And the Band Played On: Politics, People, and the AIDS Epidemic, 20th-Anniversary Edition (15 page)

This was only the tip of the iceberg, Friedman-Kien told Larry Kramer. It was going to get bigger, and studies had to get started right away.

“I don’t think anybody’s going to do anything about it,” the doctor said. “You’ve got to help. I need money for research. It takes two years to get grants.”

Larry had heard of some other guys who had come down with the disease, friends from Fire Island. He promised Friedman-Kien he would get them together in his apartment to try to raise some money.

“What can I do to not get this?” Larry asked, trying to keep the lingering hypochondria out of his voice.

“I know what I’d do if I were a gay man,” said Friedman-Kien.

Larry thought it was an odd thing for the doctor to say, but he listened intently for a prescription anyway.

“I’d stop having sex.”

On the way out of Friedman-Kien’s office, Larry was jolted to see Donald Krintzman, a fund-raiser for the Joffrey Ballet and the on-again, off-again lover of one of Larry’s good friends. He was Friedman-Kien’s next appointment.

“Don’t tell me you’ve got it too?” Donald asked.

“No,” answered Larry, not sure what to say.

“I’ve got it,” Donald said comfortably. He was just in for blood tests.

Over the next few days, Larry called Donald Krintzman and Larry Mass, a doctor who wrote medical news for the
New York Native
—the city’s most important gay publication—as well as Paul Popham, whose best friend, Larry had heard, died of KS last year, to discuss plans for a small fund-raiser at Larry’s apartment.

N
ATIONAL
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ANCER
I
NSTITUTE
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B
ETHESDA
, M
ARYLAND

When it was introduced a year earlier, most immunologists considered the new Fluorescent Activated Cell Sorter, or FACS, to be one of the most expensive scientific toys ever created. The sorter did by computer what people once did by hand, separating the T-helper lymphocytes from the T-suppressors and then counting them to see if they were in a proper ratio. In a normal person, there were, say, two helper cells for each suppressor, making a normal helper-suppressor ratio of 2:1. This quick counting didn’t make the FACS that handy a tool. After all, the subsets of T-lymphocytes themselves had only been recently discovered, and scientists weren’t that sure what the lymphocytes did or how significant the ratios were. According to lab chatter, it would be another five to ten years before those mysteries were fathomed. Only then would the expensive white elephant of a cell sorter have any practical value.

Still, Dr. James Goedert was glad the National Cancer Institute had invested the half-million to buy one of the first FACS machines available, because he had a new patient with the same kind of rare skin cancer he had first seen last December. The institute’s FACS was so new it hadn’t even been used until Goedert ran blood from the two KS patients he was treating. The helper-suppressor ratios were so far off that the lab technicians were suspicious of their results.

On a hunch, Goedert drew blood on fifteen apparently healthy gay men from the Washington area. Half of them, he found, had similar abnormalities in their immune system. The results gave him the kind of sinking feeling one gets watching television footage of an airplane making that gentle arc in the first moments of a crash landing. Whatever was causing these immune problems, Goedert knew, was very widespread. Jim was leaning toward a toxic agent and suspected poppers. He began outlining a study of gay men to test the idea.

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OUTH-OF
-M
ARKET
D
ISTRICT
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AN
F
RANCISCO

Dr. Harold Jaffe looked nervously toward the barroom door. Even with a stiff summer breeze, the air was redolent with something thickly acrid, like a strange mixture of battery acid and vegetable shortening. The Ambush looked as seedy as Jaffe had heard, the kind of place where your feet stick to the floor. It was also the source of the poppers about which the gay men in San Francisco couldn’t rave enough. The Ambush’s own brand of poppers, sold discreetly in an upstairs leather shop, didn’t give you headaches, patients told Jaffe. In fact, virtually all the city’s AIDS cases reported using Ambush poppers, leading Jaffe and Carlos Rendon, a city disease-control investigator, to the seedy leather bar on Harrison Street.

“I’m not sure I want to go in that place,” said Jaffe.

“I’ll go in,” offered Rendon matter-of-factly. “What should I ask for?”

“They call it the real thing,” Jaffe said. “Ask for the real thing.”

Rendon returned with an unlabeled amber bottle that Jaffe tucked away for chemical analysis back in Atlanta. Like Mary Guinan, Jaffe was out to explore every possible explanation with a focus on the two leading hypotheses: Either the syndrome came from exposure to some toxic substance, like Ambush poppers, or it was part of the spread of a new infectious agent.

Jaffe didn’t believe he would find the solution in poppers. If the puzzle was that simple, somebody would have solved it by now, he thought. Instead, one of Jaffe’s basic motives was to try to grasp what these new diseases were. Like the growing numbers of doctors involved in the outbreak, he was struck by how sick the sufferers were. They were so emaciated that they looked as though they had been dragged out of some sadistic concentration camp; many were so weak they needed to rest between questions. The thirty-five-year-old CDC epidemiologist had seen people with advanced cancer before, but they were never so young as these.

