And the Band Played On: Politics, People, and the AIDS Epidemic, 20th-Anniversary Edition (81 page)

AIDS was a topic of much discussion at the Republican Convention, although all of it was off the convention floor. At a party barbecue held at the estate of a millionaire Republican businessman, a fundamentalist minister delivered an invocation that included a reference to the fact that God was using AIDS to mete punishment to the immoral. At a breakfast for Republican business executives a day later, the president of American Airlines opened his talk by telling guests that the word “gay” stood for “got AIDS yet?” To highlight the link between the party of Lincoln and growing fundamentalist political clout, Republican leaders recruited Jerry Falwell to deliver the benediction for the session in which President Reagan was renominated.

For all the behind-the-scenes talk, however, AIDS remained a largely unspoken subtext in the election. When the issue was considered at all, it was generally in the context of what each political party thought was wrong with the other. For the Democrats, AIDS was another example of the woes that would be cast upon the world by aggressive reductions in domestic spending. For Republicans, the epidemic was a just dessert, the result of permissiveness bred by the secular humanism of liberals, being visited on people they largely did not care for. Thus an epidemic that had wholly unfolded within a Republican administration had a distinctly Democratic cast for Republicans; for Democrats, AIDS was a Republican epidemic.

Of course, nobody spoke the A-word aloud from the podium of either convention. The entire subject continued to be embarrassing for most people in the mainstream of society; this uneasiness was something that Republicans and Democrats shared.

S
TANFORD
U
NIVERSITY

For AIDS clinicians, the most frustrating aspect of their work was the absence of any effective treatment. When Michael Gottlieb from UCLA read about the Pasteur Institute’s work with an anti-viral drug called HPA-23, he was jubilant. Hearing that Pasteur’s Jean-Claude Chermann was lecturing at Stanford, Gottlieb eagerly made his way to the university.

Chermann showed Gottlieb a photocopy of HPA-23 research results under consideration for publication in a medical journal. According to the Pasteur research, HPA-23 successfully inhibited the reproduction of LAV in patients. The centerpiece of the French research was an AIDS-stricken hemophiliac whose health had rebounded dramatically after taking HPA-23.

“You mustn’t show this to anybody,” Chermann said, worried the data would never be published if it were released in the mainstream press.

Gottlieb persuaded Chermann to at least let him be the first American to get HPA-23 for use in the United States. Of course, Gottlieb added, HPA-23 would have to meet the FDA standards.

Chermann said he had never heard of the FDA. He figured he could send some boxes of the drug to the United States and it would immediately start being injected into AIDS victims. Gottlieb’s heart sank when he realized the legal barriers that would block testing of this promising drug, but he remained enthusiastic about Chermann’s assessment of what was necessary for successful AIDS treatment.

Because the AIDS agent was a retrovirus, Chermann reasoned, it needed to perform an extra chemical feat before reproducing in a cell, namely, copying its RNA into DNA with its reverse transcriptase. HPA-23 interfered with reverse transcriptase, Chermann said, so blocking the virus from reproducing itself. In this sense, HPA-23 was not a cure. It merely kept the virus from running wild and destroying the immune system.

The logic made sense to Gottlieb, who started pitching American pharmaceutical companies to develop reverse transcriptase inhibitors. Like Sam Broder at the NCI, however, Gottlieb found that most drug companies were not eager to get involved in AIDS work. The potential market seemed small. A drug for a few thousand AIDS cases would never offer the opportunity for profits that a successful potion to help the hundreds of thousands who suffered, say, from hypertension would. Moreover, the chances of success appeared remote.

Drug companies wouldn’t invest funds to create new drugs, but Gottlieb found they were game to use on AIDS patients whatever treatments they already had on the shelves. Gottlieb returned to UCLA and started a search of medical literature for antiretroviral drugs. He was willing to try anything that offered a reasonable chance of success. Already, a trickle of southern California AIDS patients were trekking to Mexico, where a number of drugs not available in the United States could be easily purchased at the corner
farmacia.

News about the promising French drug HPA-23 was also spreading on the gay medical grapevine. One of the people who heard the optimistic rumors was Rock Hudson. Gottlieb had been seeing the film star since Hudson was first diagnosed in June. The actor was showing signs of weight loss when he ambled into Gottlieb’s office in late August. A friend in San Francisco, Steve Del Re, had told Hudson about HPA-23. He was planning to go to the film festival in Deauville anyway; he wondered whether Gottlieb knew anybody involved with the Pasteur Institute.

