by Randy Shilts
Bob Tivey reintroduced himself to Gaetan at the end of the forum while taking the names of people who might provide or need social support services. Gaetan confided that he had been one of the first people in North America to be diagnosed with Kaposi’s sarcoma. Yes, he’d like support services, Gaetan said, but no, he did not have AIDS. He had skin cancer. Gaetan started getting angry again, talking about the doctors who said he shouldn’t be having sex. Who ever heard of cancer being infectious? Tivey detected that Gaetan was almost a textbook case of denial and anger, and he figured it would be easy to provide counseling for him.
Meanwhile, a gay newspaper in Edmonton had already written a story about an airline steward with AIDS who was popping into Alberta and screwing people in the bathhouses—but Bob Tivey hadn’t heard those stories. Not yet.
Paul Popham couldn’t believe how well Gaetan looked, considering how long it was since he had been diagnosed. Gaetan confided that he had suffered a bout of Pneumocystis that winter and had gone back to Quebec City for care. All his West Coast friends had thought they’d never see him again, but now he felt great. His hair was growing back now that he was off chemotherapy. Paul told Gaetan about the wonderful circus GMHC planned as a fund-raiser at Madison Square Garden the next month. He also mentioned that Jack Nau had died about a year and a half before.
Not far below the surface of the conversation, Gaetan’s anger continued to simmer. Suddenly, he blurted, “Why did this happen to me?”
In March 1983, the first case of AIDS was diagnosed in Australia—an American visitor. Australian public health officials now waited for their first homegrown cases, aware that tens of thousands of men from Down Under had taken advantage of the cheap “Skytrain” flights to San Francisco in the early 1980s. In France, AIDS researcher Jacques Leibowitch began calling AIDS “the charter disease,” because so many of the early European gay cases were among the men who had boarded the inexpensive charter flights to New York and San Francisco.
March 17
NEW YORK UNIVERSITY, MANHATTAN
Marc Conant picked up a copy of the Native with “1,112 and Counting from a newsstand and showed it to Paul Volberding while the two San Francisco doctors shared a private moment at a New York University AIDS conference. They were standing on a campus patio; Conant could see the scores of other doctors milling about inside, sharing their latest insights on whether this or that form of chemotherapy worked best on Kaposi’s sarcoma.
“Kramer’s right,” said Conant. “Here we are working on people who are already sick, people for whom it’s already too late. We need to be out there screaming to gay people that, if they don’t stop, we’re all going to die.” The pair decided to call a meeting of gay community leaders when they returned to San Francisco. It was time to sound major alarms.
Paul Volberding was grateful he didn’t have to contend with the politicalization of AIDS medicine in San Francisco. In New York the gay doctors seemed to make everything into a political issue. At one session of the conference, Volberding had noted that San Francisco General Hospital planned to open a ward for AIDS patients in the summer. The rationale for the AIDS ward was the same as for the city’s AIDS clinic. Presenting such a complicated array of disorders, the syndrome demanded that new specialists be created, people who understood the nuances of treatment for a Pneumocystis patient who might simultaneously be suffering from ulcerating herpes in the rectum and KS lesions coating the stomach. Dealing just with the medicines and symptoms generated some of the most intricate clinical problems in the history of medicine, drawing on virtually every medical specialty. At San Francisco General, they were literally writing the textbooks on AIDS care because of their clinic. It made medical sense to have such a ward, Volberding said, both for the patients and for the doctors who wanted to find a way out of the AIDS nightmare.
Paul Volberding was astonished at the vehemence with which Dr. Roger Enlow, the new coordinator of New York City’s Office of Gay and Lesbian Health Concerns, denounced the plans for the AIDS ward. It would be nothing more than a leper colony, he said. Dr. Enlow vociferously argued that AIDS patients should not be treated separately; it was everything they were trying to avoid in New York.
