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The China Virus
If AIDS hadn’t ravaged its way through the homosexual population, it is very likely that we would have referred to it as “the African Virus,” since that is evidently where it originated. In the early years, that’s how many French doctors and scientists thought of it, finding America’s preoccupation with its homosexual victims confusing. “This was a disease that simply struck people, and it had to come from somewhere.” But the human need to blame and compartmentalize is just too strong.
Indeed, as we will see:
Yet the strange mix of taboos and newfound freedom had created a social climate that was wonderfully tailored for aggressive little viruses.
Face Diapers
Because more surprising, and more similar to our reaction to having to change our behaviors to protect ourselves against COVID-19, was the tiptoeing around and the outright rebellion against the safety measures needed to contain the AIDS virus.
Another point of conflict was over what to tell gay men. Larry [Kramer] was adamant that GMHC [(Gay Men’s Health Crisis)] should tell homosexuals exactly what the doctors were telling board members in private meetings -- to stop having sex. Or, if not to stop having sex altogether, at least to stop having the kind of sex that involved putting semen in another person’s body. Most of the board members were themselves fresh from the hot summers in Fire Island bushes and long nights at spacious Manhattan bathhouses, and they had a hard time putting down the activities they had spent most of the past decade pursuing. It seemed prudish to make judgments. In the GMHC newsletter issued in July [1982], the first nonscientific publication issued by any organization in the world on the year-old epidemic, various views of risk reduction were presented.
“A number of physicians, many of them gay as well, have advised their gay patients to moderate their sexual activity, to have fewer partners, and to have partners who are in good health,” went the toughest advice. “It is the number of sexual partners, not sex itself, that increases risk.”
Another story, by sociologist Marty Levine, however, sneered at such suggestions as “fallacious reasoning” and such advice as “panic … still washing over us.” Levine wrote that “278 cases out of a possible 11 million (gay men in America) hardly constitutes an epidemic.”
For its part, GMHC as a group decided that its job would be to give gay men the most up-to-date information about the epidemic and let them make their own decisions. This policy engendered another fierce debate between Larry Kramer and the other board members. “We don’t want to get into the business of telling people what to do in bed,” came the chorus against Larry. During an epidemic of a sexually transmitted disease, Larry thought, this was exactly what you did to save lives. He lost the arguments but remained convinced that the board ultimately would shift its position. The only question in his mind was how many people would die first.
It is fairly remarkable that it was evidently the gay community that were the rebels against the public health recommendations during the AIDS epidemic, with the ability to engage in sexual activities with whomever and whenever they chose baked so deeply into their identity that many, if not most, couldn’t conceive of life under such a behavioral restriction.
And of the defiant, none were perhaps as defiant as Gaetan Dugas -- the French-Canadian flight attendant who is often misidentified as Patient Zero in the AIDS epidemic.
Gaeten 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 Gaeten. “It’s my right to do what I want to do with my 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,” Gaeten said angrily. “They can get it too.”
Gaeten 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 Gaeten. Dritz started talking to city attorneys to see what laws existed to empower such action.
It really puts an interesting light on the COVID-era mask-deniers. Dugas sounds exactly like them in the quotes above. It’s my body.
There are real civil liberty issues here -- whether we’re talking about government-mandated confinement during the AIDS era or government-mandated mask wearing during COVID. But despite Dritz’s wishes, no such government-mandated actions ever took place during AIDS, and very limited actions took place during COVID. In most cases, we’re talking about medical advice based on a risk assessment that, at the time offered, seemed genuine. Yet I would wager that many of us would find Dugas’s actions reprehensible, while far fewer are troubled by the rebellion of the mask deniers. From my view, if one is a sociopath, then so is the other.
Gay Cancer
One of the most illuminating parts of Shilts’s work is the way the framing of AIDS as a “gay disease” drove so much of the personal and institutional responses to it. Of course, AIDS did not exclusively afflict gay men. In fact, in its early years, it was only when it afflicted a “normal” person -- through blood transfusion or some other vector -- that it seemed to get any news coverage. And that news coverage seemed to have an ulterior motive behind it.
The focus was on the men in the white coats, who were sure to speak innocuously. The stories were carefully written not to inspire panic, which might inflame homophobes, or dwell too much on the seamier sex histories of the gay victims, which might hurt the sensitivities of homosexuals. The pieces always ended on a note of optimism -- a breakthrough vaccine was just around the corner. Most importantly, the epidemic was only news when it was not killing homosexuals. In this sense, AIDS remained a fundamentally gay disease, newsworthy only by virtue of the fact that it sometimes hit people who weren’t gay, exceptions that tended to prove the rule.
This is what all the talk of “GRID” and “gay cancer” had helped accomplish in the early months of 1982; AIDS was a gay disease in the popular imagination, no matter who else got it. It would be viewed as much as a gay phenomenon as a medical phenomenon, even by gays themselves, although they were the last to admit it. And the fact that it was so thoroughly identified as a gay disease by the end of 1982 would have everything to do with how the government, the scientific establishment, health officials, and the gay community itself would deal -- and not deal -- with this plague.
