“So the plague defied all medicines; no cure, no help could be possible nothing could follow but death. . . . The strange temper of the people . . . contributed extremely to their own destruction.”
—Daniel Defoe, A Journal of the Plague Year (1721)
Until recently, the United States has enjoyed unquestioned success in public health. Diseases once common have all but vanished with improvements in sanitation and personal hygiene. Infectious diseases, especially where no cure is available, have been controlled by the tried and true methods of: (1) finding out who is infected; (2) tracing those persons who have contacted the carriers in a manner known to spread the disease; (3) determining if carriers are likely to spread their infection; (4) quarantining of those individuals who refuse to refrain from endangering the health of the as-yet uninfected; and (5) the closing of public places where disease-spreading activity takes place. By such means have outbreaks of scarlet fever, smallpox, and typhoid been halted in this century.
Calling AIDS (Acquired Immune Deficiency Syndrome) the “highest public health priority,” President Reagan released his fiscal 1989 budget, which includes $1.3 billion for AIDS research and prevention. On April 28, 1988, the Senate approved the program by a vote of 87-4. (Senator Jesse Helms, the principal opponent, pointed out that nothing in the spending package did anything to protect the part of our population that has not been exposed to the disease.) The House was expected to approve it as well. The National Gay and Lesbian Task Force agreed that this figure “represents a significant (38 percent) increase” over current AIDS funding and was praised by NGLTF director Jeffrey Levi as “an important statement of policy and intent by the Federal Government.”
Like President Reagan, U.S. Surgeon General C. Everett Koop has repeatedly referred to AIDS as the “number one” menace to public health. Still, though AIDS is an always-fatal disease, traditional public health practices have yet to be implemented to contain its spread.
How it came to pass that this particular virus was granted an immunity from standard methods of control is one of the topics explored in Randy Shilts’s compelling history of the early years of the AIDS epidemic in America (And the Band Played On: Politics, People, and the AIDS Epidemic, St. Martin’s Press; 630 pp.; $24.95). Shilts is a homosexual writer who, since 1982, has been reporting on AIDS full-time for the San Francisco Chronicle. The book is organized chronologically and takes us back and forth from San Francisco to New York, Atlanta, Washington, DC, Central Africa, and France. We meet homosexual activists, politicians, public health officials, medical researchers, general practitioners, and some of the first people to succumb to the mysterious virus. Shilts’s study confirms what a number of students of this epidemic had already perceived, namely, that AIDS is the first politically protected disease in modern history.
Even before AIDS emerged, “out-of-the-closet” homosexuals were being “washed by tide after tide of increasingly serious infections.” By 1980, sexually active homosexuals were already saturated with syphilis and gonorrhea, hepatitis A and B, and various parasitic infections. Studies in Los Angeles revealed that 93 percent of male homosexuals were infected with cytomegalovirus, a variety of herpes linked to cancer. Epstein-Barr virus, another cancer-causing microbe, was pandemic among them. These infections were marked by latency periods during which infectious carriers looked and felt well, often long before they exhibited clinical manifestations of disease. As homosexual activity became commercialized, with bathhouses, sex clubs, spas, and tours flourishing across the country and around the world, there was no stopping the spread of diseases. Homosexual doctors who voiced concern about the frightful condition of their “community” were denounced by other homosexual leaders for being “sexual fascists.” A prominent San Francisco homosexual psychotherapist, Gary Walsh, counseled that “promiscuity was a means to exorcise the guilt and self-alienation ingrained in all gay men by a heterosexual society clinging to the obsolete values of monogramy.” (He later died of AIDS.)
