And the Band Played On

by Randy Shilts

  —ALBERT CAMUS,

  The Plague

  40

  PRISONERS

  January 3, 1984

  NATIONAL INSTITUTES OF HEALTH, BETHESDA

  Larry Kramer had spent much of the past month visiting the federal agencies involved in AIDS work. His agent was reading the early draft of his play The Normal Heart, and having been out of AIDS action for nine months, Larry wanted to review government efforts against the epidemic. In a December trip to Atlanta, he was not surprised to see that the Centers for Disease Control seemed as underfunded and overworked as ever. He was taken aback, however, when one prominent staffer in the AIDS Activities Office bluntly asked him, “Why don’t you guys get married?” When Larry started to explain that most states have laws specifically barring same-sex matrimony, the CDC doctor got impatient. “I don’t mean marry men,” he said. “I mean women. If you guys had been married to women, this never would have happened.” The comment, from one of the CDC’s top AIDS people, gave Larry insight into why, nearly three years into the epidemic, the CDC still did not include even one openly gay person on their burgeoning staff at the AIDS office.

  Interagency rivalry between the CDC and the National Cancer Institute was frequently alluded to during the Atlanta trip. One CDC official candidly admitted, “We don’t even talk to them.”

  In early January, congressional staffer Tim Westmoreland arranged a visit for Larry Kramer to the home of the director of one of the largest and most prestigious institutes among the National Institutes of Health. Like several of the other top NIH directors, this agency chief lived in a baronial mansion on the Bethesda campus, surrounded by antiques and a doting staff.

  During the luncheon, Larry excused himself to visit the lavatory. Upstairs, he was attracted to a crowded bookshelf that faced an open bedroom door opposite the stairs. Convinced that you can judge a lot about people by their books, Larry wandered in. The shelves had an eclectic assortment of volumes: popular fiction, philosophical texts, and scientific volumes, except for one shelf, on which were several expensively framed photos of handsome men in bathing suits, posing with muscles flexed and arms wrapped around each other. In one, a prominent NIH official struck a campy Charles Atlas stance.

  Back at the luncheon, the prominent institute director excused himself to return to his office after earnestly impressing on Larry how much his agency had done for AIDS. Larry remained unconvinced, knowing that this particular agency had been extremely slow to respond to AIDS. Much of its current energy, he suspected, was spent squabbling with the National Cancer Institute over which arm of the NIH should be most prominent in the fight against AIDS.

  The director’s top assistant chatted with Larry as he took the meal’s last dishes into the kitchen. Once alone with the author, the assistant confided, “My friend and I loved your novel, Faggots. We’d love to have you to dinner the next time you’re in town.”

  Larry could have been knocked over with a feather.

  “Is that one of the reasons this institute has been so negligent with AIDS?” he asked. “Because the director is in the closet?”

  The assistant looked at Larry with an embarrassed expression and did not answer.

  The situation was achingly familiar to Larry. It was a truism to people active in the gay movement that the greatest impediments to homosexuals’ progress often were not heterosexual bigots but closeted homosexuals. Among the nation’s decision makers, the homophobes largely had been silenced by the prevailing morality that viewed expressions of overt hostility toward gays as unfashionable. In fact, when not burdened by private sexual insecurities, many heterosexuals could be enlisted to support gays on the basis of personal integrity. By definition, the homosexual in the closet had surrendered his integrity. This makes closeted homosexual people very useful to the establishment: Once empowered, such people are guaranteed to support the most subtle nuances of anti-gay prejudice. A closeted homosexual has the keenest understanding of these nuances, having chosen to live under the complete subjugation of prejudice. The closeted homosexual is far less likely to demand fair or just treatment for his kind, because to do so would call attention to himself.

  Again and again, this sad sequence of self-hatred and policy paralysis played out in the AIDS epidemic, just as it did in Bethesda.

  In Washington, one of the top officials in the Department of Health and Human Services was a closeted homosexual. Dr. Marcus Conant had once hoped that this official, who had an important role in the department’s budget process, might prove a valuable ally in securing more AIDS funds. Instead, the man was a haughty defender of administration policy in his meetings with gay leaders and AIDS researchers.

