And the Band Played On

by Randy Shilts

  Without a concerted educational effort by the city, the gay community’s approach to AIDS was transformed. To be sure, tens of thousands of gay men were, quite literally, dying to know more about the epidemic. They crowded lectures on safe sex and burgeoning therapy groups on “AIDS anxiety” for the “worried well.” They educated themselves on all things relating to the immune system, often placing themselves in the unfamiliar position of lecturing less informed physicians on the intricacies of T-cells, B-cells, and macrophages.

  This collective concern fueled the most dramatic shift in behavior since the contemporary gay movement was forged in the Stonewall riots of 1969. Nonsexual social alternatives thrived. A half-block off Castro Street, the Castro Country Club flourished, offering gay men a relaxed, alcohol-free environment in which they could play “Trivial Pursuit” and canasta away from the heavy cruise scenes in gay bars. Gay Alcoholics Anonymous groups proliferated in church basements of gay neighborhoods throughout the city. Weekly bingo at the Most Holy Redeemer Church, two blocks off Castro Street, found an untapped market among gay men, who started crowding the church basement every Wednesday night. Some private sex clubs found popularity sponsoring J-O nights, in which partners were encouraged to recall the nostalgic, teenage masturbation of “Boy Scout sex.” With the national popularization of videocassette recorders, gay men realized they need never go home alone again, even if they didn’t pick someone up in the local meat rack. Dating and matchmaker services enjoyed a comeback.

  At the bars, the gay men who were still cruising rarely admitted to being single. Instead, it seemed, everybody in every gay bar had a lover who was out of town. Telephone sex services also prospered. Rates of anal gonorrhea, an indicator of the prevalence of passive anal intercourse, plummeted that year. 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 gay community, however, remained at crosscurrents with itself. Even as behavior shifted for significant numbers of gay men, others managed to party on, like the revelers in Edgar Allan Poe’s “Mask of the Red Death,” oblivious to the plague around them. When the summer’s intensive media blitz eased, bathhouse attendance picked up and lines formed around the sex emporiums every weekend.

  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.”

  Psychologists studying the gay community compared the contradictory trends to the reactions men typically have when facing their mid-life crisis. Psychologically, the mid-life crisis marks the period of individual redefinition. Friends begin to die, sparking the sudden realization of mortality. There is a sense of loss: Is my life really half over? Some men run off with their younger secretaries in an attempt to recapture their lost youth; others find that adversity engenders a new maturity and a more meaningful posture in every aspect of their lives. The gay community’s confused response marked the start of its own collective redefinition, a process that, for all its early silliness, would become one of the more profound effects of the AIDS epidemic in the coming years.

  More gay newspapers circulated in San Francisco than in any other city in the United States, but often these publications did more to cloud than to define the challenges facing gay men. Bay Area Reporter columnist Konstantin Berlandt had recently begun a new attack on the Harvey Milk Club, branding club officers as “our own worst enemies” for their “anti-sex” brochure on safe sex called “Can We Talk?”. Berlandt wrote, “Advice on safe sex, while perhaps well meaning, is actually collaboration with the death regime that delights in blaming ourselves and would pin the blame on us. The myth of ‘safe sex’ fosters the finger pointing when anyone of us does come down with a disease: ‘You see, we told you so. We brought it on ourselves.’”

  A week later, Berlandt followed this essay with a treatise that announced, “I love to rim. To some people, a tongue up the asshole can be relaxing, mesmerizing, even spiritually uplifting.” Berlandt maintained it was society’s responsibility to find the medical technology to prevent all sexually transmitted diseases, rather than the gay community’s responsibility to keep sexuality in line with what medical technology could cure. As for safe sex, he wrote, “I don’t mean we can’t make such changes if absolutely necessary, but why must we?”

  In the area of medical coverage, the Bay Area Reporter devoted the most space to a San Mateo doctor who claimed he could cure the syndrome through megadoses of vitamin C. A gay psychologist also wrote a series of articles on the “psychoincubation” of AIDS, maintaining that AIDS victims all had suffered an “emotional emergency” as children that made them feel abandoned. The abandonment now was being played out with AIDS, he said, meaning that a change in psychological posture toward the world could be the best prevention against the disease.

  The contribution of the Sentinel, the second largest gay paper in San Francisco, was a huge series of articles blasting Marc Conant’s fledgling National KS/AIDS Foundation. The stated reason for the merciless attacks was that staffers at the foundation had given AIDS patients free tickets to the Debbie Reynolds fund-raiser in June. The real reason for the assault was less savory. The Sentinel was then owned by a man who long had been in heated competition for circulation with BAR publisher Bob Ross, who was treasurer of the foundation. The attack on the foundation was little more than an attack on a business competitor.

  Nevertheless, the national foundation foundered under the criticism. 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.”