The severity of the illness as well as the number of cases also convinced Jaffe that this was not some discrete outbreak, like Legionnaire’s, that would strike and then fall quietly back into the woodwork. This epidemic was something novel, something that was only beginning to define itself and take shape. All his interviews gave Jaffe only two substantive leads: Ambush poppers and, of course, numbers of sexual partners. The typical KS or PCP patients had had hundreds of partners, most drawing their contacts from gay bathhouses and sex clubs, the businesses whose profits depended on providing unlimited sexual opportunity. The vials of Ambush poppers might offer an environmental clue to the outbreak, but the highly sexual life-style of the early victims was beginning to persuade Jaffe, as it had Jim Curran and Don Francis, that a sexually transmitted bug might be behind the unexplained cancers and pneumonia.

Mary Guinan had a terrible headache on the flight back to Atlanta. Something stank terribly on the plane and it was splitting her temples wide open. On her arrival, she pulled her purse from under her seat, heard the clatter of small glass bottles, and noticed that the stench followed her through the Eastern Airline terminal. It was those poppers, she realized. She had gone to every porno bookstore she could find to buy every conceivable brand of nitrite inhalants, picking them up herself because none of the men who worked for the New York City Health Department would walk into the places.

When one of Mary Guinan’s gay contacts suggested that the disease might be caused by a mixture of poppers and Crisco, a popular lubricant among the fist-fucking aficionados, Guinan dispatched a gay friend to collect popper-tainted globs of Crisco from various bedrooms throughout Greenwich Village for chemical analysis back at the CDC. Nothing was too farfetched to check out.

Both Jaffe and Guinan returned to the CDC in time to hear the unsettling news of the proliferation of Kaposi’s sarcoma and
Pneumocystis carinii
pneumonia. In the four weeks after the
Morbidity and Mortality Weekly Report
on KS, 67 more cases of either the cancer or pneumonia were reported to the CDC. Now there were 108 cases nationwide. Of these 43 were dead.

Of the 82 cases for which a date of diagnosis was known, 20 became sick in 1980, while 55 were stricken just in the first seven months of 1981. Curran was preparing a new
MMWR
update on the diseases, the last that would appear for the next nine months.

The task force pored over Jaffe and Guinan’s studies. Guinan was convinced it was a new infectious disease. Some of the guys she interviewed didn’t use poppers. Certainly, somebody who gets a rush from heroin isn’t going to toy around with something as lightweight as disco inhalants. Jaffe ran the lab work on Ambush poppers and discovered that their popularity rested on the fact that they were not the isobutyl nitrites usually packaged for gays, but genuine amyl nitrite, the kind you can only get with a prescription, unless, of course, you know the right leather bars in San Francisco. This prescription amyl had been around for a century without killing anybody, Jaffe knew.

Bill Darrow was alarmed by the preliminary data Jaffe and Guinan had collected. A twenty-year veteran of VD work, Darrow was generally deferred to as both the most eminent sociologist at the CDC and an expert in the gay community. At forty-two, he was pretty much the old man among the CDC staffers, who tended to be in their early thirties, and he had a calm, professorial way of analyzing a crisis. That was why people were shaken with his analysis of the thirty-one patients interviewed in New York and California.

“It looks more like a sexually transmitted disease than syphilis,” he concluded bluntly.

Hepatitis and amebiasis could be contracted in other ways than by sexual contact, like infection through food, or, as with hepatitis, through shared needles or by blood transfusions. The epidemiology was much more cut and dried with the new victims, Darrow said. The only thing that seemed to matter in these cases was number of sexual partners, which, not coincidentally, was about the only thing that mattered in charting the risk of someone with any sexually transmitted disease in a low-prevalence situation.

In early August 1981, Bill Darrow and perhaps six or seven people in Atlanta were worried; across the country, there were, maybe, a dozen or so other clinicians and gay physicians who also saw the implications of what was beginning to unfold. The trouble, Darrow thought, was trying to convince the other 240 million Americans that they had something to be concerned about too.

The next weeks were spent acculturating the CDC field staff to the complicated gay sexual scene. Local epidemiologists like Selma Dritz of the San Francisco Department of Public Health were flown to Atlanta and given instruction on how to administer the twenty-two-page questionnaire for the case-control study. Invariably, as task force members explained that some victims would have as many as 2,000 lifetime sexual contacts, somebody’s jaw would drop and he or she would ask, “How on earth do they manage that?”

August 1981

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ASTRO
S
TREET
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AN
F
RANCISCO

Gary Walsh ushered Joe Brewer, the gay psychologist with whom he shared an office, through the swinging doors of the Badlands saloon a few doors off Castro Street.

“I’m going to teach you to cruise,” Gary explained with his characteristic decisiveness. “Anybody can do it.”

Joe had spent the spring moping about the breakup of his seven-year relationship, and the ever-ebullient Gary had had enough of his friend’s depression.