April Fool's Day

by Bryce Courtenay

  With only one difference. His eyes. We couldn’t escape Damon’s eyes.

  This difference is best explained in Celeste’s own words for, as much as she tried to wind back the clock, Damon’s eyes betrayed him and reminded us that things were not the same as they’d been.

  “When Adam took me straight from the airport to the hospital and I walked into that awful room, I was terribly shocked to see what had happened to Damon. He looked like…he really looked like Jesus. Like the image of Jesus I’d seen all those times in all those churches. His beard had grown long and scraggly and his face was so thin. Damon had always had a sort of round face and now his cheeks were hollow and his face sharp, the skin seemed to be pulled tightly downwards so that you could almost see the shape of the skull underneath. His eyes looked, you know…his eyeballs had sunken. That was the look that started to happen.

  It’s such an AIDS look. He’d aged, he’d grown a lot older, his hair had started to fall out, because of all the drugs he’d been given I should imagine.

  “When he saw me he cried, we both cried, and I spent several hours at the hospital until I was almost fainting with exhaustion. I hadn’t really slept, except in snatches, for four days. But it was so lovely, so lovely, being with him again, knowing he wasn’t dead.

  “But that first shock, that first look from his eyes has never left me. It’s a look that comes and never goes away. It never again left Damon and, sometimes, I’d just start crying in the middle of a lecture at uni or when I was having a cup of coffee somewhere with a friend. I’d just start weeping when I thought of Damon’s eyes. Damon’s crucified Christ eyes.”

  Twenty-two

  Where Pooled Blood led to Murder by Decree and Doctors and Politicians Stood by with their Hands Firmly Clasped about their Buttocks.

  Damon had, in a matter of weeks, actually grown physically older, his hair had started to fall out and his skin became strangely translucent. He walked tentatively, like an old man, each foot placed carefully forward as though he were afraid of losing his balance, his neck stiff and pushed slightly forward like a cartoon turtle walking on his hind legs, his shoulders hunched over as though he wore some great scara-baeus shell.

  He wasn’t happy with the way he’d been treated at Royal Prince Alfred Hospital and he was no longer willing to be under the general care of the biro-tapper. Damon particularly disliked this doctor and no doubt the feeling was mutual. This medico was from the old school, not accustomed to being questioned, whereas Damon’s manner assumed that they were both on an equal basis. This was not the way the biro-tapper saw his relationship with his patients and so their mutual physician –patient understanding had deteriorated considerably.

  Damon felt that he would need to find proper care for himself elsewhere. While he loved and trusted Denise, she wasn’t in control of his palliative care and, although the sister in charge of the Haemophilia Centre, she too had to follow instructions. Denise was to become an expert at caring for haemophiliacs with AIDS but, at this stage, she lacked the expertise to care for both conditions in one patient. Damon knew that things had changed for him. Haemophilia was now the secondary condition with which he would have to cope and all his energy would need to be concentrated on his AIDS. He would maintain contact with Denise for his haemophilia needs but would make alternative arrangements for the AIDS.

  Damon was one of the earliest haemophiliacs to contract AIDS and eventually nearly one hundred of the state’s haemophiliacs would become infected with HIV, a legacy from a seemingly uncaring medical system. When it became known in American medical journals as early as 1981 that a disease usually seen only in people with impaired immune systems was occurring in alarmingly increased numbers in homosexual men, nothing was done to stop gay people giving blood. There was clear evidence from the U.S. at the time which could have alerted the Australian authorities and the evidence is shown here.

  In the 6 June 1981 and 3 July 1981 issues of Morbidity and Mortality Weekly Report, published by the Centers for Disease Control (CDC) in the USA, there was a front page report of the presence of Kaposi’s Sarcoma (KS), a rare cancer usually found in elderly men, in twenty-six young homosexual males. In addition, an almost equally rare form of pneumonia, Pneu-mocystis carinii (PCP), had occurred over the past twenty months in fifteen homosexual men, two of whom had also suffered from KS.

  Today we know that both these diseases are typical of AIDS but at that stage no such disease was known. However, in the final paragraph of the 3 July 1981 report, the following appeared: “Physicians should be alert for Kaposi’s Sarcoma, PC pneumonia, and the opportunistic infections associated with immuno-suppression in homosexual men.”

  These were the first early warning signs and we know they reached Australia only a week after the reports were issued. In the 28 August 1981 issue of MMWR, the leading article stated that an additional seventy cases of these two diseases had been discovered, the vast majority among young, white, homosexual men. Of the 108 cases now known, forty-three had already proved fatal. It was becoming increasingly clear that the male homosexuals as a group were becoming infected with a causative agent, possibly a virus, and that any centre anywhere in the world with a large homosexual community ought to be on the alert. Once again there is no doubt that this information was available to Australian centres of immunology as well as Australian sources of blood supply. The first really serious warning about possible blood contamination had been issued.

  By December of 1982, it was becoming abundantly clear that AIDS, as this new disease was now named, was almost certainly being transmitted through blood. Again the MMWR issue of 20 December 1982 is quoted: “This report and continuing reports of AIDS among persons with haemophilia raise serious questions about the possible transmission of AIDS through blood and blood products. The Assistant Secretary of Health is convening an industry committee to address these questions.”

