And the Band Played On: Politics, People, and the AIDS Epidemic, 20th-Anniversary Edition (66 page)

The day that Morgan MacDonald died, Gary Walsh was walking across Union Street, his favorite sixties songs running through his head from the soundtrack of the new movie he had just seen,
The Big Chill.
Suddenly, he felt dizzy. He waved his cane for a cab. The next thing he remembered was being put in an ambulance, telling somebody, “I’ve got AIDS. Take me to Franklin Hospital.”

Gary was convinced he was dying. If he wasn’t now, he wasn’t sure how much longer he wanted to continue his posthumous existence. He had been thinking about it for a week anyway. In little ways, he had begun tying up the loose ends of his life. By the time Lu Chaikin and Matt Krieger visited him that evening, he had talked to a doctor friend about his plans. Reluctantly, the physician told Gary he’d give him whatever he needed.

The next day, Gary called Matt and said he planned to commit suicide if he recovered. Weeks earlier, Matt and Gary had had a bitter confrontation on the issue, because Matt bitterly opposed suicide. Knowing Matt’s moral qualms about suicide, Gary was surprised when Matt simply said, “I support and respect your decision.”

“Really?” Gary asked.

“You’ve been enormously brave and courageous for so long,” Matt said. “You’ve been determined. Even your going to the movie alone yesterday was brave. I admire you and love you very much.”

They talked about Gary’s fears.

“That the Catholics are right,” Gary said. “That I’ll go to hell for taking my life. And that it won’t work.”

A few days later, the doctor put Gary on morphine. With his pain at a tolerable level, Gary retreated from his plan for suicide. He told Matt he was glad to have considered the issue and would now hold it open as “an option” if the pain returned.

On October 31, 1983, the Centers for Disease Control counted 2,640 AIDS cases in the country, of which 1,092 were dead. Of these, 1,042 were from New York City and 320 were from the San Francisco Bay Area. As the disease began spreading more thoroughly across the country, the geographical focus of the disease began to shift. In October 1982, about three-fourths of the nation’s AIDS caseload had lived in one of the four cities hardest hit by the epidemic: New York, San Francisco, Los Angeles, and Miami. By now, however, fewer than two-thirds of the people with AIDS lived in these cities.

Gary Walsh lay awake in his bed when she appeared to him, with long white hair and outstretched arms. Gary recognized the woman as the mother of a good friend; she had died just a few months ago. She was stunningly beautiful and beamed a spectacular smile as she assured him, “Don’t worry, honey. I’ll help you over that line. And it ain’t bad at all here.”

November 4, 1983

S
AN
F
RANCISCO
P
RESS
C
LUB

The press club had recruited Bill Kurtis, co-anchor of the “CBS Morning News,” to deliver the keynote address for the group’s annual awards dinner. As keynote speakers are wont to do, Kurtis opened his talk to the assembly of journalists with a little joke.

“I was in Nebraska yesterday and when I said I was going to San Francisco, people started talking about AIDS,” Kurtis said, smiling. “Somebody said, ‘What’s the hardest part about having AIDS?’”

Kurtis paused for his punch line: “It’s trying to convince your wife you’re Haitian.”

An uncomfortable laugh skimmed the surface of the crowd. Most people did not think it was funny. Several reporters nodded knowingly to each other, as if to say, “This is what you can expect from somebody who lives in New York.”

Kurtis clearly had misjudged his audience. Nevertheless, the joke reflected the dormant feeling among national news organizations, all of which were headquartered in Manhattan. AIDS remained something of a dirty little joke. Moreover, it was something you could josh about in crowds of reporters because you could safely assume that the disease had not touched the lives of the people who wrote the news and scripted the nightly newscasts. Homosexual reporters, particularly in New York, tended to know their place and keep their mouths shut, if they wanted to survive in the news business.

Newspapers like
The New York Times
and
Washington Post
solemnly insisted that they did not discriminate against an employee on the basis of sexual orientation. In practice, however, such papers never hired employees who would openly say they were gay, and homosexual reporters at such papers privately maintained that their careers would be stalled if not destroyed once their sexuality became known. Gays were tolerated as drama critics and food reviewers, but the hard-news sections of the paper had a difficult time acclimating to women as reporters, much less inverts. Few in the business ever talked about this. American journalism was always better at defining others’ foible than its own.

In New York, editors complained that nothing new was happening with the epidemic. Indeed, the more obvious breaking angles—such as the discovery of an accepted cause or a breakthrough in treatment—had not yet happened. Still, the numbers of new cases were rising exponentially, and even a modicum of investigatory journalism revealed a trove of flashy new angles for news stories.

