And the Band Played On

by Randy Shilts

  For all the insight the antibody testing offered, substantial mysteries remained in mid-1984. The most important question concerned exactly what the presence of HTLV-III antibodies meant. The large number of people infected with the AIDS virus might mean that it was less lethal than scientists had imagined, some researchers hoped. The early prospective studies of people with lymphadenopathy, for example, found that relatively few were developing AIDS. Perhaps, some thought, this meant that ARC was a mild form of AIDS infection, and the worst thing that ARC patients might contract was a hard lymph node and a few dermatological problems. Maybe some of the antibodies could be protective and neutralize the effect of the AIDS virus, other scientists hoped. Although the presence of AIDS antibodies in so many patients indicated that this was not always the case, there was not enough known about the antibodies to draw any definitive conclusions yet.

  Substantial debate continued as to whether the AIDS virus—whether LAV or HTLV-III—acted alone or in tandem with another infection to produce AIDS. Again, this could explain why some people infected with the AIDS virus came down with the full-blown disease while others got ARC and many more had no symptoms of malaise. Cytomegalovirus and the Epstein-Barr virus were the most-nominated candidates for AIDS co-factor. Others voted for gastrointestinal parasites.

  Against all this uncertainty, Dale Lawrence’s research into AIDS incubation gained a more pressing import. With an average incubation period of 5.5 years, there didn’t have to be many cases in 1984 to substantiate the fatality of the AIDS virus. According to his calculations, because the virus had not invaded the bodies of very many Americans until 1980, the huge number of AIDS cases would not start appearing until late 1985. Still, throughout 1984, the CDC made no effort to reveal Lawrence’s disquieting research.

  Lawrence discerned a pattern in this. All along, the agency had routinely delayed making public its new discoveries for at least six months. Other staffers’ work on intravenous drug users and their female sexual partners had encountered such delays. Leading CDC researchers assured journalists that there was “no evidence” that AIDS was an infectious disease even as they prepared the tale of Patient Zero and his clusters for official publication. Warnings about possible heterosexual transmission of AIDS were also stalled, in part because Assistant Secretary for Health Brandt did not believe AIDS could become a heterosexual problem.

  Lawrence understood the wisdom of such caution. The agency’s credibility could be undermined if it had a reputation of shooting from the hip on issues of key national health policy. Still, Lawrence was concerned that health officials across the country were relying on estimates of a two-year incubation period to support optimistic analyses that AIDS would reach a plateau soon because of recent changes in gay behavior. Those were not the statistics on which to base intelligent planning, he knew. However, from the day in December 1983 that Lawrence first advised Jim Curran of his research, it was sixteen months before scientists learned this bitter truth about the AIDS virus.

  Don Francis knew enough about the vagaries of retroviral incubation to quickly draw some depressing conclusions from the various studies on the prevalence of AIDS virus among the various high-risk groups. Gay men in major urban areas, he could see, stood to be devastated by the epidemic. Hemophiliacs faced decimation. Intravenous drug users would be wiped out in astounding numbers, taking with them their sexual partners and infant children. Equatorial Africans faced death on the scale of the Holocaust. The light at the end of the tunnel was an oncoming train.

  Grim prognostications were nothing new to the AIDS epidemic. The new wrinkle for Francis was the scientific rancor between Robert Gallo and the Pasteur Institute over credit for the AIDS virus discovery. Rather than settling the dispute, the HTLV-III announcement had enlarged it, and the fallout was profoundly frustrating Francis’s work at the CDC. Because Gallo remained angry with the CDC for leaking news about LAV on the eve of the Heckler press conference, he was reluctant to provide the CDC with substantial amounts of HTLV-III. A thimbleful of virus had arrived from the NCI in May, but the CDC lab had difficulties culturing it, so Jim Curran requested more.

  The CDC knew that plenty of this virus existed. In May, the NCI had sent out 25 liters to the five private pharmaceutical companies who were chosen to manufacture the blood screening test. However, the NCI refused to give the CDC anything but token amounts of HTLV-III. Gallo was convinced that the CDC was not sharing its best specimens with his lab, and he would not cooperate with the CDC as long as he suspected the CDC was not cooperating with him. Not until the end of the year did the NCI relent and finally enter into a purchase agreement with the CDC for 100 liters of HTLV-III.