As early as spring 1981, a once-rare form of pneumonia, Pneumocystis carinii, was turning up with alarming frequency among male homosexuals. Drs. Michael Gottlieb and Joel Weisman wrote what would be the first article relating to AIDS, for the June 5, 1981, issue of the Morbidity and Mortality Weekly Report, published by the federal Center for Disease Control in Atlanta. Gottlieb and Weisman noted that all their clients had a history of sexually transmitted infections prior to the onset of Pneumocystis pneumonia. They went on to observe that, “The fact that these patients were all homosexuals suggests an association between some aspect of homosexual lifestyle or disease acquired through sexual contact and Pneumocystis pneumonia in this population.” When they submitted their article to the CDC, it was entitled, “Pneumocystis pneumonia in homosexual men—Los Angeles.” However, before the publication, CDC editors dropped any reference to homosexuality from the title, in order not to offend the sensibilities of organized homosexuals. The unwritten policy, Shilts points out, was: “Don’t ofÃ‚Â fend the gays and don’t inflame the homophobes. These were the twin horns on which the handling of this epidemic would be torn from the first day of the epidemic.”
In addition to Pneumocystis, homosexuals and newly arrived Haitian immigrants were found to be coming down with taxoplasmosis, a lethal infection of the brain. Other maladies began to appear. Following extensive testing, a homosexual in San Francisco was discovered to be infected with cryptococcus, a parasite that inhabits bird feces. Pigeons had been depositing droppings in San Francisco for over a century, without humans becoming infected by them. University of California experts were left speechless when one of their homosexual patients was diagnosed as having chronic diarrhea caused by Cryptosporidium, a parasite that lives in the bowels of sheep. One anxious doctor asked the preeminent expert of Cryptosporidium, a professor at the University of Iowa agriculture school, how they treated infected sheep. He was told, “There is no treatment. We shoot them.” This particular patient soon died, making medical history as the first human being whose cause of death was listed as a disease of sheep.
So many homosexuals were succumbing to a host of lethal infections that medical authorities designated their condition GRID—Gay Related Immune Deficiency. The typical GRID sufferer had sex with 1,100 men in his lifetime; some boasted as many as 20,000 sexual contacts. Footloose homosexuals quickly spread the virus across our country and around the world. At the Bureau of Communicable Disease Control in San Francisco, Dr. Selma Dritz realized that the bathhouses were “biological cesspools for infection” and that a “textbook” public health response would be simply to close them down as a menace to health. Dr. Donald Francis of the CDC characterized the commercial homosexual sex industry as an “amplification system” for the disease. Such establishments ensured that AIDS would proliferate among homosexual males. At this point, Shilts remarks, “Common sense dictated that bathhouses be closed down. Common sense, however, rarely carried much weight in regard to AIDS policy.”
In Shilts’s account, AIDS is personified by “Patient Zero,” one Gaetan Dugas, a strikingly handsome Air Canada steward who apparently carried AIDS from France to the homosexual playgrounds of North America. Doctors have traced at least 40 of the first 248 homosexual AIDS cases, as of April 1982, to Dugas or someone who had sex with him. Long after he knew that he had the disease, Dugas continued to haunt gay bars and bathhouses. After sodomizing his partners, he would turn up the lights, point to his Kaposi’s sarcoma lesions, and announce, “I’ve got gay cancer. I’m going to die and so are you.” Almost until the day he died (at the age of 31 in 1984) Dugas managed to find men anxious to couple with him (he had over 2,400 sexual contacts during his lifetime. His partners, many infected with AIDS by him, in turn have had intimate contact with untold thousands of others). Dugas figured that since someone had infected him, he could give it to others. When a doctor advised him to quit, he replied, “It’s their duty to protect themselves. They know what’s going on there. They’ve heard about this disease. I’ve got it. They can get it too.”
The CDC had evidence by mid-1982 that GRID was an infectious disease. However, not to alarm the public, Drs. James Curran and Harold Jaffe reassured reporters that it wasn’t. In the meantime, GRID was redesignated AIDS, a sexually neutral term.
As time went on, doctors discovered that the range of infections related to AIDS was much broader than they had previously suspected. Among these were Burkitt’s lymphoma, a viruslinked lymph cancer, and Kaposi’s sarcoma, a usually mild variety of skin cancer that turned lethal among AIDS carriers. Mycobacterium aviumintracellular, a horrific fungal infection normally found in birds, was detected in the bone marrow of AIDS patients. AIDS was confirmed, by late 1982, to cause extensive damage to the central nervous system, with researchers informing members of the American Neurological Association that some patients were dying of brain disorders, their cerebral matter reduced to “a boggy mass.” Other fungal infections of birds, cats, sheep, and deer, as well as cancers on the tongue, in the recturn, and in the brain were added to the growing list of AIDS-related complications.