  In California, a top health official in conservative Republican Governor George Deukmejian’s administration was a covert homosexual. His job, however, required that he appear before legislative committees to argue vociferously against allocating funds for AIDS education programs in the gay community, and he performed his duties with gusto. On the municipal level, the public health director of one of the four American cities hardest hit by the AIDS epidemic was a closeted gay doctor. This man distinguished himself by presiding over a public health department that did even less than New York City’s to combat AIDS. Leaders of AIDS groups in that city privately agreed that the official declined to seek money for AIDS education from the county government because he did not want to draw attention to himself and his secret. Among gays, however, the health director was an expert articulator of AIDSpeak and talked convincingly of confidentiality and what wonderful places bathhouses were. Grateful gays made him board chairman of the city’s major AIDS group.

  As Larry Kramer shrugged on his heavy winter coat and stalked out of the agency chiefs home in Bethesda, he wondered when the deception would end. Just days before, he had met one of the nation’s most influential closet cases at a cocktail party in Washington. Larry immediately recognized Terry Dolan when he arrived at the party. The millions Dolan raised for his National Conservative Political Action Committee had been almost solely responsible for electing the New Right senators who tipped the balance of Senate power to Republicans in 1980. And in the 1980 presidential race, he had raised $10 million for Ronald Reagan. Dolan’s brother was now a White House speech writer.

  The advertising that the committee sponsored sometimes chastised Democrats for coddling homosexuals. Terry Dolan, however, was fresh from an affair with a staff epidemiologist from the New York City Health Department, Larry knew, and was thoroughly enjoying the gay life his political fund-raising sought to squash. With characteristic reserve, Larry threw a drink in Dolan’s face.

  “How dare you come here?” Larry screamed. “You take the best from our world and then do all those hateful things against us. You should be ashamed.”

  January 7

  UNION SQUARE, SAN FRANCISCO

  Cleve Jones could barely drag himself out of bed that morning, but these were demonstrations that he could not miss. Dan White was being released from Soledad Prison after serving five years, one month, and thirteen days of his prison sentence. Cleve remembered the day when he saw Harvey Milk’s corpse being rolled over and stuffed into a black plastic body bag, and knew he had to join in protesting the killer’s release.

  Speakers told the crowd at the Union Square rally that the Dan White story should inspire them to work at rooting out the deeper social bias that had allowed White to think it was entirely moral to murder a gay man. The crowd, however, wanted no part of such cool analysis, and they booed these speakers down with chants of “Kill Dan White.” Some protesters wore lapel buttons announcing themselves as members of the “Dan White Hit Squad.”

  By the time the marchers had wound their way through the financial district, more than 3,000 had joined the cacophonous procession, many in three-piece business suits. On Castro Street that night, 9,000 held a rally against the release, again chanting their mantra of hate: “Kill Dan White. Kill Dan White.” The anger was problematical. It was doubtfu
l that the fury was connected as much to the now five-year-old murder of Harvey Milk and Mayor George Moscone as to the simmering rage at the AIDS epidemic.

  Cleve marched and shouted with the throngs, ecstatic that some of the old fighting spirit had returned to the gay community. As the afternoon waned, however, Cleve left the march and returned to his apartment off Castro Street. The exertion had exhausted him completely. In fact, persistent fatigue had dogged him for months. At nights, he sometimes broke into unexplained sweats.

  Prejudice makes prisoners of both the hated and the hater. That truth would surface less than two years later, when Dan White put his car in his closed garage and turned on the motor, killing himself. Even outside Soledad, he lived as a prisoner and died as one.

  January 26

  Dr. Marcus Conant avoided memorial services for his patients, but Paul Dague had not merely been a patient. In August 1981, Conant had recruited Paul to counsel newly diagnosed Kaposi’s sarcoma patients at Conant’s KS Clinic at UCSF. It was Paul who enlisted a floundering Berkeley grief-counseling group, the Shanti Project, to help in the epidemic. In the years since then, Marc Conant and AIDS Clinic doctors Paul Volberding and Don Abrams increasingly had called on Paul Dague to help them as they coped with their daily stress of telling thirty-year-old men that they were about to die.

