And the Band Played On: Politics, People, and the AIDS Epidemic, 20th-Anniversary Edition (42 page)

This was the mobilizing meeting Marc Conant and Paul Volberding had decided to orchestrate when they were at the AIDS conference at New York University, when Conant read “1,112 and Counting.” These were the leaders who could ring the alarms, Conant thought.

Lia Belli, a longtime proponent of gay causes and wife of the city’s most prominent and bellicose lawyer Mel Belli, had offered the playroom of her Pacific Heights mansion for the event. The playroom, it turned out, was the entire top floor of the palatial home; a lot of the activists privately conceded they had come just to see what the house, at one of the most fashionable addresses in the city, looked like. When she introduced Marc Conant, Lia Belli pleaded that the epidemic demanded the gay community’s “immediate action” and that it was “an issue that’s above politics.” Conant had assembled every major AIDS researcher in town to recite a litany of horror about the years that lay ahead.

By current estimates, the incubation period was as long as eighteen months, Conant said, meaning the AIDS cases of tomorrow were out there spreading the virus around today. “The 1984 AIDS victims have already contracted the disease,” said Conant. “Even if we had a vaccine today, there is nothing we could do to prevent these cases.”

Selma Dritz gave the latest update on numbers, reporting 207 Bay Area cases, “as of today,” and the probability of hundreds more by the end of the year. Andrew Moss showed his census tract charts that identified Castro Street as ground zero of the local epidemic. Moss’s line graphs showed a near-vertical curve of cases that wouldn’t begin to level off, he noted, until well after gay men started changing their sexual activity.

Paul Volberding talked about the Los Angeles cluster study and Patient Zero. The study indicated that you didn’t need 1,100 sexual contacts to get AIDS anymore, he said. It was just a matter of luck. Sex as a lottery. “When the disease first started, it probably took more contacts in order to get it, because there was less incidence of the disease,” he said. “That’s not the case anymore.”

Questions focused largely on one issue: Did the doctors
really
know how AIDS was transmitted? Anal intercourse could be a major problem, the scientists said, given the hepatitis B model of transmission. The virus, obviously present in semen, could be injected directly into the bloodstream through fissures in the rectal lining. Nobody, however, seemed particularly enthralled with Conant’s suggestion that gay men start wearing condoms. The CDC case-control study had indicted promiscuity, a word quickly denounced by gay leaders as “judgmental,” but the doctors could offer little direct advice on which practices spread the disease. Because of federal funding shortages, no subsequent epidemiological studies had been undertaken to investigate this issue, even though they were precisely the inquiries that could most directly have saved lives. Now doctors, who were trying to urge a reluctant gay community to change, were bearing the burden of the shortfall.

“Bodily fluids,” suggested Dr. Robert Bolan of the Bay Area Physicians for Human Rights.

It was the first time the gay community had heard the expression; and it wouldn’t be the last.

“You have to avoid contact with bodily fluids,” said Bolan, who had emerged as the most militant AIDS fighter in the gay doctors’ group. “That would include semen, urine, saliva, and blood. And I mean avoid them. This is the big enchilada, guys. You don’t get a second chance once you get this.”

Hearing this, San Francisco Supervisor Carol Ruth Silver, a close, longtime ally of the gay community, made what she considered a logical suggestion: “If you’re saying that this can be spread through sexual contact, it makes sense to me to have the public health department get a court order to shut down the gay bathhouses. That would probably save lives.”

A chorus of boos and hisses greeted Silver’s recommendation. The gay leaders were prepared to, perhaps, think of AIDS as a big enchilada, but they were not ready to swallow a combination plate. Such action would have profound political ramifications, they warned. The sheer volume of the heckling cowed Silver into silence, as it would every other civic leader. Not only was closing the bathhouses something that could not be done, it was something that could not even be discussed.

As the leaders slowly filed out, they invariably told Marc Conant or Paul Volberding what fine work they were doing. Keep it up, they said. Conant had a sinking feeling as he walked down the mansion’s twisting, baronial staircase to leave. He had hoped the leaders would agree on a call to arms to fight the epidemic within the gay community. Instead, they seemed preoccupied with the politically correct thing to do. Conant feared that people were going to die because of it.

Bill Kraus preferred long yellow legal pads for writing, jotting down his ideas carefully in longhand with no punctuation other than dashes. He had hoped some kind of consensus might emerge from the Belli meeting on what to do, but instead the conflicts had become clearer. AIDS could not be fought effectively if gay people continued to think in terms of the old gay community, Bill thought. The rhetoric of the old gay movement—the sexual liberation movement—also needed to be revised. It was not anti-gay to be pro-life, he thought. Bill Kraus began writing his manifesto, one that drew the battle lines on which he would wage his fiercest political fight.