  NEW YORK CITY

  The Hispanic man arrived at a meeting of the People With AIDS group looking confused. He had just been told he had contracted a deadly disease of which he had never heard. It was called AIDS.

  “How come nobody told me there was an epidemic?” he asked the PWA president, Michael Callen.

  “Don’t you watch TV?” asked Callen.

  “No.”

  “Don’t you read the Native?”

  “No.”

  For all the problems in San Francisco, at least the West Coast city had a program for AIDS, however torpid. In New York City, an interagency task force met monthly to discuss the epidemic, but meetings were little more than a chance to enumerate all the things that the city was not doing to meet the challenge of AIDS. Official inaction was not a matter of neglect; now it was elevated to the level of policy. Unlike San Francisco, where the health department assumed a direct role as service coordinator, New York City Health Commissioner David Sencer maintained that the proper role of the health department “should provide those services that others have not, will not, should not, or cannot provide.” The interagency task force defined its role as “seeki
ng not to direct, but to provide a neutral meeting ground.” Essentially, Dr. Sencer said, the health department should fill gaps, not launch any ventures of its own.

  This was a fortunate ideology for David Sencer, since he maintained that few gaps existed in New York. He opposed establishing coordinated care facilities like those at San Francisco General Hospital, saying that “attempts at the municipal level to bundle these [preventive, ambulatory, and institutional] services too closely are dangerous.” Sencer maintained a similar lack of enthusiasm for education and prevention programs. At the Weiss subcommittee hearings, one Republican congressman suggested that Sencer “ought to be really quite loud about…methods of prevention.” Commissioner Sencer, however, responded, “I think that there are ways in which this could be accomplished without taking to the soapbox. I certainly believe that the information is going to be better accepted and come from a stronger support if it comes from the affected communities themselves.” Sencer said he was working with gay newspapers, adding, “I think that public exhortation has not stopped the spread of venereal disease.”

  The reliance on gay newspapers was a curious position for a public health education program. New York City had only one gay newspaper, the New York Native. Its circulation was about 20,000, in this city with an estimated gay population of 1 million. That meant that 49 out of 50 gay men did not read the publication upon which New York City based its entire AIDS education effort.

  By the end of 1983, the entire contribution the government of New York City had made to AIDS services or education was a $24,500 allocation to the Red Cross to provide home attendant care to AIDS patients. Even that program started three months late because nobody bothered to get phones hooked up so prospective clients could call. The Red Cross service was designed to serve 200 AIDS patients. In the fifteen months before the contract was canceled, however, only 80 patients were helped, because of bureaucratic problems in administering the agreement.

  Meanwhile, Gay Men’s Health Crisis was running its entire operation out of five small rooms in a boarding house. The group had enlisted 300 clinical volunteers and coordinated twenty training sessions a months for doctors and nurses seeking information on treating AIDS. They trained 50 new volunteers every month for new clients. Although the GMHC space was woefully inadequate, few landlords wanted their buildings to become the site of Manhattan’s “leper central.” Dr. Joseph Sonnabend, one of the city’s leading AIDS doctors, filed suit against his co-op association after he was ordered evicted from his offices because of the large number of AIDS patients visiting his West 12th Street address. When GMHC asked the city if it could use an abandoned high school on West 13th Street as an AIDS service center, the city demanded $2 million cash up front. Gays were not about to get charity from the Koch administration.

  After meeting with Mayor Koch, Dr. Mathilde Krim sat down with Joseph Sonnabend and GMHC Executive Director Rodger McFarlane to write a proposal for a coordinated city response. Based on the San Francisco program, the group described a plan for diversified care alternatives, including hospice beds, AIDS wards, and clinics. Krim took the idea to public officials but found few interested in the epidemic. Carol Bellamy, the New York City Council president, wouldn’t see the researcher. Andrew Stein, the Manhattan Borough president, chatted politely with Krim but declined to take any action. Krim later summed up New York City’s official attitude in four words: “Nobody gave a damn.”

  When Larry Kramer checked his mail on one of his trips back from Cape Cod, he found five letters. Four of them were from doctors worrying that gay men were returning to their old licentiousness now that AIDS was out of the headlines. They also despaired that the gay political leadership had not challenged the mayor or health department to do something, anything, about stemming AIDS. The fifth letter was the announcement of a memorial service for a friend who had just died of AIDS. He was the thirty-second friend of Larry’s who had succumbed to the syndrome.

  GMHC was having a hard time selling tickets for its latest Madison Square Garden fund-raiser, so a private donor took out a full-page Village Voice ad and asked Larry to write a plea for support. In the appeal, “2,339 and Counting,” Larry lashed out at the two evils upon which he blamed the sorry state of affairs in New York—Mayor Koch and the newspaper that continued to ignore the local policy aspects of AIDS, The New York Times.