Gottlieb called Chermann, who referred him to Dr. Dominique Dormant, an army doctor who had been experimenting with HPA-23 for a number of years. When Hudson arrived in Paris in September, Dormant called Gottlieb to talk over some details concerning the actor’s condition. It turned out that Dormant had no idea who Hudson was until the actor stepped into his office. The Frenchman then recognized the actor from his films.

At that time, the Pasteur had two regimens for treating AIDS patients, one in which the patient was given large doses of HPA-23 for several weeks and another in which the patient was given lower doses of the drug daily for a more extended period. Hudson was committed to return to the United States to appear in the television series “Dynasty,” so he opted for the short-term regimen. At the conclusion of his treatments, Dormant told Gottlieb that the AIDS virus was no longer detectable in Hudson’s blood.

Later, it would be clear that the short treatments were flawed. Although HPA-23 might halt the replication of the virus, as soon as the patient was off the drug, viral reproduction began anew, ravaging the patient’s immune system. This would not be clear for several months, however, so Hudson left Paris convinced he was cured of AIDS.

Back in the United States, Hudson, a life-long Republican, attended a state dinner at the White House. Noting that the actor had lost weight, an old friend from Hollywood expressed concern about his health.

“I caught some flu bug when I was filming in Israel,” Hudson assured his friend, Nancy Reagan. “I’m feeling fine now.”

September 1984

D
UBLIN
S
TREET
, S
AN
F
RANCISCO

More than a year after her hip replacement surgery, Frances Borchelt still had not recovered her health. The painful psoriasis persisted; she never regained the twenty pounds lost during her bout with hepatitis. In August, a case of the sniffles turned into a severe cold that would not go away. Frances either trembled from chills or sweated profusely from fevers that peaked daily at 103 degrees. As usual, the doctors were baffled.

Sometimes Frances asked her husband Bob to hold her. Even as he became drenched in her sweat, Bob stared down on his suffering wife, feeling pity and compassion and sorrow, wishing desperately that he could do something to ease her agony.

The nightsweats started about the same time Frances complained that she was having a hard time catching her breath. Her appetite declined. Bob and the couple’s daughter, Cathy, forced her to eat.

Cathy’s suspicions continued to grow. Maybe it was the story in the paper about the wealthy Belvedere matron, Mary Richards Johnstone, who had recently died from a blood transfusion supplied by the Irwin Memorial Blood Bank. Cathy insisted that Bob ask the family doctor whether any of Frances’s problems resembled what might happen to somebody who got AIDS.

The doctor assured Bob there were no indications of the syndrome, but Cathy was less convinced. Her boss’s wife was a registered nurse who had recently attended an AIDS seminar. She gave Cathy some brochures about AIDS and Cathy was immediately struck by how closely her mother’s symptoms resembled those listed in the brochure.

Nobody debated whether blood transfusions could spread AIDS anymore. By early September, the Centers for Disease Control counted 80 cases of transfusion AIDS, a quadrupling of confirmed cases in just eight months. A report released several weeks later announced that 52 hemophiliacs in twenty-two states suffered from CDC-defined AIDS, while another 188 had contracted ARC. The first cases of AIDS in both the wife and infant child of a hemophiliac had just been reported. Even more frightening were new studies indicating that as many as 89 percent of the most severe hemophiliacs were infected with HTLV-III, predicting thousands of potential AIDS cases in future years. The National Hemophilia Foundation reported a 20 to 30 percent drop in the use of Factor VIII among members, indicating that some hemophiliacs would rather hazard the potentially fatal consequences of uncontrolled bleeding than inject Factor VIII and risk AIDS.

Dr. Joseph Bove, who had led opposition to blood screening for surrogate AIDS markers, was so shaken by the unfolding statistics that he shifted views and was arguing for FDA regulations to require hepatitis B core antibody screening. When the FDA advisory panel on blood products considered the issue again during the summer, however, other blood industry spokespeople prevailed and Bove’s arguments were rejected.