That afternoon, Congressman Phillip Burton introduced a resolution in Congress asking for an additional $10 million in funding for the Centers for Disease Control for AIDS research. Congresswoman Barbara Boxer, the other representative from San Francisco, introduced a parallel bill to allocate $20 million to the National Institutes of Health for AIDS studies. The money bills were calculated and written by the Capitol’s three most prominent, openly gay aides, Bill Kraus, Tim Westmoreland, and Michael Housh from Boxer’s office. The Reagan administration, of course, was still solemnly insisting it did not need more money for AIDS research. Scientists had all the funds they needed, they claimed. For the three gay aides, however, the bills were just the opening salvo in the funding wars. Westmoreland already was planning a Health Subcommittee hearing on AIDS for May, while Manhattan’s Representative Ted Weiss, who chaired an oversight committee on government operations, was considering a full-scale hearing to delve into the government’s entire response to the epidemic.
We’ve finally got things moving, thought Bill Kraus as he typed Phil Burton’s press release on the AIDS bills.
The three-day NYU conference on AIDS offered the embattled blood industry a chance to draw its battle lines against further government demands for blood testing. Dr. Joseph Bove had by now become the leading spokesman for the blood industry, given his roles as chair of the FDA blood advisory panel, chief of the blood bank at Yale-New Haven Hospital, and chair of the American Association of Blood Banks Committee on Transfusion-Transmitted Disease. With the Public Health Service blood guidelines less than two weeks old, Bove worried aloud that the “CDC—now more aggressive and independent”—would want even more action from blood banks in its compulsion to “do something.” Bove mocked the CDC’s evidence of blood transmission, insisting the action could not be warranted until the CDC showed definitively that an infectious agent caused AIDS. “The evidence for nearly all this is inferential,” said Bove, a professor of laboratory medicine at Yale. “I wish it were better.”
Moreover, in only one transfusion AIDS case could the CDC pair a transfusion recipient with a donor who actually had AIDS. In the other six cases under investigation, the donors were in high-risk groups showing early AIDS symptoms, but none had one of the diseases the CDC required to substantiate a case of full-blown AIDS. The report of the San Francisco baby appeared in the MMWR, Dr. Bove added, not a standard peer-reviewed medical journal. Bove chose not to dwell much on the fact that such peer-reviewed publication takes six to nine months. “Nothing exists in the peer-reviewed medical literature—not one case!” said Bove. “…Evidence for such [blood] transmission is lacking.”
Years later, when it was clear that hundreds were dying because the blood industry and federal regulators at the FDA heeded the calls of people like Joseph Bove, the doctor would pull a copy of his speech from his shelf at Yale to show that his 1983 presentation at NYU was, technically, accurate. “I wrote ‘evidence is minimal,’ “said Bove. “I was extremely cautious about my choice of words. I didn’t want to go on the record either way. I was smart enough not to say it wasn’t there. Technically, I was not inaccurate.”
On the day the NYU conference opened, the San Francisco gay newspaper, Bay Area Reporter, published Larry Kramer’s broadside of anger and outrage. The issue also included an editorial that contained some startling confessions from editor Paul Lorch. “This space—for that matter, the entire paper by editorial fiat—has been sparse in its coverage of what has come to be known as AIDS,” Lorch wrote. “The position we have taken is to portray that each man owns his own body and the future he plots for it. And he retains ownership of the way he wants to die…. [Now] we have made a very deliberate decision to up the noise level on AIDS and the fatal furies that follow in its wake.”
CASTRO STR
EET, SAN FRANCISCO
Gary Walsh and Joe Brewer were enthralled by the Larry Kramer story. Gary couldn’t stop reciting the litany of complaints Larry raised. There wasn’t enough government funding. The newspapers weren’t paying attention. Nobody cared; there was no outrage.
Joe was pleased to see Gary get worked up about AIDS; he hadn’t seen Gary’s famous temper since his diagnosis.
“We’ve got to do something—something dramatic,” Gary said.
