And the Band Played On

by Randy Shilts

  February 2

  ALPINE TERRACE, SAN FRANCISCO

  Throughout the year since Gary Walsh’s AIDS diagnosis, he had busied himself with a major redecoration of his Castro District apartment. The refurbishing had become something of a joke among Gary, Lu Chaikin, and Matt Krieger, because it seemed that Gary always had something to buy for this Sisyphean task. It seemed that he was never going to see his plans completed. Finally, on this Thursday morning, the embellishments were to be completed with the delivery of a new couch.

  Gary had spent the night before the sofa’s arrival sleeping only fitfully. He was in constant pain. Breathing was difficult. In the morning, his doctor told Gary to check into the hospital, but Gary had insisted on an appointment first. He didn’t want to sit for hours in some sterile hospital room unless it was absolutely necessary on this particular day. A quick checkup confirmed what Gary’s doctor had feared—the Pneumocystis was returning. Matt rushed to the doctor’s office so he could drive Gary to the hospital.

  “Are you scared?” Matt asked. He was helping Gary walk up the stairs to his apartment, so Gary could pick up some belongings.

  “Yes,” Gary confided.

  “Well, we’ll get you through this one,” Matt said. “Good grief, I leave you alone for one night and look at the trouble you get into.”

  As Gary and Matt stepped out of the apartment building, the delivery truck arrived with the sofa that completed the redecoration.

  At Davies Medical Center, the morning seemed like a three-ring circus to Matt. Nurses, phlebotomists, X-ray technicians, and various orderlies streamed in and out of Gary’s room, hooking up machines to test for this vital sign or that possible ailment. Amid it all, Gary signed papers renewing his insurance policy so he wouldn’t lose the disability payments that had permitted him to live fairly comfortably over the past year. Already, the insurance company had dropped the group policy that covered the other psychotherapists with whom Gary shared a building in the Castro. His own premiums were now up to $300 a month because of his astronomical medical expenses. Given the fact that Gary’s health care over the past year had totaled $75,000, the premiums were a bargain.

  The lung X-rays proved inconclusive—Gary could have either regular pneumonia or Pneumocystis, his doctor reported later. Whatever type it was, the physician felt optimistic that they had caught the bug early enough to stop its progression.

  That night, Matt wrote in his journal: “The day left me feeling exhausted. But I don’t feel scared for Gary’s well-being. Somehow I feel confident that he will be home in a few days. I have an increased confidence that Gary will be well and that he will beat AIDS. I almost feel that the determination on both of our parts will accomplish this. We have many things to do together in the years ahead.”

  QUEBEC CITY, QUEBEC

  From his bed in the Catholic hospital, Gaetan Dugas had never looked so scared, his friend thought. Like Gaetan, the friend was an airline steward, and he had arranged his visit to Gaetan between flights. This third bout with Pneumocystis had prompted Gaetan to move back to Quebec, where he could enjoy the care of his devoted family. His family was constantly at his bedside, and Gaetan was in good spirits, but he had wasted away to almost nothing and suffered from a perpetual fever. His old drinking buddy didn’t think Gaetan would make it this time.

  The winter in eastern Canada was bitter cold, Gaetan complained, even as the first warm days of February were hitting British Columbia. Before long, he started talking about returning to Vancouver, looking for somebody to fly to Quebec and escort him back to British Columbia, because he didn’t want to make the flight alone.

  “I am trapped in a dungeon where the guards wear white coats,” he pleaded. “Please rescue me.”

  41

  BARGAINING

  February 1984

  UNIVERSITY OF CALIFORNIA, SAN FRANCISCO

  Dr. Marcus Conant completed his examination, marveling again at the strange twists of this most eccentric syndrome. The patient was suffering from idiopathic thrombocytopenic purpura, which meant that his blood had stopped producing the platelet cells necessary for blood clotting. The condition also had all but destroyed his spleen, and he obviously did not have much longer to live. Still, the man had no visible health problems beyond a few dermatological glitches. He remained the picture of Castro Street handsome. As he put his hand on the knob of the examining room door to leave, he told Conant, “Well, I’m off to the baths.”

