And the Band Played On

by Randy Shilts

  The blood industry had discounted all previous transfusion AIDS cases in evaluating the extent of the transfusion AIDS problem. With these two adult cases and the San Francisco baby, however, there were now three cases featuring both a donor and recipient who suffered from the syndrome. Altogether, the CDC counted seventy-three transfusion AIDS cases by March 12, including the twenty-four hemophiliacs. Of these, twenty-two already had died. When the stories of Mary Johnstone and the Los Angeles nurse came out in March, however, faithful medical writers almost unanimously followed the blood bankers’ rhetoric that they were the first two adults diagnosed with transfusion AIDS in the United States.

  Despite the unstinting support of the news media, Brian McDonough, president of the Irwin Memorial Blood Bank, faced a dilemma with Mary Johnstone’s diagnosis. Two of the three AIDS cases to which the blood industry did admit had come from Irwin blood. Another fourteen diagnosed AIDS patients were among Irwin donors in recent years, McDonough also knew. Mary Johnstone was only one of twenty-two recipients whom the blood bank was tracking for signs of AIDS. Already, eleven of these people were having problems with their immune systems. Most significantly, at least one of the donors had given blood after the deferral screening had begun last year. When asked by the blood bank why he had donated, he explained that he never considered himself at high risk for the disease, even though he was a sexually active gay man. It wasn’t like he was some fist-fucker who hung out in leather bars.

  With Mary Johnstone’s husband making noises about a lawsuit, McDonough decided his blood bank could no longer take the wait-and-see attitude that characterized his industry’s response to the AIDS problem. He knew he would face the wrath of the blood industry for breaking ranks, but he made his decision nonetheless. Even before disclosing the Johnstone case, the Irwin Memorial Blood Bank announced that, as of May 1, the blood bank would begin testing for antibodies to the core of the hepatitis B virus, the test that the Centers for Disease Control had urged blood bankers to start in January 1983.

  “Self-exclusion has not worked well enough in the San Francisco area,” McDonough said, “and some individuals are giving blood who should not.” In announcing that the testing would begin in May, Dr. Herbert Perkins, the Irwin medical director, tried to reassure a jittery public about the safety of the blood supply. The risk of getting AIDS is extremely low, he said, and was less than 1 chance in 500,000.

  Other Bay Area blood banks quickly announced that they would follow Irwin’s example and begin core hepatitis testing, albeit reluctantly. When the San Jose Red Cross announced that it would start testing, it did not cite safety concerns as its impetus but “competitive pressure from other blood banks in the area.” In other words, the Red Cross was worried that it would lose customers to Irwin if it did not start the hepatitis screening.

  Brian McDonough came under immediate attack by his colleagues in the blood industry after the announcement. Industry spokesman Dr. Joseph Bove told the Wall Street Journal that “more people are killed by bee stings” than by transfusion AIDS.

  The newsletter of the American Association of Blood Banks gave the most telling report on industry response to McDonough’s announcement: “Aaron Kellner, M.D., of the New York Blood Center, stated that his facility was ‘not about to make a decision in favor of anti-core testing,’ not because it would cost $10 million and defer six percent of donors, but because they don’t believe it would do anything to improve transfusions safety. ‘We’re not convinced that AIDS is transmitted by blood transfusion…. the evidence is very shaky,’ said Kellner. None of the [blood industry] panel spoke out in favor of anti-core testing for AIDS.”

  It was against this backdrop that Dr. Dennis Donohue, director for the blood and blood-products laboratory of the Food and Drug Administration, met with the AIDS task force of the FDA Blood Products Advisory Committee. The task force had been established to study Donohue’s four-month-old suggestion that hepatitis core antibody testing be instituted for the entire nation’s blood supply. While commercial blood companies, sensitive to the demands of hemophiliacs, supported testing, nonprofit blood banks, most notably the American Red Cross, continued to oppose it. As usual, the blood bankers argued cost, saying that testing would add $12 to the cost of a unit of blood and that they would have to recruit new donors to replace the 6 percent of donors whose blood would be rejected because of the testing.

