heightened concern among public health workers: homosexuals. While
homosexual men had for decades wrestled with a medical discourse that
constructed them as pathological, during the fi rst half of the twentieth
century they had generally not been associated in the medical and sci-
entifi c literature with higher levels of venereal diseases. Instead, medical
science had interpreted their difference largely in terms of psychologi-
cal and psychiatric deviance.26 Gradually this focus began to broaden at
midcentury, with public health offi cials and physicians increasingly dis-
cussing men having sex with other men as a group at higher risk of ac-
quiring VD.27
25. William J. Brown, “Migration as a Factor in Venereal Disease Programmes in the
United States,” British Journal of Venereal Diseases 36, no. 1 (1960): 49– 58. This reading
coexists uncomfortably alongside other photographs from this period showing PHS em-
ployees drawing blood from black participants in the Tuskegee syphilis study; see images
following p. 108 in Susan M. Reverby, Examining Tuskegee: The Infamous Syphilis Study
and Its Legacy (Chapel Hill: University of North Carolina Press, 2009).
26. See Jennifer Terry, “The Seductive Power of Science in the Making of Deviant Sub-
jectivity,” in Science and Homosexualities, ed. Vernon A. Rosario (New York: Routledge,
1997), 271– 96.
27. Herman Goodman, “An Epidemic of Genital Chancres from Perversion,” Ameri-
Figure 2.2 Map depicting travel patterns of domestic migratory agricultural workers and
photograph of rapid syphilis testing in the United States, 1960, both in William J. Brown,
“Migration as a Factor in Venereal Disease Programmes in the United States,” British
Journal of Venereal Diseases 36, no. 1 (1960): 53, map and photograph each 14.5 × 9.5 cm.
The original captions accompanying the images have been retained to provide context.
Readers are invited to compare this map of the United States, which suggests the external
threat of syphilis— pumped slowly throughout the country via the arterial- like migration
of agricultural workers— with the very different image in chapter 4, fi gure 4.1.
The Cluster Study 89
“Homosexuality as a Source of Venereal Disease,” the title of an ar-
ticle published in 1951 by two concerned venereal specialists in Van-
couver, Canada, succinctly captured the emerging view of “a hitherto
unsuspected source” of VD transmission.28 The physicians’ language
here echoed centuries-
old views that perceived certain individuals—
particularly female prostitutes and wet nurses— to be not simply con-
duits but sources of venereal disease.29 While these physicians were by
no means to fi rst to report that sexual contact between men could trans-
mit infections, a long- practiced cultural silence surrounding same- sex
sexual practices would mean that a number of physicians over hundreds
of years would “discover” this particular mode of transmission anew.30
can Journal of Syphilis, Gonorrhea, and Venereal Diseases 28 (1944): 310– 14; this article
is also cited in William W. Darrow et al., “The Gay Report on Sexually Transmitted Dis-
eases,” American Journal of Public Health 71, no. 9 (1981): 1004, 1010; Parascandola, Sex,
Sin, and Science, 146– 47. For an examination of the mid- twentieth- century associations
linking sex between men with venereal disease, which expands upon the material in this
section, see Richard A. McKay, “Before HIV: Venereal Disease among Homosexually Ac-
tive Men in England and North America,” in The Routledge History of Disease, ed. Mark
Jackson, 441– 59 (London: Routledge, 2017), http:// www .tandfebooks .com/ userimages/
ContentEditor/ 1489134497468/ 9780415720014 _oachapter24 .pdf.
28. B. Kanee and C. L. Hunt, “Homosexuality as a Source of Venereal Disease,” Cana-
dian Medical Association Journal 65, no. 2 (1951): 138– 40.
29. William Naphy, Sex Crimes: From Renaissance to Enlightenment (Stroud: Tempus,
2002), 57– 58. Roger Davidson relates how in 1973 a Scottish committee tasked with con-
trolling sexually transmitted diseases described “passive homosexuals” as “reservoirs of
infection”: see “‘The Price of the Permissive Society’: The Epidemiology and Control of
VD and STDs in Late- Twentieth- Century Scotland,” in Sex, Sin and Suffering: Venereal
Disease and European Society since 1870, ed. Roger Davidson and Lesley A. Hall (Lon-
don: Routledge, 2001), 220– 36.
30. For a possible mid- nineteenth-century suggestion that male prisoners could trans-
mit diseases through “libidinous indiscretions,” see Jonathan Ned Katz, Gay American
History: Lesbians and Gay Men in the U.S.A. (New York: Thomas Y. Crowell, 1976), 572.
By 1892, Katz reports that a professor of nervous diseases in Washington, DC, presented
a paper to his colleagues about the spread of venereal disease through same- sex acts (40–
42). Work on the early modern period in Spain, France, and England suggests that physi-
cians and patients may have been aware of this mode of venereal disease transmission but
practiced a well- kept silence. See Cristian Berco, “Syphilis and the Silencing of Sodomy in
Juan Calvo’s Tratado Del Morbo Gálico,” in The Sciences of Homosexuality in Early Mod-
ern Europe, ed. Kenneth Borris and George Rousseau (New York: Routledge, 2008, 92–
113; Kevin Siena, “The Strange Medical Silence on Same- Sex Transmission of the Pox, c.