Candles, Gary thought suddenly. The candlelight march.
It was the perfect idea. The candlelight march from Castro Street to City Hall in 1978 on the night of the assassinations of Supervisor Harvey Milk and Mayor George Moscone had been one of the most dramatic moments of their lives. Gary had even left the march to call his parents and dramatically announce he was gay, prompting his mother to worry openly that Gary would not go to heaven.
A stream of candles glimmering down Market Street, Gary thought. It would be such a gentle, nonthreatening battle line. The demands could be made, not in an ugly confrontational way, but in a way that invited the best in people. Besides, the media could not avoid taking long, lingering shots of homosexuals holding candles. It would be a smash.
Gary got on the horn to other people with AIDS. It was going to be their march, they decided, articulating their needs as the people most intimately struggling with the horrors of the new disease. There was no more talk of suicide as Gary busied himself with his new project and started boning up on AIDS facts for the media appearances and political lobbying he planned.
Joe Brewer began putting together notes for a series of articles he wanted to put in the local gay newspapers to give gay men the psychological tools to start changing their sex lives. His denial about AIDS had been shattered too late, only when Gary was diagnosed. He could date his practice of strictly no-risk sexuality only to his Christmas trip to Key West. All the AIDS groups, like the Shanti Project, the KS Foundation, and especially the San Francisco Department of Public Health, were obsessed with keeping gay men from panicking. From his own experience, and from conversations with clients, Joe figured gay men could use a little panic now if they were going to change their sex lives and survive.
VANCOUVER, BRITISH COLUMBIA
When Gaetan Dugas’s best friend moved from Toronto back to Vancouver, he felt like he had landed in the middle of Peyton Place. Everybody was talking about Gaetan as “the Orange County connection,” going out to the bars and having sex with people. It hadn’t helped when Gaetan made a scene at the AIDS Vancouver forum, arguing about whether AIDS actually could be spread through sex. Gaetan’s sexual prowling had reached near-legendary proportions since then. He made little effort to conceal his medical problems, casually rolling up his sleeves as he quaffed beers at pubs, despite the lesions on his forearms.
According to one story, one tryst of Gaetan’s was so furious when he heard that Gaetan had AIDS that he tracked the former airline steward down to confront him. By the time they were done talking, Gaetan had charmed the man back into bed.
The friend from Toronto sat Gaetan down for a talk. They had known each other for years, since they were Air Canada stewards together in Halifax and had escaped to San Francisco for the Gay Freedom Day parades and parties. He genuinely loved Gaetan, knowing him as a kind and caring friend, not just somebody to party with. If a friend were sick, Gaetan could be relentless in his attentions, and there never seemed to be an end to the little considerate gestures Gaetan doled out to the people close to his heart. Still, the friend suspected that the rumors might be true. Asking Gaetan to give up sex, he knew, would be like asking Bruce Springsteen to give up the guitar. Sex wasn’t just sex to Gaetan; sex was who Gaetan was—it was the basis of his identity.
Gaetan at first denied he was having sex with anyone. His friend didn’t let it end at that. He suggested to Gaetan that anyone with AIDS should stop having sex. Period.
“They can’t tell me that having sex is going to transmit it,” said Gaetan. “They haven’t proved it yet.”
“Yes,” his friend countered, “but if there’s even the slightest possibility, then you shouldn’t do it.”
“Yes, I suppose you’re right,” Gaetan shrugged.
The friend wasn’t sure that Gaetan agreed at all. He recalled the conversations they had had years before in Halifax, deciding whether they could hit the bars on the nights after they had shots for gonorrhea. The doctors always said to wait a few days, but Gaetan figured that since somebody gave it to him, he could give it right back.
“This is incurable,” Gaetan’s friend pushed. “You don’t just get a shot. It would be so incredibly unfair to give it to someone.”
Yes, Gaetan said, so unfair.