  Donohue later said that, given the task force membership, all efforts at initiating testing were doomed. Members were either in the blood industry or allied with blood interests. There were no members whose role was to protect the interest of the customers of these business executives. And, ultimately, that is how the eminent doctors who ran the nation’s blood banks behaved—like business executives. Both the task force and the blood advisory committee were clubbish groups devoted to little more than protecting the interests of blood banks. Both voted in March to take no action on Donohue’s recommendation for hepatitis testing. That largely marked the end of the Food and Drug Administration’s meager effort to protect the nation’s blood supply from AIDS. When pressed later about why this agency forswore its mandated duty to guard the integrity of America’s blood, FDA spokesmen declined comment.

  CENTERS FOR DISEASE CONTROL, ATLANTA

  James Mason, the CDC director, had a blunt directive for Don Francis on March 21.

  “Get it done,” he instructed.

  In his scientific notebook, Don Francis wrote PRESSURE and underlined the word twice. The heat was on to resolve the AIDS mystery, and Francis didn’t have any doubts that the proximity of the presidential election motivated the unusual administration concern. Nevertheless, Francis was pleased that scientific evidence was accumulating rapidly for the French virus. All the CDC experiments were conducted with LAV, because Robert Gallo at the National Cancer Institute, still angry at the defection of Dr. Kalyanaraman, continued to refuse to provide samples of his HTLV-III virus for experiments. By late March, Francis had detected LAV among asymptomatic people who were in AIDS risk groups. The CDC’s own LAV antibody tests proved even more sensitive than comparable tests used at either the Pasteur Institute or the National Cancer Institute. At the CDC, 75 percent of AIDS patients tested positive for LAV antibodies. In a complicated process of viral isolation, LAV itself was recovered in seven of eight AIDS patients tested.

  Don Francis felt confident enough to take the costly step of inoculating two unfortunate chimpanzees named Manvel and Chesley with the French virus. By now, Francis knew that his efforts to infect marmosets with AIDS were a failure that had cost the CDC much time. He had used marmosets instead of chimpanzees in order to preserve scarce funds, but the smaller monkeys obviously were not susceptible to AIDS. He could only hope now that the costlier chimpanzees were.

  The most significant breakthrough for CDC AIDS research came a few weeks later when Dr. Kaly independently isolated LAV from the blood of the Los Angeles nurse who had contracted AIDS through a blood transfusion. The discovery of LAV, in blood drawn before the nurse came down with AIDS, marked the first time scientists could begin to meet the demands of Koch’s postulates, and became the single most important step in proving that LAV was the cause of the syndrome. The presence of the virus in the nurse’s blood showed that infection with LAV preceded the onset of AIDS, eliminating suspicion that LAV was merely an opportunistic infection taking advantage of the AIDS patient’s compromised immune system. The subsequent isolation of LAV in the blood of the transfusion donor showed direct evidence of transmission of the virus in a natural setting, another prerequisite to nailing down a certain agent as the cause of a disease.

  The scientific politicking surrounding the announcement of HTLV-III began to take increasing portions of Don Francis’s attention. On March 27, Francis talked to Bob Gallo in an effort to reach some agreement for a joint announcement from the CDC, NCI, and Pasteur. Gallo wanted to delay any statement. “If we make an announcement, AIDS research will be taken over by NIAID,” he said. “W
e need to keep it quiet.”

  But Gallo was also concerned that, if the Americans waited too long, the French would preempt them and take the credit for the virus’s discovery. “They better have what I have or there will be a major battle,” he told Francis, noting that Pasteur researcher Francoise Barre, who first detected LAV, had trained in Gallo’s lab. “I think I gave a lot to the French,” he said.

  Bob Gallo continued to be angry that the European press was giving the French credit for discovering the cause of AIDS. “Montagnier is in the papers every day,” he said. Don Francis knew this was a sore spot with Gallo. In February, Gallo had called the Pasteur scientists “whores” for so aggressively courting the media.

