And the Band Played On: Politics, People, and the AIDS Epidemic, 20th-Anniversary Edition (100 page)

The various American controversies over AIDS education and antibody testing continued through the spring. As the international AIDS conference approached, pressure mounted on the Reagan administration. Though Reagan had at last uttered the word AIDS, he still had not given an address on the six-year-old epidemic. By now, his silence was thunderous. Even the hard-bitten White House press corps, which had never considered AIDS a serious issue, clamored for quotes. In his barnstorming for greater AIDS awareness, Dr. Koop met ever more frequently with embarrassing questions about why President Reagan refused to meet with him.

By the beginning of May, public attention forced the Senate, which had been far less active on AIDS issues than the House of Representatives, to pass unanimously a resolution calling on Reagan to appoint a national AIDS commission. The resolution, drafted by Senate Republican leader Senator Robert Dole, drew a remarkable array of Republican and Democratic co-sponsors.

Conservatives were no less anxious for Reagan to take a stand. Education Secretary William Bennett, a leading spokesman for conservatives on AIDS issues, was strident in his calls for mandatory testing and increasingly vocal in his criticism of Koop. Conservative opinion leaders and newspaper columnists joined the chorus; some called for Koop’s resignation. Increasingly, all sides wanted to know where the president stood on AIDS.

As the AIDS conference approached, Reagan announced he would accede to the Senate’s wishes and appoint an eleven-member presidential commission to advise him on the epidemic, and he would address an AIDS fund-raising dinner on the eve of the conference. By late May, it became clear that this would be more than just another scientific gathering. Here, at the hub of power in the United States, the science, the politics and the people of the AIDS epidemic would come together; these days would be remembered as the prologue to the future course of AIDS in America. The week would be one of those rare times when the past, the present and future converged. And everybody seemed to understand that as they trekked to their Washington hotel rooms on that cloudy, muggy Sunday afternoon.

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Just a few days from now would mark the sixth anniversary of the publication of Michael Gottlieb’s article on the mysterious cases of
Pneumocystis carinii
pneumonia in five Los Angeles gay men. Six years ago, Gottlieb had been an eager young immunologist in his first months at UCLA. Now, he was co-chair of a foundation hosting a dinner at which the President and First Lady were guests of honor. On Gottlieb’s arm was a famous movie star, and senators and congressmen crowded the restaurant, enjoying cocktails and hors d’oeuvres. AIDS had become so respectable, Gottlieb could scarcely believe it.

Gottlieb knew that much of the success of both the evening and the foundation was the work of his escort, actress Elizabeth Taylor. Taylor’s interest in AIDS had been building before it became a fashionable Hollywood cause, back when Gottlieb was discussing his plans for a national AIDS fund-raising group with Dr. Mathilde Krim of the AIDS Medical Foundation in New York City. In the last months of his life, Gottlieb’s most famous patient, Rock Hudson, had launched the American Foundation for AIDS Research, or AmFAR, with a $250,000 contribution, and Taylor agreed to become the group’s national chair, giving the epidemic the star quality it had long lacked.

As Gottlieb walked with Taylor through the restaurant, many people at the dinner whispered to each other about the circumstances of Gottlieb’s recent departure from UCLA. Even though Gottlieb’s expertise as one of the world’s leading AIDS clinicians had helped secure a $10.2 million federal grant for the institution, he remained something of a persona non grata in Westwood. Yes, he was one of the most published and celebrated researchers at UCLA, but that did little more than inspire jealousy among senior academicians who had never considered AIDS to be legitimate research. If he were truly dedicated to research, they reasoned, why was he running around with movie stars, raising money and indulging in the tainted world of politics?

Gottlieb understood, of course, that much of his colleagues’ antipathy dated back to 1983, when he and Dr. Marcus Conant had gone over the heads of University of California administrators to secure an emergency legislative appropriation for AIDS research. Conant had suffered a similar academic exile at UCSF and had largely limited his recent AIDS activities to his private practice. By early 1987, Gottlieb realized the breach of academic politics had destroyed his university career as well. In just six months, Gottlieb, who remained a mere assistant professor, was turned down for tenure three times. There was also talk that the envious academicians thwarting his tenure would also effectively blackball any move he might try to make to any other university research center. Gottlieb couldn’t help but recall a conversation he had had with Marc Conant in April 1982, after they had appeared at the first congressional hearing on AIDS to plead for more funding and more concern. At that time, the pair thought that once people realized how serious the threat was, they would be cast as villains for not being more strident in their warnings. Now, both Gottlieb and Conant found themselves undone, not because people believed they hadn’t cared enough, but because they cared too much. A few weeks before the conference, Gottlieb left his position at UCLA and opened a private practice of immunology in Santa Monica.

The night’s main event was scheduled before dinner, outside, in a huge tent that had been properly secured by Secret Service agents for President Reagan’s speech. As people filtered from the restaurant to the tent, their master of ceremonies was on hand to greet them. Easily recognizable by his shock of silver hair, Dr. Mervyn Silverman, former director of the San Francisco Department of Public Health, was now the president of AmFAR. Of all the early AIDS figures who had left an ambiguous legacy, it was Silverman who had taken the most redeeming course in recent years.