The blood banking industry comes under heavy fire from Shilts, and deservedly so. Evidence had accumulated by late 1981, indicating that AIDS was a blood-borne infection that could be transmitted through blood transfusions. In 1982 the CDC reported cases of hemophiliacs infected with AIDS via contaminated clotting factor. Yet, the American Association of Blood Banks joined with homosexual rights groups in denouncing claims of transfusion-related AIDS and appeals made by hemophiliacs that homosexuals be discouraged from donating blood. Before the actual AIDS virus was discovered, scientists at the CDC recognized that nearly 90 percent of those infected with AIDS also showed signs of hepatitis B. They recommended that blood banks test blood for traces of past hepatitis infection—a proposal that was flatly rejected by the blood industry. Shilts reveals that at least 12,000 Americans were infected with AIDS acquired from transfusions “largely administered after the CDC had futilely begged the blood industry for action to prevent spread of the disease.”
Once the HIV (Human Immunodeficiency Virus) was identified and an effective blood test became available, the Lambda Legal Defense Fund, a homosexual rights organization, threatened to go to court to block release of the test. Here was a test that could save the lives of the uninfected—including the lives of uninfected homosexuals—yet homosexual activists worked ceaselessly to prevent its use. As the author observes, failure to be tested “meant you might be carrying a lethal virus, which you could give to others . . . There was also the broader public health question of how you can control a disease if you decline to find out who is infected.”
Shilts ends his review in mid-1985. By then the agent causing AIDS had been isolated, testing of the blood supply had finally commenced, and, with the death of actor Rock Hudson, AIDS had become a national issue. Shilts chides the Reagan administration for not responding sooner to a health crisis that was largely confined to homosexuals and intravenous drug users. Given that many, perhaps most, sexually active homosexuals were already infected with AIDS before the disease was discovered, it is difficult to see what Reagan or anyone else could have done to save their lives. Konstantin Berlandt, a homosexual activist from San Francisco, expressed the attitude of Gay Liberationists when he claimed that it is “society’s responsibility to find the medical technology to prevent all sexually transmitted diseases, rather than the gay community’s responsibility to keep sexuality in line with what medical technology can cure.”
Shilts concedes that formulation of AIDS policy has “never been animated by rational forces.” He goes so far as to cite, with approval, a Danish AIDS specialist. Dr. Ib Bygbjerg, who despaired that, “Gay radicals are holding public policy hostage to their politics. We need to stop this disease, and we’re not being allowed to.” In many respects. And the Band Played On is to the development of the AIDS epidemic what The Valachi Papers was to the Mafia: a record that only an insider could have written.
It has become increasingly clear that it is in the self-interest of the public to take whatever measures are necessary to control AIDS. Recent scientific discoveries offer little assurance that this is anything but a serious medical problem.
AIDS is a dynamic disease. The retrovirus that apparently causes it, HIV, mutates at a much higher rate than any previously encountered. Within the lifetime of an AIDS patient, the original strain of virus that started the infection can mutate into several new strains, all of which continue to proliferate. And the strains are often different enough that were a vaccine effective against one strain, it would fail to protect against another. A scientist at the University of Colorado medical research center in Denver confided to this author that many in the field are convinced that a vaccine for AIDS is a “theoretical impossibility.” Given that HIV, like all other viruses and retroviruses, is not an independent life form but a piece of genetic material that becomes a part of an infected cell, researchers at the Center of Molecular Biology in Madrid and the Pasteur Institute of Paris suggest that any vaccine that might protect someone from acquiring AIDS would destroy the person’s immune system, thus causing a disease similar to AIDS.
