And the Band Played On: Politics, People, and the AIDS Epidemic, 20th-Anniversary Edition (33 page)

In the long brainstorming in the weeks that followed, Brun and Klatzmann also arrived at the idea that any search for such a virus would best be started not in the blood of AIDS patients but in the lymph nodes of men with lymphadenopathy. If anything marked the blood work of AIDS patients, Klatzmann said, it was the virtual absence of T-4 lymphocytes. The virus appeared so deadly that it killed its host cells, which might render fruitless a search for the virus in the blood. Given the fact that lymphadenopathy appeared to be some kind of early symptom of AIDS, it made more sense to try to find the culprit while it was still proliferating and not after it had delivered the coup de grace to so many T-4 cells.

This line of inquiry turned out to be one of the most momentous in the scientific history of the AIDS epidemic. Nothing seemed certain then, however, except that the French doctors finally had a tangible plan and, most importantly, that they needed a big retrovirus lab to see whether it would pan out.

On October 28, the Centers for Disease Control reported that 691 Americans were documented as contracting AIDS in the United States, of whom 278 were dead. Nearly one in five of the cases had been reported in September or October. The epidemic had swept into four more states in those past two months with the reports of the first cases in Alabama, Kentucky, Vermont, and Washington. Twenty states, largely in the South and Rocky Mountain regions, still reported no cases. Three more nations reported their first AIDS cases in those two months. Altogether, 52 cases had been reported in fifteen foreign nations, largely in western Europe.

October 30

U
NIVERSITY OF
C
ALIFORNIA
,
S
AN
F
RANCISCO

Dr. Marc Conant had organized one of the first national conferences on the AIDS epidemic, and Catherine Cusic, a respiratory nurse, eagerly took her place in the crowded auditorium for the session on epidemiology. For a year, she had been treating AIDS patients, putting tubes down their throats when they went on ventilators, holding them as they wheezed and coughed through the night. An active member of the Harvey Milk Gay Democratic Club, Cusic also had been bending Bill Kraus’s ear about the lack of local educational programs for AIDS prevention. She hoped the new epidemiology might nudge Kraus’s attention away from strictly federal issues and into local public health concerns.

Pediatric immunologist Art Ammann’s presentation at the conference on his AIDS babies gave final proof to Cusic’s conviction that AIDS was an infectious disease. The three children of the intravenous drug-using prostitute, all suffering from immune problems, established blood transmission that, together with the drug addicts themselves and the cluster study, was all the evidence Cusic needed to bolster her fears about the epidemic spreading among gay men. Epidemiologist Michael Gorman was droning on about census tracks and diagnosed cases when Cusic heard a statistic that made her sit bolt upright in her seat.

“In a central part of the city, one percent of gay men have been diagnosed with AIDS,” Gorman said cautiously.

Cusic interrupted him: “What central part of the city?”

Gorman looked flustered.

“A central part of the city,” he repeated.

Cusic knew immediately what he didn’t want to say. The central neighborhood of the city was, of course, the Castro Street District. One percent of the men there were diagnosed and nobody had told them? For Christ’s sake, she thought, half the guys she talked to remained convinced that AIDS was some media hype. This study could go a long way toward letting gay men know it was serious business.

“What are you going to do with this study?” Cusic demanded. “This is a phenomenal rate.”

The information had been submitted to a medical publication in England, Gorman explained. It couldn’t be released until it was published there, he said. Of course, the statistics were now available to every participant at the conference, and they quickly became the talk of the gay leadership.

Catherine Cusic started goading Bill Kraus to get the study into the newspapers so people would know how serious AIDS already was. Things had to get moving, she said. Kraus started checking around and was surprised that the consensus of gay leaders was to withhold the information. “It could destroy the Castro,” he was told.

After his presentation at the UCSF conference, Harold Jaffe from the CDC huddled with Dr. Art Ammann to check on reports of more pediatric AIDS cases. The CDC was preparing an article about the AIDS babies in New York and New Jersey. Jaffe knew that Ammann’s substantial reputation among pediatric immunologists would help give the report more credibility. It was during the conversation about the three children of the prostitute that Ammann mentioned another infant. Neither parent was an intravenous drug user or in any AIDS risk group, Ammann said, but the baby had undergone extensive transfusions at birth.

