And the Band Played On: Politics, People, and the AIDS Epidemic, 20th-Anniversary Edition (22 page)

“What do you do with sheep that get this?” he asked eagerly.

“There is no treatment,” the expert said. “We shoot them.”

March 3, 1982

C
ENTERS FOR
D
ISEASE
C
ONTROL,
A
TLANTA

Don Francis viewed his life as an accumulation of chance decisions that had put him in the right place at the right time. When he followed his first wife to Los Angeles, he was lucky that L.A. County-University of Southern California Medical Center Hospital was near her house and was the first place he applied for a residency, because that put him under the tutelage of Dr. Paul Wehrle, a former CDC staffer, who urged Francis to join the CDC’s Epidemiological Intelligence Service as an alternative to conscientious objector work. By chance, the CDC sent Francis to Sudan, where he was able to help wipe out smallpox, giving him, at the age of thirty-three, an accomplishment he figured he would never be able to surpass. After Africa, he followed a new girlfriend to Boston and ended up studying feline leukemia virus at the Harvard School of Public Health. The CDC had hurriedly pulled Francis away from these studies to handle Ebola Fever virus. After subsequently completing his doctorate on retroviruses, Francis’s next CDC assignment sent him to Phoenix, where he worked with the gay community as lab director for the CDC’s hepatitis study.

By chance after chance, Don Francis felt he had been delivered to this moment in early March 1982 when it all fit together. The retrovirology, the cat leukemia, the experience with African epidemics, and long work with the gay community—it all let him see something very clearly. His object on this day at the Public Health Service’s first conference on GRID was to inform concisely the representatives of the National Institutes of Health as to what was happening and, hopefully, to enlist their help.

Like many of the CDC doctors, Francis was incredulous that the National Cancer Institute was still fiddling around with half-baked theories that GRID was caused by poppers or sperm. But those were the presentations the NIH researchers made at the conference. None of them was talking about what Francis thought was the most obvious cause, a new viral agent.

During a lunch break, Francis dashed to the library and photocopied the study he had made on feline leukemia with Max Essex back at Harvard. As one of the most eminent virologists at the CDC, Francis was slated to give the last lecture of the day; he wanted to have impact.

The thirty-nine-year-old researcher presented two charts. The first traced the epidemiological work he had done in Harvard on feline leukemia. The seminal work was familiar to most in the small CDC auditorium, but Francis repeated it carefully in his soft, northern California voice to let the significance sink in.

There were 134 cats in his study, 73 of which were infected with feline leukemia virus. Of these, 63 contracted lymphomas, cancers, or various blood disorders. Only 1 was alive and healthy. Of the 61 noninfected cats, only 2 developed lymph cancer and 21 others fell ill of other causes, while most were healthy and alive. Infection with just one virus, in this case a retrovirus, could cause immune suppression that would lead to cancers and a laundry list of diseases, Francis stressed.

He pointed to his other chart, which listed the risk groups for hepatitis B, most notably the categories of gay men and intravenous drug users. Preliminary data from the case-control study showed that the risk factors were virtually identical for GRID and hepatitis, Francis said. Numbers of partners, attendance at gay bathhouses, and passive anal intercourse all seemed predictors of GRID, just as they were for hepatitis.

“Combine these two diseases—feline leukemia and hepatitis—and you have the immune deficiency,” said Francis.

To Francis, the conclusions were obvious. Blood products were likely to show evidence of contamination next, and substantial lab work needed to be done to track down the viral culprit so that work on treatments and vaccines could begin. The CDC also needed to launch some educational campaigns among gays to prevent the disease.

Although most in the CDC Task Force had long been persuaded by Francis’s arguments, the response from the experts at the National Institutes of Health was underwhelming. Don sensed that the various institutes felt he was making a pitch for CDC supremacy in GRID studies and that his theory was simply a way to divert research funds from the National Institutes of Health to the CDC. Clearly, the NIH doctors were going to steer their own course through the epidemic. His ideas, they told him, were, um, interesting.

He might as well be talking to a wall, thought Francis as he took down the charts. Their arrogance would cost lives, and there was nothing he could do.

C
HINATOWN
, L
OS
A
NGELES

“If we don’t eat, we’ll be worthless.”

Bill Darrow and Dave Auerbach had spent another exhausting day doing interviews on the reported connections between the first GRID cases in Los Angeles. They were supposed to be in Orange County by 8:30 that night, and it was nearly 8 P.M. already and they were still downtown. Auerbach was glad that Darrow opted for tardiness over hunger, and the pair trekked to Chinatown for some quick Mandarin food. Auerbach also was glad to have Darrow in L.A. from the CDC headquarters in Atlanta because Darrow, a sociologist, had such a keen memory. He could remember names and connections that went years back. His gentle, professorial manner also worked well in the long interviews during which gay men were asked to reveal everybody with whom they had gone to bed over the past few years.