The
San Francisco Chronicle
struck pay dirt in late November when a Freedom of Information Act request unearthed hundreds of pages of internal memoranda revealing the serious funding shortages at the Centers for Disease Control. The duplicity of many of the nation’s top health officials was also apparent by comparisons of the newly released memoranda and conflicting congressional testimony offered on virtually the same days. In Washington, administration officials braced for a torrent of journalistic investigations after the front-page
Chronicle
stories, but nothing happened. To other news organizations, AIDS was a science story or a human interest story, but for years to come, AIDS would not be a story to which standard journalistic techniques applied. Thus, the federal government did not have to fret that news hounds would dog their AIDS efforts. It wasn’t going to happen.

News coverage and the lack of it left a profound mark on local public policy. When the Institute for Health Policy Studies at the University of California in San Francisco later analyzed the differences between the municipal responses to AIDS in New York City and San Francisco, it concluded that the disparate quality rested in part on the vast difference in news coverage by the two cities’ major newspapers. Between June 1982 and June 1985,
the San Francisco Chronicle
printed 442 staff-written AIDS stories, of which 67 made the front page. In the same period,
The New York Times
ran 226 stories, only 7 of which were on page one. From mid-1983 on, the coverage of the
Chronicle
focused on public policy aspects of the epidemic, while the
Times
covered AIDS almost exclusively as a medical event, with little emphasis on social impact or policy. The study concluded, “The extensive nature of coverage by the
Chronicle,
aside from providing a degree of health education not found in New York, helped sustain a level of political pressure on local government and health officials to respond to the AIDS crisis.”

Nationally, the problem was not so much in what the press covered as in what they did not print. Indeed, throughout the epidemic, well-intentioned journalists went out of their way to calm hysteria. Particularly since the “routine household contact” fiasco, virtually every news story stressed that AIDS was not casually infectious and that it posed no threat to “the general population.” In the soul-searching that came later, journalism reviews criticized news organizations for not discussing the specific sexual practices that spread AIDS, most notably anal intercourse. This was a proper criticism, but it was a minor one. The fact that it was the only major self-criticism by the news business was a measure of the epidemic’s continued trivialization, even after AIDS was a major national news story.

It wasn’t that the news organizations weren’t thinking about AIDS during this time. Everybody talked about it; everybody joked about it. Planning for coverage of the 1984 Democratic National Convention in San Francisco created unusual concerns for sophisticated Manhattanites journeying to what they considered the AIDS capital. NBC News, for example, queried local caterers as to whether homosexuals would be serving food if hired to cater the NBC news staff. NBC wanted assurances that their staff would not be served by gays, it turned out, because they were afraid of getting AIDS.

N
ATIONAL
C
ANCER
I
NSTITUTE
,
B
ETHESDA

The laboratory of Tumor Cell Biology fills the B corridor of the sixth floor of red-brick Building 31 at the National Cancer Institute. The cinder block walls are painted a cheerful yellow; the sound of centrifuges echoes behind gray doors sealed with double air locks to keep the labs’ deadly retroviruses from escaping. For six months, B corridor was headquarters for the nation’s laboratory war against AIDS, and the man in office 6B03 was Dr. Robert Gallo, its commander.

In September, the Pasteur Institute had sent to Gallo isolates of its LAV to help establish their case that LAV was not a relative of HTLV-I but a distinct virus. The chronology of this virus’ arrival in Bethesda would later prove very important.

Shortly after receiving the virus, Dr. Gallo had started forging major breakthroughs in his AIDS research. For more than a year, Gallo’s progress had stumbled on one key point. His laboratory staff could not grow whatever virus was causing AIDS. It kept killing his cell lines. Gallo was sure some kind of retrovirus was at work. For months, he had detected reverse transcriptase activity, but that didn’t do him much good when he needed to isolate the specific virus, sustain the microbe’s growth, and establish that this was the cause of AIDS. Gallo had a nagging fear that the retrovirus he was seeing was simply another opportunistic infection. Without isolates of a specific virus, there was no way to resolve this question.

Gallo also was getting impatient. In the fall, he had confided to an AIDS writer from the gay paper the
Advocate
that if his HTLV studies did not prove fruitful soon, he would shift his research to other diseases and more promising fields. By November, however, his doubts had passed. Although Gallo told few colleagues, he believed he had now isolated the virus that caused AIDS.