The Tylenol Scare
This is one of the most striking contemporaneous comparisons between how the public weighed health risks during these times.
The discovery of cyanide in Tylenol capsules occurred in those same weeks of October 1982. The existence of the poisoned capsules, all found in the Chicago area, was first reported on October 1. The New York Times wrote a story on the Tylenol scare every day for the entire month of October and produced twenty-three more pieces in the two months after that. Four of the stories appeared on the front page. The poisoning received comparable coverage in media across the country, inspiring an immense government effort. Within days of the discovery of what proved to be the only cyanide-laced capsules, the Food and Drug Administration issued orders removing the drug from store shelves across the country. Federal, state, and local authorities were immediately on hand to coordinate efforts in states thousands of miles from where the tampered boxes appeared. No action was too extreme and no expense too great, they insisted, to save lives.
Investigators poured into Chicago to crack the mystery. More than 100 state, federal, and local agents worked the Illinois end of the case alone, filling twenty-six volumes with 11,500 pages of probe reports. The Food and Drug Administration had more than 1,100 employees testing 1.5 million similar capsules for evidence of poisoning, and chasing down every faint possibility of a victim of the new terror, according to the breathless news reports of the time. Tylenol’s parent company, Johnson & Johnson, estimated spending $100 million in the effort. Within five weeks, the U.S. Department of Health and Human Services issued new regulations on tamper-resistant packaging to avert repetition of such a tragedy.
In the end, the millions of dollars for CDC Tylenol investigations yielded little beyond the probability that some lone crackpot had tampered with a few boxes of the pain reliever. No more cases of poisoning occurred beyond the first handful reported in early October. Yet the crisis showed how the government could spring into action, issue warnings, change regulations, and spend money, lots of money, when they thought the lives of Americans were at stake.
Altogether, seven people died from the cyanide-laced capsules; one other man in Yuba City, California, got sick, but it turned out he was faking it so he could collect damages from Johnson & Johnson.
By comparison, 634 Americans had been stricken with AIDS by October 5, 1982. Of these, 260 were dead. There was no rush to spend money, mobilize public health officials, or issue regulations that might save lives.
The institution that is supposed to be the public’s watchdog, the news media, had gasped a collective yawn over the story of dead and dying homosexuals. In New York City, where half the nation’s AIDS cases resided, The New York Times had written only three stories about the epidemic in 1981 and three more stories in all of 1982. None made the front page. Indeed, one could have lived in New York, or in most of the United States for that matter, and not even have been aware from the daily newspapers that an epidemic was happening, even while government doctors themselves were predicting that the scourge would wipe out the lives of tens of thousands.
It wasn’t just that people didn’t care -- the government and media institutions also didn’t care -- which helped transfer that apathy onto the people. The constant emphasis on homosexuals and the knee-jerk framing of AIDS as a “gay disease” was undoubtedly responsible for this outcome.
Blood Banks
But, of course, gay sex was not the only vector of AIDS transmission. When investigators tracked several AIDS cases to the national blood supply -- overseen largely by private company “blood banks” -- their reaction was stark when compared to the Tylenol scare.
They did not want to believe their industry could be involved in something as horrible as AIDS, so they had simply denied the problem existed. To a large extent, the same thing was happening in the gay community, [Harold] Jaffe knew, but the blood bankers were doctors and scientists of a sort. They were supposed to be rational and most had sworn to uphold the Hippocratic oath.
It didn’t seem to matter. Even after it was proven that AIDS could be and was being transmitted through blood transfusions, the industry did little to prevent it.
The newsletter of the American Association of Blood Banks gave the most telling report on the industry response… “[One facility would not test its blood for the AIDS virus], 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 [Dr. Aaron] Kellner. None of the [blood industry] panel spoke out in favor of anti-core testing for AIDS.”
And even a specially empaneled FDA task force, led by Dr. Dennis Donohue, decided to skirt the issue.
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 [1984] 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 to comment.
Tony Fauci
But perhaps the most surprising part of the story -- especially when viewed through the lens of the COVID epidemic forty years later -- is the role played by Anthony Fauci.
As an AIDS clinician at the National Institutes of Health Hospital, Anthony Fauci was noted for his heroic efforts to save lives early in the epidemic. He had risen rapidly in the NIAID hierarchy and was deemed a major NIH expert on AIDS at the time the infamous JAMA editorial was published [which speculated on ways in which AIDS could spread to the “general” population]. Fauci quickly cast blame on a hysterical media for taking his comments “out of context.” After all, he had said only that the possibility of household transmission might raise all these scientific implications. The lay public did not understand the language of science, he pleaded. Science always dealt with hypotheticals; this did not mean he was saying that AIDS was spread through household contact. Moreover, the chief villain, he would accurately note, was the press office of the American Medical Association, which had so shamefully sensationalized the medical journal articles in an effort to draw attention to a journal that always found itself playing second fiddle to Science and the New England Journal of Medicine.
