And the Band Played On

by Randy Shilts

  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.

  UPPER ASHBURY, SAN FRANCISCO

  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.

  CLUB BATHS, SAN FRANCISCO

  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.”

  NEW YORK CITY

  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.

  CASTRO DISTRICT, SAN FRANCISCO

  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.”

  IRWIN MEMORIAL BLOOD BANK, SAN FRANCISCO

  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.”

  Gaetan Dugas was not alone among AIDS patients at the bathhouses. Bobbi Campbell, who had made his self-avowed role as a KS Poster Boy into something of a crusade, was also going to bathhouses, although he denied having sex with people. Gay doctors had told Dritz that several other patients still went as well. The situation was intolerable, Dritz thought, and she had no doubt as to what she would like to do. There was only the question of whether it would stand up in court. These people should be locked up, particularly Gaetan. Dritz started talking to city attorneys to see what laws existed to empower such action.

  Two more states reported their first cases of Acquired Immune Deficiency Syndrome in the month of November. Altogether, 788 AIDS cases in thirty-three states had been reported to CDC since the epidemic was first detected in June 1981. About 400 of these cases were in the New York City area, accounting for half the AIDS diagnoses in the country, while 10 percent more were in San Francisco, the second hardest-hit city. The AIDS casualties had quadrupled in the first eleven months of 1982. It was exactly one year since Ken Home, the first AIDS case reported to the CDC, had died in a dark hospital room on November 30, 1981; by November 30, 1982, nearly 300 were dead nationwide.

  December 1

  NATIONAL CANCER INSTITUTE, BETHESDA

  Robert Gallo was supposed to be the star of the day, but there was growing interest in AIDS, so the National Cancer Advisory Board put Jim Curran on the agenda of their regular Wednesday meeting as a prelude to Gallo’s talk. It was just as well because the peripatetic Gallo was late. He came in while Jim was in the midst of his thirty-minute dissertation on the iceberg and the vast numbers of asymptomatic carriers who were probably spreading AIDS now without even knowing about it. Toward the end of the meeting, Gallo finally walked to the front of the room, clearly relishing the applause of his colleagues. It was a sweet vindication for his work. After Gallo’s problems in the late 1970s, when his career took a nosedive because of a mistake in his cancer studies, he had become the fading star of the NCI. But he had hung in there and made his Human T-cell Leukemia virus discovery and was fresh from winning the prestigious Lasker Award. Now he was, inarguably, one of the nation’s foremost retrovirologists.

  Curran had spent much of the year trying to jawbone such prominent scientists into working on AIDS, with little success. Curran also was filled with talk from Don Francis, who kept insisting that AIDS could well be caused by a retrovirus, like feline leukemia. As the applause faded and Gallo approached the lectern, Curran made his move. “You’ve won one award,” he told Gallo, loud enough to be heard in the microphone. “You should come back when you win another award for working on AIDS.”

  Gallo smiled graciously as he shook Curran’s hand. Curran wondered if he had overstepped his bounds. In the hierarchy of government science, he knew, the CDC was considered the minor league to the NCI’s New York Yankees. There was the hint of the brash upstart in his comment.

  For his part, Gallo had had it up to here with this goddamn disease. At the prodding of Max Essex, who had found HTLV antibodies in the serums of two AIDS patients, Gallo’s lab had searched through AIDS blood in hopes of finding some retrovirus. He later estimated that perhaps 10 percent of his lab time in 1982 had been spent on the baffling disease. He considered that quite enough. If the truth be known, AIDS had always created some discomfort for Gallo, who hailed from traditional Italian-Catholic stock in New Jersey. There was all this dirty talk of 1,100 partners, fist-fucking, and other exotic sexuality; frankly, Gallo found it embarrassing to talk about. Besides, the lab research had been so damned frustrating.

  The work had turned up one intriguing clue. Because the genetic material of retroviruses is made of RNA that must be transcribed to DNA for the construction of viral duplicates, retroviruses need a special enzyme to reproduce—the reverse transcriptase enzyme. By November, Gallo’s lab had found evidence of reverse transcriptase in the infected lymphocytes of AIDS patients. This enzyme, in effect, had left the footprints of a retrovirus all over the lymphocytes. But it was impossible to find the damned retrovirus itself. That was the rub.

  In addition, Gallo’s staff couldn’t keep the lymphocytes alive. They died. Any leukemia virus, Gallo knew, caused the proliferation of cells, not their death. People with leukemia have too many white blood cells. When Gallo’s staff added lymphocytes from the blood from AIDS patients, however, to lymphocytes in culture, the lymphocytes would die without any proliferation. The frustration was galling and, by November, Gallo had made what would prove to be among the most important decisions of his career. He gave up. Sure, he would let his name go on some research papers that were to be published in the spring, linking HTLV to AIDS. But his research wasn’t getting anywhere. In November, his lab staff took the AIDS cultures they’d been studying and slipped them into the round metal liquid nitrogen freezers of Ga
llo’s Tumor Cell Biology Laboratory. For the time being, at least, he was done with AIDS research.

  PASTEUR INSTITUTE, PARIS

  “Is there a retrovirologist in the house?”

  The audience gave a collective groan. By now, many of the doctors in attendance had heard about how the unorthodox Dr. Willy Rozenbaum had to change hospitals because he refused to give up his studies on this strange new disease. He was respected as the continent’s foremost clinical authority on the epidemic, but he was also known to be thoroughly wrapped up in his own almost childlike enthusiasm. He couldn’t resist the play on the old Groucho Marx line, “Is there a doctor in the house?,” when he gave his lecture on SIDA, as the French called AIDS, at the august Pasteur Institute.

  Toward the end of the talk, he got around to explaining his opening joke. Some researchers at the NCI and the CDC were hypothesizing that a retrovirus caused AIDS. His working group on AIDS was trying to recruit laboratory assistance to help find the virus. “Is there a retrovirologist in the house?” he asked again.

  After the talk, Francoise Brun-Vezinet approached Rozenbaum with an idea. She had studied under Dr. Jean-Claude Chermann, one of France’s most famous retrovirologists. She’d ask him for help.

  Brun-Vezinet quickly called Chermann. Meanwhile, by coincidence, officials were approaching the Pasteur Institute’s leading virologist, Dr. Luc Montagnier, about AIDS. The Pasteur Institute’s pharmaceutical company, which generated a good portion of the revenue that financed the privately run institute, was frantic over rumors about the hepatitis vaccine. Pasteur Production had the license to manufacture the vaccine in France. The vaccine was derived from the plasma of gay men, and with the hemophiliac cases, people were worried that the inoculations might transmit AIDS. Although Montagnier learned that an American researcher, Dr. Don Francis, already had done research on the vaccine and found no link between AIDS and the vaccine inoculations, Montagnier agreed he would look into it further. The inquiry from Brun-Vezinet was fortunate; both Montagnier and Chermann agreed to make the Pasteur’s retrovirus labs available to the research.