And the Band Played On

by Randy Shilts

  January 29

  SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH

  As the newly formed San Francisco Health Commission began its first meeting, member Jim Foster looked wearily toward the succession of civil liberties lawyers and gay activists who had come to argue against the ban on “high-risk sex” at the city’s bathhouses. The debate was rapidly growing moot, Foster knew. Only three of the city’s eleven bathhouses were still in business; the owners, who were funding the new Committee to Preserve Our Sexual and Civil Liberties, were here to argue against the sex regulations.

  Jim Foster certainly understood the group’s rhetoric. As a father of San Francisco gay politics, founder of both the pioneering Society for Individual Rights and the Toklas Democratic Club, Foster had fashioned much of the sexual liberation ideology that bathhouse owners were now championing.

  But the words rang hollow to Foster today, and he wondered how gay men at this time and in this place could ask public commissions to campaign for their right to unlimited sex.

  Thirty hours before this commission meeting convened, Jim Foster had been in his comfortable Victorian home on Eddy Street, holding the hand of Larry Ludwig, his lover of twelve years. After suffering the ravages of Kaposi’s sarcoma for seventeen months, Larry had slipped into a coma. At midnight, Larry took four deep labored breaths and then breathed no more.

  It was a horrible moment, and it was a beautiful moment, Jim Foster thought. He certainly had not helped build a gay community so that his generation would spend its middle age in death vigils. Yet, through the ordeal, Foster had seen the incredible courage of people like Larry, and he had experienced the compassion with which gay men were helping each other through this collective trauma. Foster sensed that there was a new community emerging from the AIDS tragedy. It was not the community of politicians or radicals talking about bathhouses, but of people who had learned to take responsibility for themselves and for each other.

  This is what a community really is, Foster thought. And ultimately that was what he had been fighting for in all those years of gay politicking: the opportunity for gay people to enjoy their own community. Now, against this backdrop of tragedy, that community was being forged.

  After presentation to the health commission, the leaders of the Committee to Preserve Our Sexual and Civil Liberties were shocked when this elder statesman of San Francisco gay politics dismissed them with the comment that their concerns were “trivial.”

  January 31

  CENTERS FOR DISEASE CONTROL, ATLANTA

  Don Francis had finally completed his nine-page program: “Operation AIDS Control.” Warning that between 20,000 and 50,000 deaths could be expected from AIDS within “the next few years,” Francis had designed a plan that employed the only two weapons with which health authorities could fight the epidemic—blood testing and education. Francis wanted to begin a six-month program to test blood collected at drug treatment centers and venereal disease clinics. The imminent licensure of the HTLV-III test meant that, finally, the CDC could get an accurate grasp on how far the virus had penetrated American society. They could also start warning infected people that they carried the virus and, most significantly, that they were capable of transmitting it to others.

  Francis also recommended education programs to reduce sexual transmission that were tailored for the various risk groups—gay men, drug users, and promiscuous heterosexuals. To slow down the soaring births of AIDS babies, the government must begin advising female intravenous drug users on how to avoid pregnancy. Gay men should be encouraged to know their antibody status, Francis wrote, and be tested through confidential programs outside of blood banks. Not until authorities could determine who was infected, and who was not, could they begin to reduce the number of newly infected people through education.

  Francis knew that his proposal was fraught with political problems. Gay groups would object to his call for widespread testing of gay men. Conservatives would object to AIDS education programs. Already, he had noted that the federal government had all but refused to start any AIDS education programs for fear that conservatives would object to government instructions on how to have safe gay sex. The only education the government had thus far paid for was a small amount channeled through the U.S. Conference of Mayors.

