And the Band Played On: Politics, People, and the AIDS Epidemic, 20th-Anniversary Edition (85 page)

Conservative opponents immediately blamed Labor’s support of repeal of the nation’s old sodomy laws. “If it wasn’t for the promotion of homosexuality as a norm by Labour, I am quite confident that the deaths of these three poor babies would not have occurred,” said Ian Sinclair, leader of the right-wing National Party. One National Party parliamentary candidate advocated manslaughter trials for any gay men found to be donating blood; others said they should be indicted for murder.

Leading fundamentalists said this never would have happened if (he nation had heeded their 1983 call for a quarantine on all gay men traveling to the United States. Gay rights groups reported numerous gang attacks on gay men, apparently inspired by the AIDS panic.

With clamor rising across the country, Prime Minister Hawke interrupted a campaign tour and called an emergency meeting of AIDS experts and state health ministers in Melbourne. The atmosphere was acrimonious. According to one report, the Queensland health minister refused to so much as walk into the room where an openly gay man was present. A number of committees and task forces were established, and the health ministers agreed to impose national guidelines to deal severely with people who misled blood bankers when filling out questionnaires about their status as possible members of high-risk groups. Hawke issued a national call for female donors.

Although Australia was the hotspot for AIDS hysteria in 1984, concern grew elsewhere as well. The World Health Organization reported a threefold increase of AIDS cases in western Europe during 1984, with 762 cases diagnosed in fourteen nations. About one-third of the cases were in France. The two nations with gay populations most prone to travel, Denmark and Switzerland, reported the highest per capita rates of AIDS on the continent.

Blood testing continued to show the penetration the AIDS virus was making into countries that had yet to report a high incidence of the disease. Finland, for example, reported only five cases, all of which were diagnosed in the last six months of 1984. Testing of 175 Finnish gay men, however, revealed that 10 percent were infected with HTLV-III. Of these, one-third already had developed ARC.

In the Federal Republic of Germany, the second hardest-hit nation in Europe, testing found that two-thirds of hemophiliacs, 20 percent of intravenous drug users, and one-third of gay men carried HTLV-III antibodies. West German authorities predicted 10,000 AIDS cases in that country by 1990. The projections led to the first proposals to place AIDS patients under the same restrictions that apply to people with syphilis or gonorrhea. Under these venereal disease laws, which were in force in virtually every northern European country, it was a crime for a person infected with a sexually transmitted disease to have sex.

The spread of AIDS in Africa most likely outpaced the spread in any other region in the world, although determining this with any degree of accuracy remained problematical. African governments continued to be reluctant to acknowledge that the epidemic even existed within their borders. Therefore, the extent of the problem was most obvious in Europe, where one in six AIDS patients was African. These cases could be traced to eighteen sub-Saharan African nations. Two-thirds of the African-linked AIDS cases in Europe, however, came from one country, Zaire, and 11 percent came from the nearby Congo. Belgian scientists reported only one major risk factor in these nations: heterosexual promiscuity.

In December, a new wave of concern over AIDS flared in England when health authorities reported that fifty-five Britons had been treated with blood products contaminated with AIDS. Within days, the first British transfusion-AIDS case was announced. The victim was a baby whose mother had received an infected unit of blood during pregnancy. Doctors were anxiously watching the mother for signs of the disease.

In the United States, the CDC reported ninety cases of transfusion AIDS by the end of 1984. Another forty-nine hemophiliacs had contracted the disease from infected Factor VIII.

December 10

S
ETON
M
EDICAL
C
ENTER
,
D
ALY
C
ITY
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ALIFORNIA

One doctor suggested Frances Borchelt was suffering from psittacosis when they admitted her to the hospital this time. Maybe she had picked up the disease from the family parakeet, he said. Frances’s daughter Cathy had studied her AIDS brochures and believed her mother had AIDS, but the doctors were adamant that she did not have any of the symptoms.

They cultured Frances Borchelt’s blood, tested her bone marrow, and used every gadget of nuclear medicine to see what was wrong. Meanwhile, the grandmother grew weaker with each passing day. Breathing was becoming excruciatingly difficult.

On December 23, Frances went into respiratory failure and was rushed into the intensive care unit. On a respirator, Frances managed to communicate with her worried husband and children by scribbling on a piece of paper. It was the first anniversary of the death of her older daughter and one day away from the anniversary of her father’s death, she noted. As orderlies prepared Frances for emergency surgery, the fiercely superstitious woman said, “This time it’s my turn.”

