And the Band Played On: Politics, People, and the AIDS Epidemic, 20th-Anniversary Edition (23 page)

Just as this information convinced most at the CDC that GRID was a sexually transmitted disease, the Los Angeles cluster of cases added a dimension to their understanding of the epidemic. The clusters proved not only that the disease had a long incubation period between infection with the virus and the manifestation of the disease, but that carriers could spread the disease during that period. A latent carrier state of between three to six months had enabled hepatitis B to rage out of control in the major gay urban centers; the carrier state for GRID clearly was much longer, allowing even greater potential for spread by unsuspecting transmitters.

“Semen depositors,” said Mary Guinan. “We’ve got to talk about semen depositors.”

This became Guinan’s crusade at the CDC in the spring of 1982. She talked about semen depositors the way Don Francis talked about cat leukemia. It was the logical inference from the information now bursting forth from Guinan’s research.

No sooner had she convinced the CDC that intravenous drug users were indeed a category of GRID cases separate from gay men, than her field of investigations discovered the first reported GRID cases among prisoners and prostitutes. Guinan had already spent most of the spring in methadone clinics interviewing male heroin addicts and their girlfriends to establish the blood transmission of GRID among junkies sharing needles, and the subsequent heterosexual transmission from the addicts to their girlfriends. The first prison reports, however, took the attractive blond researcher to the small interview chambers of maximum security prisons.

Guards were reluctant to leave Guinan alone in the rooms with the prisoners, but she officiously insisted on one-to-one interviews, aware that she needed the most candid conversations possible if she was going to get anywhere tracking this epidemic. With prisoners that meant serious probing about their penitentiary sex lives.

“Have you ever been raped?” Guinan would ask in her frankest Brooklyn accent.

“I have lots of friends here,” said one prisoner matter-of-factly. “They know I’ll kill somebody if they touch me.”

Guinan believed him.

The blank stares that answered Guinan’s questions about poppers and fisting also indicated that those two predilections, however common among the gay patients, were unknown to these heterosexuals. Moreover, blood sampling of the intravenous drug users also revealed that, although many were infected with cytomegalovirus, the viral strains were all different. This was strong evidence that this herpes virus, which many scientists considered a strong candidate for being a causative agent, had not developed some new virulent strain. No single strain emerged, lending further weight to Don Francis’s hypothesis that a new virus, not CMV, was at work.

Even as this medical hypothesis was eliminated, however, more mystery grew around the clinical manifestations of GRID in intravenous drug users. Although they suffered from the same depletion of T-4 lymphocyte cells that marked all the immune deficiency patients, they were not getting Kaposi’s sarcoma. Instead, they’d get
Pneumocystis
or some other opportunistic infection. Only gay men seemed to be getting the skin cancer. This led to the suspicion that KS itself may progress from a separate cause, perhaps stimulated by some uniquely gay factor like poppers, after another virus did the initial immune busting.

Human mysteries compounded these growing medical mysteries. There was, for example, the first case of Kaposi’s sarcoma in an otherwise healthy woman. The woman, a registered nurse, spurned Guinan’s requests for an interview. Guinan persisted with the investigation, however. It was of national significance because it could mark the first GRID case in a health care worker. With GRID so precisely targeting the other high-risk groups for hepatitis B, federal officials held their breaths in fear of cases among health care personnel, who also were a high-risk group for hepatitis because of needle-stick injuries and blood contact. What kind of care would GRID patients get if their physicians and nurses thought they could contract the disease as easily as hepatitis B?

The nurse, it turned out, didn’t want to talk because she had just gone through a nasty divorce with her husband. There were some private issues she didn’t want to get into. Guinan began to understand when she traced the nurse’s employment records and found that she had recently worked as a nurse in a prison. Circumstantial evidence indicated sexual transmission, and health care workers, it seemed, were safe. At least for now.

By March, ten women had contracted GRID, and Guinan’s research confirmed that nearly all of them had sex with somebody in a high-risk group: a bisexual man or, most typically, a drug addict. These cases and stories like that of the prison nurse led Mary to her repeated lectures about “semen depositors.” That was the key to understanding this epidemic, she said, not homosexuals. This disease was being spread through sex by people depositing their infected semen in sundry orifices of their partners. In gay men, the deposits that could get into the bloodstream seemed to be made mostly in the rectum; vaginal deposits clearly were spreading this disease among heterosexual women. Gays were just getting it more frequently because they were more active sexually and they had institutions like bathhouses that were virtual Federal Reserve Banks for massive semen deposition. The major question that remained was not whether heterosexuals would get this disease but how fast. Men could give it to women, but how efficiently could women, without semen to deposit, give it to men?

March 14

N
EW
Y
ORK
C
ITY

Jim Curran flew in from Atlanta to address the organizational meeting of the New York Physicians for Human Rights, a Manhattanized version of the four-year-old San Francisco gay doctors group. New York City Health Commissioner David Sencer, a former CDC director, had made his appearance among the 250 lesbian and gay physicians, medical students, and health professionals and was chatting casually about syphilis and gonorrhea. When it came time for the diminutive Curran to speak, he climbed on top of a chair and paused briefly as he surveyed the crowd.