  The MMWR issue of 4 March 1983 summarised the report of the industry committee which included the National Gay Task Force, the National Haemophilia Foundation, the American Red Cross, the American Association of Blood Banks, the Council of Community Blood Centres and several other organisations. The report stated: “Blood products or blood appear responsible for AIDS among haemophilia patients who require clotting factor replacement.” Further on in the same report the Public Health Service makes several recommendations, first, and most obvious, being that sexual contact should be avoided with persons known to have AIDS. The second recommendation reads: “As a temporary measure, members of groups at increased risk for AIDS should refrain from donating plasma and/or blood. This recommendation includes all individuals belonging to such groups, even though many individuals are not at risk of AIDS".

  The National Haemophilia Foundation, a member of the industry committee, made a special recommendation: “The interim recommendation requesting that high-risk persons refrain from donating plasma and/or blood is especially important for donors whose plasma is recovered from plasmapheresis centres or other sources and pooled to make products that are not inactivated and may transmit infections such as hepatitis B. The clear intent of this recommendation is to eliminate plasma and blood potentially containing the putative AIDS agent from the supply.”

  The recommendations end by saying: “…the above recommendations are prudent measures that should reduce the risk of acquiring and transmitting AIDS.”

  I know that some readers may find the information above somewhat tedious to follow and some may even ask what has all this to do with Australia? After all, these findings come from the US and the same conditions might not have prevailed here.

  In fact, this is precisely my point; the gay nexus between America and Australia was already well developed in 1981. New York, Los Angeles and San Francisco, the three major centres of the new infection, were linked with Sydney as the most desirable destinations for homosexuals from both countries. Special gay package tours from America to Australia, and the other way around, were well established and Aust
ralian health authorities, aware of this, kept a constant check on the migration of sexually transmitted diseases among this group. What I am saying is that what happened to gays in America was an immediate and urgent warning that Australia was likely to be next or, given the frequent travel and known promiscuity of gays travelling between both countries, the simultaneous manifestation of a new infection was never out of the question. The weekly reports through the American Centers for Disease Control are and were required reading among those people in this country whose task it is to be concerned with infectious disease.

  This clear, you could say overwhelming, warning to Blood Banks, hospitals and health authorities should, as a matter of sound medical practice, have led to an immediate cessation of homosexuals donating blood.

  Of course the vast majority of the blood given by the gay community would naturally have been uncontami-nated and therefore a valuable source of supply. But as there was no way at that time of removing the virus from contaminated blood, health authorities should, as a matter of correct procedure, have declined all homosexual donors. But, of course, no such thing happened. Perhaps at a pinch, this can be understood in 1981 and 1982. After all it was early days, the AIDS virus was still a mysterious disease thought to be carried predominantly by homosexuals. At that stage no person in Australia had actually been diagnosed as having AIDS. In fact, Australia’s first AIDS case was hospitalised in Sydney in late 1982.

  But in 1983 this was no longer the case – the evidence was conclusive that HIV was carried through blood. The 1983 medical journals throughout the world reported that AIDS was spreading world-wide. In June that year, the Council for Europe recommended that doctors use caution in prescribing blood concentrates made from vast pools which might contain infected blood. This followed a warning by the National Haemophilia Foundation of America carried in an official report of the CDC, arguably the most prestigious medical authority in the world for infectious diseases, clearly stating that haemophiliacs should not be treated with plasma from pooled blood resources. However, the new product containing AHF (antihaemophilic factor), though prepared from large donor pools, came into common use during the 1980s, replacing the earlier cryoprecipitate. While a cryo transfusion exposes the haemophilia patient to a smaller donor pool, it is much less convenient than the freeze-dried, assayed AHF.

  I must, as a matter of integrity, point out that one man did try to do something. In May 1983, Dr Gordon Archer, Director of the Blood Bank, made a public announcement that homosexuals would no longer be accepted as blood donors. It was his belief that AIDS was in the Australian blood supply and this step had to be taken in an attempt to control its spread.

  When Dr Archer, on behalf of the NSW Blood Bank, issued the edict, the Sydney Blood Bank was picketed by gay activists. Leaflets were distributed to donors branding Dr Archer a bigot and anti-homosexual. The press and media had a field day and the rights of Australians to a blood supply free of AIDS were ignored in favour of gay civil rights.

  The Australian Red Cross, fearing a backlash from gay activists, backed down and ignored Dr Archer’s recommendation, so that gay donors were not seriously stopped from giving blood for the next two years. The Archer recommendation was simply overturned and a new policy announced allowing homosexuals to give blood providing they did not have “multiple partners". Of course there was no possible method, short of a signed affidavit, for the Blood Bank to determine whether a donor had one or a hundred partners. Nor did anyone institute a reasonable questionnaire or interview technique in an attempt to vet or isolate promiscuous bisexuals or homosexuals.