Meanwhile, rivalry continually dogged AIDS research at the National Institutes of Health. Robert Gallo’s temper had earned him many enemies within the NIH. Some NIH doctors wouldn’t allow their lab techs to deliver tissue samples to Gallo, so Dr. Sam Broder, who was working with AIDS patients at the NIH hospital, took to walking specimens from patients to Building 31 himself.

Sniping also continued between the National Cancer Institute and the National Institute for Allergy and Infectious Diseases. The strangest twist came in late October when Dr. Ken Sell and other NIAID researchers announced that they had discovered a fungus they believed might cause the syndrome. The fungus, they said, mimicked the immune suppression caused by drugs used to artificially slow immune response. NCI doctors believed that the announcement by Sell, who had served as AIDS coordinator for NIAID, was made to embarrass Gallo and detract from his retroviral theories. Researchers at the Centers for Disease Control thought the fungal theory bordered on witchcraft. Few suspected that the announcement was anything other than the continuation of the NIAID-NCI feud over which institute should have primacy in AIDS research.

Scientists outside the NIH expressed more open skepticism about the HTLV-I hypothesis. In no study had HTLV been found in more than 25 percent of AIDS patients. These isolates tended to come from Haitians who hailed from a region where the leukemia virus is endemic anyway. Harvard’s Dr. Max Essex, the leading proponent of HTLV-I, argued that the HTLV-I antibody tests might not be sensitive enough, but this convinced few scientists. By October, Dr. Paul Black of Boston University School of Medicine warned in the
New England Journal of Medicine
that HTLV-I had been “overplayed to the point where I worry that it will diminish interest in other viruses…. I think it’s getting an overwhelming emphasis. There’s a lot of hype associated with it.” In backing his “serious doubts” about HTLV-I, Black noted that HTLV “immortalized” cells, allowing them to propagate madly, while the AIDS virus had the opposite effect and was killing lymphocytes.

Research in other government laboratories continued to bog down because of the lack of resources. Dr. Bill Blattner, division director of the NCI Environmental Epidemiology Branch, where NCI AIDS research began in June 1981, continued to pilfer from other research projects to support his AIDS studies. Although money now existed for AIDS research, a hiring freeze had aborted Blattner’s attempts to add scientists to his staff. Even worse, Blattner was unable, because of the freeze, to replace researchers when they left his division. At times, when he heard NIH officials tell Congress that AIDS researchers had all the money they needed, he wondered whom the officials were talking to. They obviously weren’t talking much to the researchers.

At the Centers for Disease Control, laboratory work stalled because Dr. Gallo had made good on his threat to deny HTLV reagents to Dr. V. S. Kalyanaraman as punishment for leaving the NCI. Dr. Kaly was left to start his retrovirus lab from scratch and hunt down people who were infected with HTLV-I and HTLV-II so he could culture the retrovirus and antibodies himself. Don Francis opened all his lab reports at every weekly meeting of the CDC AIDS researchers in Atlanta with an enumeration of the problems caused by lack of space, lack of staffing, and lack of money. Money had started to trickle in from the various congressional funding initiatives, but, as was always the case in AIDS studies, it tended to come a day late and a buck short.

When the
San Francisco Chronicle
pressed Dr. James Curran for an assessment of funding needs in the wake of the Freedom of Information Act disclosures, Curran conceded that problems had troubled the early efforts of the AIDS Task Force at CDC but that everything was fine now. “This is cursing the darkness after the candles have been lit,” said Curran. “You can’t single out the government; everybody was late in picking up on how serious this was. The media wasn’t around two years ago and neither were the congressmen who are talking so much now.”

At both the NIH and CDC, anxiety grew more profound. In early 1983, virtually everyone had expected that the AIDS virus would have been found by then.

In Paris, over six months before, scientists had published articles on the virus that caused AIDS, but few were paying much attention to them. With characteristic French understatement, Pasteur Institute researchers recalled the fall of 1983 as the time of “the long walk across the desert.”

The Pasteur scientists were convinced they had accumulated enough evidence to decisively demonstrate that they had isolated the virus behind the epidemic. They had cultured virus or detected LAV antibodies in all ten lymphadenopathy patients on whom they had performed blood work, and they were working on a standardized test to detect LAV antibodies for use in blood banks. They had sent the virus to both the CDC and the Max-von-Pettenkofer Institute in Munich for inoculation in chimpanzees. Exhaustive immunological work determined that the virus selectively targeted the T-4 lymphocytes, the very cells that disappeared in AIDS victims, setting the stage for the final collapse of the immune system. Trials of the antiviral drug HPA-23 were under way among sixty French AIDS patients to determine the toxicity of the drug.