  Even the release of the CDC’s data on the possible uses of nonoxynol-9 became mired in controversy. In late 1984, a researcher in Francis’s lab ran tests that showed that nonoxynol-9, the spermicidal ingredient in birth-control foams, successfully killed the AIDS virus in test tubes. Francis was excited about the finding, since it finally presented gays with something constructive they could do to save their lives. Using nonoxynol-9 with a condom could help prevent transmission, Francis thought, and he wanted the findings released immediately. But Jim Curran had stalled publication because a number of scientists listed as senior authors on the paper were unsure of the study’s methodology. Curran did not want bad science coming out of the CDC that could later be used to attack the agency. Francis suspected politics. The federal government didn’t want to concede the value of nonoxynol-9 because that might be interpreted as condoning anal sex.

  To some extent, other CDC staffers noted that the conflicts between Don Francis and Jim Curran reflected the underlying tension between Francis’s approach to epidemics and Curran’s. Under Curran’s leadership, the CDC had done an admirable job of collecting AIDS data. He had guided CDC AIDS research on a course that he felt was the best that could be done in a conservative administration.

  Francis remained the idealist oriented toward stopping the epidemic. He felt that the CDC had surrendered its role in controlling AIDS in favor of providing the most up-to-date body counts. He also understood that he was losing his battle. “Operation AIDS Control” was his last-ditch proposal to get the CDC in a control modality. The price tag on the program was $32.8 million. Although this was far more than what the federal government had spent for all CDC AIDS research in the past year, Francis thought the cost was modest compared to the billions of dollars in health care costs and prevention programs that would be needed in years to come if the government did not get serious about AIDS today.

  On January 30, the day that Don Francis submitted his proposal, the CDC released figures showing that, in the previous week, the nation’s AIDS caseload had surpassed 8,000.

  February 4

  THE CAPITOL, WASHINGTON, D.C.

  Even the most cynical critics of the Reagan administration were staggered when the Office of Management and Budget released its proposed AIDS budget for the 1986 fiscal year. Not only had the administration not increased AIDS funding but the budget called for reducing AIDS spending from the current level of $96 million to $85.5 million in the next fiscal year. The 10 percent reduction would be felt across the board in AIDS research but most heavily at the CDC, where funds would be cut back 20 percent to just $18.7 million. The government’s planned appropriation for education aimed specifically at the gay community was $250,000, which, again, was to be channeled through the U.S. Conference of Mayors in an effort to ensure that no federal agency was in the business of telling gays how to perform sodomy safely. Altogether, about 5 percent of the AIDS budget would go to AIDS prevention and education efforts.

  The cuts came at an inopportune time. Secretary Margaret Heckler had let it be known to gay leaders that she did not want to use her political capital to fight for AIDS funding in the administration when she knew that Congress was going to allocate more funds anyway. As it was, Heckler’s stock in the administration had dropped precipitously. In Virginia, Margaret Heckler’s husband of thirty-one years was suing for divorce, claiming, among other things, that Margaret had ceased having marital relations with him twenty-two years ago. Margaret, who was a devout Roman Catholic, had refused to get a divorce, he said, because she felt it would hurt her political career. Gay leaders were aghast at the thought that someone who apparently had had no sex since 1963 was presiding over the government’s AIDS fight, and the admin
istration was said to be extremely embarrassed by the publicity. Ironically, Secretary Heckler also was criticized within the administration for doing too much on AIDS. Other conservative administration officials were angry at Heckler for the high profile she had taken on the issue. Rumors abounded that the secretary was on her way out.

  The Office of Management and Budget was tired of the repeated HHS requests for budget augmentations. As far as they were concerned, Heckler could do whatever she wished with the $8 billion pot of money the administration allocated to all the nation’s health agencies. It wasn’t that they didn’t want to give her more money to spend on AIDS; they just didn’t want to give her more money. Budget officials thought the directors of the NCI, CDC, and NIAID tried to gain new money for AIDS research because they were too cowardly to tell their own scientists that their pet projects needed to be cut in favor of AIDS studies.