Christmas Eve

Bill Kraus’s mother Mary had looked forward to her Christmas visit with her two boys in San Francisco. She had been devastated since Bill’s diagnosis and felt isolated because there was no one with whom she could discuss Bill’s plight. She didn’t feel comfortable talking to her friends about AIDS. For years, she often avoided saying even that her two sons lived in San Francisco for fear that it would explain why they were still unmarried.

On Christmas Eve, Bill was in bed, suffering from a cold. He was moody and seemed troubled when he talked to his mother.

“I’ve had this recurring dream that there’s a wall of ice in front of me,” Bill said.

“Visualize the wall melting,” Mary suggested. “Make it go away.”

Bill hesitated for a moment, and then confessed, “It scares me.”

Christmas Day

Lying on the respirator, with tubes coursing through her, Frances Borchelt was her usual commanding self, writing notes to Cathy about how to cook the roast beef and prepare the mashed potatoes. Normally, Christmas was a major production at the Borchelt household, with Frances ruling the kitchen and doting over the grandchildren. The family tried to be cheerful on this Christmas, even as nurses insisted they don gowns and gloves before seeing Frances. The matriarch’s two granddaughters stayed behind in the waiting room; nobody wanted the children to see Frances weak and wasted on the breathing machine.

Three days later, the family doctor told Bob Borchelt that the lung biopsy showed that Frances had contracted
Pneumocystis carinii
pneumonia. He mentioned that it was a pneumonia that people with AIDS sometimes got, but went no further into this troublesome side of the diagnosis. When Bob told Cathy, she wanted to scream.

“Dad, that’s AIDS,” she said. “Mom has AIDS.”

In Washington, meanwhile, the Reagan administration had yet to decide whether to release the $8.4 million that Congress had appropriated more than two months before to speed the HTLV-III antibody test to blood banks. The matter was “still under discussion,” a White House spokesperson said.

Attempts at the year’s end to prod other national institutions toward paying attention to the implications of the epidemic proved unsuccessful. Defense Secretary Casper Weinberger declined to meet with outgoing health chief Edward Brandt, who felt the military needed to face up to the problems that undoubtedly would arise from AIDS infection of U.S. servicemen. In private discussions with insurance lobbyists, meanwhile, congressional aide Tim Westmoreland warned that they should use their substantial political muscle to pressure for more AIDS funding. He predicted billions of dollars of medical expenses in future years that would cripple the corporations. However, like most large corporations, insurance companies supported conservative leaders who were for less government spending, not more. They weren’t about to start dallying with a gay issue like AIDS, so Westmoreland found few willing listeners.

Nineteen eighty-four was the year of the films
Amadeus
and
Purple Rain.
Tina Turner made a dramatic comeback, inspiring New Year’s Eve costumes for drag queens across the country. And it seemed that every year-in-review piece on the television newscasts featured huge American flags waving at the U.S. Olympics in Los Angeles and at the Republican National Convention, scored to the music of the year’s top-selling record,
Born in the U.S.A.
This Bruce Springsteen album was a collection of songs about the ignored Americans who were left out of the American dream, stranded in despairing lives of unfulfilled aspirations. A more powerful message of discontent had not been written in twenty years, and yet, somehow,
Born in the U.S.A.
was seen as part of the flag-waving patriotism that had thoroughly seized the nation that year.

It was easy to ignore anomalies in 1984. President Reagan, who had presided over the greatest deficit spending of any government in human history, won reelection on a platform promising to make deficit spending unconstitutional. And everybody agreed the future of the United States was bright again. On December 31, the Centers for Disease Control reported that 7,699 Americans were dead or dying of a disease that had never been heard of when President Reagan was sworn in during his first term, and nobody paid much attention to the CDC’s warnings that tens of thousands more would be dead by the time he was done with his second.

S
AN
F
RANCISCO

In San Francisco, the endgame of AIDS public health politics also came in December when Dr. Mervyn Silverman called a press conference to make an announcement that surprised nobody. After seven years as the city’s health director, he needed “to do something else.” He was resigning.

The handwriting urging Silverman’s departure had been on the municipal wall for several weeks. In November, voters passed a proposition shifting control of the health department from the city manager to a new health commission to be appointed by the mayor. Three days after the election, Mayor Feinstein announced the formation of a high-level task force to chart the transfer of the department; pointedly, she did not appoint Silverman.

