And the Band Played On: Politics, People, and the AIDS Epidemic, 20th-Anniversary Edition (82 page)

Of even more concern was new data on gay sexual behavior generated by the first professionally designed random survey of San Francisco homosexuals. The study, undertaken by Research & Decisions, a prestigious marketing firm, found that 12 percent of local gay men had gone to a private sex club at some point during the month of August. During the same period, 1 in 10 gay men had gone to a bathhouse. The fact that so many gay men continued attending the facilities, despite the unprecedented publicity about their dangers, argued against the notion that baths would close for lack of business if gays were educated about AIDS.

Pressure mounted on Silverman not only from political quarters but from medical authorities alarmed at the steep increase of local AIDS cases. At one hospital, sixty doctors signed an open letter to Mayor Feinstein in the
Chronicle,
demanding closure and saying that “there is a strong need for aggressive public policy measures that do not capitulate to any political pressure.” On September 14, Silverman met with Mayor Feinstein, hospital administrators, and Jim Curran from the CDC to privately announce that he would close the baths as soon as the private investigators’ reports were complete.

During the third week of September 1984, America’s AIDS caseload surpassed 6,000. Treatment costs for these first patients, the CDC estimated that week, would run at about $1 billion.

A
TLANTA

The car swerved, jolting Don Francis awake. Francis regained control of his Volvo and continued home. The night before, he had arrived home at 6 P.M. and was in bed by 8:30 P.M., as usual, so he could slip into the CDC headquarters on Clifton Road by 5 A.M. to get a few hours of work done before the meetings began and the phone started ringing. When he had a paper to write, Francis went to work at 2 A.M., sometimes running into Jim Curran, who would only then be on his way out of the office. Francis had learned such rigorous schedules when he was fighting smallpox in India. It was you against the disease, his ethos went, and the disease might win if you let up for one day. In India, however, Francis had felt he had a chance to win.

By the time he was nodding asleep at the wheel of his car on the way home from a sixteen-hour day at the CDC, he no longer had that confidence in regard to AIDS. More than three years into the epidemic, the CDC still did not have the staff or resources to tackle the syndrome. Francis’s proposals were still being killed by budget officials. Meanwhile, scientific politicking continued to taint the field. Bob Gallo had taken an increasingly strong role in AIDS science, exacerbating the divisions among researchers over the NCI-Pasteur feud.

On his rare evenings home, Francis wondered what he was doing with his life. His sons, four and six years old, barely knew their father: He had spent most of their lives waging his Sisyphean struggle against a strange acronym they did not comprehend. All the boys knew was that the neighbors did not want their kids to play with the children of a scientist involved in AIDS research; it might be catching.

Don Francis’s wife, Karen, had given up her job with the Epidemiological Intelligence Service to move to Atlanta. She was a highly esteemed epidemiologist in her own right, having discovered the link between aspirin use and Reye’s syndrome. Now she was without a job, without her familiar home, and for all practical purposes, without her husband.

Increasingly, Don Francis fell into conflicts with Jim Curran. Francis’s orientation was toward control: Find the uninfected people and get them vaccinated. Curran’s, however, was oriented in epidemiology, charting the course of diseases through a population. He did not have the background in control. He was also a realist. He favored control programs, but he knew that the money didn’t exist for such projects even if he designed them. Other AIDS staffers were not surprised at the clashes between Francis and Curran, only that they had taken so long to surface. Curran was a take-charge administrator who kept firm control over his department. This put him in an awkward position with Francis. On the one hand, Curran was respectful of Francis’s international reputation; on the other, he wasn’t about to surrender control of the AIDS Activities Office. Increasingly, Francis was on the losing end of policy decisions at CDC.

On September 21, Don Francis met with Walt Dowdle, Director of the Center for Infectious Diseases, and outlined his frustration at the lack of a crash vaccine development project and infection control programs. He wanted out. Dowdle warned Francis against a hasty move and suggested he chart where he’d like his career to move in future years. Francis agreed, although he had resolved by then that whatever his future included, it would not mean working in Atlanta. He had never known defeat before, and he would not stay at the CDC headquarters and endure its daily reminders.

September 23

G
AY
C
OMMUNITY
S
ERVICES
C
ENTER
,
N
EW
Y
ORK
C
ITY

The 200 gay physicians munched on
dolmades
and shoved broccoli into vegetable dips. Jim Curran fiddled with his slide projector. Curran was always cautious when he talked to newspaper reporters, fearful that his observations on the future of the AIDS epidemic might be fashioned into the stuff of sensational headlines, but he felt no such inhibition with the gay community. Instead, he felt his mission was to constantly stress the gravity of the unfolding epidemic. With each new epidemiological study revealing a more disheartening future, Curran came loaded with bad news to the general membership meeting of the New York Physicians for Human Rights.