Here was a cohort of physicians who were all roughly his age, in their mid-thirties, or even younger, and by now he knew what they would be spending their entire lives doing. They may not know it, Curran thought, but with the preliminary data from the case-control study and Bill Darrow’s stories of the Los Angeles clusters, it was clear to Curran that all of them now had their lives inextricably bound to this phenomenon.

Curran started with his standard rap about the iceberg and how the KS and
Pneumocystis
cases were just the tip and people with swollen lymph nodes were in the middle, and how there was probably this vast reservoir of asymptomatic but infected people out there. Curran had said all this before in the matter-of-fact, midwestern way that people from Michigan talk. His voice became more tenuous as he began to escort the group from Before to After.

“It isn’t going away,” he said. “Even if we find a causative virus or other agent, it will be considerable time, probably years, before we can develop a vaccine or some strategy to eradicate it. We are in for a long haul.”

Curran scanned the young faces that had suddenly grown so still.

“It’s likely we’ll be working on this for much of our careers,” he said, “if not most of our lives.”

Later, many of the doctors confided to each other that Curran was being a bit hysterical.

Meanwhile, at the fledgling Gay Men’s Health Crisis, fights flared unpredictably between Paul Popham and Larry Kramer, such as on the night the committee received the 10,000 invitations for its upcoming April disco fund-raiser, “Showers.” Paul Popham, the new president, was incensed that the invitation’s return address included “Gay Men’s Health Crisis.”

“We can’t mail this out,” said Paul.

Nobody else could figure out why he was so upset.

“It says gay on it,” he fumed. “You can’t send something to people that has the word ‘gay’ on it. What if they’re not out of the closet?”

Larry Kramer was not terribly sympathetic. Besides, the invitations already were late. They needed to get them out right away.

“We can strike it out with a magic marker,” Paul suggested.

“Ten thousand invitations?” Larry asked.

“What about my mailman?” Paul finally burst. “He’s going to know I’m gay.”

Kramer was incredulous.

“What about your doorman?” he shot back. “You drag tricks up to your apartment every night. Don’t you think your doorman suspects something? Why aren’t you worried about him?”

The invitations were mailed out, but Kramer wondered about what would happen later, when this community really needed something and the people who were supposed to do the demanding were so ashamed of themselves that they didn’t even want their mailmen to know they were gay.

C
ENTERS FOR
D
ISEASE
C
ONTROL
,
A
TLANTA

During the final weeks of March 1982, the pace quickened in the labyrinthine corridors of the red brick Building 6 of the CDC in Atlanta. The ten people assigned to the task force barely had time to write up a new development before the epidemic took another unexpected turn that had them racing to catch up again. The latest crisis had started with sporadic reports to the CDC’s parasitic disease division of toxoplasmosis in Haitians, first in Miami and then in New York City. At first, parasitologists thought this was some problem unique to the malnourished refugees who had come from the most impoverished nation in the Western Hemisphere. Others remembered reports of strange cases of toxoplasmosis among gay men in the early cases.

Dr. Harry Haverkos of the KSOI Task Force flew from Atlanta to Miami and reviewed the Haitians’ medical records. The refugees were suffering not only from toxoplasmosis but also
Pneumocystis
and severe disseminated tuberculosis. There were fewer cases of Kaposi’s than among gay men, but some biopsies had confirmed that diagnosis nevertheless. The patients themselves presented yet a new scene in the unfolding horror show. They tended to die quicker than the gay men Haverkos had seen, and their wasting was far more striking. He came back convinced: The Haitians had GRID.

This new risk group presented still more mysteries to the task force, which was only beginning to fathom the unknowns behind GRID cases diagnosed a year ago. There was talk of voodoo rituals that might allow blood transmissions. Investigations were made difficult by language barriers and the suspicions Haitians had of anything governmental, a not unlikely tendency after life under one of the most ruthless dictators the U.S. government had ever financed. In their crisp Creole, the patients muttered to interpreters that Haverkos, an Ohioan with a penchant for polychromatic plaid jackets, was a CIA agent. Haverkos found it nearly impossible to track down family members or friends because all the refugees had come to America illegally and few patients were willing to risk their friends’ deportation.

Were these people really gay, having picked up the disease from vacationing New Yorkers? Had they given it to gay Manhattan men on holiday? Was the disease spreading through ritualistic scarring that might engender blood transmission? Haverkos was already working with Mary Guinan on prisoners and keeping track of possible cases among hemophiliacs. He had taken the Miami trip on what was supposed to be a week off between studies. He quickly mapped out a case-control study that the CDC should conduct on the Haitians. Whatever they held in common with gay men and intravenous drug users might give scientists the key to the epidemic.

As with so much in this year of lost opportunity, however, Haverkos’s proposal languished among the many other projects left undone because the CDC didn’t have enough money. By the time the study was begun two years later, everybody already knew what was causing the disease and the research became art academic exercise that provided interesting, but not essential, information.