Fauci has evidently learned nothing in forty years -- as during COVID he was still talking “hypothetical” science to the public, and then blaming the news media when the public misinterpreted what he was saying.
Although maybe we can cut Fauci some slack, since the forces he found himself up against during AIDS and again during COVID are as old as time itself.
In San Francisco, plague met politics. Instead of being confronted by a united authority with intelligent plans for defense, it found divided forces among which the question of its presence became the subject of factional dispute. There was open popular hostility to the work of the sanitarians, and war among the City, State and Federal Health authorities. … For a while the people were in the gravest danger and it seemed impossible to convey any adequate warnings to them.
That’s from a report from a Citizens’ Health Committee on Eradicating Bubonic Plague from San Francisco in 1907. Not believing what the authorities tell you, and washing all your thoughts and actions first through your factional allegiance and then your rational brain seems hardwired into the human animal.
Still, Fauci seems both phenomenally smart and phenomenally bad at this.
Several months later, this was followed by the announcement that Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, would become the associate NIH director for AIDS. It was not clear what difference the new title would make. Fauci remained NIAID director, a full-time job in itself, considering that the agency was supposed to administer, monitor, and plan for $310 million in AIDS studies alone in the next fiscal year. Fauci also continued to do immunological research at the NIH hospital. The piling up of responsibilities was in keeping with an NIH management mentality that seems to hold that billion-dollar AIDS programs should be run like a mom-and-pop store, with Dad stocking the shelves, running the cash register, and doing the books at night.
Not surprisingly, NIH management problems persisted, adding horrendous delays to even the simplest AIDS research projects. One planned CDC study on the effect of AZT on healthy people infected with the AIDS virus, for example, was delayed five months while the NIH bitterly fought for control of the research, insisting the NIH, not the CDC, should conduct the study. When the NIH won the turf battle, it refused to use the already prepared CDC protocol, and so the study waited two more months while a near-identical protocol was written by an NIH doctor. It took four months to find placebo tablets that looked like AZT; apparently, nobody had thought of this detail before it could delay the study. And then recruiting actual study subjects was delayed many months more while each hospital participating in the study submitted the protocol to their institutional review boards, some of which met only once every few months. A year and three months after the CDC had been ready to launch the study, fewer than one-half the study subjects had been enrolled in the NIH program. And this study, which might determine whether AZT could halt the almost-certain progression from HIV seropositivity to AIDS, was, everyone agreed, the most important piece of AIDS clinical research in the United States. Even more frightful stories accompanied attempts to move other drugs into clinical trials. When pressed, however, NIH officials, particularly Dr. Fauci, insisted that there were no internal problems. The NIH had all the staff and money it needed, he said, to conduct its research, which must be done in a manner that was ‘scientifically responsible.’
Science, at least Dr. Fauci’s version of it, is not only never answerable to the people paying for it, it is also largely indecipherable. Because, of course, the story gets worse.
The issue exploded into a major embarrassment just weeks before the Stockholm conference, when U.S. Representative Ted Weiss called Fauci and other officials from the NIH and FDA to his oversight subcommittee, the site of so many revealed AIDS hearings in the early 1980s. Weiss put Fauci under oath, and only then did the truth about the NIH management problems come out. Under sharp questioning, Fauci admitted that the problems in getting aerosolized pentamidine into testing stemmed “almost exclusively” from the lack of staff at the NIH. In fact, under further interrogation, it turned out that Fauci had requested 127 staff positions to handle AIDS treatment protocols at the NIAID; the administration had granted him only 11 employees. When pressed by U.S. Representative Nancy Pelosi, the freshman legislator who had been elected to the seat of the late Representative Sala Burton of San Francisco, Fauci admitted that if he were ailing he would seek out aerosolized pentamidine himself, even if it meant he had to get it “in the street.”
The admission that the administration was still nickel-and-diming the NIH was damning enough. Even worse was the fact that it was Fauci who had spent much of the past year assuring reporters that the only barriers to AIDS treatments were unavoidable delays that were all in the interest of ‘responsible science.’ It was now clear that Fauci had spent much of the past year not telling the truth. What stunned congressmen even more was that the only way to get the NIH’s top-ranking AIDS official to admit the staffing shortfalls publicly was to put him under oath and, in effect, threaten him with penalty of perjury. It brought back all the murky memories of the deceitful health officials streaming to Congressional committees in 1982 and 1983 to insist that ‘government scientists have all the funds they need … no stone is being left unturned.’ Government scientists, it seemed, still were less interested in protecting the public health than in saying what the Reagan administration wanted them to say, even if it meant that thousands would die as a result.
A remarkable history … and a disturbing track record. It is exactly this kind of political shenanigans that inspired the title of Shilts’s book.
What remained most noteworthy about AIDS in America during 1987 and 1988 was how, in Congress, in the White House, at the National Institutes of Health, and in the media, very little had fundamentally changed. The band still played on.
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This post first appeared on Eric Lanke's blog, an association executive and author. You can contact him at eric.lanke@gmail.com.
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