by Randy Shilts
In calm, firm tones, Gottlieb began reading from his statement.
“Mr. Hudson is being evaluated and treated for complications of Acquired Immune Deficiency Syndrome.”
PART IX
EPILOGUE: AFTER
“It was only possible for me to do it,” he said, “because it was necessary. I either had to write the book or be reduced to despair: it was the only means of saving me from nothingness, chaos and suicide. The book was written under this pressure and brought me the expected cure, simply because it was written, irrespective of whether it was good or bad. That was the only thing that counted and while writing it, there was no need to think at all of any reader but myself, or at the most, here and there another close war-comrade, and I most certainly never thought then about the survivors, but always about those who fell in the war. While writing it, I was as if delirious or crazy, surrounded by three or four people with mutilated bodies—that was how the book was produced.”
—HERMANN HESSE,
The Journey to the East
58
REUNION
May 31, 1987
WASHINGTON, D.C.
A sticky mugginess hung over Washington the day they arrived. The temperature was trapped in the upper’ nineties, and the air dense with humidity. Occasionally, lightning flashed and conversation stopped expectantly; thunder lumbered through the heavens, then passed. There was to be no relief.
The heat induced a light nausea among even the most acclimatized natives. For the thousands crowding airport cab stands, shuttle buses, and hotel lobbies that afternoon—the scientists and researchers, public health officials and activists converging on the capital city—the oppression was palpable.
The occasion was the Third International Conference on Acquired Immunodeficiency Syndrome, co-sponsored by the World Health Organization and the U.S. Department of Health and Human Services. Though the conference, a successor to the first international symposium held in Atlanta in 1985, would feature state-of-the-art information on all things AIDS-related, the focus of world attention on this event had less to do with such substance than with the conference’s timing. Something had happened in the last two or three months; the epidemic had finally hit home.
Dr. Michael Gottlieb had been correct two years earlier when he stood in that auditorium in Los Angeles and realized that everything would be different for the AIDS epidemic from that day on. It was commonly accepted now, among the people who had understood the threat for many years, that there were two clear phases to the disease in the United States: there was AIDS before Rock Hudson and AIDS after. The fact that a movie star’s diagnosis could make such a huge difference was itself a tribute to the power the news media exerted in the latter portion of the twentieth century.
Attention to the epidemic waned only slightly in 1986. There were other celebrity AIDS patients now, but for all the media cachet, the disease remained fundamentally embarrassing. When Broadway’s star choreographer-director Michael Bennett fell ill, he maintained he was suffering from heart problems. A spokesman for Perry Ellis insisted the famed clothing designer was dying of sleeping sickness. Lawyer Roy Cohn insisted he had liver cancer, even while he used his political connections to get on an experimental AIDS treatment protocol at the National Institutes of Health Hospital. Conservative fund-raiser Terry Dolan claimed he was dying of diabetes. When Liberace was on his deathbed, a spokesman maintained the pianist was suffering the ill effects of a watermelon diet. As these well-known gay men lied to protect their posthumous public images, it was the first professional athlete to contract AIDS, former Washington Redskin star Jerry Smith, who calmly stepped forward and told the truth.
Even while such stories gave news organizations fresh angles, there was one aspect to the epidemic that continued to elude intelligent investigation: the federal government’s role in combating the virus. Congress continued its ritual of force-feeding AIDS funds to a reluctant Reagan administration. Funding levels increased dramatically, but within the executive branch of government, there seemed little excitement about launching anything like a coordinated attack on the disease. Initiatives for development of a vaccine and effective treatments puttered along at their usual speed.
Nor had the federal government launched anything resembling a coordinated AIDS prevention program. In late 1985, the CDC had actually stopped money from being spent on AIDS education when conservatives in the White House worried that the government should not be in the business of telling homosexuals how to have sodomy. Even Dr. James Mason was heard complaining that since he had become CDC director, he found himself talking to complete strangers about sexual acts he would not discuss with his wife even in the privacy of his own home.
Liberal congressional aides struggled to interest reporters in these prosaic stories of federal sluggishness, but the media was unimpressed. Instead, stories dealt with celebrity AIDS cases or schoolchildren with AIDS or laboratory “breakthroughs.” Just about every newspaper had also, by now, run a series of profiles following the life of an AIDS patient. And, of course, there were endless stories about the “spread of AIDS among heterosexuals.” No hint that the disease might spread to straights, no matter how specious, was too small to put on page one.
Meanwhile, during most of 1986, anxious Health officials within the administration desperately tried to turn the media’s attention to the more significant story: the message that the AIDS challenge still was not being met. At one point, the Public Health Service held a meeting of its eighty-five top AIDS experts at the Coolfant Conference Center in Berkeley, West Virginia, to make recommendations on federal AIDS policy. Their stunning projections were covered by the press—that in five years the cumulative number of AIDS cases in the United States would be 270,000 and deaths would total 179,000. The recommendations—for massive public education, better coordination of the federal government’s AIDS research and a blue-ribbon commission on AIDS to study whether enough money was being spent on research and treatment—were largely ignored.