1660– 1760,” in Borris and Rousseau, Sciences of Homosexuality in Early Modern Europe,
115– 33.
90
chapter 2
The Vancouver physicians’ comments were amplifi ed a decade later at
the World Forum on Syphilis and other Treponematoses, held in Wash-
ington, DC, in 1962. Twelve hundred participants attended the confer-
ence, organized as part of an American- led drive to eradicate syphilis—
among them, the newly appointed VD investigator Bill Darrow.31 To
assembled delegates, one speaker, a medical representative of the Los
Angeles City Health Department, declared that the “social cluster-
ing” of homosexual men in urban environments “creates a huge reser-
voir when syphilis is introduced.” This trend, he noted, had been wit-
nessed in Los Angeles— where early case rates had tripled over the last
decade— as well as other urban centers. Of the 506 male syphilis patients
his department’s staff had interviewed for contact information, one half
had revealed exclusively homosexual contacts, and less than a third
named only female contacts. “Unquestionably,” the speaker concluded,
“the white male homosexual has replaced the female prostitute as a ma-
jor focus of syphilis infection.”32
Researchers in New York further cemented the connection between
homosexual men and VD in a 1963 article, noting the “mounting con-
cern that this is one of the important reservoirs of infectious venereal
disease.”33 The authors emphasized that homosexual men made up
15 percent of all new VD cases treated by physicians in solo practice
in Manhattan during a study conducted in 1960 and 1961, and that epi-
31. Nate Haseltine, “Complacency Slowed Anti- Syphilis
Drive in U.S., Health Chief
Admits,” Washington Post, September 5, 1962, A3.
32. Ralph R. Sachs, “Effect of Urbanization on the Spread of Syphilis,” in Proceed-
ings of World Forum, by U.S. Department of Health, Education and Welfare (Washington,
DC: US Government Printing Offi ce, 1964), 154– 55. The racial specifi city of this remark
is striking, particularly when compared to other contemporary links being made between
VD and certain racial/ethnic groups. It raises questions about the use of public clinics by
different groups, racial segregation in sexual networks in Los Angeles during this period,
and the possibility of differing levels of comfort among men of different racial and ethnic
groups in acknowledging partners of the same sex to public health offi cials. The last point
resonates with more recent discussions of “secretive sex,” between non- gay- identifi ed men
who have sex with men, in the context of HIV prevention; see Lena D. Saleh and Don
Operario, “Moving Beyond ‘the Down Low’: A Critical Analysis of Terminology Guiding
HIV Prevention Efforts for African American Men Who Have Secretive Sex with Men,”
Social Science and Medicine 68 (2009): 390– 95.
33. Anna C. Gelman, Jules E. Vandow, and Nathan Sobel, “Current Status of Venereal
Disease in New York City: A Survey of 6,649 Physicians in Solo Practice,” American Jour-
nal of Public Health 53, no. 12 (1963): 1912.
The Cluster Study 91
demiologic investigations of this population were of “vital importance,”
given their potential to uncover chains of sexual contacts numbering in
the hundreds.34 From the late 1950s onward, investigators responded to
this growing sense of urgency with vigor. Author and later AIDS activist
Larry Kramer recalled in an interview the tenacious qualities of a VD
investigator attempting such an inquiry: “In 1958 when I came to New
York, after the army, I got syphilis from somebody. And in those days
syphilis was a reportable thing to the public health people and they’d
contact you. And this health care worker came to interview me, and he
wanted to know everybody I’d been to bed with. And I had no idea and
we would get in his car and we would drive around, and I’d say, ‘Oh, up
there on the third fl oor.’ Literally.”35
From a public health perspective that viewed male homosexuals as
an undrained “reservoir” of infection, the cluster interviewing technique
appeared to be effective. The author of a report of a “Homosexual Syph-
ilis Epidemic” in Fort Worth, Texas, explained that repeatedly inter-
viewing infected patients, as well as their sexual partners and associates,
allowed investigators to detect more infected individuals and to break
through what they perceived to be a protective wall of silence. This ap-
proach was likely to succeed, in the author’s view, due to “the fact that
the homosexual group is an exclusive fraternity and that friends of ho-
mosexuals are, in most instances, sex partners as well. In a large homo-
sexual group it is impossible to show by epidemiologic charting the wide-
spread inter- relation of the group. During an interview of one of the last
patients diagnosed as infectious, the request for names of contacts in-
curred the remark, ‘I’ll be glad to tell you who I’ve been with, but you
have already checked all the people like me in town.’”36
This quotation invites several observations. First, it suggests the inves-
tigator’s faith in the effectiveness of the cluster technique in identifying
suspected infections by casting wide the net of suspicion. Second, it points
crudely to one of the challenges faced by contact epidemiologists. With
34. Ibid., 1915.
35. Larry Kramer, interview with author, New York City, April 14, 2008, recording
C1491/23, tape 1, side B, BLSA.