  After writing the appeal, Larry traveled to Little Washington, Virginia, where he was polishing his play, still not sure of what he should call it. “City of Death,” his first idea, was too depressing, he decided. One night, perusing a book of W. H. Auden’s poetry, Larry found the perfect title in the classic poem “September, 1939.” He’d call his play The Normal Heart, he decided, from the verses:

  What mad Nijinsky wrote

  About Diaghilev

  Is true of the normal heart;

  For the error bred in the bone

  Of each woman and each man

  Craves what it cannot have,

  Not universal love

  But to be loved alone…

  And no one exists alone;

  Hunger allows no choice

  To the citizen or the police;

  We must love one another or die.

  In the first five years of the AIDS epidemic the brightest moments only served to illuminate how bad things really were. That San Francisco had managed the best response to the AIDS epidemic in the United States was the pride of the city; that San Francisco had managed the best response to the AIDS epidemic in the United States measured the shame of the nation.

  By late 1983, San Francisco had put together the only thing resembling an official response to the epidemic thus far mounted in the country. Although New York City had no services beyond what an overstrained gay community provided themselves, patients at least could look forward to reasonably decent care in the city’s hospitals. In other parts of the country, public health mechanisms and the medical community were so poorly prepared for the epidemic that patients could not even expect this ration of comfort.

  The report submitted to Florida Governor Bob Graham on the Morgan MacDonald incident concluded that hospital officials had “acted in good faith” when they loaded the young man on a plane and dispatched him to San Francisco. The hospital had only wanted to put the patient in a city where support services existed, the state health department decided. The transfer, of course, could have been avoided if Florida had adequate facilities to treat patients who no longer needed acute-care hospital beds, but no such facilities existed outside San Francisco. Partially in response to the furor surrounding the MacDonald case, the American Hospital Association was putting together recommendations requiring all healthy hospital employees to work with AIDS victims. The guidelines followed the logic laid out by the University of California in September that stated, “There is no scientific reason for healthy personnel to be excused from delivering care to patients with AIDS.”

  Morgan MacDonald died a “quiet death” of cardiac arrest on Ward 5B of San Francisco General Hospital on October 20, 1983. He was the 111th person to die of the disease in San Francisco. Health Director Mervyn Silverman sent the Shands Hospital in Gainesville a bill for the $6,500 it had cost the city to care for the man, and accused the hospital of “hastening” MacDonald’s death through its actions. At Morgan MacDonald’s passing, Mayor Dianne Feinstein issued a statement. “It is sad,” she said, “that a young man had to spend his final days as a medical outcast.”

  The day that Morgan MacDonald died, Gary Walsh was walking across Union Street, his favorite sixties songs running through his head from the soundtrack of the new movie he had just seen, The Big Chill. Suddenly, he felt dizzy. He waved his cane for a cab. The next thing he remembered was being put in an ambulance, telling somebody, “I’ve got AIDS. Take me to Franklin Hospital.”

  Gary was convinced he was dying. If he wasn’t now, he wasn’t sure how much longer he wanted to continue his posthumous existence. He had been thinking about it for a week anywa
y. In little ways, he had begun tying up the loose ends of his life. By the time Lu Chaikin and Matt Krieger visited him that evening, he had talked to a doctor friend about his plans. Reluctantly, the physician told Gary he’d give him whatever he needed.

  The next day, Gary called Matt and said he planned to commit suicide if he recovered. Weeks earlier, Matt and Gary had had a bitter confrontation on the issue, because Matt bitterly opposed suicide. Knowing Matt’s moral qualms about suicide, Gary was surprised when Matt simply said, “I support and respect your decision.”

  “Really?” Gary asked.

  “You’ve been enormously brave and courageous for so long,” Matt said. “You’ve been determined. Even your going to the movie alone yesterday was brave. I admire you and love you very much.”

  They talked about Gary’s fears.

  “That the Catholics are right,” Gary said. “That I’ll go to hell for taking my life. And that it won’t work.”

  A few days later, the doctor put Gary on morphine. With his pain at a tolerable level, Gary retreated from his plan for suicide. He told Matt he was glad to have considered the issue and would now hold it open as “an option” if the pain returned.

  On October 31, 1983, the Centers for Disease Control counted 2,640 AIDS cases in the country, of which 1,092 were dead. Of these, 1,042 were from New York City and 320 were from the San Francisco Bay Area. As the disease began spreading more thoroughly across the country, the geographical focus of the disease began to shift. In October 1982, about three-fourths of the nation’s AIDS caseload had lived in one of the four cities hardest hit by the epidemic: New York, San Francisco, Los Angeles, and Miami. By now, however, fewer than two-thirds of the people with AIDS lived in these cities.