And the Band Played On: Politics, People, and the AIDS Epidemic, 20th-Anniversary Edition (59 page)

On July 8, the first Australian death from AIDS was recorded at Prince Henry Hospital in Melbourne. The forty-three-year-old man, who had been living in the United States, had fallen ill on a visit home in April, doctors said. Authorities had by now confirmed four other AIDS cases in Australia and were investigating fifteen more. All twenty men reported having sex with American men in recent years.

The death engendered the first wave of AIDS hysteria on that continent. In Sydney, hospital lab workers discussed whether they should seek a ban on blood analysis of reported AIDS cases, fearing that they would contract the disease at work. One conservative religious group proposed closing all the nation’s gay bars and quarantining all gay men returning from the United States. The
Medical Journal of Australia
commented, “Perhaps we’ve needed a situation like this to show us what we have known all along—depravity kills.”

The same day the first Australian died, health authorities in Cape Town announced that five gay men in South Africa were suffering from AIDS. With 160 cases diagnosed in western Europe, socialist leaders in the European Parliament called on health authorities to ban the importation of all U.S. blood products. In France, authorities followed the American lead and began screening blood bank donors for their sexual and drug-use histories. The increase of cases in Europe prompted the World Health Organization to call an international meeting on the epidemic for November.

In San Francisco, Dr. Selma Dritz announced that AIDS was now the leading cause of death among single men in their thirties and forties. Analysis of AIDS cases further indicated that they were moving from a concentration in the Castro neighborhood to a broader cross-section of gay men living throughout San Francisco.

July 17

M
IAMI

It was true of the AIDS epidemic that whenever a new discovery occurred, marking a moment things might turn more hopeful or more dark, the new turn almost always was dark, and far darker than anyone suspected.

Worst-case scenarios had so often compounded worst-case scenarios that Dr. Dale Lawrence of the Centers for Disease Control was not shocked when he went to Miami to investigate what appeared to be the first incidence of AIDS in the wife of a hemophiliac AIDS sufferer.

The seventy-year-old woman was breathless, having just recovered from her first bout with
Pneumocystis carinii
pneumonia. Her husband had died just two months ago of
Pneumocystis.
Dale quizzed her on every possible risk factor. Had they peeled vegetables together? Was there possible rectal bleeding in the shared toilet? Did the couple use the same toothbrush? There was only one risk behavior, she said, and it was far more obvious. Because the pair rarely had intercourse, Dale could estimate when the wife was infected. From the dead man’s medical records, Dale soon realized that the husband had been infected with the virus long before his elderly wife. However, both became sick at virtually the same time.

The disease’s incubation period could be either very long or very short, depending on the victim’s own constitution. Moreover, the average incubation period for the disease could run four years, Lawrence now figured, far longer than the six months to two years that most researchers speculated.

Lawrence had spent the past year studying AIDS among hemophiliacs and blood transfusion recipients. He had long worried about what might happen to the wives and sexual partners of hemophiliacs, but the CDC, still starved for resources, had not devoted any research to this subject.

As the implications of these two AIDS cases in Miami took shape, Lawrence began to sense that the AIDS epidemic was unfolding in separate waves, or more precisely, like different marathons begun at differing times. The first race was run by gay men with AIDS. Another race, run by the recipients of blood products, had started much later, but its first runners had made it over the finish line in 1982, not much behind the runners of the first race. The hemophiliac’s wife who had moved from infection to disease so rapidly was like the runner of still another marathon, making it across the finish line with her husband, even though he had started much earlier than she. She simply needed less time to complete the course. The first cases in this or that remote state, and this or that country, were merely the leading edge of the first race, and the “winners” of the second race would be arriving soon, even though they were not yet visible. The bulk of the runners had yet to come within sight of the race’s end.

Standing at the finish line, the CDC was only clocking the arrival times. With the blood cases, where an infection date could be objectively ascertained by transfusion records, the CDC saw only the average times of the swiftest runners, who came down with AIDS two, four, or six months after their transfusion. The people who already had withstood two, three, or four years of incubation were yet to come.

Back in Atlanta, Dale Lawrence noted in his back issues of
Lancet
a study that had been conducted in San Francisco on the infection rate of gastrointestinal parasites among gay men. The study included a chart marking the steep curve of parasitic infection through the late 1970s and early 1980s. They were the very curves that had worried Selma Dritz years before, when she fretted about what would happen if some new infectious agent got loose in this population. Lawrence charted the numbers of AIDS cases in San Francisco and compared this curve to the
Lancet
curve on parasitic infections. They were virtually identical—but about five years apart. The slope of AIDS, of course, had just begun. Given the incubation period he now predicted, Lawrence had no doubts that AIDS would increase as dramatically as the parasite pandemic.