Silverman had little support anywhere in the city now. Doctors and politicians who supported a vigorous response to the AIDS epidemic felt Silverman had moved too slowly. Meanwhile, many gays felt Silverman had done too much. The health department’s new education program was nothing more than a revamping of the “behavior modification” plan forwarded by Dr. Marcus Conant earlier in the year, they noted bitterly. For months, the gay papers had been crammed with vitriolic editorials and nasty letters condemning Silverman as “homophobic.” The criticism was ironic, of course, because so many of Silverman’s problems were a direct result of his unwillingness to do anything that might be perceived as even remotely anti-gay.

In any event, Silverman was weary at the end of the year and looking forward to the rest. He was not resigning in disgrace. After all, he was handing his successor an AIDS program that was now internationally esteemed as the model against which all future efforts in other cities would be judged. To be sure, the education and prevention projects had taken years to forge in the highly charged atmosphere of public health politics in San Francisco, but they were now complete. Silverman felt proud of what he had accomplished, and if he had it to do over again, he did not feel he would do it very differently.

During Silverman’s press conference, a reporter asked Silverman how he felt to be leaving his job “in the middle of an epidemic.”

“I’m afraid we’re not in the middle of an epidemic,” Silverman answered. “This is the beginning.”

January 1985

N
EW
Y
ORK
C
ITY

At the emergency room of St. Vincent’s Hospital in Greenwich Village, the patient lay on a gurney, wheezing from
Pneumocystis.
He had lain there for twenty-four hours, waiting for a room. Under normal circumstances, his doctor would have called the hospital and had the man admitted. But hospital administrators preferred not to take any more AIDS patients; they already had so many. The man’s doctor had told him to circumvent standard procedures and simply show up in the emergency room, where, under New York law, he could not be turned away.

That’s what doctors advised patients who needed hospitalization for AIDS in New York City in early 1985. At Memorial Sloan-Kettering Cancer Center, Dr. Mathilde Krim fielded calls daily from doctors desperate to find hospital rooms for their ailing patients. Physicians were afraid to send their patients to a number of the city’s hospitals, given the bad treatment AIDS patients had received in the past; institutions with good reputations for dealing with AIDS already were overwhelmed.

Uptown at St. Luke’s-Roosevelt Hospital, one of the largest medical centers in the world, half of the hospital’s private rooms were filled with dying AIDS victims. In one well-known New York hospital, the vice-president of one of the largest corporations in New York City, who was suffering from Kaposi’s sarcoma, was denied a bed and had to check into the hospital through the emergency room. Even there, running a 104-degree fever, the executive had to wait seven hours for a room. There was talk among AIDS clinicians that one AIDS sufferer had already died while waiting for a room at one of Manhattan’s most prestigious university hospitals. Throughout the city, AIDS clinicians could not imagine what they would do in coming months when burgeoning numbers of patients overwhelmed the hospitals’ finite resources.

“We’re not talking about a nightmare that is going to happen,” said St. Luke’s-Roosevelt AIDS expert, Dr. Michael Lange. “It already is a nightmare.”

At Jacobi Hospital in the Bronx, three-year-old Diana waved wanly at Dr. Arye Rubinstein, one of the only familiar faces she had known in her life. She had lived in the hospital since 1983, not because she needed hospitalization but because New York City had no place else to put its AIDS patients. There were at least twenty-five children like her in the hospitals of New York and New Jersey, and every month, as the parents of such children died or abandoned them, there were more. Everybody had known this would happen, of course, but nobody had really planned what to do when it did.

The crisis in New York AIDS treatment characterized the new phase the AIDS epidemic was entering. The unheeded warnings of 1983 and the lost opportunities of 1984 were materializing into the tragic stories of 1985. The future shock of the AIDS epidemic was arriving; the butcher’s bill had come due.

January 3

T
HE
T
ENDERLOIN
, S
AN
F
RANCISCO

Street lights and blinking neon signs cast shadows across the young woman’s face. She pouted histrionically when the undercover police asked for her identification. The other women quickly hustled themselves off the dingy block of Ellis Street in the heart of San Francisco’s sleazy hooker district. In this part of town, of course, such arrests were not rare occasions.