  Marc Conant could tell the patient had made the comment to see how he would react.

  “Do you have sex?” Conant asked.

  “Of course,” the patient said.

  “When you have sex, do you tell the guy you have AIDS?”

  Of course he didn’t.

  Conant immediately recalled the French-Canadian he had seen almost two years ago, the airline steward who had sparked all the controversy about AIDS patients going to bathhouses. As far as Conant was concerned, however, Gaetan Dugas was a sociopath, driven by self-hatred and inner turmoil. This patient, Conant knew, was an intelligent man with a doctorate in computer sciences and a solid reputation in the community.

  “Somebody thinks you’re smart—they gave you a Ph.D.,” Conant began. “don’t you think it’s your responsibility not to spread this disease any further? At the very least, you should warn the people with whom you have contact.”

  The patient bristled.

  “Anybody who goes to the baths is a goddamn fool and deserves anything he gets,” he said.

  Conant thought of the roller coaster he recently had ridden at the big beachfront amusement park in Santa Cruz. At first he had had trepidations about getting on what seemed a rickety old mechanism, but he had figured that if it was unsafe the government wouldn’t let it operate. He thought of the guys who would line up to have sex with this attractive patient and made a quick parallel: They must be thinking that if these bathhouses really were dangerous, some responsible authority would not let them operate. Instead, the bathhouses, all licensed by the city, were prospering.

  Rather than condemn the institutions, Public Health Director Mervyn Silverman had adopted the latest neologism of AIDSpeak and had begun praising the bathhouses as wonderful places to conduct educational campaigns. That was where the people who needed education the most congregated, he reasoned. Although, privately, he preferred that they be shut down, Silverman did not want to endanger the relationship his department had with the gay community, a relationship he considered essential to facilitating public health education.

  Marc Conant had never been enthusiastic about the continuation of commercialized sex during the epidemic, but like most doctors, he hated entering the local political fray, particularly over an issue that so inflamed gay community passions. A few days after his disconcerting conversation with the AIDS patient, however, Conant was talking over the bathhouse issue with Bill Kraus. As far as Bill was concerned, bathhouses had become dens for publicly licensed murder. He considered Silverman an accomplice to the killings for letting them stay open so long. Urging people to go to bathhouses for AIDS education, Bill Kraus contended, was like telling people to stay in a burning building so they can learn about fire safety. Bill thought it was time to resurrect the issue and was organizing a forum on the bathhouses for the March meeting of the Harvey Milk Gay Democratic Club.

  Marc Conant agreed with Bill Kraus. “I’ll speak at the forum,” Conant said, “but the ideal scenario would be to get the gay community to shut down the bathhouses themselves. Without state action, the closure could be hailed as the work of people taking responsibility for their own lives.”

  Conant was not prepared to come out and say public officials should shut the baths down. Rather, he’d say the community needed to start discussing whether to close them.

  Bill Kraus was not confident that the community would move. Nothing had happened since the last bathhouse controversy nine months before. Everybody seemed hopeful that the whole controversy would go away; instead, it
was gay men who were going away.

  Bill also was alarmed at data collected by Drs. Leon McKusick, William R. Horstman, and Thomas Coates in their continuing surveys of changing sexual behavior among San Francisco gay men. The psychologists had queried nearly 700 gay men from a sample drawn among men handed questionnaires as they left gay bars and bathhouses. A third group of men in monogamous relationships, recruited through gay newspaper ads, received questionnaires by mail. When broken into three groups—the bar group, bathhouse patrons, and married men—some startling differences in sexual behavior emerged.