After his resignation as health director, he had quickly been tapped by a number of national medical groups to articulate the public health perspective on AIDS issues. During the LaRouche AIDS initiative in California, which called for mandatory AIDS testing, his mediagenic demeanor provided anti-hysteric forces with their most reasoned spokesman. As antibody testing emerged as a potent and divisive issue around the nation in 1987, it was Silverman who patiently explained the public health point of view. In the previous days, he had worked with Reagan speech writers on early drafts of that night’s presidential address. It was a long way from painful meetings with sexual liberationists who worried that the city’s safe-sex warnings sounded too “anti-sexual.” Silverman had been a man of good intentions when AIDS policy was determined by the people of good intentions. Though he had sometimes bumbled, he was also a visible reminder in these less hospitable times that the people of good intentions would ultimately do far less harm to the cause of public health than the people of bad intentions.

While Dr. Silverman greeted colleagues and chatted with movie stars at the front of the tent, Dr. Paul Volberding took a seat near the back, away from the crowd. The first heat of the summer reminded him of the epidemic’s first appearance. For Volberding, that day had been July 1, 1981, his first day on the job at San Francisco General Hospital, when the man whom he was replacing had pointed into an examining room and said, “There’s the next great disease waiting for you.” It had been an uncannily prescient introduction to Volberding’s first Kaposi’s sarcoma patient; his subsequent six years of AIDS research had made him one of the world’s leading AIDS clinicians. Today, he had suffered a typically hectic schedule, awaking early for an appearance on “Meet the Press.” He also had been chosen as one of nine members on a committee organizing an International AIDS Society. A week of speeches, meetings, and interviews lay ahead. In a few days, he would announce that San Francisco had been chosen as site of the 1990 international AIDS conference.

The band struck the fanfare from “Hail to the Chief,” and everybody rose as the president and Mrs. Reagan walked into the tent.

As Silverman gave his opening remarks, Volberding marveled at how far the epidemic had come—to the forefront of American life. Where would it go in another six years? Volberding couldn’t comprehend what it would be like. He certainly understood the projections of cases, and he had some grasp of what it would mean for his hospital and his clinic. But he truly couldn’t comprehend what it meant in a larger sense—what it meant for the nation, for the world, for history. He was too involved to allow himself to get frightened; yet, he knew that if he weren’t so involved, he would be very frightened.

The crowd cheered loudly, even pointedly, and stood when Elizabeth Taylor presented a special award to the surgeon general. After Koop delivered his brief remarks, glancing toward the president when he endorsed “voluntary” testing with guarantees of confidentiality and nondiscrimination, Dr. Silverman introduced Dr. Gottlieb, who was about to hand out the first of two scientific awards for AIDS research.

A restrained but courteous applause greeted Dr. Robert Gallo when he walked to the podium to accept his award from Gottlieb. Gallo, of course, gave a nod to the French for their contributions to AIDS research and talked about how international cooperation was necessary among scientists to overcome the epidemic. In the tent, however, significant glances darted quickly among the gathered scientists. The events of the past two years of bitter feuding between French and American scientists was hardly a tribute to international cooperation.

The Pasteur Institute’s lawsuit against the National Cancer Institute, filed in late 1985, had threatened to bring their ugly dispute to trial in federal court. Though the suit asked only for a share of the royalties that the NCI had accrued from its AIDS blood test patent, the scientific community understood that the French were really suing for the full recognition that had been denied them. To be sure, the Rock Hudson affair had brought worldwide attention to the Pasteur Institute’s work in AIDS treatments. And the Pasteur continued to produce world-class AIDS research, most notably with the discovery of a second AIDS-like virus in late 1986. But they still felt they had been robbed of recognition for their most important achievement, the discovery of the elusive AIDS virus.

The United States government, which had so brazenly transformed Gallo’s work into political capital for the Reagan administration, tenaciously held on to the myth that Gallo had discovered the AIDS virus. This meant adhering to Gallo’s notion that the virus was a relative of the HTLV family that Gallo also had discovered, and that he had the right to name the virus, as viral discoverers always do. Ultimately, it had, taken an international committee to rule that, no, this was not a leukemia virus and, no, Dr. Gallo did not have the right to name it. To smooth ruffled feathers, however, the committee arrived at a compromise name: Human Immunodeficiency Virus, or HIV.

Throughout 1986, however, the Pasteur pursued its depositions and Freedom of Information Act requests against the National Cancer Institute. It slowly became obvious to even the most obdurate government lawyers that the lawsuit could prove very embarrassing for the United States government. A pithy memorandum from Dr. Don Francis on the potentials of such a suit warned the administration, “If this litigation gets into open court, all of the less-than-admirable aspects will become public and, I think, hurt science and the Public Health Service. The French clearly found the cause of AIDS first and Dr. Gallo clearly tried to upstage them one year later.” On the most central issue of whether HTLV-III was the product of viral pilfering, Francis posed the hypothetical question: Could the prototype isolates of HTLV-III and LAV be identical merely by coincidence? And he answered, “Probably not.” However, two years later, at the request of Dr. Gallo, Francis wrote to Gallo, “I do not now, nor ever have, supported the claim that you or anyone in your laboratory ‘stole’ LAV.”