  Gallo was also adamant that the CDC not perform genetic comparisons between HTLV-III and the French LAV. Gallo promised to do his own comparison between HTLV-III and LAV, but the results weren’t forthcoming. Francis knew the comparison could settle whether the two viruses were identical; if identical, it also would settle the question of who discovered the AIDS virus first. Gallo did not want this settled, Francis thought, because it would show he had lost the great viral competition of the twentieth century. Francis anticipated that Gallo would spend a year publishing reams of scientific papers on HTLV-III. Later, when he was internationally recognized as the virus’ discoverer, he would allow that HTLV-III and LAV were the same. Gallo viewed this as part of normal scientific competition; Francis thought it smarmy.

  At the Pasteur Institute, French researchers were miffed at being treated as pretenders to the throne, awaiting Bob Gallo’s confirmation that their claim to the coveted discovery was rightful. Internationally, scientists working on AIDS were forced to choose sides between the French and the Americans. Within a week of the announcement, Francis got into a bitter public argument at a scientific conference in France with Dr. William Haseltine, a Harvard researcher aligned with Gallo.

  “How can you share specimens with the French and not with Bob Gallo?” Haseltine shouted at Francis.

  Around them, other scientists fell silent. Don Francis was stunned. The comment revealed that Gallo had shown Haseltine the private memos he had been circulating in the NIH complaining about the CDC.

  “don’t get involved with things you don’t know anything about,” Francis shouted back. “Keep your nose out of it.”

  Because the Reagan administration had relied on Gallo to take the political heat off the AIDS epidemic, the top officials at HHS and the Public Health Service supported the NCI. At one point, they ordered the CDC to stop referring to the virus as LAV in their research papers and instead defer to Gallo’s taxonomy of HTLV-III. The request was ludicrous: All CDC research was on the French-supplied LAV, if for no other reason than they couldn’t get HTLV-III from Gallo. Ultimately, the CDC persuaded higher administration officials to accept the compromise moniker of LAV/HTLV-III.

  There were also problems publishing studies. During an argument over hiring Dr. Kaly, Gallo had sworn to Don Francis that “you’ll never get anything published.” Francis dismissed the pledge as an empty threat.

  As the imbroglio grew more bitter, Francis noticed that good virologists were shying away from AIDS research, reluctant to become stuck in what had become a quagmire of scientific politicking. AIDS research had become “wretched, rank with politics,” Francis wrote in his journal that summer. “It’s lost all the fun and excitement of science.”

  The intrigue played against the usual backdrop of funding shortages. By the summer of 1984, of course, Francis’s lab technicians were working with large quantities of the deadly LAV as well as large amounts of tissue from AIDS patients. His antiquated laboratories, however, did not have an autoclave to sterilize pans and instruments. Instead, technicians carried their contaminated trays and instruments down a hallway to another lab for cleaning. Doing this required the workers to precariously balance their materials in one hand while they turned the doorknob with their contaminated lab gloves. In the summer of 1984, Francis’s problems with doorknobs came to
summarize his despair over adequate resources.

  Fearing a viral spill or the spread of the pure AIDS virus from the contaminated doorknobs, Don Francis asked the building engineers for swinging doors so his employees could back out of the lab. Such doors were too expensive; it would take months to get approval for them. Francis then asked for the doorknobs to be replaced with the European-style hooks that hospitals routinely use instead of knobs. Thus, the techs could open a door with an arm while keeping both hands on AIDS-infected materials.

  Francis wrote out his request, but nothing happened. He wrote more memos and discussed his safety concerns at every staff meeting, but nothing happened. Altogether, Francis agitated for four months before he was able to negotiate two $2.75 hooks for his lab doors.

