Authors: Randy Shilts
Such stories raised the stakes in the drama unfolding around the release of the HTLV-III antibody test. On January 31, Dr. Mervyn Silverman made good on his promise to announce the objections of the American Public Health Association and the U.S. Conference of Local Health Officers. The groups wanted funding for the alternative test sites for AIDS blood tests, Silverman announced, and the federal government’s refusal to provide them could result in the contamination of the blood supply.
The officials at Secretary Heckler’s office and the FDA had avoided making any decision on funds for the alternative test sites during the months of negotiations, but they were on the phone to Silverman within an hour of the first reports of his press statements, assuring him they would make $12 million available for the program. Then they delayed release of the test for two weeks so the program could be put in place.
Although this settled the public health questions surrounding the test’s licensure, it did not resolve the civil rights questions that troubled gay leaders. The federal government had made no provisions about confidentiality of blood test results. As battle lines hardened, the conflict became a classic confrontation of public health and civil liberties. The Lambda Legal Defense Fund, a New York-based gay legal group, threatened to block release of the test in court. How could the government release a test that could have such devastating impact on so many American lives, without any safeguards? they asked. At the CDC, doctors who had worked on transfusion-AIDS research were dumbfounded. How could these people threaten to halt a test that could clearly save lives? By mid-February, the two sides had reached a standoff.
U
NIVERSITY OF
C
ALIFORNIA,
S
AN
F
RANCISCO
For the past year, the cooperation that had marked the relationship between Marc Conant’s AIDS Clinical Research Center at UCSF and San Francisco General Hospital had been dissipating. With the hospital’s growing international reputation and prestige, its researchers had developed leverage for their own government grants. They also were mindful that the focus of local AIDS work had shifted to the county hospital in large part because UCSF officials were uncomfortable with the UC Medical Center becoming a focus for AIDS studies.
Marc Conant continued to argue that the medical center should carry more of the city’s AIDS burden, if for no other reason than because of its geographic location on the edge of the largest concentration of gay men in the Western world. Conant’s own influence, however, was waning. Ever since he had gone directly to the legislature for state research funding, over the heads of UC administrators, he was something of a marked man at the university. And so he was not surprised to be told at a meeting, on a cold January day, that it would be best for the university if he resigned as director of the Clinical Research Center. The university, of course, presented reasonable arguments as to why Conant should step down. He was a clinical professor, and the center would have more eminence if the title of director was conferred on a full professor with broader scientific credentials, they said.
Virtually everyone close to AIDS research, however, knew the other reasons for the shift. University officials continued to worry that they were losing top applicants for residencies because of San Francisco’s reputation as the center of the AIDS epidemic. Four years of Conant’s dire predictions had succeeded in convincing university officials of the skyrocketing number of AIDS cases that would come from the nearby Castro neighborhood, so the future did not look more promising to anxious UCSF administrators. Other UCSF scientists were being told to tone down their AIDS pronouncements, and enthusiasm for AIDS research dropped among university officials. Removing Conant would rid the university of a troublesome maverick whose priorities did not lie within academic politics.
The university no longer had to worry about the political ramifications in the gay community of Conant’s departure. Conant’s role in opposing bathhouses and pushing for an aggressive education campaign had made him persona non grata among most gay political leaders as well as among the gay doctors in the Bay Area Physicians for Human Rights. Hardly an issue of the
Bay Area Reporter
came out without some personal attack on Conant.
The dean who accepted Conant’s resignation assured Conant that it was what was best. Conant recalled, however, that this was the dean who also once observed, “At least with AIDS, a lot of undesirable people will be eliminated.”
U
NIVERSITY OF
C
ALIFORNIA,
L
OS
A
NGELES
Dr. Michael Gottlieb had spent the past two years pleading for an AIDS clinic, but UCLA administrators wanted no part of it. When they finally gave him an office in which to see his patients, Gottlieb could scarcely believe the site—in the corner of the old Veterans Administration Hospital that had been largely abandoned when the newer hospital was built next door. A trip to Gottlieb’s office took patients through a dusty and deserted lobby and down dank hallways past gutted rooms. At the sound of footsteps, huge cockroaches scurried out of the walls, many of which were torn apart. This clearly was a place for patients the university was not enthralled about treating. Gottlieb had to remind himself that the University of California system was not one of the worst places for AIDS research; it was among the best.
January 29
S
AN FRANCISCO
D
EPARTMENT OF
P
UBLIC
H
EALTH
As the newly formed San Francisco Health Commission began its first meeting, member Jim Foster looked wearily toward the succession of civil liberties lawyers and gay activists who had come to argue against the ban on “high-risk sex” at the city’s bathhouses. The debate was rapidly growing moot, Foster knew. Only three of the city’s eleven bathhouses were still in business; the owners, who were funding the new Committee to Preserve Our Sexual and Civil Liberties, were here to argue against the sex regulations.
Jim Foster certainly understood the group’s rhetoric. As a father of San Francisco gay politics, founder of both the pioneering Society for Individual Rights and the Toklas Democratic Club, Foster had fashioned much of the sexual liberation ideology that bathhouse owners were now championing.
But the words rang hollow to Foster today, and he wondered how gay men at this time and in this place could ask public commissions to campaign for their right to unlimited sex.
Thirty hours before this commission meeting convened, Jim Foster had been in his comfortable Victorian home on Eddy Street, holding the hand of Larry Ludwig, his lover of twelve years. After suffering the ravages of Kaposi’s sarcoma for seventeen months, Larry had slipped into a coma. At midnight, Larry took four deep labored breaths and then breathed no more.