Meanwhile, as the Centers for Disease Control continued to struggle against a blood banking industry that preferred not to believe in the existence of transfusion-associated AIDS, a pharmaceutical company was licensed to start manufacturing heat-treated Factor VIII. The product was introduced to end the threat of hepatitis transmission from the clotting factor, and the CDC doctors figured that the heat used to sterilize the product also would kill the viral agent that they assumed was the cause of AIDS. However, the pharmaceutical company planned to price the heat-treated Factor VIII at double the cost of the traditional injections. A year’s worth of treatment for this sterilized material, therefore, would cost the typical hemophiliac between $16,000 and $24,000, according to the estimates of CDC hemophilia expert Dr. Bruce Evatt. Few hemophiliacs could afford the more expensive treatment. Evatt considered the heat-treated material to be outrageously priced but could not argue for greater availability of the formula on the grounds of AIDS prevention. The CDC had not yet definitively proved the existence of an AIDS virus, much less isolated the microbe responsible for the plague. The agency was in no position to make demands of major corporations.

Within the federal government or the public health establishment, the CDC found little support for its concern about the integrity of the nation’s blood supply. The administration’s top health officials, most notably Health and Human Services Secretary Margaret Heckler and Assistant Secretary for Health Dr. Edward Brandt, toed the blood banks’ line that there was minimal if any chance of contracting the disease through blood.

“I want to assure the American people that the blood supply is 100 percent safe,” said Secretary Heckler in early July, when she went to the Washington, D.C., Red Cross office to donate blood. As a model citizen, Heckler spent half an hour filling out the medical form for the self-deferral program, to demonstrate the effectiveness of donor deferral. “The blood supply is safe both for the hemophiliac who requires large transfusions and for the average citizen who might need it for surgery,” Heckler said at a Red Cross press conference.

Like blood banks across the country, the Washington facility had suffered a dramatic drop in donations during the preceding weeks of intense publicity over AIDS. In June, donations fell by 16 percent; in July, the level of donations in many blood centers was off 30 percent from the previous year. Spot shortages of blood occurred in urban areas. Controversy raged about consumers across the country who clamored for “designated” donor programs in which persons looking ahead to surgery would have friends and relatives donate blood specifically for their use. All the major blood banking organizations urged their members not to permit directed donations, fearing that the designated donor route would cause havoc in the blood industry.

“We want to help curb the panic,” said Dr. Herbert Perkins, medical director of San Francisco’s Irwin Memorial Blood Bank, when he announced that his center would ban designated donors. “The risk of getting AIDS from a transfusion is about one in a million.”

With the best of intentions, the establishment rallied to support the blood banks; after all, you couldn’t let hysteria undermine an institution that, undeniably, was a cornerstone of American medicine. Local public health officials demonstrated their interest by minimizing the threat of transfusion AIDS. In Los Angeles, for example, the announcement that three infants had died of AIDS probably contracted through transfusions brought heated denials from hysteria-wary local officials. “Unless you can find a direct link between a person with AIDS who exposed the infant in some way, it is difficult to call it AIDS,” said Dr. Shirley Fanin, associate deputy county health director. Fanin said the cases probably stemmed from congenital immune defects. The doctors argued that the immune profiles were those of AIDS patients, not the victims of genetic immune problems, but to little avail.

In Washington, Secretary Heckler and Assistant Secretary Brandt delivered familiar reassurances at another news conference to counter fear over the Los Angeles cases. “I think it is very important that the public have confidence in the safety of our blood supply,” said Heckler. Even if the cases did turn out to be AIDS, Brandt said, the problem was that the transfusions were given before the donor-deferral guidelines were established. “We think the guidelines will help considerably” to reduce risk, he said.

As was so often the case, the media became an integral part of the story. Seeing themselves as the bastions of common sense, science writers and reporters covering the epidemic also wrote curb-the-panic stories and avoided asking the blood bankers tough questions. Although there was ample evidence that gay men were sexually transmitting the disease to each other long before they showed any overt symptoms, the media accepted the blood bankers’ assertion that transfusion AIDS could only be proved when a diagnosed AIDS case had given blood to a person later diagnosed with the disease. This is why
only
those people showing overt symptoms of the disease were disallowed from donating blood under the deferral guidelines, which remained the only protection Americans had against transfusion AIDS.

Rancor grew between blood banks and CDC researchers, who continued to insist that the banks needed to test the blood itself for signs of past hepatitis infection, and that deferral guidelines needed to be much broader. By summer, Dr. Harry Haverkos, who was organizing all the transfusion cases into a formal report on the AIDS danger, found blood bankers were becoming openly hostile to the agency. He now had documented ten transfusion cases. With the third case, he was convinced of the danger and was astounded that the Food and Drug Administration remained so skeptical of the CDC’s conclusions. To the disbelieving blood bankers, he finally asked in exasperation, “Tell us a number you need. If we have 20, 40, 100 cases—will you believe it then?”

At Stanford University Hospital Blood Bank, Dr. Ed Engleman was less convinced than most of his colleagues that donor-deferral guidelines were effective. The Stanford blood bank remained one of the few blood centers in the country to screen blood. One in fifty donations was being discarded because of immune irregularities. In July 1983, one donor imparted his “gift of life” at a bloodmobile visiting his work site. The blood, however, was discarded after Stanford tests measured the ratio of T-helper to T-suppressor lymphocytes to be .29 to 1, far below the average ratio of 2 to 1. The ratio was either the result of a botched test or severe immune problems. As was routine, the blood bank asked the donor, a thirty-nine-year-old male, to return to the blood bank for a battery of follow-up tests.