  Francis figured the funding problems dominated nearly 90 percent of his time. For example, he had conducted a nationwide search for another virologist to ease his staff’s load. Once employed, the scientist had to wait two months before he could get to work, because there wasn’t enough lab space for him. Francis gave up his office so it could be converted into a lab, but conversion took three months because the CDC didn’t have enough building engineers to do the construction.

  Francis and his scientists were forced to do their paperwork on desks in hallways four floors above the sub-basement where their labs were located. The constant problems were taking a toll on his lab crew. Everybody worked until 2 A.M. every day. By that summer, one researcher in the virology lab was hospitalized with an ulcer; another developed severe hypertension.

  As far as Don Francis was concerned, the reward for government work rested in impact. You didn’t get a hefty salary, a fancy office, or elaborate perks as a government scientist, but you could make a difference. Francis had beaten every virus he had fought; that was impact. He had helped wiped out smallpox and the dreadful Ebola Fever virus. But he couldn’t beat the system when it conspired to help the viral enemies of humankind. By the summer of 1984, Francis was beginning to feel thoroughly beaten down.

  Resource problems frustrated every aspect of AIDS research. Until the end of 1984, only two scientists had received grants to conduct research on retroviruses and AIDS—Drs. Bob Gallo at NCI and Max Essex at Harvard. Despite his achievements, Gallo was given no new personnel for the stepped-up AIDS work his lab was expected to perform. When Gallo frequently mentioned his problems to other scientists, they laughed. Nobody believed him.

  Most striking, however, was the deficiency in funds for research into treatments for AIDS. The LAV/HTLV-III discoveries opened the way for testing of experimental anti-viral drugs. One CDC doctor wanted to test ribavirin, a drug that had had some success against flu viruses. To test the drug’s efficacy, however, the doctor needed viral cultures on the blood of his subjects. Only with this capability could he determine whether the drug was reducing the level of virus in his test subjects’ blood. Don Francis had to reject his request because the CDC lab could make only fifteen viral cultures a week, and this capacity was required for more pressing work.

  At the National Cancer Institute, Dr. Sam Broder was in charge of treatment strategies, and he too found little interest in developing anti-AIDS drugs. After all, the “miracle drug” advances of the past decades had come in treatments for bacterial organisms, which are independent life forms. Viruses and retroviruses, however, are not independent life forms but are pieces of genetic material that actually become part of the infected cell. Killing the virus means killing the cell. Science had yet to develop any successful treatments for viral diseases. Vaccines could create antibodies to protect people from infection, but they were not cures. Given the lack of success in fighting viruses in the past, some scientists believed that no treatment for AIDS would ever be found. Broder argued bitterly for at least exploring possibilities. “If you declare the patient terminal and don’t do anything to treat him, he’ll always die,” Broder said.

  Meanwhile, Ed Brandt was aware of the discontent at all levels of the Public Health Service over AIDS funding, but he could do nothing. His May 25 request for expanded AIDS research continued to sit on Secretary Heckler’s desk, unanswered.

  SAN FRANCISCO

  The shingles had started on the back of his neck and spread over the right side of his scalp to cover his forehead and right eye. Another outbreak had gone down his shoulder and over his chest. Just the movement of wind through his hair caused extraordinary pain. Cleve Jones was frantic by the time he got to the doctor’s office.

  “Do you know what this means?” the physician asked.

  “What?”

  “All the young men who I’ve seen get this are developing AIDS.”

  Cleve dragged himself to the nearest gay bar for a drink. A few days before, he had been on the assembly floor in Sacramento when he heard a familiar name being read as the day’s session was adjourned. It was Frank, the lawyer from Long Beach with whom Cleve had had his brief affair in 1982. The assembly was being adjourned in Frank’s honor that day because he had just died of AIDS. Another boyfriend had died a few weeks before. Cleve’s romantic interest from the summer of 1980, civil rights lawyer Felix Velarde-Munoz, had suffered a bout of Pneumocystis.

  Together, Felix, Frank, and Cleve had helped chart a new world for gay people, and now one was dead and another was doomed. Cleve wondered when this nightmare would consume him too. He gulped another vodka tonic; he knew he would have to get drunk this afternoon. He felt adrift. There was no way out.

