew had almost backed out of the conference altogether when National Gay Task Force leaders, who had organized the meeting, mentioned they would bring Marc Conant as well as Michael Callen, the leader of the New York People With AIDS group.

  To get some common agreement on the dimensions of the crisis, Conant had prepared a one-page introduction to the epidemic for the meeting. It lay now on the oak table with its prescient final paragraph: “Western Civilization has not confronted an epidemic of this magnitude in the twentieth century. Perhaps this is why our government has been slow to respond to this challenge. Fortunately we have the knowledge and the tools to conquer an infectious disease. Emergency action is desperately needed to put these tools to work immediately to slow the spread of this epidemic and prevent a calamity of incalculable magnitude.”

  Marc Conant had other reasons to think Thomas Donnelly might be personally sympathetic, but his hopes were quickly dashed when Judi Buckalew set the tone for the meeting.

  AIDS would be like cancer, she said. It would take years to unravel. There would be no “quick fix.”

  AIDS is an infectious disease, argued Conant. It will be much easier to find the cause. Moreover, even today, programs could be begun to prevent its spread.

  Donnelly’s tone was not condescending, just officious, Conant thought, when Donnelly dismissed Conant’s worries about hundreds of thousands dead in the future.

  “Once gay men realize it’s a fatal disease, they’ll change their behavior and it will go away,” Donnelly said.

  Conant thought that Donnelly, of all people, should know better.

  “People aren’t changing their ways,” said Conant, “and people are dying. The administration needs to move faster.”

  A number of congressmen had called for a federal AIDS coordinator. Conant agreed, saying the work of the NIH, CDC, and FDA had to be more carefully organized with goals set and priorities arranged. “The response of our government should be the same as to an outside invasion,” he said. “Unless we respond, a solution will be five or ten years down the road.”

  Donnelly launched into a long recitation of what the administration had done so far, a speech that had been carefully prepared for the health officials streaming to congressional inquiries with greater frequency.

  It was hysterical to suggest that the time-honored peer review system for distributing grants should be expedited, Donnelly said. He couldn’t believe scientists were asking that this process be short-circuited for AIDS money.

  The National Gay Task Force issued a press release after the meeting, saying Virginia Apuzzo was “encouraged by the administration’s commitment to maintaining a dialogue with those most affected by AIDS.”

  As Marc Conant boarded his jet at Washington’s National Airport, he was not encouraged by anything. On the flight back to San Francisco, he wrote a letter to President Reagan. The country needed to organiz
e experts for an expedited peer review of research and appoint an AIDS coordinator who could draft a national plan, Conant wrote. Ultimately, this epidemic could overshadow all the ambitions the president had articulated for America’s future. In history, Marc Conant warned, Ronald Reagan could go down as the president who did nothing while thousands died. And thousands and tens of thousands and perhaps hundreds of thousands would die, he wrote. Most of them needlessly.

  Conant gazed blankly from his small window toward the Bay Area as the plane circled for landing. He saw the fog sweeping from the sea into the western half of San Francisco, its ghostly fingers creeping over the hillsides that guard Castro Street from the ocean breezes. At forty-seven, Conant felt too old for all this. He wondered when he would ever rest.

  June 23

  The fund-raiser for the National KS/AIDS Foundation had all the raciness of a true San Francisco event. When host Debbie Reynolds introduced the surprise guest, actress Shirley MacLaine, with the comment that MacLaine had great legs, MacLaine responded by pulling down the top of her long strapless gown, demonstrating that she had other equipment to match. The crowd cheered enthusiastically: “We love you, Shirley.” Not to be outdone, Reynolds lifted the rear of her slitted gown to reveal her brief black underwear.

  “Debbie’s Tammy image is blown forever,” sighed one realtor in the audience.

  “Wait till I flash,” joked singer Morgana King moments later. Instead, she played it safe and stuck to crooning “My Funny Valentine.”

  Eyebrows raised when news of the shenanigans spread to other parts of the country, but that long had been the reflex San Francisco inspired in the hinterlands. More noteworthy was the fact that the night brought out the first array of big names to work a crowd for an AIDS benefit. In fact, the participants, who also included television actor Robert “Benson” Guillaume, were about the only big names who would associate themselves with AIDS. Most other stars, including many who had built their careers on their gay followings, were not inclined to get involved with a disease that was not…fashionable.

  As an issue, AIDS still lacked star quality. Even among gays, the epidemic had yet to gain the aura of a trendy cause. The foundation sold far fewer tickets than it had hoped. Although the fund-raiser came out in the black, organizers had to paper the house, giving away free tickets to make sure the symphony hall looked more crowded than ticket sales would indicate. In fact, in the Castro, there was new talk: “I’m tired of gay cancer,” people said. The last few months of intense media scrutiny had been exhausting; people were beginning to wish it would go away. The lines at bathhouses, which had thinned during all the publicity about posting warnings, began to swell again.

  The Next Day

  SAN FRANCISCO MEDICAL SOCIETY

  During the summer of 1983, Dr. James Curran had grown fond of citing the “Willie Sutton Law” as evidence that AIDS was caused by a retrovirus. The notorious bank bandit Willie Sutton was asked once why he robbed banks, to which he replied, “Because that’s where the money is.”

  “Where should we [at the CDC] put our money?” Curran would ask. “Where would Willie Sutton go? He would go with retroviruses, I think, right now.”

  The explanation was always good for a laugh. Jim Curran had become the federal government’s ambassador of AIDS, taking his iceberg slides and scary graphs all over the country. Today he was talking to the Bay Area Physicians for Human Rights, a polite group of gay doctors who seemed downright giddy in the presence of such an important man. Curran’s standard pitch now included little stories that showed how seriously the Reagan administration was taking the epidemic.