“We believe it is time to speak the simple truth—and to care enough about one another to act on it. Unsafe sex is—quite literally—killing us…. Unsafe sex with a number of partners in San Francisco today carries a high risk of contracting AIDS and of death. So does having unsafe sex with others who have unsafe sex with a large number of partners. For this reason, unsafe sex at bathhouses and sex clubs is particularly dangerous….

“If the gay movement means anything, it means learning self-respect and respect for one another. When a terrible disease means that we purchase our sexual freedom at the price of thousands of our lives, self-respect dictates it is time to stop until it once again is safe….”

Cleve Jones and Ron Huberman—Bill Kraus’s best friend and the vice-president of the Milk Club—both signed the letter with Bill. When Huberman took the letter to the
Bay Area Reporter,
publisher Bob Ross joked that a lot of his advertisers wouldn’t like its tone. And it was six weeks before it was published.

Meanwhile, three Castro-based psychologists—Leon McKusick, Thomas Coates, and William Horstman—were tabulating results from a sample of 600 gay men surveyed in mid-March as to their sexual behavior. Although it did not draw on a randomly selected population, the study was the most extensive ever attempted. The results were culled from questionnaires handed out in the early evening at gay bars and to men leaving gay bathhouses and sex clubs late at night. Another 200 respondents were gay couples, filling in the surveys mailed to them. The sampling revealed how vast the task would be for public health educators.

Only 15 percent of the respondents said they had stopped passive anal intercourse, one-third said their level of that activity had remained the same, and 28 percent said they were doing less. About 20 percent of respondents said they were rimming less often, while one in nine were rimming new partners at the same level as the previous year. Twenty-eight percent had stopped rimming altogether. The most difficult behavior to change, it turned out, was oral sex. Although one in three men said they were sucking less, only 5 percent had stopped altogether, while 55 percent were partaking at the same rate as before the epidemic.

Even worse, bathhouses and sex clubs clearly remained a major center of gay sexual activity. One in four gay men went to bathhouses at least once a week, while one in five others went once a month. The popularity of the sex palaces was ironic given how health conscious gay men had become. Two-thirds of the respondents had visited their physician in the ten weeks before the sampling. Only one in twelve had not seen their doctor in the past year.

Also disconcerting was the survey’s finding that one in six men agreed with the following statement: “Since I found out about AIDS, sometimes I get so frustrated that I have sex that I know I shouldn’t be having.”

Altogether, the study was alarming on a number of points. First, it showed that gay men knew what put them at risk for AIDS. That message had gotten out. However, 62 percent still engaged in high-risk sex at the same frequency—or more often—than before they found out about AIDS. Only 30 percent had reduced their risk behaviors, although not even all of these men had eliminated all activities likely to put them in the path of the AIDS virus. Secondly, the study showed the dangerous role bathhouses played in the spreading epidemic. Men who went to bathhouses were far less likely to have changed their sexual behavior than the other groups sampled in the survey and were far more likely to be infected with a sexually transmitted disease. Sterner messages needed to be delivered to prevent more deaths, the doctors concluded.

“As the rate of infection is climbing exponentially while this report is being submitted, it is evident that measures gay men are currently taking to avoid infection have begun but are still inadequate,” the authors wrote. “As the survey indicates, the gay men surveyed are still poorly informed about disease transmission or are unwilling or unable to change sexual patterns in a manner that will place them at lower risk.”

March 31

The analysis of the first quarter’s AIDS incidence figures in San Francisco indicated how widespread the risk had become. The report on the AIDS caseload as of the end of March found that 1 in 250 single men between the ages of thirty-five and forty-four living in the Castro Street neighborhood had been diagnosed with AIDS, while 1 in 150 of the same age group living in the adjacent Duboce Triangle area was now stricken. Assuming that some of the men living in the neighborhood were heterosexual, Dr. Andrew Moss concluded that “in some cohorts of gay men in San Francisco, AIDS incidence rates in the thirty and forty-year-old groups are now of the order of 1 to 2 percent.”

Only later would studies show that by this time in 1983, the 62 percent of gay men who still engaged in risky sexual behavior had at least a 25 percent chance of being intimate with someone infected with the new virus. Hellish odds in this lottery of death.

By the end of March 1983, it was also clear that the epidemic was taking on different faces as it spread through different parts of the country. In New Jersey, for example, epidemiologists found that gay or bisexual men represented a minority of AIDS cases reported to state authorities as of March 28. Instead, intravenous drug users accounted for 44.2 percent of the state’s AIDS casualties, with Haitians making up another 4 percent. AIDS was rapidly becoming a disease of the poor and the non-whites in the sprawling ghettos bordering New York; 68 percent of New Jersey AIDS cases were black or Hispanic. In fact, researchers later marked the spread of AIDS in concentric circles, pulsing out of the center of Manhattan to include larger and larger rings of land and population in the impoverished outlands of metropolitan New York City. This proliferation of AIDS through the East Coast corridors of poverty heralded the start of the second AIDS epidemic in the United States, distinct from the epidemic in gay men.