  In this way the “civil rights” of homosexuals to give blood was given over the rights of patients in hospitals requiring blood or haemophiliacs whose very lives depended on it. The consequence of this backdown by the Australian Red Cross is that many, many Australians, my son Damon among them, have died and will continue to die. It is now generally regarded that this period of three years – 1983 to 1985 – when basically all the facts required to take responsible action were known, and nothing was done, was when most victims of medically acquired AIDS became infected.

  So, in summary, this is what was known in Australia in March 1983:

  • AIDS is in the Australian blood supply.

  • AIDS is a disease largely carried in Australia by homosexuals.

  • AIDS is transmitted by blood.

  • AIDS has been transmitted in the U.S. through a blood transfusion.

  • Haemophiliacs are directly exposed to and have AIDS through donor blood.

  In fact, in June 1983, Professor Ian Gust wrote an editorial in the Australian Medical Journal in which he presented the Australian situation: “It is now recommended that individuals at risk should not donate blood. The risks to persons with haemophilia can only be covered by replacing pool Factor VIII (AHF) with single donor cryoprecipitate – a formidable exercise.”

  What all this means is that it was acknowledged that homosexuals, who were most likely to carry HIV, should not be allowed to give blood, and that the only way a haemophiliac could be completely safe was to stop using AHF and return to transfusions of cryo-precipitate.

  Yet no move was made to change back to cryopre-cipitate and AHF, now known to carry HIV, continued to be issued as the only blood product available to Australia’s haemophiliacs, who were told that it was completely safe and that no danger whatsoever existed for the user.

  The knowledge that HIV was transported in blood was so widespread among the haemophiliac community in 1983 that I recall asking whether the use of AHF was safe and what was its potential for carrying HIV. It now transpires that we were not the only haemophiliac family to ask these questions and to seek reassurance from our health authorities. The point behind our questions was fundamental. If AHF was a risk we would have elected to continue to use cryoprecipitate. If necessary we would supply the blood for its manufacture from our families and friends whom we could reasonably assume to be outside the high-risk area and who, in any event, could easily be tested for AIDS before giving blood.

  We had always been warned that cryoprecipitate, the previous transfusion product, could potentially carry hepatitis; though in the seventeen years of Damon’s haemophilia we did not hear of a single haemophiliac who had contracted hepatitis through blood transfusion. The assurance that AHF was safe to this enormous degree from HIV was a major consolation. Even so, had we wanted to return to the older and more tedious method of transfusions we were not given a choice, cryoprecipitate had been withdrawn from the system and was simply no longer available.

  We believed what we’d been told and embraced the new blood product for all it was worth. We were grateful and counted ourselves fortunate to be the recipients of such a marvellous medical advance as the multiple donor AHF. It meant a 60 ml transfusion using an easy-to-store powdered concentrate that was mixed in moments with distilled water, rather than a 250 ml bag of Factor VIII frozen plasma.

  The government acted totally irresponsibly in not withdrawing AHF until it could be certain there was no contamination. That decision must surely stand as one of the most cold-blooded and uncaring in the history of our national health system.

  Compounding this cynicism, in 1985, two years after a clear warning that it carried HIV, AHF blood product was finally subjected to heat treatment to make it safe; this had been developed in October in the previous year. For once the Australian medical system didn’t lag behind. But untreated and therefore potentially still contaminated AHF, already in the fridges of Australian haemophiliacs, appears not to have been withdrawn from use. Certainly those supplies we carried in our own fridge were not returned. I contacted the Haemophilia Society of Australia which was unable to find a single family who were contacted by the health authorities and asked to return or destroy existing supplies of AHF.

  Had the Blood Bank and government health authorities at the time allowed for reasoned debate within the community and released all the available information about AIDS, the matter m
ight have been quite easily settled and a great many innocent lives saved.

  I disagree fundamentally with the gay rights movement on the issue of compensation for people who acquired AIDS through receiving infected blood via blood transfusion. Their argument is that there is no distinction to be drawn between those contaminated by blood products and those infected by anal intercourse between two consenting males. Allowing that compassion for either group is not in question, there is a legal argument which we use in other areas of insurance against accident, where there is fault caused by neglect by a second party. The tragedy is that no accident insurance exists for medically acquired AIDS.

  The Australian barrister Mr Jack Rush, on 15 May 1992, at a conference organised by the Australian Doctors Fund, stated the legal argument:

  “I would submit that the distinction is obvious. I give the following analogy. An accident in circumstances where the driver is injured as a consequence of driving his car off the road into a light pole will normally occur in circumstances where no one is at fault. On the other hand a person injured in a car as a result of someone else driving through a red light can look to the other driver for compensation. The injuries occurred as a consequence of someone else’s negligence. Our law entitles the other person to claim compensation for injuries occurring as a consequence of the other driver’s negligence.

  “Thus the haemophiliac or the blood recipient who can show HIV infection as a consequence of the negligence, the want of reasonable care, from the Red Cross, the Commonwealth Serum Laboratory, a doctor or anyone else, has a right to compensation upon proving the case. Indeed the gay man who can show his infection is due to the negligence of someone else has the same rights.

  “In this context to condemn these settlements and to equate a person who has contracted the AIDS virus as a consequence of the receipt of contaminated blood with a person who has contracted AIDS as a consequence of consensual anal intercourse is fallacious.”