Four months later, the prestigious Institute of Medicine of the National Academy of Sciences tried to direct the media’s attention to the government’s performance on AIDS with a 390-page report that called the administration’s response to the epidemic “woefully inadequate.” The academy report called for a permanent national AIDS commission and the start of coordinated planning, as well as scaling up of AIDS spending to $2 billion annually in research and education. Pointedly, the report also called for “presidential leadership to bring together all elements of society to deal with the problem,” Again, congressional aides hoped the blast at the administration might prompt ambitious reporters to investigate the Reagan administration’s AIDS efforts. To be sure, every major news organization gave the academy report serious news placement the day after its release, alongside assurances that AIDS was the administration’s “number-one health priority.” That, however, was the end of any investigation. After a few days, the report faded from the news altogether.
Ultimately, it was a report issued in October 1986 that turned the tale, galvanized the media and allowed AIDS to achieve the critical mass to make it a pivotal social issue in 1987.
Dr. C. Everett Koop had come to President Reagan’s attention because of his leading role in the anti-abortion movement. His conservative religious fundamentalism horrified liberal, feminist, and gay leaders who had fiercely opposed his nomination as surgeon general in 1981. The administration prevailed, however, and few in the White House inner circle had any trepidations when Reagan went to the Hubert Humphrey Building the day after his 1986 State of the Union speech and asked Koop to write a report on the AIDS epidemic.
Koop spent much of 1986 interviewing scientists, health officials, and even suspicious gay community leaders. Once the text was prepared, he took the unusual step of having tens of thousands of copies printed—without letting the White House see it in advance. When Koop went public with the report, it was clear why. The “Surgeon General’s Report on Acquired
Immune Deficiency Syndrome” was a call to arms against the epidemic, complete with marching orders. For one of the first times, the problem of AIDS was addressed in purely public health terms, stripped of politics. AIDS education, Koop wrote, “should start at the earliest grade possible” for children. He bluntly advocated widespread use of condoms. Compulsory identification of virus carriers and any form of quarantine would be useless in fighting the disease, Koop concluded.
The surgeon general’s research also had led him to some inescapable conclusions about AIDS antibody testing, which continued to be a controversial issue. Mandatory testing would do little more than frighten away from the public health establishment the people most at risk for AIDS, the people who most needed to be tested, Koop said. He reiterated what health officers had been saying for nearly two years—large-scale testing would not be feasible until people did not have to worry about losing their jobs or insurance policies if they took the test. A push for more testing should be accompanied by guarantees of confidentiality and nondiscrimination, Koop said.
Such safeguards proved an anathema to conservatives, who viewed them as coddling homosexuals. In California, conservative Republican Governor George Deukmejian vetoed anti-discrimination legislation for people with AIDS or the AIDS virus, not once but twice in 1986 alone. Koop, however, saw such laws as tools with which the epidemic could be fought.
The report proved an immediate media sensation. The calls for sex education and condom use at last gave journalists something titillating on which to hang their stories. This wasn’t some tedious call for a blue-ribbon commission or bureaucratic coordination, this was about rubbers and sex education. At last, there was also a sensible explanation about why compulsory AIDS testing wasn’t such a good idea. Uncorrupted by the language of AIDSpeak, Koop was able to talk in a way that made sense; at last, there was a public health official who sounded like a public health official. Not only that, he was able to utter words like “gay” without visibly flinching.
Koop’s impact was due to archetypal juxtaposition. It took a square-jawed, heterosexually perceived actor like Rock Hudson to make AIDS something people could talk about. It took an ultra-conservative fundamentalist who looked like an Old Testament prophet to credibly call for all of America to take the epidemic seriously at last.
Unwittingly, the Reagan administration had produced a certifiable AIDS hero. From one corner of the country to the other, AIDS researchers, public health experts, and even the most militant of gay leaders hailed the surgeon general. Koop quickly became so in demand for speeches that he was called a “scientific Bruce Springsteen.”
In the broader historical sense, Koop’s role in the epidemic was a bit more ambiguous. After all, the surgeon general had managed to maintain a complete silence on the epidemic for over five years. By the time he spoke out, 27,000 Americans already were dead or dying of the disease; Koop’s interest was historic for its impact, not its timeliness. There was no denying, however, that the report proved a watershed event in the history of the epidemic, and conservatives were stunned.
Anti-feminist leader Phyllis Schlafly decreed that the sex-ed recommendations represented little more than a call to institute grammar school sodomy classes. Anti-abortion groups went about the business of withdrawing their previous awards to Koop. President Reagan observed his ritualistic silence, though the PHS officials who had approved the report’s printing without White House clearance quickly found themselves exiled to bureaucratic Siberia.
In the early weeks of 1987, conservatives retaliated with a call for AIDS testing, lots of it. The call for massive, even compulsory, AIDS testing carried a homophobic tenor; this was AIDSpeak with a new accent. Public health officials who opposed such testing, conservatives intimated, were patsies for homosexual militants. It was, of course, an ironic argument. Despite the early gay politicization of AIDS issues, it was also true just about anything done to fight AIDS for many years—whether in AIDS education or in lobbying for research—had come solely from the gay community. The new conservative concern in the epidemic belied the fact that conservatives had been entirely indifferent to the threat of the spreading pestilence. To be sure, the gay community’s own obstructionism to early public health efforts, particularly on issues like bathhouses, had fueled the public conception that gays would flout the public health for their own interests. And public health officials hadn’t helped by framing issues politically themselves. The public was used to hearing health officials sound like politicians, so it didn’t sound jarring when politicians started talking like they were health officials.