  As Marc Conant listened to the speakers eulogize Paul at the memorial, he remembered how devastated he had been when he told Paul Dague that the purple spots that had appeared on Paul’s skin were Kaposi’s sarcoma. That was in June 1982, when Paul was the 52nd local man to be diagnosed with AIDS. Now, in January 1984, Paul was the 149th San Franciscan to die of the disease. It was the week that the city’s AIDS caseload surpassed 400.

  Conant remained unsettled throughout the service. Glancing around the crowded room, he noticed Gary Walsh, sitting with a worried-looking friend. It had been a year since Conant had told Gary that he suffered from KS—one year and one day, to be exact—and Conant noticed that Gary looked as though he didn’t have much longer to live.

  Gary Walsh also usually avoided AIDS memorial services, but he had known Paul Dague for years and felt obliged to attend this night. Lu Chaikin was there with him. As she fidgeted in her folding metal chair, Lu reflected that out of love she had allowed most of her life the past year to revolve around Gary Walsh. Already, she recognized, she was suffering anticipatory grief for Gary’s death. Through all the eulogies, she could only think that soon she would be sitting through a service like this for her closest friend. Always the streetwise tomboy from Flatbush, Lu knew she could endure the grief; always the psychotherapist, she also knew she would learn from it.

  The memorial service impressed upon her, however, how much she already had learned about feelings this past year. In her earlier relationship with Gary, he was the sweet one, while she was strong. As Gary’s disease progressed, however, Lu noted that Gary had gained an inner strength, confronting fate’s cruel prognosis. Lu had learned about vulnerability; she had opened herself completely to Gary, without procrastination, because they had so little time. Even now, as their time together evaporated, Lu saw that during the past year she had learned from Gary much about being a woman, and Gary acknowledged that he had learned from her much about being a man.

  Such realizations tended to overwhelm Lu with sadness, because she saw again how much she would miss Gary when he was gone. At the end of the service, Lu felt weak and borrowed Gary’s silver-headed cane so she could walk out.

  CENTERS FOR DISEASE CONTROL, ATLANTA

  On the same day that Marc Conant, Gary Walsh, and Lu Chaikin attended Paul Dague’s memorial service, Dr. Max Essex at Harvard told Don Francis that Robert Gallo had twenty different isolates of the retrovirus that caused AIDS. That week, Gallo also told Jim Curran at the CDC that he had isolated the elusive AIDS agent.

  Gallo now was trying to culture as many different isolates of the AIDS virus as he could. He wanted the evidence to be overwhelming when it was announced, so there would be no lingering doubt as to what caused AIDS. Gallo decided the new retrovirus was the third variant of the Human T-cell Leukemia virus family he had discovered in 1980, and so he called it HTLV-III.

  Four days later, researchers from the Pasteur Institute provided Don Francis with convincing proof that their virus, LAV, caused AIDS. In October, Francis had sent the French scientists thirty blood samples, including ten from the San Francisco hepatitis B cohort of gay men who had developed AIDS, ten from gay men with lymphadenopathy, and ten from heterosexuals not at risk for AIDS. The samples were sent blind, marked only with code numbers. The French researchers reported to Don Francis their results: positive LAV antibody tests in twenty of the samples and negative tests in ten. Francis quickly paged through his notes to compare the code numbers. The French had accurately sorted the blood of AIDS and lymphadenopathy patients from the blood of uninfected people. Francis was elated. With the cause of AIDS found, scientists could now get on with the business of controlling the spread of the epidemic and finding a vaccine.

  One building away from Don Francis’s office at the CDC that day, the secretaries in the CDC Public Affairs office neatly typed out the new updates on AIDS casualties that were released to the press every week. As of January 30, 3,339 AIDS cases had been reported to the CDC, of whom 1,452 had died. Of these cases, 38 had occurred in people whose only risk for contracting AIDS was that they had received a blood transfusion.