  In Congress, many of the congressional aides were beginning to balk. It had been their behind-the-scenes maneuvering that had secured added appropriations for AIDS research in previous years, and some of them now confided to the National Gay Task Force co-director, Jeff Levi, that they were tired of making President Reagan look good. It seemed that no matter how much administration officials worked to oppose funding initiatives on Capitol Hill, they were always ready to take credit for the research advances that resulted from funds that were provided.

  No congressional spokesperson for AIDS issues had yet emerged in either the Senate or the House of Representatives. Most AIDS legislation was handled by Representatives Henry Waxman of Los Angeles or Ted Weiss of New York City, but both were subcommittee chairmen with other issues to attend to. Neither of San Francisco’s two representatives, Barbara Boxer or Sala Burton, had made AIDS their top priority; they focused instead on environmental and defense issues. Without a legislative spokesperson, the work for getting AIDS money would again fall to such gay lobbyists as Jeff Levi and a handful of key congressional aides, such as Tim Westmoreland. AIDS remained something of an orphan issue in Congress. Neither the staggering AIDS caseload nor the increasingly apocalyptic predictions of future deaths made much difference.

  On the same day the Reagan administration released its budget, health authorities in Hong Kong announced the diagnosis of the first case of AIDS on the Asian mainland. The forty-six-year-old Chinese seaman had spent a vacation in Miami last year, officials said, and now was near death in a Hong Kong hospital.

  The AIDS epidemic had now spread to every populated continent on the planet.

  CENTERS FOR DISEASE CONTROL, ATLANTA

  The chief assistant to Dr. Walt Dowdle, director of the Center for Infectious Diseases, encountered Don Francis in a hallway at CDC headquarters.

  He gave Francis the verdict on his ambitious “Operation AIDS Control.” The CDC didn’t have the funds to finance the project.

  The recommendation to Francis was, “Do as little as possible but look like you’re doing a lot.”

  Francis had decided what he would do if he could not initiate his AIDS-control effort. He couldn’t stand spending more time banging his head against the administration’s stone wall. As it was, the AIDS efforts at the CDC were being reorganized into a separate branch, and the epidemiology and lab work were being merged. It was a convenient time for him to depart. He had informally lined up a new job as CDC liaison on AIDS to the California Department of Health Services. He was going to leave Atlanta.

  53

  RECKONING

  February 8, 1985

  HARLEY HOTEL, NEW YORK CITY

  Dr. Joseph Sonnabend looked troubled. The panel of journalists, which included most of the nation’s leading reporters on the AIDS epidemic, looked confused.

  “The implications are terribly important,” said Sonnabend cautiously.

  Sonnabend, one of New York City’s leading AIDS doctors, was trying to explain the significance of an earlier presentation by Dr. Luc Montagnier in the day-long AIDS conference co-sponsored by the AIDS Medical Foundation and the Scientists’ Institute for Public Information.

  In his patrician, professorial manner, Montagnier had described the genetic sequencing the Pasteur Institute had performed on the prototypes of the three AIDS viruses, LAV, HTLV-III, and Jay Levy’s ARV. The gene sequences of the French LAV and ARV varied by about 6 percent, which was normal, the scientists at the conference agreed. The genes of any two different isolates of the AIDS virus are expected to deviate from each other, usually by 6 to 20 percent. Montagnier’s lips tightened, however, when he said flatly that the genetic sequence of the HTLV-III prototype isolate had varied from LAV by less than one percent.

  Those words started the AIDS researchers present mumbling among themselves, even while the reporters yawned. Journalists had long assumed HTLV-III, LAV, and ARV were all different names for one virus. The reporters, however, were missing the point.

  “It would appear that HTLV and LAV are too identical,” Sonnabend said, stepping delicately around the fundamental issue. “They are identical to a degree that would not be anticipated with two independent isolates from the same family.”

  The reporters still didn’t get it. The doctors did, but they were afraid to say it aloud.

  “Would you be brave enough to voice explicitly the implication of what you’re saying here?” one doctor shouted to Sonnabend.