“AIDS will certainly be the major cause of death during the lifetime of everyone here, and probably through the 21st century,” Curran said. “In spite of good intentions and continuing efforts of the gay community and scientific sector, we should not expect scientific technology to rescue us from AIDS in the next few years, although eventually technology may help conquer the disease.”

An unmarried man over the age of fifteen in New York City now stood a higher chance of dying of AIDS than of heart disease, which is traditionally the greatest killer of men, Curran said. In San Francisco, a single man was five times more likely to die of AIDS than of a heart attack. It was now clear that the CDC had vastly underestimated the scope of the epidemic, he added. Curran recited the statistics garnered from the San Francisco hepatitis cohort and more recent studies among hemophiliacs and IV drug users. Between 200,000 and 300,000 were infected with HTLV-III/LAV—and possibly many more. At least 10 percent would get AIDS, Curran estimated, and perhaps as many as 20 percent. Within five years, he added, the nation could expect 25,000 AIDS cases.

Given the sheer prevalence of AIDS infection, reductions in sexual contacts were not enough to avoid infection, Curran noted. A man who was having one-third the number of sexual partners of a year ago had done nothing to reduce his overall risk of AIDS if three times as many people were infected with the virus. In fact, with increases in prevalence outpacing changes in behavior, it appeared that the typical gay man who participated in any risky sexual behavior stood a greater chance of contracting the AIDS virus.

Curran bluntly addressed the political concerns that these AIDS statistics generated. The question was not if there would be a backlash against gays, but when. It might come soon. “You should get ready for it,” he said. And, of course, there would be the loss of lives.

“When I spoke before you two years ago, on a kitchen chair in a living room, I looked out at the audience and felt these guys are the same age as I am. We’re the same age as the men who are dying of AIDS. That was two years ago. The average age of men dying of AIDS is now younger than ours. It is time to start thinking about how to save the younger generations of gay men as they move out into sexual activity in a world full of AIDS.”

The
New York Native
subsequently chastised Curran for his assessment, saying the federal government had no intention of finding an AIDS cure if it was warning gays that AIDS would be around until the next century. Ironically, Curran’s projections that night vastly
underestimated
the scope of the AIDS epidemic. There would be 25,000 AIDS cases within two years, not five, and by then, the estimates of infected Americans would increase fivefold.

Even the milder prognosis, however, stunned most of the earnest physicians at the NYPHR meeting, particularly because it came at a time when the already lamentable state of affairs regarding AIDS in New York City was getting worse.

In August, Dr. Roger Enlow resigned as head of the Office of Gay and Lesbian Health Concerns. Although Enlow declined to give interviews about his experiences, he did offer one comment about his eighteen months working on AIDS in the Koch administration: “I spent a lot of time talking.”

Meetings of the Interagency Task Force on AIDS turned into gripe sessions with members fuming about the lack of any substantive action to solve the festering problems. Task force member Arthur Felson came to the September meeting with a detailed review of what the group had accomplished in its two years of existence. By Felson’s count, the task force had discussed the problem of housing for AIDS patients sixteen times, the lack of any active surveillance in the city fourteen times, and the need for home health care eight times, all without any resulting moves by the city government. Health Commissioner David Sencer acknowledged that the task force was “better at raising issues than solving them” and announced he would form yet another task force. This one, he said, would be geared at action rather than talk.

The sorry state of affairs led Larry Kramer to try again to be reinstated on the board of directors for Gay Men’s Health Crisis. He had four producers making offers on
The Normal Heart;
the play most certainly would go into production in early 1985, but he certainly had time to work on AIDS now. The absence of any official moves against AIDS had only vindicated his anger, Kramer told the board when they met in mid-September. Kramer was devastated when the board voted down his request to be reinstated. Paul Popham said, “He’ll join the board over my dead body.”

October 1

M
USCLE
S
YSTEM
,
S
AN
F
RANCISCO

Bill Kraus had completed a set of Nautilus exercises and fell back on a bench for a rest. He bent his head down to catch his breath and spotted a purple spot on his right thigh. He told himself it was a blood blister. That night, Bill had two friends over for dinner; they laughed, drank, and argued about movies, and Bill didn’t mention anything about the spot on his right thigh. He waited two days before he went to see Marc Conant.

Conant’s assistant Mark Illeman saw Bill first.

“I can’t tell you for sure that it’s not KS,” said Illeman.

He could tell Bill already knew it was; he was hoping against hope that he was wrong.

Marc Conant and Bill Kraus had grown so close in the past years of behind-the-scenes maneuvering on AIDS that Conant felt a numbness fall over him when he walked into the examination room. He felt Bill’s neck and noted that virtually overnight, Bill’s lymph nodes had burst forth with the swelling characteristic of AIDS patients. He could tell right away that the five-millimeter lesion was not a blood blister, but he couldn’t offer Bill any definitive diagnosis until he performed a biopsy. Normally, KS biopsies took ten days to perform, but Conant assured Bill he’d have the results right away.