A team of scientists from Norway, Sweden, and West Germany have established that a person does not need a cut, wound, rash or other abrasion of the skin to acquire AIDS, since HIV has been found to thrive in the Langerhans cells, which are present in skin and mucous membranes. Langerhans cells are relatively easy to infect and these in-vitro infected cells can in turn infect other cells.
The spring issue of the quarterly AIDS Research and Human Retroviruses reported that people infected with AIDS become more infectious as time passes, increasing the risk to others.
Strange as it may seem, as Vernon Mark of Harvard Medical School points out, we still do not know how rapidly AIDS is spreading or how many are currently infected. This is because federal health officials have yet to conduct a cross-sectional analysis to discover the extent and intensity of AIDS infection. Mark is foremost among those calling for a series of epidemiological studies, utilizing population sample statistics, to determine the degree of HIV infection among various demographic segments of our society. (The oft-repeated figure of one to 1.5 million AIDS carriers in the U.S. is a 1986 CDC guestimate. In 1985, a report in The New England Journal of Medicine estimated that 1,765,000 were already infected. More recently, the CDC suggested that for every case of AIDS, there are 10 cases of ARC [AIDS Related Complex, a host of symptoms including weight loss, fever, night sweats, fatigue, persistent diarrhea, that are themselves often fatal or are precursors to full-blown AIDS] and for every case of ARC there are 10 asymptomatic carriers. With 59,287 official cases of AIDS reported in the CDC’s AIDS Weekly Surveillance Report for April 11, 1988, this would give the U.S. 583,550 cases of ARC and a total of some 5,835,550 actual AIDS carriers.)
Not only do we not know how many people are currently infected, but “civil rights” protection has been granted to carriers, so that, in many states and municipalities, even doctors performing surgery on the AIDS-infected are not informed about the condition of their patients. Nor, where such guidelines are in force, do doctors have the right to refuse to operate on a patient with AIDS. This situation is leading many health-care workers to consider if they want to continue in medicine.
Although the case for applying traditional public health measures to the AIDS epidemic grows stronger by the week, the likelihood of this happening anytime soon seems less and less. For the Democratic Party, homosexuals are a key component of its metropolitan election strategy—the lavender layer of the Rainbow Coalition. Party leaders support the “Gay Rights” amendment to the Civil Rights Act and a presidential executive order banning anti-homosexual discrimination in the federal government, including the military. They oppose prohibition of homosexual immigrants and defend the rights of lesbians and homosexual males to child custody (for example, on April 13, 1988, Rep. Pat Schroeder [D-CO] spoke before the homosexual Gertrude Stein Democratic Club in Washington, DC, and said that liberals must take back the concept of the American family from the right wing).
The Reagan record has been “mixed,” at best. The most sensible statements and proposals on AIDS have come from the Department of Education, not the Public Health Service or Surgeon General’s Office. Surgeon General Koop has not been reined-in, despite his medically inaccurate AIDS Report that was enthusiastically endorsed by homosexual activists. The administration has since mailed an AIDS brochure that includes more misleading assertions to 107 million American households. Furthermore, the administration has pointedly failed to throw its support behind the two most important pieces of AIDS-related legislation introduced in the 100th Congress, by Rep. William Danneymeyer (R-Calif): H.R. 2272, calling for mandatory reporting of HIV infection to public health authorities in every state, and H.R. 2273, which requires AIDS tests for hospital admissions between the ages of 15 and 49, premarital applicants, clients of sexually transmitted disease clinics, and convicted prostitutes and IV drug users. Will George Bush take a tougher stand on AIDS?
AIDS is one of those issues—I believe immigration is another—that will determine whether America survives as a viable entity. The response thus far is not encouraging. Surveying the situation, I have that sinking feeling that Andrew Hacker was right when he wrote in his 1970 book. The End of the American Era, “The United States no longer has the will to be a great international power, just as it is no longer an ascending nation at home. . . . We are now at that turning point ancient philosophers called stasis, a juncture at which it becomes pointless to call for rehabilitation or renewal. Such efforts would take a discipline we do not have, a spirit of sacrifice which has ceased to exist.”
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