The testing issue allowed conservatives to seize the AIDS issue as their own with rhetoric implicitly arguing that those thoughtless homosexuals were so awful that they should be forced to submit to testing, to protect all the good people who weren’t infected with the virus. Public opinion polls showed most Americans favored massive AIDS testing, perhaps because most people were confident they wouldn’t test positive for the virus and would not have to suffer the consequences of forced testing policies. With such popular support, conservative political theorists already were talking about what a good issue AIDS would be for Republicans in the next presidential election.
Meanwhile, the rest of the world was awakening to the AIDS threat. While the disease had been reported in 51 countries in January 1986, by the spring of 1987 there were 113 countries, on every continent except Antarctica, reporting over 51,000 cases. Ultimately, WHO warned, the planet could expect 3 million AIDS cases internationally by 1991.
European countries rushed to provide nationwide educational efforts. English authorities launched a huge campaign of billboards, newspaper advertisements, and television commercials on AIDS education, hammering on one theme: “don’t die of ignorance.” Indeed, by early 1987, the only major Western industrialized nation that had not launched a coordinated education campaign was the United States.
The various American controversies over AIDS education and antibody testing continued through the spring. As the international AIDS conference approached, pressure mounted on the Reagan administration. Though Reagan had at last uttered the word AIDS, he still had not given an address on the six-year-old epidemic. By now, his silence was thunderous. Even the hard-bitten White House press corps, which had never considered AIDS a serious issue, clamored for quotes. In his barnstorming for greater AIDS awareness, Dr. Koop met ever more frequently with embarrassing questions about why President Reagan refused to meet with him.
By the beginning of May, public attention forced the Senate, which had been far less active on AIDS issues than the House of Representatives, to pass unanimously a resolution calling on Reagan to appoint a national AIDS commission. The resolution, drafted by Senate Republican leader Senator Robert Dole, drew a remarkable array of Republican and Democratic co-sponsors.
Conservatives were no less anxious for Reagan to take a stand. Education Secretary William Bennett, a leading spokesman for conservatives on AIDS issues, was strident in his calls for mandatory testing and increasingly vocal in his criticism of Koop. Conservative opinion leaders and newspaper columnists joined the chorus; some called for Koop’s resignation. Increasingly, all sides wanted to know where the president stood on AIDS.
As the AIDS conference approached, Reagan announced he would accede to the Senate’s wishes and appoint an eleven-member presidential commission to advise him on the epidemic, and he would address an AIDS fund-raising dinner on the eve of the conference. By late May, it became clear that this would be more than just another scientific gathering. Here, at the hub of power in the United States, the science, the politics and the people of the AIDS epidemic would come together; these days would be remembered as the prologue to the future course of AIDS in America. The week would be one of those rare times when the past, the present and future converged. And everybody seemed to understand that as they trekked to their Washington hotel rooms on that cloudy, muggy Sunday afternoon.
THAT NIGHT GEORGETOWN
Just a few days from now would mark the sixth anniversary of the publication of Michael Gottlieb’s article on the mysterious cases of Pneumocystis carinii pneumonia in five Los Angeles gay men. Six years ago, Gottlieb had been an eager young immunologist in his first months at UCLA. Now, he was co-chair of a foundation hosting a dinner at which the President and First Lady were guests of honor. On Gottlieb’s arm was a famous movie star, and senators and congressmen crowded the restaurant, enjoying cocktails and hors d’oeuvres. AIDS had become so respectable, Gottlieb could scarcely believe it.
Gottlieb knew that much of the success of both the evening and the foundation was the work of his escort, actress Elizabeth Taylor. Taylor’s interest in AIDS had been building before it became a fashionable Hollywood cause, back when Gottlieb was discussing his plans for a national AIDS fund-raising group with Dr. Mathilde Krim of the AIDS Medical Foundation in New York City. In the last months of his life, Gottlieb’s most famous patient, Rock Hudson, had launched the American Foundation for AIDS Research, or AmFAR, with a $250,000 contribution, and Taylor agreed to become the group’s national chair, giving the epidemic the star quality it had long lacked.
As Gottlieb walked with Taylor through the restaurant, many people at the dinner whispered to each other about the circumstances of Gottlieb’s recent departure from UCLA. Even though Gottlieb’s expertise as one of the world’s leading AIDS clinicians had helped secure a $10.2 million federal grant for the institution, he remained something of a persona non grata in Westwood. Yes, he was one of the most published and celebrated researchers at UCLA, but that did little more than inspire jealousy among senior academicians who had never considered AIDS to be legitimate research. If he were truly dedicated to research, they reasoned, why was he running around with movie stars, raising money and indulging in the tainted world of politics?