THERE WAS no excuse, in this country and in this time, for the rapid spread of a deadly new epidemic. For this was a time in which the United States boasted the world's most sophisticated medicine and the world's most extensive public health system, geared to eliminate such pestilence from our national life.
But in the early years of the AIDS epidemic, the federal government viewed it primarily as a budget problem, local public health officials saw it partly as a political problem, gay leaders worried about it as a public relations problem and many in the news media regarded it as a homosexual problem of limited interest to anybody else. Consequently, despite the efforts of certain medical doctors and scientists and important medical advances, not enough Americans confronted AIDS for what it was -- a profoundly threatening medical crisis.
People will be debating the AIDS story for decades to come. The following vignettes provide one view of how the crisis unfolded.
University of California Medical Center, San Francisco, September 1980:
"Too much is being transmitted here."
It was getting to be the standard finale to Dr. Selma Dritz's presentation on the problem of gastrointestinal diseases among gay men. But Dritz found her message received coolly by the center's experts on sexually transmitted disease. Despite the alarming statistics, scientists had a hard time believing that the sexual revolution had turned amebiasis -- Montezuma's revenge -- and hepatitis B -- the junkies' malady -- into social diseases with long latent periods in which infectious carriers showed no symptoms. This was a scenario for catastrophe, Dritz thought, and the commercialization of promiscuity in bathhouses was making it worse. "If something new gets loose here," she said, "we're going to have hell to pay."
On Friday, June 5, 1981, the Centers for Disease Control published what would be the first report on the AIDS epidemic, based on recent cases of Pneumocystis in Los Angeles. A month later, CDC released its first report on Kaposi's sarcoma in gay men. Thewriting of both reports seemed crafted not to offend or panic. The notion there might be a new infectious agent at work was downplayed in favor of hypotheses involving environmental factors -- such as "poppers", a popular stimulant -- or a new strain of an old virus.
Don't offend the gays and don't inflame the homophobes. In my view, the handling of this epidemic twisted on these twin horns from the first day of the epidemic.
Centers for Disease Control, Atlanta, August 1981:
Bill Darrow, a twenty-year veteran of VD work, was alarmed by the preliminary data from interviews with 31 patients in New York and California."It looks more like a sexually transmitted disease than syphilis," he concluded bluntly. The only thing that seemed to matter in these cases was number of sexual partners. Bill Darrow and perhaps six or seven people in Atlanta were worried; the trouble, Darrow thought, was trying to convince the other 240 million Americans to be concerned too.
Castro Street, San Francisco, August 1981:
When psychologist Joe Brewer first came to the Bay Area in 1970, he found the gay subculture of Castro St. liberating and the sex brotherly.But slowly, the relational aspects of the sexual interaction dropped away. Now, about 3,000 gay men a week streamed to the gargantuan Club Baths, which could serve up to 800 customers at any given time. As Joe saw it, the trouble was that there was nobody to say "no."
2 Fifth Ave. New York City, Aug. 11, 1981:
Twilight brought no respite from the humidity as eighty men streamed into Larry Kramer's apartment. The men milled around, sharing the latest rumors about who was sick or didn't look well. Paul Popham was there along with the rest of New York's gay A-list, the hottest guys you'd see at the trendiest discos.
Dr. Alvin Friedman-Kien told the group he didn't know what was causing the epidemic, but he knew that the people who got sick had lots of sex partners and a long history of VD. The word needed to get out, Friedman-Kien warned, adding that he needed money for research-now. Some people left Larry Kramer's apartment angry. When one man asked him how to avoid getting this gay cancer, Friedman-Kien had repeated that he would stop having sex. The gay community didn't need some Moral Majority doctor telling them what to do with their sex lives, somebody fumed.
The small band of organizers figured they'd be able to raise thousands from the 15,000 gay men who had congregated for the last bash of the '81 season on Fire Island. They were wrong. "This is a downer," was one typical reaction. The proceeds of the weekend's fund-raising totaled $124. Paul had never thought about how frivolous people could be. He wondered what it would mean for the future, when more people were dying.
Larry Kramer would maintain that from the start, gay men knew precisely what they needed to do -- and not do -- to avoid contracting the deadly new syndrome. By late 1981, Kramer was embroiled in controversy over the outspoken role he had assumed in trying to alert New York gays to Kaposi's sarcoma. Wrote one gay writer in the New York Native. " . . . I think the concealed meaning of Kramer's emotionalism is the triumph of guilt: that gay men deserve to die for their promiscuity."
Meanwhile, Kramer was despairing over the lack of any official attention to the epidemic. His pleas to The New York Times for more coverage were unanswered. Even The Village Voice had so far failed to run a single story. When Larry called Mayor Ed Koch's liaison to the gay community, the aide assured Larry "I'll get back to you tomorrow" and was never heard from again.
On the night of April 8, 1982, Paul Popham and the other organizers from the Gay Men's Health Crisis nervously waited to see whether anyone would show up for their first benefit. To their relief, lines started queuing up an hour early. The committee raised $52,000, a gratifying response but still, Kramer thought, a pittance compared to the government's vast research budgets. Paul Popham addressed the crowd in his broad, plainspoken Oregon accent: "It may be that an equal measure of fear and hope has brought us together, but the great thing is, we are together."
In March 1983, twenty months into the epidemic -- and despite collection of reams of case-control data -- the Public Health Service pronouncements on AIDS offered only two sentences of guidance: "Sexual contact should be avoided with persons known or suspected to have AIDS," the PHS wrote. "Members of high-risk groups should be aware that multiple sexual partners increase the probability of developing AIDS."