  By the end of that day’s conversation, however, Gallo agreed he would share credit for the HTLV-III discovery and acknowledge the CDC for performing the epidemiological studies. He also would give the French their credit as first discoverers if he was convinced that LAV was the same as HTLV-III.

  Francis believed that agreement among the American and French scientists was essential to achieving the acceptance of the scientific data and getting on to the subsequent business of finding AIDS treatments, a vaccine, and some way to control the disease. Francis began to work furiously to set up a meeting with the NCI, CDC, and Pasteur Institute to reach an agreement for a joint announcement.

  March 28

  SAN FRANCISCO

  The morning paper carried a front-page story about Larry Littlejohn’s initiative to ban sexual activity in gay baths. The political reality that gays now confronted became instantly clear.

  Littlejohn had five months in which to collect a mere 7,332 signatures to qualify his ballot proposition. Nobody doubted that the signatures could be collected easily. Once placed on the ballot, few doubted that it would pass overwhelmingly. No politician could afford to put his or her reputation on the line for bathhouses. Even worse, the controversy would flare through the summer, while the international spotlight shone on San Francisco during the 1984 Democratic National Convention. Although Mayor Feinstein made no on-the-record comment about the bathhouses, off-the-record sources confirmed that she had spent much of the past two weeks in private meetings with gays, trying to persuade them to close the facilities themselves. And she told the newspapers now, “I am watching the situation as closely as I can.”

  At first, Bill Kraus was furious with Littlejohn. Such a volatile issue in a citywide election could only bring disaster for the gay community, he said.

  “But do you agree that what’s going on in the baths is killing people?” Littlejohn asked.

  Bill Kraus didn’t answer.

  “I’m only doing what needs to be done,” Littlejohn said. “It can’t go on the way it is.”

  Still, he offered a compromise. If the public health director, Merv Silverman, instituted the regulations that Littlejohn proposed through the use of Silverman’s quarantine powers, Littlejohn would withdraw the initiative petitions.

  Bill Kraus’s anger dissolved in the light of the opportunity Littlejohn’s petition availed. Nobody, he reasoned, would want the measure to go on the ballot—not the liberal public officials who would be caught in a no-win choice between alienating gays by opposing bathhouses or offending straights by supporting them. Obviously, the bathhouses now were doomed. The question was only who would kill them, heterosexual voters or the gay community itself. As far as Kraus was concerned, the only obstacle was Dr. Silverman, who would not close the baths without community support.

  Kraus conceived his squeeze play. Silverman would be told that gay leaders were now willing to support bathhouse closure. In the meantime, gay leaders would be told that Silverman planned to close the bathhouses whether they supported him or not. They had the choice of claiming victory when Silverman shut the facilities, seemingly at their request, or being cast as losers if he closed the baths without their assent. Kraus explained the strategy to Marcus Conant, who subscribed to its wisdom.

  Of course, bathhouse closure was not a fait accompli. The acquiescence of gay leaders and Dr. Silverman to closure came only because each side felt compelled to action by the other. Kraus was not stricken by pangs of guilt at his chicanery. As far as he was concerned, the continued operation of bathhouses amounted to little more than officially condoned homicide. The ruse was a necessary, if unfortunate, way to get Silverman to finally do what he should have done a year ago, Kraus thought.

  The newspaper report on the Littlejohn initiative set off a stampede of public officials and gay leaders, all of whom were suddenly urging Silverman to close the bathhouses. Mayor Feinstein again deferred public comment, even while a spokesman confided that she believed they should be closed. Longtime gay ally Supervisor Richard Hongisto said most eloquently: “I have too many beloved friends in the gay community who have died or who are dying of this. I’m going to too many funerals. It’s time the bathhouses be closed.”

  Pressure from gay leaders also mounted, and the Chronicle’s story included a not-for-attribution comment from Bill Kraus: “Silverman can defuse this issue, make it go away, by just closing the bathhouses now. When the Democratic Convention comes to town with 10,000 reporters, we don’t want the big local issue to center on gays’ right to commit suicide in bathhouses.”