  While all three sectors had the same awareness of the AIDS problem and how to avoid contracting the disease, men who went to bathhouses were far less likely to be following safe sex guidelines than any other group. Even worse, 68 percent of bathhouse patrons said they used “anonymous sex as a way of relieving tension.” This compared with 29 percent of the total survey who acknowledged such behavior. Sixty-two percent of the bathhouse group said, “Sometimes I get so frustrated that I have sex I know I shouldn’t be having.”

  Also revealed in the welter of statistics gathered by the health department was that 8 percent of the men at bathhouses had enlarged lymph nodes. This meant that 1 in 12 patrons probably was already in the early stages of AIDS infection. A bathhouse customer netting three trysts in one visit would have one chance in four of bedding with one of these men. Not surprisingly, the study concluded: “The efforts of the Public Health Department have been ineffective in influencing sexual activity at the bathhouses.”

  Although many gay men had changed some sexual behavior, the study found, only a minority had entirely eliminated all behavior that would put them at risk for contracting AIDS. Collectively, the gay community was going through the phase in the grief process known as bargaining. On the individual level, this stage follows denial and anger; it is characterized by the desire of the terminally ill patient to try to strike a bargain with the fatal disease, or with God. The classic example is the dying patient who pleads to be just well enough to attend this last wedding or give that last performance. Once the wedding is attended and the performance sung, there often is another marriage to celebrate or another song to sing. The bargaining is an attempt to postpone. So gay men bargained. Safe sex had come to mean eliminating your least favorite sexual activity and hedging on the rest. Maybe if I give up getting fucked, I can still have oral sex, many reasoned.

  Politically, gay leaders bargained as well. It was all right to have warning posters, but they didn’t want to give up bathhouses just yet—not until an AIDS virus actually was found and the means of transmission was proven. Of course, once the virus was found and the transmission routes were completely established, there would be further demands; this bargaining was not a reasonable process. In this sense, the bathhouse issue for gays continued to play like the blood banking issue for heterosexuals. There was denial and then bargaining. The gay response to the bathhouse problem was not a homosexual reaction; it was a human reaction.

  The gay psychologists understood this and pleaded for patience. Bill Kraus figured that by the time the gay community had run through this complicated psychological marathon to acceptance, a good share of them would be dead. Time was a luxury the gay community could not afford. All the psychological pampering wasn’t saving lives, Bill decided. Politically, he felt that efforts for closure had to move ahead now, despite the fact that researchers at the San Francisco General Hospital AIDS Clinic had warned him that city leaders would want to sweep the issue under the rug before the Democratic National Convention, which was to convene in five months.

  It was time to reach over the heads of the health department and gay community leaders, Bill Kraus decided. On Thursday morning, February 2, he called a reporter at the San Francisco Chronicle and casually mentioned the statistics from what had become known as the McKusick study.

  The reporter’s subsequent visit to Dr. Selma Dritz revealed more concern about the bathhouses. Dritz had just completed a chart of the city’s rectal gonorrhea rate. Although the statistics had been plummeting, the number of rectal gonorrhea cases for the final quarter of 1983 showed the first increase of the disease in five years. The rise was not dramatic, but Dritz was stunned that the disease—which could only be contracted through unprotected, passive anal intercourse—should increase at a time when gay men were being told that passive anal intercourse was a ticket to oblivion.

  Selma Dritz handed the graph to the reporter. “This says that at the same time we noticed increased activity at the bathhouses, we started seeing another increase in rectal gonorrhea,” she said. “This is very strong presumptive evidence of a parallel.”

  As the reporter was leaving, Dritz glanced at the blackboard with all its circles, arrows, and numbers. “On Monday alone, I logged in eight new cases,” she said, her voice sounding tired. “Eight young men and they’re probably all going to die.”