26
THE BIG ENCHILADA
March 20, 1983
79 URANUS STREET, SAN FRANCISCO
Rain beat against the redwood deck outside the sliding glass doors; winter was leaving northern California reluctantly that year. The core of gay political activists who had been closest to Harvey Milk sat around the kitchen table, a copy of “1,112 and Counting” lying nearby in case anybody hadn’t read its call to action. Among others were Bill Kraus, Cleve Jones, and Dick Pabich, the aide who had rushed into Harvey Milk’s tiny office on the dark November day five years before to discover the group’s political mentor lying facedown in a pool of blood.
Dana Van Gorder, aide to Supervisor Harry Britt, laid out the problem on the city level. The Department of Public Health still had not produced one piece of informational literature on AIDS. Endless committee meetings were being held to determine the politically correct way to say what had to be said. The simplest suggestions, like Dana Van Gorder’s old proposal for bus signs on the city-owned transit system, also were bogged down in process. There was no sense of emergency at the health department.
There was also the question of the study. As early as October, epidemiologists from the University of California in San Francisco, working in conjunction with San Francisco General Hospital, had been talking about data that compared the incidence of diagnosed AIDS cases with census tracts counting unmarried males. By the end of December, 1 in 333 single men over age fifteen in the Castro neighborhood already was diagnosed with AIDS. Factoring out heterosexual single men and the delay in reporting diagnoses, this meant that perhaps 1 in 100 gay men in this area already had AIDS. A person having twenty sexual contacts a year had 1 chance in 10 of making it with an AIDS sufferer. The odds shot up astronomically when larger numbers of infected but asymptomatic gay men were included.
The researchers, Drs. Andrew Moss and Michael Gorman, had given their incidence study to the Bay Area Physicians for Human Rights and other gay political leaders in January, figuring they would release the statistics and sound alarms to gay men. However, these gay doctors and activists, assuming they knew what was best for the city’s homosexuals, had done nothing. Instead, they were pondering how to deliver the information…. appropriately. They feared that the study results would have a devastating impact on the Castro neighborhood and prove a major public relations nightmare, and they managed to intimidate the researchers with that argument. The epidemiologists, fearing they would lose the community cooperation that was the key to their studies, agreed to hold off releasing their results until the study was published in April in the form of a letter to the British medical journal Lancet.
Public Health Director Dr. Mervyn Silverman had done nothing to disseminate the study’s findings in the weeks since his meeting with Supervisor Harry Britt, who informed him of the study. Rather, Silverman seemed content to simply lay the responsibility for education on gays themselves. It was the liberal thing to do. It was politically savvy as well, because no gay leaders would be offended this way. Bill Kraus noted that this also was the cheapest course for the health department, requiring no commitment of departmental staff time or educational resources.
“Okay, we have to do an end run around these people,” Bill said to the group gat
hered at 79 Uranus Street. “We’ll just do it like a political campaign. We’ll get the message out about safe sex, and repeat it and repeat it until it sinks in. Targeted mailings. Brochures that speak to the audience. We’ve done it all before.”
Also, the study needed to be emancipated from the gay-leader types, Bill decided. Fuck process. When people see how serious this is, they’ll change. Who did these leaders think they were, deciding the life and death of the community?
Over the next two hours, the group mapped out an educational plan. Since the health department wouldn’t send out brochures, Bill Kraus would get Phil Burton and Barbara Boxer, who also was aligned with the Milk Club, to send out their own brochures using their congressional franking privileges. The mailings could be directed to the computerized mailing lists of single, male voters in heavily gay precincts. The Harvey Milk Club, meanwhile, could do another brochure that was much more explicit than anything congressional representatives could issue. Gay men needed simple direct messages about what to do, and not do, for the community to survive.
After these tasks were assigned, Bill pulled Cleve aside into a guest bedroom. He had this spot on his leg, he said, pulling up the cuff on his pants. Cleve examined the discoloration and pronounced it a garden-variety liver spot.