36. W. V. Bradshaw Jr., “Homosexual Syphilis Epidemic,” Texas State Journal of Medi-
cine 57 (1961): 909. The author urged readers to look beneath appearances, as one married
man— who was “an alert, intelligent person with none of the characteristics normally at-
tributed to the homosexual”— nevertheless yielded the names of twenty- eight homosexual
contacts under the duress of a 2½- hour interview.
92
chapter 2
the widespread interrelatedness of sexual partners in some homosexual
networks, it was extremely diffi cult to represent all of the connections be-
tween members, a point that would again be recognized in the AIDS era.
Third, it highlights the extent to which some investigators believed that
they were dealing with a secretive, and potentially hostile, band of devi-
ants. The curiously ambivalent fi nal remark from the patient appears to
have been received as a confi rmation of the cluster technique’s effective-
ness, though it may also read as a studied refusal to supply names.
Certainly, venereal disease investigators were taught to expect that
many homosexual men would attempt to conceal their sexual identity
and the names of their sexual partners, and that it was the investigator’s
responsibility to deftly wrest the information from them. Darrow later
wrote, self- deprecatingly, of his youthful enthusiasm and skill in apply-
ing the taught interview technique “to discover the patients’ most inti-
mate secrets and to elicit information from them about other people who
might be infected with syphilis.”37 The 1962 Field Manual of the Vene-
real Disease Division of the CDC, which was prescribed training ma-
terial for all new investigators, emphasized the benefi ts of such diligent
and persistent interviewing: “Although laws and circumstances differ in
various states, and elaborate safeguards are invariably thrown around
the right of the physician to protect his patient’s reputation, it is often
possible by persuasion to ferret out the chain of contacts, frequently with
rewarding— though astonishing— results.”38
The manual’s description of the investigator invokes the familiar per-
sona of a detective, further demonstrating the Venereal Disease Divi-
sion’s self- identifi cation with the popular image of CDC workers being
presented in the press. The good investigator, it explained, “must know
the places where people gather to spend leisure and socialization time.
It is advisable to become friends of the owners, managers, waitresses,
bartenders, etc. of certain establishments. These people can give him
the three- monkey act, ‘hear nothing, see nothing, speak nothing’ or, on
the other hand, supply him with much helpful information if proper rela-
tionships have been made.”39 Though much of the contact- tracing work
37. Darrow, “Few Minutes,” 158.
38. US Department of Health, Education, and Welfare, Venereal Disease Branch Field
Manual (Atlanta: Communicable Disease Center, 1962), H18. When I met with Darrow in
March 2008, he suggested that the manual was “where I learned it all.”
39. Ibid., E27.
The Cluster Study 93
would focus on urban areas, the manual helpfully noted that “in rural
areas the cross- road storekeeper and the rural route mailman are good
> sources of information.”40 The book’s euphemistic reference to “certain
establishments” suggests known trouble spots or hideaways and hints at
the background role of alcohol, which facilitated the sexual interactions
enabling the spread of VD. The manual also emphasized that the inves-
tigator, in fulfi lling his “enigmatic” function, needed to recognize that
his work could have him interact with anyone. “He may use his facts in
a somewhat evasive manner, if necessary,” the text explained, “to effect
the examination of a husband, a wife, a teenager from a prominent fam-
ily, a child, a prostitute, or a homosexual executive, so as not to disturb
the status of any of them.” To protect the people he investigated from so-
cial sanction, the investigator would “learn through experience to be-
come a master at evasion and a professional purveyor of silence.”41
Investigators were to be attentive to clues suggested by comments
made by the subject, paying early attention to the subject’s fi eld of em-
ployment: “Here the interviewer may receive his fi rst indication as to the
sexual behavior of the patient. Certain known occupations may suggest
deviant sexual activity to the interviewer.”42 Similarly, the manual high-
lighted the qualities investigators could expect to fi nd and were explic-
itly seeking to confi rm: “With this and subsequent sexual behavior ques-
tions, the interviewer attempts to establish the fact that the patient is
a sexually promiscuous person and that this promiscuity has developed
into a continuous pattern from early in life.”43 Given the mid- twentieth-
century concerns linking homosexuality with venereal disease, the man-
ual gave detailed instructions to investigators on how to elicit such infor-
mation and assess whether someone was being untruthful when asked
whether he had any same- sex sexual partners. “Based on past experi-
ences, the observant interviewer may obtain some indication about
the patient’s sexual adjustment from the manner in which a negative
40. Ibid.
41. Ibid., E29.
42. Ibid., E15. A sociological study of the Montreal gay community had claimed that
“overt homosexuals” tended to work in occupations either with “traditionally accepted ho-
mosexual linkages,” such as the artist, the interior decorator, and the hairdresser, or ones
Patient Zero and the Making of the AIDS Epidemic Page 16