Jaffe knew immediately what Ammann potentially had—the first documented case of AIDS contracted through a blood transfusion. As soon as he returned to Atlanta, Jaffe called Dave Auerbach in Los Angeles for the most important AIDS investigation since Auerbach’s work on the cluster study.

Back in San Francisco, Ammann called Selma Dritz and told her the particulars of the baby’s health. Dritz contacted the Irwin Memorial Blood Bank, which had supplied all the baby’s blood.

In the early days of November, the bank completed its records search and came up with thirteen donors whose blood had been transfused into the baby in March 1981. Dritz’s eyes froze on the name of one donor. She recognized it as the socially prominent international trade consultant who had died of encephalitis in August, the one who so vehemently had denied being gay.

“Oh, God,” she sighed. The familiar feelings returned to her: the excitement of being on the cutting edge of one of the most intriguing phenomena anyone in her profession could ever hope to experience, and the sadness because of what her insights meant for the society whose health she had spent a lifetime trying to protect.

She called Jaffe in Atlanta.

“You won’t believe this, but one of the donors is a man who was diagnosed with AIDS,” she said.

“It’s finally happened,” Jaffe thought.

November 1982

C
LUB
B
ATHS,
S
AN
F
RANCISCO

Gaetan Dugas examined himself closely in the steamy mirror of San Francisco’s most popular bathhouse. He had always been looking for someone, he thought. As a child he had searched for his mother, not the woman who had brought him up in Quebec City, but his real mother. As soon as he was old enough to understand that he had been adopted into that rough-hewn life of the French-Canadian working class, he had dreamed of the day he would meet his true mother. He knew he was meant to be born into a better life, far from the brawny bullies who called him a faggot and rubbed snow in his face during those bitter Canadian winters.

He could see the difference in his face; he was meant for something better. He loved his family and adored his older sister, but they were dark and plain looking while he had always had delicate features and light, winsome hair. He was like the prince taken up by the farmers, he thought. When he did finally meet his natural mother, he told friends they fought. She wouldn’t say who his father was and she didn’t seem like a princess, and suddenly Gaetan had stopped talking about searching for his parents. Anyway, he had found his own niche in the royalty of gay beauty, as a star of the homosexual jet set.

Now, as he searched the mirror, oblivious to the smiles aimed at his still-handsome body, he was thinking about another search. Who had done this to him? Certainly somebody had. They had passed him the virus that meant he was going to die, and he couldn’t get over wondering who it was, the way he once could not stop wondering what his real mother looked like.

Gaetan stood back to give his smooth body another appraisal. He was thirty years old, the age he had never thought he would make. But he was triumphing. He was living in San Francisco, where he had always wanted to live. He had outlived all the doctors’ predictions and felt quite nice, thank you, two and a half years after he was told that the small purplish spot near his ear was Kaposi’s sarcoma. True, he was a bit more tired these days and sometimes breathing came hard. He would win, nevertheless, and enjoy his evening here at the baths.

Of course, those assholes at the CDC might scream at him for being here, but he had told them to fuck off. They were bothering his old boyfriends with phone calls and nosy questions. The other doctors could fuck themselves, too, with all their warnings that he might be spreading this thing. Everybody knew you couldn’t catch cancer. He wanted to see proof. Besides, Gaetan had told the doctors defiantly, somebody gave this to him.

Gaetan peered down the long hallway of cubicles, some with their doors open. Inside, men lay on their stomachs, usually with a can of Crisco and a small bottle of poppers at their side. Gaetan surveyed the material and made his choice. He edged into the small cubicle and waited for the ritual nod that indicated he would be welcome. Without a word, the assignation was set. Gaetan pushed the door shut.

U
PPER
A
SHBURY,
S
AN
F
RANCISCO

Paul Volberding looked down at his long fingers. They were bony now. His full frame, made strong through a childhood of chores at his parents’ Minnesota dairy farm, was gaunt and emaciated. He was like all the rest, now. The breaths were coming harder as he lay in his home in Upper Ashbury, above the Castro District where so many of the others had lived and died. And now Paul Volberding was dying too. Had he given it to his child? What would happen to his wife? This was the time that Volberding usually woke up.