  “The other day, I got a call in my hotel room—they said it was the secretary,” said Jim Curran, now two years into his tenure as AIDS coordinator for the CDC. “Who got on the line but The secretary. Secretary Heckler. I wasn’t expecting that.”

  As the chuckles subsided, Curran continued, “But the Secretary does support us in our efforts.”

  The well-mannered physicians blanched when they saw a Chronicle reporter trail Curran out of the room and into the men’s bathroom and right up to the urinal, asking impertinent questions about the adequacy of funding resources. The polite doctors had not asked such questions, perhaps as a matter of professional courtesy to a respected colleague.

  “We have everything we need,” insisted Curran.

  It was the message he delivered across the country that summer.

  Three years later, the same reporter who had dogged Jim Curran in the lavatory asked him about those comments. Freedom of Information Act requests had revealed that things weren’t so rosy at the CDC, and Curran knew it. Even while he reassured gay doctors in San Francisco, he was writing memos to his superiors begging more money.

  Curran chose his words carefully.

  “It’s hard to explain to people outside the system,” he said. “It’s two different things to work within the system for a goal and talking to the people outside the system for that goal,” he said. “Should I have answered: ‘I’ve been trying to get a statistician but can’t?’ I knew the assistant secretary was working on budget proposals to get that. It was not time to stand up in San Francisco and announce it. Listen, you have three options: you can exit in frustration; maybe you can take a second option, exit and then become an outside voice; or you can be loyal and work on the inside. People on the outside might think you’re lying or covering up. That’s not true.”

  Besides, there weren’t many willing to listen to complaints. The news media were not doing public policy stories, Curran later noted. No newspaper or television network showed any interest in using such information even if Curran had provided it. “There were only two things keeping AIDS programs alive—inside pressure and pressure from the gay community,” he said. “That was it.”

  In Atlanta, Dr. Bruce Evatt of the CDC’s Division of Host Factors was worried about how hardened the battle lines had become between blood banks and the CDC. He frequently flew to Washington to advise blood industry leaders about the mounting evidence that AIDS had contaminated the blood supply. Rather than reaching agreement on some course of action, however, each side grew more entrenched. Meetings often degenerated to blood bankers questioning Evatt’s credentials as a scientist and mocking the CDC’s competence to guide policy matters. Bruce Evatt had never seen such nasty personal attacks in all his years at the CDC. Repeatedly, Evatt warned the bankers that they were opening the way for negligence suits. Under special protection granted by Congress, blood banks were immune from product liability claims. But negligence was an entirely different matter, he warned. It could be argued that by now the blood banks knew better than to dispense freely blood they suspected of being infected with AIDS without taking any precautions except the cursory screening of donors. The argument, Evatt could see, carried little weight with a blood industry that considered itself above any law because of its special congressional protection.

  In late June, the American Red Cross, the American Association of Blood Banks, and the Council of Community Blood Centers issued a joint statement decrying the fears about poison blood and insisting again that, if the problem existed at all, there was only “one AIDS case per one million patients transfused.” As he tried to forge a consensus policy on blood, Assistant Secretary for Health Edward Brandt—the official at whose desk the buck stopped for health policy—reiterated his support for guidelines that permitted screening donors but did not require any actual testing of blood itself.

  June 25

  NAPLES, ITALY

  As far as AIDS conferences went, the first workshop of the European Study Group on the Epidemic of Acquired Immune Deficiency Syndrome and Kaposi’s Sarcoma did not attract a stellar cast of scientists. However, the conference did feature a most romantic setting, in the grand Castel del Ovo, a fifteenth-century castle set on the Bay of Naples. Dr. Michael Gottlieb was there from Los Angeles to present his current theory on a two-virus model for Kaposi’s sarcoma. The cancer had presented Gottlieb
with the most intriguing mysteries of the epidemic, because its appearance seemed limited to gay men. In Africa, the disease had long been linked to the CMV herpes virus, leading Gottlieb to believe that, perhaps, a second virus worked in tandem with a still-undiscovered AIDS virus to cause KS. According to his two-step idea, a person first needed infection with a virus that clobbered lymphocytes, a lymphotrophic virus, while a second virus caused the specific outbreak of KS. The lymphotrophic virus alone would bring about AIDS, under this thinking, which explained why intravenous drug users and transfusion recipients rarely experienced the skin cancer. Gottlieb’s likely candidate for the KS-specific virus was CMV; he still lacked a nominee for the lymphotrophic agent.

  Michael Gottlieb had read the Pasteur Institute’s Science article on their discovery of a new human retrovirus, but he hadn’t thought much of the work. Like most scientists, he needed more evidence. When Dr. Jean-Claude Chermann from the Pasteur Institute started presenting the institute’s latest discoveries on its virus, Gottlieb perked up. Their virus, LAV, was incredibly cytopathic, Chermann reported, devastating the cells it infected. Gottlieb matched the viral description to the wasted immune systems he had seen as a UCLA clinician. It made sense. He raised his hand during the question session.

  “Is this virus HTLV-I?” Gottlieb asked.

  “Ah,” said Chermann, warming to the question. “If you ask me if it’s an HTLV, I’ll say yes. It is a human T-cell lymphotrophic virus. But if you ask me if it’s HTLV-I, no, it is not.”

  The Frenchman explained the differences between the core proteins and other characteristics of the virus. Meanwhile, another Pasteur immunologist, David Klatzmann, presented blood work from a variety of AIDS patients that clearly implicated LAV.