  Dr. James Curran needed little goading when he was contacted by a San Francisco newspaper reporter. As a federal official relying on gay community cooperation for much of his research, Curran wouldn’t go so far as to tell Dr. Merv Silverman to close the bathhouses, but he did opine, “I wish the gay community would officially express concern over bathhouses. I’d like to see all bathhouses go out of business. I’ve told bathhouse owners they should diversify and go into something healthy—like become gymnasiums. Gay men need to know that if they’re going to have promiscuous sex, they’ll have the life expectancy of people in the developing world.”

  Gay community leaders became choleric at the resulting bathhouse story in the Chronicle. The reporter, they agreed, suffered from internalized homophobia. Anger exploded into fury when the following day’s paper carried a long news analysis on the challenges that bathhouses posed to the city’s AIDS educational program. The article quoted prominent AIDS researchers who mocked the accentuate-the-positive tack taken by the San Francisco AIDS Foundation. Rather than focus on the harsh realities of AIDS, the city-funded foundation’s educational campaign now featured full-color posters graced by the backsides of two nubile men. “You Can Have Fun (and Be Safe, Too),” the cheerful slogan advised. Publicly condemning the health department’s don’t-panic-gays posture, Supervisor Harry Britt announced that he would meet with doctors and AIDS researchers to start organizing his own educational campaign to inform gay men that “sexual activity in places like baths or sex clubs should no longer be associated with pleasure—it should be associated with death.”

  Dr. Silverman maintained that he would not take any action on the bathhouses, even to enforce his own much-publicized edict that the businesses should post warnings.

  “Any action on this is going to have to come from the gay community, not my office,” Silverman said. As for the city’s educational program, he insisted, “I think the record shows we’ve done everything we possibly could do to educate people about this. I’ve been thinking about this every day and every night for a year—it’s not something I take lightly.”

  By Monday, February 6, behind-the-scenes maneuvering on the bathhouse issue escalated. Bathhouse owners met and issued a statement, condemning the “uncaring and unscrupulous theocrats [who] have stooped to manipulating public fears about AIDS in order to serve their own private, political goals of eliminating first the gay baths, then the gay bars, then all gay businesses and organizations, and possibly the jobs of every gay person.” The Bay Area Reporter readied its own editorial, blasting the Chronicle and anybody who doubted that the bathhouses were terrific places for AIDS education. As usual, the issue was framed in terms of human rights, not human life. “If the baths pulled their own plugs and died a natural death—like some of their patrons—no one would be the richer or the poorer,” the BAR editorialized. “The issue in this case would be constitutional, not a health issue. A major segment of the body politic would be denied the right to assemble in a place where nothing illegal was taking place.”

  Meanwhile, the National KS/AIDS Foundation�
��s board of directors met a few blocks away. Bill Kraus wanted the foundation to approve a warning card that all bathhouse owners would be required to give to patrons as they walked in. The warning card would bluntly tell customers that they might die if they participated in unsafe sexual acts. If the bathhouse supporters were going to argue that gays had a right to an informed choice, then there should be assurances that all patrons were indeed informed, Bill Kraus said. Ten of the twelve board members agreed on the warning, but it faced vociferous opposition from foundation treasurer Bob Ross, the publisher of the Bay Area Reporter, a publication that reaped hefty advertising revenues from bathhouses. Faced with certain condemnation in the BAR if they called for the warning card, the board deferred action. Marc Conant and Bill Kraus left to attend another meeting that Harry Britt had called with Merv Silverman, public health director.

  By the time that meeting convened, the battle lines were clear. The only gay political leaders supporting action against the baths were allied with the Milk Club. Of course, longtime public health veterans like Selma Dritz supported closure, as did the increasingly vocal doctors at the AIDS Clinic. But physicians’ advice had carried little weight in decision making at any governmental level during the first five years of the AIDS epidemic, and nobody paid much attention to them now. Lined up against closure were most of the city’s other gay leaders, the Bay Area Physicians for Human Rights, and the advertising-conscious gay newspapers. Bathhouse owners, some of whom had spent much of the last decade barring racial minorities from their businesses, themselves had become new champions of civil liberties.