The dream was recurrent in the last months of 1982, settling a layer of dread on each night, because Paul never knew when the nightmare would return. On his first day at San Francisco General Hospital back in July 1981, when the veteran oncologist had told him that the “next great disease” awaited him, Volberding had seen AIDS as a curiosity. By early to mid-1982, it was an intriguing phenomenon. Now, Volberding saw, it was turning into a catastrophe.

Just a few months before, he had known all the names of the local AIDS cases when he sat down with Marc Conant, Selma Dritz, Don Abrams, and the handful of other involved doctors who regularly went to Conant’s biweekly meetings for updates on the epidemic. Now cases were mounting rapidly, far outstripping Conant’s own depressing projections. Volberding’s AIDS outpatient clinic would open in January, but he had not foreseen the rapid increase in the rate of new cases and wondered whether his budget could handle it.

His concerns were not only professional. The Orange County cluster, the hemophiliacs, and now talk of a transfusion case at UCSF had convinced Volberding that this certainly was a viral disease that could be spread like hepatitis B. Already, some nurses had reconciled themselves to gallows humor about their vulnerability to the disease. There would soon be a fifth “H” to add to the “Four H’s” of the disease risk groups—homosexuals, heroin addicts, hemophiliacs, and Haitians. The fifth “H,” they said, would be house staff. In New York, there were reports that some nurses were simply refusing to work with AIDS patients, leaving food trays at their door and allowing them to lie for entire shifts in sheets stained with defecation.

Volberding’s own nightsweats had started in the waning weeks of autumn, coming on like any viral infection with high fevers and the wrenching, sheet-soaking perspiration all night. Volberding knew AIDS had a long incubation period. Was it incubating in his body? Had he given it already to his baby boy? A spot had appeared on his body. Marc Conant had assured him it wasn’t a KS lesion, but was there another splotch of purple now growing silently on his back, where he might not see it?

Paul knew his fears were not unique. His assistant director, Don Abrams, had spilled some liquid nitrogen on his hand, causing a big purple spot, and had also become convinced he was going to die, even though the discoloration was easily shown to be the legacy of the nitrogen. A prominent Harvard clinician had called Volberding, complaining of fevers and shortness of breath. “Do I have
Pneumocystis?”
he asked.

C
LUB
B
ATHS,
S
AN
F
RANCISCO

Back in the bathhouse, when the moaning stopped, the young man rolled over on his back for a cigarette. Gaetan Dugas reached up for the lights, turning up the rheostat slowly so his partner’s eyes would have time to adjust. He then made a point of eyeing the purple lesions on his chest. “Gay cancer,” he said, almost as if he were talking to himself. “Maybe you’ll get it too.”

N
EW
Y
ORK
C
ITY

For Enno Poersch, the terror settled in as department stores began erecting their cheerful Christmas displays. In the first year after Nick’s death, Enno hadn’t worried much about catching whatever killed his younger lover. Toxoplasmosis, he heard, wasn’t a contagious disease. But now, nearly two years after Nick had died, Enno was scared. At the Gay Men’s Health Crisis board meetings, he had heard about a man who had sex with all these guys who died in Los Angeles and about how it was spreading through hemophiliacs. When the Christmas decorations went up, the idea overtook him. He’d never live to see Christmas. AIDS would kill him too, the way it already had killed so many friends—Rick Wellikoff, the schoolteacher, Jack Nau, the window dresser, and of course, Nick, the man with whom he had spent eight blissful years in love.

C
ASTRO
D
ISTRICT
, S
AN
F
RANCISCO

The large gray Victorian stood proudly over the sidewalk, as if it graced the street by its presence. Gary Walsh had always loved the gingerbread trim on these grand remnants of 1880s tract housing, and he was thrilled that he and Lu Chaikin, a lesbian psychotherapist, had bought their own offices in the Castro.

“It’s like we’re married professionally,” teased Gary, his green eyes sparkling at the fifty-seven-year-old Lu Chaikin.

Lu gave him an affectionate shove and considered that they were indeed an odd couple, the laid-back lesbian nearing sixty and the handsome, hot psychotherapist in his prime. Privately, Lu worried that their relationship was unequal. Gary seemed so often to be the nurturer and teacher, almost in the traditional female role, while Lu, former tomboy from Flatbush, had the rougher male role.