As Bill started dressing, Conant walked into the hall and told Illeman to record a diagnosis of Kaposi’s sarcoma on Bill Kraus’s chart.

“He’s got it,” Conant said somberly.

October 1984

S
AN
F
RANCISCO

So many people had AIDS now that the old Public Health Service Hospital was converted into an AIDS hospital. Bill Nelson was surprised to see that all the old hands from San Francisco General Hospital’s AIDS ward were there, serving as administrators. They were together again, like the old days on Ward 5B, back when you could have an AIDS ward that only had twelve beds.

Then Bill noticed that Allyson Moed, who had been the head nurse at 5B, was having a hard time breathing; she had
Pneumocystis.
Another nurse, it turned out, had toxoplasmosis, while nursing unit coordinator Cliff Morrison had tuberculosis.

Bill looked at himself while passing a mirror. Kaposi’s sarcoma lesions covered his face.

“I can’t go outside with all these KS lesions on my face,” Bill said. “I can’t be seen in public.”

Bill bolted upright in bed, his face covered with a film of cold sweat. Earlier in the day, he had read a story in the paper in which Marc Conant predicted that, by 1988, there would be so many AIDS cases in San Francisco that the city might need an AIDS hospital and that the city should think about converting the shut-down Public Health Service Hospital into an AIDS facility. Everybody was talking about how crazy Conant was. That was where Bill Nelson’s dream had come from.

Bill eased back into his bed. In the morning, he would return to his job as a nurse in the AIDS Ward and the nightmare would begin again.

October 4

Bill Kraus took the wheel of the convertible and sped along the back roads of the hill country north of San Francisco, past the geysers and vineyards of Napa County, and the redwoods and lighthouses of Sonoma County. Beatles, Supremes, and Jefferson Airplane songs blared from the car stereo.

“I look in the mirror and it’s like looking twenty years in the past,” Bill said.

The music and the general aimlessness of the day reminded Bill’s friend Dennis Seely of the past as well, when he met Bill in 1974 and they both were unemployed hippies hanging out on Castro Street. Dennis had known Bill before he had become involved in gay politics; in fact, it was Dennis who had introduced Bill to Harvey Milk. Now, when Bill needed a friend who predated his life as a gay political celebrity, he turned to Dennis Seely. They were wasting time before Bill called Marc Conant for the results of his biopsy.

“I don’t know what’s going to happen when they tell me,” Bill said.

Dennis didn’t believe that Bill really had AIDS. After all, Bill had scaled back his life-style before anyone he knew. For most of 1984, Bill had calculated that he would be home free once December came, because that marked two years of completely safe sex. The second anniversary was only six weeks away. It would be a cruel cosmic joke for Bill to get AIDS now, Dennis thought.

“How could you have it?” Dennis said. “You hardly ever got fucked—unless there’s something you haven’t told me.”

“I only have six weeks left to go,” said Bill. “It’s so unfair. I’m the one who stopped having sex and got called all that shit for being ‘anti-sexual.’ I was the sexual fascist, and now I’m the one getting it.”

Back at Dennis’s apartment, Bill didn’t want to phone Conant. Dennis cajoled him into making the call. Conant would tell Bill he was fine, and then Bill would leave and Dennis could take a nap. But Conant’s nurse told Bill he had to come in, because Conant wanted to check his bandages. Bill started to cry.

“They don’t need to check my bandages. It was only a small biopsy,” Bill said. “I’ve got it.”

“Stop being melodramatic,” said Dennis.

When they got to Conant’s waiting room, Bill took a Valium. A nurse asked Bill if he wanted a cup of coffee.

“Did you see the way she looked at me?” Bill asked, crying again.

“She looked at you like you wanted a cup of coffee,” Dennis said.

“I’ve got it,” Bill said. “I know it.”

They went into Conant’s office together. Inside, Conant put his hand on Bill’s shoulder.

“I asked them to check it again, because I didn’t want to believe it,” he said. “You’ve got Kaposi’s.”

Dennis started to cry. Bill froze, one tear forming in the corner of his eye.

“I guess you and Kico will get my house,” Bill said to Dennis.

“I’m not sharing the house with Kico,” Dennis said, trying to joke even as he wept. “He’s so irresponsible, he’ll never pay his share of the expenses.”

“You’ll have to share it with him,” Bill persisted, “because I’m going to leave it to both of you…”

“Wait a minute,” Conant interjected. “You don’t have to talk about who’s getting the house yet. There are things you can do, Bill. With the position you’re in, working for Sala, you can pressure for more funding. You can make your position an activist one. The bad news is that this is a life-threatening disease. But there are people who have lived three years. There are a lot of things that can happen.”