  “No, I wouldn’t,” Sonnabend answered. “I’m not the right person to be saying that.”

  “Neither am I,” the other doctor said.

  “What are you talking about here?” asked the Associated Press reporter.

  “Do you know something that you’re not saying?”

  “They appear to be the same actual isolate,” Sonnabend finally said. “Or some strange coincidence.”

  “What are you suggesting?” somebody asked.

  Dr. Mathilde Krim, who had organized the conference, stepped to the microphone.

  “Dr. Montagnier,” she said, “felt very appropriately that he was not the person to point this out.”

  “Nobody’s pointed it out quite exactly yet,” said one of the exasperated reporters.

  “It’s perhaps a complicated notion for you to understand,” Krim said, “but I think you are coming close.”

  Veteran science writer Donald Drake of the Philadelphia Inquirer was one of the two or three journalists in the room who understood the implications of Sonnabend’s remarks.

  “Are you suggesting that Gallo swiped his virus from the French?” Drake asked.

  “Or Montagnier swiped Gallo’s virus, or we are dealing with a very strange coincidence,” said Sonnabend diplomatically.

  “A light bulb goes off,” said the San Francisco Chronicle reporter on the panel.

  The reporters now understood what the scientists had been discussing in Harley Hotel hallways all day. In the world of virology, it was inconceivable that there could be a genetic variation of less than one percent between two different isolates of this virus. That would be like finding two identical snow-flakes. It simply didn’t happen.

  What made the similarities more unlikely was that the prototype isolates of LAV and HTLV-III were supposed to have been taken seventeen months apart, from two different men living on two different continents. The only way to account for the identical properties of the two prototypes was if they were the same virus taken from the same person.

  Montagnier knew enough about the chronology of Gallo’s discovery to be suspicious, although he never publicly made the accusation himself. Even by Gallo’s own account, he did not isolate HTLV-III until late 1983—well after September 1983 when the Pasteur Institute sent him LAV samples. To both the French researchers and many of the AIDS doctors at the conference that day, Montagnier’s comparisons indicated that the NCI prototype of HTLV-III, announced in April 1984, could have been grown out of the same cells the French had cultured in January 1983. If it had, this had the makings of a scientific scandal of immense proportions.

  On a number of counts, the AIDS Medi
cal Foundation conference in New York on that bitterly cold Friday in February delivered the first sign of what was to come in the AIDS epidemic. The butcher’s bill was so high that long-tolerated transgressions could no longer be ignored. Reckoning was at hand.

  Always looking for a new way to interest reporters in the epidemic, Krim had put together this conference in an attempt to get the crème de la crème of AIDS scientists and AIDS journalists into one room. Hidden agendas abounded, and many of the key AIDS players who had first committed themselves to attend the conference suddenly took waivers.

  At the last minute, for example, Secretary Heckler canceled her keynote address, pleading the flu. Maybe it was because she had heard that Krim planned to talk about the “fabricated figures” the federal government was using to justify its claims that it was spending enough on AIDS research. And Dr. Robert Gallo had also canceled at the last minute.

  Pasteur researcher Jean-Claude Chermann attended the conference to present data on the promise of HPA-23 experiments. Not coincidentally, Krim and other New York clinicians were spending substantial time pleading with a reluctant FDA to speed approvals on experimental treatments for AIDS drugs. Meanwhile, Montagnier’s talk on the genetic properties of LAV came as a growing body of evidence was accumulating in support of his contention that LAV was not a leukemia virus related to the HTLV family but a lentivirus, as the French had long maintained. The issue now was of more than academic interest, given the fact that some AIDS researchers were diverting their attention to studies on HTLV-I and HTLV-II in hopes that these allegedly related viruses might yield answers to the mysteries of HTLV-III infection. Clearly, such work was wasted if HTLV-III was wholly unrelated to the other HTLV viruses. There were significant points of prestige in this as well, now that Stockholm Fever had swept the small community of AIDS researchers.