Irwin Memorial Blood Bank and other Bay Area blood banks had been testing for the hepatitis antibody since May; Irwin was also storing vials of blood taken from every donated unit so they could test donations once the HTLV-III antibody test was available. For taking these precautions, Irwin continued to be chided by other blood bankers. Los Angeles Red Cross spokeswoman Gerri Sohle said in late August that “political pressure” had forced Bay Area blood banks to start the CDC-suggested testing. “I think they’ve been politically pressured into doing the tests, probably by people worried about the gay community,” she said. The executive director of the Council of Community Blood Centers argued that such testing would create “unnecessary anxiety” among donors whose blood might be rejected.

Thus, efforts to protect the nation’s blood supply continued to be frustrated for the rest of 1984 by the factors that always seemed to interfere with intelligent AIDS policy—denial and delay, sophistry and self-interest.

N
ATIONAL
C
ANCER
I
NSTITUTE
,
B
ETHESDA

A summer of investigation of HTLV-III by Dr. Robert Gallo had not produced reassuring information. When he began studying HTLV-III, he figured that perhaps 1 in 100 people infected with the virus would develop AIDS. A few months later, he adjusted his estimate to 1 in 25. By the end of the summer, he confided that he thought 1 in 7 people infected with the virus would develop AIDS, and maybe more.

“It’s unfortunately as efficient a virus as I’ve ever seen,” Gallo told the
New York Native.

An even more sobering discovery followed when Gallo began picking up clues that HTLV-III infected brain cells as well as T-4 lymphocytes. The insight solved a key puzzle that had baffled clinicians throughout the epidemic. AIDS patients frequently suffered neurological problems that could not be linked to any particular brain infection. Often, the early symptoms were mild, marked by depression, loss of memory, or a mental disorder that resembled senility. Doctors initially blamed psychological factors such as stress. As problems with the central nervous system became more pronounced and increasingly common, however, this diagnosis began to ring hollow. Some patients were dying from their brain dysfunctions. The observation that the problems might stem from an HTLV-III infection of the brain solved the puzzle but added serious obstacles to the search for a cure.

To infect the brain, the retrovirus had to cross the blood-brain barrier, a cellular filter that normally keeps microbes away from the body’s most crucial organ. Any medication that sought to successfully treat AIDS, therefore, also had to cross this blood-brain barrier. Otherwise, the virus could lurk in brain cells and reinfect the blood. Few medications, however, could do this, setting up still another hurdle that a treatment must leap in order to be effective.

Gallo’s genetic sequencing of HTLV-III also revealed variations in the virus as it appeared in different people. Such mutations raised fears that science might not be able to make a vaccine, since a vaccine that worked for one strain of HTLV-III might not work for another.

At the National Institute for Allergy and Infectious Diseases, the news was another piece of gray sky on an already bleak horizon. As it was, the vaccine development field had suffered in recent years for lack of interest. In the 188 years since Edward Jenner accomplished the first vaccination, science had created vaccines for just twenty-three diseases. In 1980, Dr. Richard Krause, the NIAID director, had proposed a program to develop ten new vaccines over the next ten years, but few pharmaceutical companies were eager to participate. The hepatitis vaccine, for example, had cost tens of millions to produce, but the anticipated market for the product had never materialized. Between hepatitis B and the swine flu fiasco, many pharmaceutical companies had become convinced that vaccine development promised not profits but large research expenses and huge liability lawsuits. Meanwhile, funds to entice scientists into AIDS vaccine development were on the list of Dr. Brandt’s AIDS projects ignored by Secretary Heckler. Despite the hindrances, the HTLV-III/LAV discoveries continued to propel a quantum leap in the understanding of the AIDS epidemic, nailing down aspects of the disease that had lived only in the realm of the hypothetical for the past three years.

By August, Manvel and Chesley, the two chimpanzees that Don Francis had infected with LAV five months earlier, developed swollen lymph nodes and LAV antibodies in their blood. This proof of AIDS infection strengthened the case that LAV caused AIDS and at last provided scientists with what could be an animal model for the disease. Finding an animal susceptible to the disease was a crucial step for vaccine development; a vaccine’s effectiveness could be tested on laboratory animals.