In November, Lu and Gary decorated the new offices and waiting room they would share. Gary groused a bit during all the shopping, complaining of fatigue, but he was excited about the move and about his planned Christmas trip to the Yucatan with Joe Brewer. However, Gary remained run down, and when he went to the drugstore to pick up some medication, he admitted to Lu that he was “very worried.”

Lu didn’t understand why. She knew Gary had recently suffered a case of salmonella so severe that he was hospitalized for a few days, but most of her clients were gay men and it seemed they all had parasites at one time or another. Gary looked impatient at Lu’s naivete.

“AIDS,” he said, confiding his deepest fears for the first time. “These are all symptoms of AIDS.”

Lu dismissed the thought. AIDS was some exotic disorder, something far from her life.

“If you get AIDS,” she joked, “I’ll kill you.”

I
RWIN
M
EMORIAL
B
LOOD
B
ANK,
S
AN
F
RANCISCO

Dr. Herbert Perkins looked like a man whose cocker spaniel puppy had been run over by a truck. Selma Dritz understood Perkins’s despondence. He was the medical director of northern California’s major blood bank—the source of the blood products transfused into the ailing baby at UCSF. Dritz knew, of course, that the announcement of the nation’s first AIDS-by-transfusion case would batter the blood industry. Both could predict what would follow. There would be calls to ban gays from giving blood. The suggestion ran counter to both doctors’ sensibilities, but Perkins added in another factor. A drop in gay donors would have a terrible effect on the region’s always-tenuous supply of blood. Between 5 and 9 percent of Irwin’s donors were gay, he told Dritz. “They are very good donors,” he sighed.

Dritz was sympathetic, but she had the public health to worry about and there was still a troubling aspect to this case. The donor, the blue-blood who had died in August, insisted to the end that he was heterosexual. The case for blood transmission of AIDS had to be made as clearly as possible if health authorities were going to get about the business of saving lives, Dritz thought. The man’s disputed sexual orientation only muddied the scenario. He certainly was not a prime suspect for sharing needles in some shooting gallery. He was probably gay, like 98 percent of the city’s other AIDS cases. Dritz needed to talk to the family and try to find the truth. Perkins provided what information he could.

Dr. Dave Auerbach, one of the CDC’s Epidemiological Intelligence Service officers, went to see the donor’s brother. Like Dritz, Auerbach also had previously interviewed the recalcitrant AIDS sufferer who had so vehemently denied being gay during their various epidemiological investigations. The brother was more cooperative, telling Auerbach about sifting through the dead man’s personal effects after his death in August. That was when he found this, he said, showing Auerbach a small black address book.

Back at Public Health, Dritz leafed through the pages eagerly, thankful once again that she was born so nosy. Under “B,” Dritz saw a name she recognized.

Practicing out of Davies Medical Center on Castro Street, Dr. Bud Boucher was one of the first local physicians to direct a practice specifically at gay men. Like all the gay doctors, Boucher had known Dritz for years because of her parasite preaching. He pulled the patient’s files without hesitation. The donor only came to Boucher for those messy little troubles that he didn’t want to tell the socially prominent physician handling his routine medical care. Among those problems was a case of rectal gonorrhea back in 1980. The mystery was solved.

Gaetan Dugas’s eyes flashed, but without their usual charm, when Selma Dritz bluntly told him he must stop going to the bathhouses. The hotline at the Kaposi’s Sarcoma Foundation was receiving repeated calls from people complaining of a man with a French accent who was having sex with people at various sex parlors and then calmly telling them he had gay cancer. It was one of the most repulsive things Dritz had heard in her nearly forty years in public health.

“It’s none of your goddamn business,” said Gaetan. “It’s my right to do what I want to do with my own body.”

“It’s not your right to go out and give other people disease,” Dritz replied, keeping her professional calm. “Then you’re making decisions for their bodies, not yours.”

“It’s their duty to protect themselves,” said the airline steward. “They know what’s going on there. They’ve heard about this disease.”

Dritz tried to reason further but got nowhere.

“I’ve got it,” Gaetan said angrily. “They can get it too.”