  Cleve’s own aimlessness reflected the gay community’s confusion over the epidemic. The bathhouse controversy had defied resolution, turning into an only-in-San Francisco political controversy full of unexpected twists. In early June, it was revealed that Mayor Feinstein had dispatched police investigators into the bathhouses to don towels and write a report on the activities within. She had commissioned the research in March, in the wake of the Littlejohn initiative, presumably to get data that would strengthen her hand with the wavering public health director. The disclosure of the investigation three months later, however, angered the mayor’s friends and foes alike, because it conjured memories of the days when police officers raided bars and bathhouses to enforce their Irish Catholic morality.

  Feinstein countered her critics by forthrightly demanding that Silverman “have the guts” to shut the bathhouses before the imminent Gay Freedom Day Parade. “You go to the AIDS Ward and you see young people dying and you feel a strain,” she said. “Dr. Silverman should take his medical information, make a decision and go with it—not count hands to see what is popular.”

  The proposed ordinance to transfer bathhouse licensing authority from the police to the health department continued to be stalled in the board of supervisors. After hearing testimony from such noted public health experts as the Bay Area Lawyers for Individual Freedom and the American Association for Personal Privacy, a supervisors’ committee decided that they would postpone making any decision. The supervisor proposing the seven-week delay was Supervisor Richard Hongisto, who had said in March the baths should be closed because he was spending too much time at funerals of gay friends. Hongisto was thinking of running for mayor in 1987.

  Even while gay political leaders were making bathhouses their top issue, support for the facilities steadily dropped within the community itself. With patronage plummeting, member clubs of the Northern California Bathhouse Owners Association joined to take out full-page ads in gay newspapers offering half-price coupons that carried a full reprint of the group’s “Resolution Regarding an Objective Response to AIDS” on its reverse side. The business decline, however, proved lethal for many bathhouses and private sex clubs. The Hothouse, Cornholes, and Liberty Baths were gone. The cells at the Bulldog Baths were locked for the last time. The Cauldron announced “The Last J-0 Party” and threw in the sling.

  The most festive closing came at the Sutro Baths, the city’s only “bisexual bathhouse,” which catered to males and females of all sexual orientations. Over 500 went to its three-day Fare
well Orgy in early June to nostalgically recall the Sutro’s carefree early days. The festivities climaxed when five people who were losing their jobs because of the bath closure lined up on the stage and stood over a barbecue, burning AIDS brochures.

  “If we can’t pass them out, we might as well burn them,” reasoned Sutro’s owner. The logic was abstruse for most people, however, and the sight of the bathhouse employees publicly burning AIDS-prevention guidelines became one of the most enduring images of the AIDS-stricken gay community in San Francisco that summer.

  With the advent of summer, general interest in the epidemic fell precipitously. Between July and September 1984, the nation’s major print news organizations published only 266 articles on AIDS, the lowest level of reportage on the epidemic since the first quarter of 1983. This amounted to about one-third the number of stories written by the same publications during the height of the media blitz in the summer of 1983.

  What did increase was the number of people dead or dying. In the last week of June 1984, AIDS cases in the United States surpassed 5,000. The epidemic had spread to forty-six states, and nearly 2,300 had died.

  47

  REPUBLICANS AND DEMOCRATS

  July 1984

  RAYBURN HOUSE OFFICE BUILDING, WASHINGTON. D.C.

  In virtually every subsequent interview on the AIDS epidemic, Assistant Secretary for Health Ed Brandt denied leaking a photocopy of his May 25 memorandum to Secretary Heckler seeking $55 million in new AIDS funds. Even so, Brandt frequently joked that he was reading copies of his memorandum in the San Francisco Chronicle before his secretary got them out of her typewriter. Tim Westmoreland, counsel to the House Subcommittee on Health and the Environment, suspected Brandt; but when a copy of the memo arrived in a plain brown envelope in his office mail, Westmoreland was less concerned about the identity of his mystery correspondent than jubilant over the memo’s appearance. At last, Westmoreland had his smoking gun.