Bill wasn’t paying attention.

“Then I am to die,” he said. Conant paused.

“We’re all going to die,” he said finally, his voice turning grim. “If something doesn’t break, we’re all doomed.”

William James Kraus was the 728th San Franciscan diagnosed with Acquired Immune Deficiency Syndrome.

By the time Bill Kraus got home, his closest friends had assembled at the two-flat Victorian he recently had purchased with Ron Huberman, Milk Club vice-president. His old friend Gwenn Craig was there. Bill’s friends immediately laid plans to tap their lists of campaign contributors and raise enough money so Bill would not be wanting for anything during his ordeal. They stayed up late into the night, drinking and reminiscing around Bill’s kitchen table.

“I wish I didn’t have to get sick before I saw how many people really like me,” Bill observed.

Kico Govantes came late and felt as though he had walked in on a funeral. Except, of course, that the person everyone was mourning was right there.

Bill wept and Kico held him, realizing their roles were now reversed. In years past, he had always needed Bill; now Bill needed him.

The next morning, Bill woke up enveloped in dread. Every physical movement required tremendous exertion. He had not felt this way since his father died.

Was it true? he wondered briefly. Had yesterday really happened?

He realized that it had happened and that he would spend this day, and all the days he lived, knowing that he might die at any time. A microscopic junta had seized control of his body; he was under its command.

“You don’t have to die.”

Bill Kraus’s old friend Sharon Johnson saw Bill becoming more and more morose in the days after his diagnosis. Long ago, Sharon had sensed that Bill had a martyr complex. Like Bill, Sharon had been raised a devout Catholic, and she knew one thing about martyrs: They died. He’d kill himself with his grief, Sharon thought, so she took Bill to a psychic healer she knew, Jocelynn Nielsen.

Bill Kraus was cynical, but he was also desperate. He had been with Nielsen only a few minutes when she began talking about his father’s death and the death of someone else very close, someone like a father, about fifteen months earlier. It had been Nielsen’s experience that people diagnosed with a terminal disease usually had undergone some kind of trauma fifteen months before the onset of symptoms.

Bill was stunned. Obviously, she had no way of knowing about his father’s death a quarter-century earlier, and she had perfectly described his emotional reaction to the death of Phil Burton. Bill poured out his heart to Nielsen. He told her about how for months, he had imagined seeing his own memorial service. Everybody had gathered in an auditorium to talk about him, and he wasn’t there. The vision scared him.

Nielsen asked Bill to meditate and tell her what pictures he saw. Bill went into a trance but was quickly fidgeting with fright.

“I see snakes,” he said. “They are out to attack me. They want to kill me.”

“You can be afraid of them or you can master them,” Nielsen said. “Make friends with the snakes. Don’t be afraid of them.”

And then Nielsen told Bill, quite simply, “You don’t have to die.”

He had created his own illness, she said. He could heal himself.

Bill was ecstatic at the idea, and he religiously adopted the regimen of diet and meditation she outlined. He gave away all his black and gray clothes to Dennis Seely after Nielsen said he would be healthier if he wore only earth tones. Bill threw himself into the effort to save his own life with a gusto he normally reserved for a political campaign. He ordered all his friends to visualize him well. Nobody was ever to talk about death around him again.

“I created this,” Bill told Kico Govantes. “And I can beat it.”

October 9

S
AN FRANCISCO
D
EPARTMENT OF
P
UBLIC
H
EALTH

Reporters jockeyed for position when Merv Silverman strode into the auditorium and sat before the scores of microphones. Six months before, he had walked into the same room before the same reporters for his now-famous “no comment” press conference on the baths; today, he spoke with unaccustomed decisiveness, comparing the baths to “Russian roulette parlors.” It might be legal to play Russian roulette at home, he said, but you can’t open a business and charge people $5 a head to come in and play Russian roulette for profit.

“Today I have ordered the closure of fourteen commercial establishments that promote and profit from the spread of AIDS—a sexually transmitted fatal disease,” Silverman said. “These businesses have been inspected on a number of occasions and demonstrate a blatant disregard for the health of their patrons and of the community. Where activities are proven to be dangerous to the public and continue to take place in commercial settings, the health department has a duty to intercede and halt the operation of such businesses. Make no mistake about it: These fourteen establishments are not fostering gay liberation. They are fostering disease and death.”

Within an hour, health inspector Thomas Petty was taping public health notices on the door of The Slot bathhouse on Folsom Street: “The continued operation of the above designated business constitutes a hazard and menace to the public health,” the order read. When Petty found the manager, he explained, “I’ve been directed by the director of public health to order you to cease operations as of noon today.” A few blocks away at the San Francisco Club Baths, an announcement over the public address system told patrons to turn in their towels.