It was a horrible moment, and it was a beautiful moment, Jim Foster thought. He certainly had not helped build a gay community so that his generation would spend its middle age in death vigils. Yet, through the ordeal, Foster had seen the incredible courage of people like Larry, and he had experienced the compassion with which gay men were helping each other through this collective trauma. Foster sensed that there was a new community emerging from the AIDS tragedy. It was not the community of politicians or radicals talking about bathhouses, but of people who had learned to take responsibility for themselves and for each other.
This is what a community really is, Foster thought. And ultimately that was what he had been fighting for in all those years of gay politicking: the opportunity for gay people to enjoy their own community. Now, against this backdrop of tragedy, that community was being forged.
After presentation to the health commission, the leaders of the Committee to Preserve Our Sexual and Civil Liberties were shocked when this elder statesman of San Francisco gay politics dismissed them with the comment that their concerns were “trivial.”
January 31
C
ENTERS FOR
D
ISEASE
C
ONTROL,
A
TLANTA
Don Francis had finally completed his nine-page program: “Operation AIDS Control.” Warning that between 20,000 and 50,000 deaths could be expected from AIDS within “the next few years,” Francis had designed a plan that employed the only two weapons with which health authorities could fight the epidemic—blood testing and education. Francis wanted to begin a six-month program to test blood collected at drug treatment centers and venereal disease clinics. The imminent licensure of the HTLV-III test meant that, finally, the CDC could get an accurate grasp on how far the virus had penetrated American society. They could also start warning infected people that they carried the virus and, most significantly, that they were capable of transmitting it to others.
Francis also recommended education programs to reduce sexual transmission that were tailored for the various risk groups—gay men, drug users, and promiscuous heterosexuals. To slow down the soaring births of AIDS babies, the government must begin advising female intravenous drug users on how to avoid pregnancy. Gay men should be encouraged to know their antibody status, Francis wrote, and be tested through confidential programs outside of blood banks. Not until authorities could determine who was infected, and who was not, could they begin to reduce the number of newly infected people through education.
Francis knew that his proposal was fraught with political problems. Gay groups would object to his call for widespread testing of gay men. Conservatives would object to AIDS education programs. Already, he had noted that the federal government had all but refused to start any AIDS education programs for fear that conservatives would object to government instructions on how to have safe gay sex. The only education the government had thus far paid for was a small amount channeled through the U.S. Conference of Mayors.
Even the release of the CDC’s data on the possible uses of nonoxynol-9 became mired in controversy. In late 1984, a researcher in Francis’s lab ran tests that showed that nonoxynol-9, the spermicidal ingredient in birth-control foams, successfully killed the AIDS virus in test tubes. Francis was excited about the finding, since it finally presented gays with something constructive they could do to save their lives. Using nonoxynol-9 with a condom could help prevent transmission, Francis thought, and he wanted the findings released immediately. But Jim Curran had stalled publication because a number of scientists listed as senior authors on the paper were unsure of the study’s methodology. Curran did not want bad science coming out of the CDC that could later be used to attack the agency. Francis suspected politics. The federal government didn’t want to concede the value of nonoxynol-9 because that might be interpreted as condoning anal sex.
To some extent, other CDC staffers noted that the conflicts between Don Francis and Jim Curran reflected the underlying tension between Francis’s approach to epidemics and Curran’s. Under Curran’s leadership, the CDC had done an admirable job of collecting AIDS data. He had guided CDC AIDS research on a course that he felt was the best that could be done in a conservative administration.
Francis remained the idealist oriented toward stopping the epidemic. He felt that the CDC had surrendered its role in controlling AIDS in favor of providing the most up-to-date body counts. He also understood that he was losing his battle. “Operation AIDS Control” was his last-ditch proposal to get the CDC in a control modality. The price tag on the program was $32.8 million. Although this was far more than what the federal government had spent for all CDC AIDS research in the past year, Francis thought the cost was modest compared to the billions of dollars in health care costs and prevention programs that would be needed in years to come if the government did not get serious about AIDS today.
On January 30, the day that Don Francis submitted his proposal, the CDC released figures showing that, in the previous week, the nation’s AIDS caseload had surpassed 8,000.
February 4
T
HE
C
APITOL
,
W
ASHINGTON
, D.C.
Even the most cynical critics of the Reagan administration were staggered when the Office of Management and Budget released its proposed AIDS budget for the 1986 fiscal year. Not only had the administration
not
increased AIDS funding but the budget called for reducing AIDS spending from the current level of $96 million to $85.5 million in the next fiscal year. The 10 percent reduction would be felt across the board in AIDS research but most heavily at the CDC, where funds would be cut back 20 percent to just $18.7 million. The government’s planned appropriation for education aimed specifically at the gay community was $250,000, which, again, was to be channeled through the U.S. Conference of Mayors in an effort to ensure that no federal agency was in the business of telling gays how to perform sodomy safely. Altogether, about 5 percent of the AIDS budget would go to AIDS prevention and education efforts.
The cuts came at an inopportune time. Secretary Margaret Heckler had let it be known to gay leaders that she did not want to use her political capital to fight for AIDS funding in the administration when she knew that Congress was going to allocate more funds anyway. As it was, Heckler’s stock in the administration had dropped precipitously. In Virginia, Margaret Heckler’s husband of thirty-one years was suing for divorce, claiming, among other things, that Margaret had ceased having marital relations with him twenty-two years ago. Margaret, who was a devout Roman Catholic, had refused to get a divorce, he said, because she felt it would hurt her political career. Gay leaders were aghast at the thought that someone who apparently had had no sex since 1963 was presiding over the government’s AIDS fight, and the administration was said to be extremely embarrassed by the publicity. Ironically, Secretary Heckler also was criticized within the administration for doing too much on AIDS. Other conservative administration officials were angry at Heckler for the high profile she had taken on the issue. Rumors abounded that the secretary was on her way out.