Pacific Heights, San Francisco, March 31, 1983:
Marcus Conant scanned the room full of the top ranks of the city's gay politicians. "Things have to change and change fast, or you won't have any constituents left."
Most of the politicos were much more familiar with discussions about discrimination, liberation and heterosexist oppression. When dealing with AIDS at all, they tended to frame the epidemic in familiar concepts. This is why condemning the federal government had become so popular. Now, however, doctors were tossing the ball squarely into the gay leaders' court.
"You have to avoid contact with bodily fluids," said one of the most militant in the gay doctors' group. "You don't get a second chance once you get this." When one longtime ally of the gay community suggested, "It makes sense to me to have the public health department shut down the gay bathhouses," a chorus of boos and hisses arose.
Gary Walsh's idea for a candlelight march in San Francisco had spread nationally by early May, 1983. AIDS sufferers in dozens of cities took the lead in putting together observances. Some of the gathering thousands brought snapshots of friends who had died; others carried signs that read like gravestones. In a way, the televisions cameras and print journalists had come to need events like the march as much as the marchers needed the reporters.
Castro Street, San Francisco, May 1983:
"You're a sexual Nazi."
Bill Kraus heard variations on this theme from the moment his essay calling on gay men to change their life-styles and redefine gay liberation had been printed in the Bay Area Reporter. A long-time gay activist, Kraus had tried to advance the idea that "we gay men can transform this epidemic into our finest hour." The reaction was swift and nasty. Kraus was called an "antisex" brownshirt, out to destroy the gay community with his talk about not going to bathhouses. Bill Kraus was crushed at the criticism, especially at a time when his own work on AIDS had accelerated into hyperdrive.
New York City, March 1985:
Paul Popham took stoically the news that the purple spot on his neck was Kaposi's sarcoma. For many years, Paul had never seen the sense of all this gay-movement talk. But now, after four years as one of GMHC's central organizers, when he saw a volunteer returning from the bedside of a dying man, he realized he had gained faith in his embattled gay community. Larry Kramer was fond of saying, "There are no heroes in the AIDS epidemic," but Paul disagreed. There were heroes in the AIDS epidemic, he thought, lots of them.
AIDS policy matters were becoming local issues in a number of jurisdictions. Massachusetts' Democratic Governor Michael Dukakis enraged gay leaders by initially submitting a budget that did not earmark one cent for AIDS. In New York, Governor Mario Cuomo, another Democrat with liberal credentials, also was accused of shortchanging AIDS research. The controversy was a comfort to conservative California Governor George Deukmejian who could point out that California was spending more on AIDS than all other states combined.
San Francisco, June 30, 1985:
A crowd of 250,000 clogged sidewalks and streets for the Gay Freedom Day parade. There was a different mood to this parade. After years of denial and anger, the San Francisco gay community was mobilized to fight the epidemic as no other single group in the country. The largest contingent stretched for two full blocks, marching under the banner of "Living Sober." They were the burgeoning ranks of gay people who had given up drugs and alcohol and were among the pioneers of the new emerging life-style of safe-sex and steady relationships.
Attention to the epidemic waned only slightly in 1986. There were other celebrity AIDS patients besides Rock Hudson now, but the disease remained fundamentally embarrassing. A spokesman for Perry Ellis insisted the famed clothing designer was dying of sleeping sickness. Lawyer Roy Cohn insisted he had liver cancer, conservative fund-raiser Terry Dolan claimed he was dying of diabetes, Liberace was suffering the ill effects of a watermelon diet. It was the first professional athlete to contract AIDS, former Redskin star Jerry Smith, who told the truth.
Ultimately, it was a report issued in October 1986 by Surgeon General C. Everett Koop that galvanized the media and made AIDS a pivotal social issue in 1987. This wasn't some tedious call for a blue-ribbon commission or bureaucratic coordination, this was about condoms and sex education. There was also finally a sensible explanation about why compulsory AIDS testing wasn't such a good idea. Not only that, Koop was able to utter words like "gay" without visibly flinching. It took a conservative fundamentalist to credibly call for all of America to take the epidemic seriously at last.
Washington, May 31, 1987:
Ronald Reagan grinned boyishly and started his first address on AIDS with the words, "Many years ago, when I worked for General Electric Theater . . . ."
All afternoon, Larry Kramer had asked himself how he would respond to President Reagan's speech. As he listened, he became aware the president's speech made no mention of the word "gay." There was talk about hemophiliacs who got AIDS, transfusion recipients and the spouses of intravenous drug abusers, but the G-word was never spoken.
Kramer's temper began to rise. Certainly no one knew better than he the shortcomings of the gay community. But Kramer also knew that just about anything good that happened in the first five years of the epidemic -- research breakthroughs, AIDS education and patients' services -- came from support, lobbying and volunteer work provided by the gay community. There was something so utterly dishonest about discussing the AIDS epidemic and not mentioning the fact that it was homosexuals who had done so much to fight the epidemic for all those years that Reagan had ignored it.
The battles that had divided the community were over. On the night the president spoke, Paul Popham was three weeks dead, having gone to his grave profoundly disillusioned with the country for which he had fought in Vietnam. Bill Kraus who had done so much to awaken San Francisco to the scourge was also dead. And now Reagan refused to talk about these men who had shown so much courage. And when Reagan started talking about testing, as if he were really proposing policies that might at last do something to stop the epidemic, the anger of six years swelled up inside Larry Kramer, and he began to jeer.
By the time President Reagan delivered his first speech on the epidemic of Acquired Immune Deficiency Syndrome, 36,058 Americans had been diagnosed with the disease; 20,849 had died.
Randy Shilts covers the gay community for the San Francisco Chronicle and is the author of "And the Band Played On," from which this article is adapted.