Now that scientists knew what they were looking for, researchers were able to study various body fluids and confirm the presence of the AIDS agent. HTLV-III was recovered in the semen of both an AIDS-stricken man and a healthy gay man with HTLV-III antibodies, proving definitively that healthy carriers could spread AIDS. Virus also was recovered in vaginal fluids of an infected woman, explaining the bidirectional heterosexual transmission that clearly was spreading the disease in Africa. The retrieval of virus from the saliva of eight ARC patients was more problematical. Not one of the nation’s nearly 6,000 AIDS cases had contracted the disease from saliva. Given the low levels of virus in saliva, Dr. Jay Levy frequently argued that the only way you could get AIDS from spit was to inject a gallon of saliva intravenously. Still, sensing the potential for hysteria, Dr. Edward Brandt held a press conference as soon as the saliva studies were released to assure the public they would not get AIDS from a sneezing homosexual.

By early October, NCI scientists also found a drug they hoped might prove effective in fighting AIDS. Suramin had been used for sixty years to treat African sleeping sickness. In test tubes, the drug interfered with the reverse transcriptase enzyme, disabling HTLV-III’s reproduction mechanism. Dr. Paul Volberding made plans to test the drug at San Francisco General Hospital’s AIDS Clinic in the early months of 1985.

Antibody testing continued to offer reassurances that the AIDS epidemic hadn’t broken out of the afflicted communities to threaten the entire society. The virus simply was not spreading outside the previously defined routes of transmission. NCI tests on the families of hemophiliacs found that no family members were infected with HTLV-III, despite daily contact with HTLV-afflicted hemophiliacs. In labs throughout the country, doctors and technicians who had been working with AIDS for years eagerly tested themselves. Between needle sticks and constant exposure to infected blood, most considered it likely that they harbored HTLV-III in their blood. In test after test, however, their fears proved unfounded. A substantial dose of the virus fed directly into the bloodstream, either through sex or transfusion, was required to get AIDS.

The fact that science was making swift strides in understanding AIDS did not mean that the disease had acquired a new respectability in medical circles. The syndrome still lacked star quality, and most scientists who labored on it did so without much institutional support. Assistant professors who were among the international experts in AIDS research were denied promotions, while associate professorships went to doctors studying more conventional diseases. At the University of California in San Francisco, administrators mentioned to one of the nation’s foremost researchers that they wanted less publicity about AIDS. UC officials worried that top interns were choosing to go to other medical centers because the UCSF teaching hospital was San Francisco General, the nation’s premier AIDS facility. The best medical school graduates, they feared, would not want to perform internships at a hospital if all they would see was one kind of patient.

Researchers, however, thought the reluctance to embrace AIDS as a legitimate topic for scientific study reflected more than just concern over the quality of interns a university might attract. Put simply, AIDS continued to embarrass people. From the start, it had made people uncomfortable, whether they were in government or media, in public health or prominent universities. AIDS was about homosexuals and anal intercourse, and all kinds of things that were just plain embarrassing. And when UCSF opened its own AIDS clinic in the summer, it did not call it a clinic for Acquired Immune Deficiency Syndrome, but a center for Adult Immune Deficiency.

S
AN
F
RANCISCO

Men carried surgical tubing down the hall of Animals, a popular gay bathhouse, as casually as business executives carried briefcases in the financial district. Once upstairs, one man wrapped the tubing around another patron’s biceps, pausing until the vein bulged. A long sigh signaled that the needle had accurately delivered the methadrine to the patron’s central nervous system. When the man with the needle noticed somebody watching him, he cheerfully offered the observer a hit of crystal. Across the hall, another man’s arm disappeared between the legs of his partner, and throughout the bathhouse, scores of men participated in sexual acts that did not fall under the heading of “safe” in the risk-reduction guidelines passed out by the Bay Area Physicians for Human Rights.

By late September, patrons at the city’s remaining bathhouses and private sex clubs included private detectives who had been hired by the San Francisco Department of Public Health to document whether the facilities encouraged sexual activity that spread AIDS. The report was to be used when Merv Silverman went to court in a few weeks to close down the bathhouses.

Silverman had hoped the issue would not come to such a confrontation, but he had no doubt as to what course of action he would take when he read the investigators’ reports.

Even Silverman, who was not naive about what went on in gay bathhouses, was shocked by what investigators found. The X-rated, eighty-five-page report certainly documented the fact that condoms and safe-sex brochures were available in almost every bathhouse. Most patrons, however, ignored them. Just about every type of unsafe sex imaginable, and many variations that were unimaginable, were being practiced with carefree abandonment at the facilities. That, after all, was what bathhouses were for.