Auerbach had returned today to that intriguing lead about the French-Canadian airline steward. His name had come up three times. But all the reports came from lovers of deceased patients, not from anybody who had actually slept with Gaetan Dugas themselves. Gaetan, of course, was just one of three airline stewards involved in this clustering. The air bridges between Los Angeles, New York, and San Francisco clearly had helped spread this virus around the country at breakneck speed.

When Auerbach and Darrow finally arrived in Orange County, they were forty-five minutes late. The ailing hairdresser they were to interview led them through his well-appointed living room to a picnic table he had in the kitchen. The man was suffering from Kaposi’s sarcoma. It didn’t take him long to get straight to the point.

“I bet I know how I got this thing,” he said directly. “I had sex with this attractive guy I had met at a bathhouse. He came over and spent the weekend. He came back to Los Angeles for a few more weekends, even stayed here for Thanksgiving, and then I never saw him again. He gave me hepatitis, and I bet he gave me this new disease too.”

The man paused and then admitted, “I’m still quite fond of him.”

He rustled through a book for the man’s address and phone number.

“Gaetan Dugas,” the man said. “He’s an airline steward, and here’s how you can reach him.”

Bill Darrow dropped his pencil.

Auerbach shot a glance at him. The man could tell from the meaningful looks between the two epidemiologists that he had said the magic word.

He had. Finally, Auerbach and Darrow had a live person telling them he had had sex with this flight attendant. It was, Darrow said later, one of the most significant moments of the epidemic. The ball had dropped on the game show.

The connections started falling into place. Of the first nineteen cases of GRID in Los Angeles, four had had sex with Gaetan Dugas. Another four cases, meanwhile, had gone to bed with people who had had sex with Dugas, establishing sexual links between nine of the nineteen Los Angeles cases. Moreover, the links bore out Don Francis’s fears about the virus having a long latency period. For example, the Orange County man Darrow and Auerbach had interviewed did not show symptoms until August 1981, some ten months after Gaetan spent the weekend with him on Thanksgiving 1980. Another Los Angeles man found his first Kaposi’s sarcoma lesions thirteen months after he had slept with the French-Canadian during a trip Gaetan made to southern California in February 1980.

Darrow wanted to get back to New York City so he could attempt to track this flight attendant’s Manhattan escapades, but first, he made a side trip to San Francisco to see Selma Dritz’s blackboard with its arrows and circles.

Like public health officers across the country, Dritz was anxiously waiting for the case-control study and couldn’t fathom what was taking the CDC so long in getting this crucial information out. She was intrigued, however, when Darrow walked into her office, glanced at her blackboard and announced, “I’ve got nine.”

Dritz immediately recognized two other Orange County names as people who lived part-time in San Francisco. At least one San Francisco KS patient had had sex with them. Again, there were the dual sentiments with which Dritz was getting so familiar during this epidemic. On one hand, there was an exhilaration when some new connection arose, some insight was gained. And there was the second, sinking feeling of despair that Selma could feel settling into her stomach now. Yes, this was intellectually exciting, but every insight only revealed more bad news, portending greater disaster ahead.

On March 19, 1982, the Centers for Disease Control reported 285 cases of GRID in seventeen states. Half the cases were diagnosed in New York City and about a quarter of the cases lived in California. Five other nations, all in Europe, also reported cases of the diseases.

C
ENTERS FOR
D
ISEASE
C
ONTROL
,
A
TLANTA

Bill Darrow called in daily to Harold Jaffe with all the latest scoops about where his cluster study was leading him. Every day added some new twist to the story, and Jaffe felt as though he were beginning to know all the victims and their lives from the complicated interrelationships Darrow mapped out. The sexual politics and, in Los Angeles, the political links with a big fund-raising dinner in 1979 seemed interwoven with these stories of party people who so casually leaped continents for their pleasures. It was like a transcontinental homosexual soap opera. The links also provided a development that, at last,
meant
something.

Darrow’s work in the cluster study began coming in at the same time computer tabulations were finally being completed on the CDC’s case-control study. That would be the way the CDC Task Force worked during this year of gathering darkness; no sooner was one issue laid to rest than a larger and more troubling crisis would develop, adding a new level of confusion to what had only briefly seemed resolved.

The cluster study had just that effect on the case-control study. The long-awaited comparison with GRID cases and their controls had turned up exactly what CDC Task Force members had noted in their first talks with patients last July. Patients tended to have twice the sexual contacts as the controls and to draw these contacts from among other promiscuous men, because they were far more likely to go to gay bathhouses for sexual recreation. A typical GRID case had sex with 1,100 men in his lifetime; a few counted as many as 20,000 sexual contacts. There were also correlates of having syphilis and other sexually transmitted diseases, as well as higher levels of drug use among cases, but these seemed more a part of the fast-lane life-style than predicators of immune suppression itself. The study nixed the notion that poppers or any environmental factor was behind GRID, given the fact that both cases and controls used the inhalants and were exposed to virtually the same environmental factors.