  STANFORD UNIVERSITY, STANFORD, CALIFORNIA

  The early February call to Dr. Ed Engleman at the Stanford University Blood Bank confirmed all the blood banker’s worst fears about the voluntary donor-deferral guidelines that remained society’s only protection against AIDS-infected blood. A blood bank in Davis, California, had called Engleman because a donor had listed Stanford as one of thirteen blood banks at which he had given blood in recent years. The Davis facility had discarded his blood because it showed severe immune abnormalities. Stanford also had thrown out the man’s blood in August. None of the other blood banks to whom the donor had given blood, however, had discarded the donation, and eleven people were on record as having been transfused with this man’s blood.

  Nothing, it seemed, would awaken either the blood industry or the industry’s regulators at the Food and Drug Administration to the dangers of transfusion AIDS. Throughout 1983, Engleman had been a lonely voice calling for blood screening in his industry. For this, he had been vilified in local blood banking circles. At the end of 1983, one of the nation’s leading blood bankers told the Wall Street Journal that Stanford’s own testing program was merely a commercial ploy to try to lure patients from other Bay Area hospitals.

  By early 1984, however, concern was spreading. Recalls of Factor VIII were now routine news stories. In one instance, 3 percent of the national supply of the clotting factor was taken off the market after an alert blood banker in Austin, Texas, saw a news story on that city’s first AIDS case and recognized him as a regular paid donor for a local plasma collection center. In that recall alone, 60,000 vials of Factor VIII were rounded up. So far, sixteen hemophiliacs were suffering from AIDS. In just two years, the disease had emerged as the leading cause of death among hemophiliacs in the United States, even surpassing uncontrolled bleeding.

  The blood industry continued to stonewall. A CDC study in the New England Journal of Medicine warned again of the problem of transfusion AIDS and was roundly criticized by blood bankers, who picked apart the methodology of the research. Among the most vociferous critics was the spokesman for the American Red Cross, Dr. Gerald Sandier, who maintained that “most of the seven patients in the study were very sick people who required many more units of blood than the average three per patient.” Thus, the American Red Cross took the position that only people who needed a lot of blood might be at risk for contracting AIDS from transfusions. The president of the Council of Community Blood Centers told the Journal of the American Medical Association that his group believed there might be a blood-borne AIDS
virus, but that it probably was not highly infectious. In a January essay in the New England Journal of Medicine, industry spokesman Dr. Joseph Bove wrote, “Whether the disease is caused by a transfusion-transmitted infectious agent is still unknown and will continue to be until further data are gathered and the agent isolated…. Patients should be reassured that blood banks are taking all possible steps to provide for safe blood transfusions.”

  By now Dennis Donohue, director of the FDA’s blood and blood-products laboratory, was not convinced that all possible steps were being taken. In December, Donohue began pushing the industry to adopt the hepatitis core antibody test that the CDC had first proposed at the disastrous Atlanta blood meeting a year before. In early January, Assistant Secretary for Health Ed Brandt set up a conference call of blood bankers and CDC officials to discuss the AIDS problem. The upshot of all the talk was no new FDA policy; instead, the blood bankers agreed to form a task force to study the issue. The task force moved with the speed that characterized government response to virtually every aspect of the AIDS epidemic: The group decided to hold its first meeting in three months.

  DUBLIN STREET, SAN FRANCISCO

  In the six months since Frances Borchelt had been given the transfusion of three pints of blood, she had not regained her health. Her spirits dropped. Her fatigue was so relentless that she could no longer bustle through the busy days that had characterized her life. She felt a prisoner of the small home she shared with her husband in San Francisco’s Excelsior District.

  In early February, however, the nightmare turned darker. It started with a psoriasis rash on Frances Borchelt’s arms. Before long, the itchy red rash covered her entire body, from the top of her scalp to the soles of her feet. Bob Borchelt took his wife to every specialist he could think of, from dermatologists to gynecologists. Each offered a different diagnosis, but none could offer a cure. It was during this outbreak that Frances’s daughter Cathy began to fear that something was wrong with her mother beyond this or that ailment she had suffered since the August operation. It was just a suspicion at this time, and nothing that Cathy voiced to her apprehensive parents, but she now had started paying close attention to news reports about something that had seemed very removed from her life—the epidemic of Acquired Immune Deficiency Syndrome.