  Marc Conant called Merv Silverman.

  “I’ve got what you’ve said you needed,” he said, explaining that gay leaders were ready to support Silverman in closing the baths.

  That night, Conant left a retirement dinner for Selma Dritz and joined Bill Kraus and his friend Dick Pabich. Together, the three men went to the home of Dr. David Kessler, where a number of doctors from the Bay Area Physicians for Human Rights were working on a long-planned statement asking gay men voluntarily to stop going to bathhouses.

  Conant told them that Silverman was about to close the bathhouses. Pabich suggested that gay community leaders should endorse the move to make the decision appear as a community victory. The doctors were reluctant, but after much discussion, ten of the twelve people in attendance agreed to support Silverman and drafted a statement: “This is an extremely painful and difficult decision which we make reluctantly after serious soul-searching and consultation with many members of our community. Bathhouses have long been important for gay people, but clearly now, saving lives is of greater importance…. Therefore in the interest of saving lives, we call on the director of public health to temporarily close such establishments for the duration of this public health emergency.”

  David Kessler was one of the two doctors who was anxious about how the community would react to such a statement and decided against putting his name on it. As the meeting concluded, Kessler’s young lover, Steve Del Re, stomped into the room and started shouting at Marc Conant.

  “You’re doing a dreadful thing—you’ll rot in hell,” he screamed, his face turning red with anger. “Blood will be flowing in the streets. You have all made a serious mistake.”

  The next morning, Bill Kraus called Cleve Jones, asking him to attend a press conference with the health director to support “Merv’s decision” to close the baths. Cleve had not been gung ho about closing the facilities, but he certainly did not want the issue on the ballot, and he never considered bathhouses worth fighting for.

  “Let’s close them and get it over with,” he agreed.

  Like Bill Kraus and Dick Pabich, Cleve Jones had worked the phones all day, enlisting support. Within a few hours, he had lined up all eleven members of the board of supervisors for closure. Since he had the best rapport with gay street radicals, Cleve also got assurances from many leftist gays that they would not actively oppose closure, even if they did not support it. Later that day, Cleve received a call from Merv Silverman.

  “I’m sorry it’s come to this,” Silverman said.

  Cleve didn’t know what he was talking about.

  “I think it’s a sad day for your community,” Silverman said.

  “If you feel it needs to be done,” Cleve said, “I’ll
go along with you.”

  Then the light began to dawn. Cleve called Marc Conant and demanded, “Are we acquiescing or are we initiating?”

  Later, Cleve heard that pro-bathhouse staffers at the San Francisco AIDS Foundation had called a community meeting for that night, with Silverman and all the bathhouse owners scheduled to attend. He wondered how well Bill Kraus’s strategy would hold together.

  Bill had no such trepidations. By the end of the day, he had fifty leaders from a broad spectrum of community, political, and professional groups who would endorse Silverman’s closure. Lawyers in the city attorney’s office spent the day drawing up quarantine orders for the city’s fourteen bathhouses and sex clubs.

  By early afternoon, Silverman announced he would hold a press conference the next morning.

  Toward the end of the afternoon, Selma Dritz received an anonymous phone call in her office. “Silverman will be killed tomorrow if he closes the baths,” the caller said.

  In Atlanta, Don Francis had by now made the final phone calls to finesse the meeting between the NCI, CDC, and Pasteur Institute. The next week, he and Bob Gallo would fly to Paris to work out all the details for a joint announcement on the discovery of the AIDS virus.

  QUEBEC CITY

  The morning newspapers on Monday, March 26, carried stories of a study about to be published in the Journal of American Medicine. News of this formal publication of the cluster study, two years after the CDC’s Bill Darrow had pieced the tale together, was accompanied by complicated diagrams, with all the arrows and circles centered on one person—the now-famous Patient Zero. The study and the news stories, of course, did not name Gaetan Dugas, although they did allude to the fact that researchers believed he was still alive.