Silvana Strangis ignored the stares of passing motorists while the arresting officer waited for the radio to tell him whether the thirty-four-year-old brunette had an arrest record. Her record, it turned out, was unusually impressive, even for this part of town. In the past five years, she had been busted thirty-two times and charged with thirteen felonies and thirty-nine misdemeanors, from robbery and grand theft to tonight’s offense, “obstructing a sidewalk.”

When Silvana brushed her long straight hair out of her eyes, the arresting officer could see the dark brown puncture marks on her arm where she injected her heroin. He knew her story; it wasn’t that different from the other prostitutes who worked the Tenderloin.

Silvana was handcuffed and put in the back of the squad car. Right away, she noticed that the vice cops seemed inordinately chatty. Instead of reading her Miranda rights, they wanted to talk about Silvana’s boyfriend and pimp, Tony Ford. They’d heard on the street that Tony had AIDS. Was it true?

Years of heroin addiction had undone whatever Silvana Strangis had learned of discretion, and she admitted that Tony had just been discharged from the AIDS Ward. She was worried that she had AIDS too, she added.

It was then that Silvana noticed that instead of turning toward the Hall of Justice, the patrol car was heading through the Mission District. A little past midnight, the police officers brought the handcuffed prisoner into the emergency room at San Francisco General Hospital.

“We want her to have the AIDS test,” one of the officers said.

The hospital personnel were astonished at the request. They carefully explained that so far no AIDS test, per se, existed. The HTLV-III antibody test had yet to be licensed, and that was not an AIDS test. Moreover, they could not force a handcuffed prisoner to take any test so that the results could be turned over to police officers. Maybe the woman should come back when the AIDS Clinic was open and when she could decide for herself what she wanted to do.

The disappointed officers put Silvana back in the cruiser, wrote out a citation for obstructing a sidewalk, and drove back to the Tenderloin. Silvana should go back to the AIDS Clinic, they instructed, and get whatever tests she could. And she should get the results in writing. They’d be back to check up on what the doctors had to say.

Silvana was shaken when she stepped out of the car. She searched out her dealer, scored some heroin, and took it back to her seedy room, where Tony Ford was waiting. They shot the heroin, sharing the needle, just as they always had. Soon, the pair passed out.

The next morning, a
Chronicle
reporter, tipped off by an emergency room attendant, knocked on Silvana’s door.

“Tell him to get the hell out of here,” Tony grumbled.

“I need a ride to the clinic,” Silvana said, pulling a beat-up poncho over her blue jeans.

At the AIDS Clinic, the head nurse, Gayling Gee, cleared her schedule to talk to Silvana Strangis, although the hooker was too embarrassed about her predicament to say much. Instead, she asked the reporter to tell Gee about her profession and the vice cops and her urgent need for AIDS screening. Gee and the other clinic staffers who heard the tale were dumbfounded. They wondered about issues like confidentiality and civil rights.

Silvana didn’t want to hear about this. All she wanted was a piece of paper that said she didn’t have AIDS. She could show it to the vice cops and get on with the business of turning tricks and buying heroin. Gee gave her an appointment for the next week.

“How did you end up like this?” the reporter asked, as he drove Silvana back to her Jones Street hotel room.

Silvana turned up the Moody Blues tape on the car stereo, sighed, and said she had grown up in a nice Italian family in a San Francisco suburb. When she had graduated from a Catholic high school in 1968, she was full of optimism about a world that seemed on the brink of a New Age. The idealism faded in the years that followed, and she started taking drugs, and then she met Tony and bore his child. It was easy to make money by turning tricks, and life now went from trick to trick, from fix to fix.

By the time the couple heard about AIDS and the threat posed by sharing needles and sexual relations, it was too late. Tony already had the first symptoms of immune disorder, and the threat of some distant health problem paled in comparison to the urgency of getting that soothing rush of heroin. Nobody cared much about this disease in the Tenderloin, she added. When Tony lay in the AIDS Ward a few weeks ago, some of the other players from the neighborhood brought Tony’s fixes to his bedside. They’d close the door, make jokes about the gay male nurses, and all shoot up together, sharing the same needle.

There was, of course, no question of what Silvana would do tonight. Tony couldn’t work. He certainly didn’t want her to stop working either; that would mean the end of his heroin.

“It’s the drugs,” she concluded. “It’s like what they say on TV. You get in and you can’t get out.”

That was why Silvana was going back to the streets that night. Yes, she was worried about spreading AIDS. In fact, her lymph nodes were swollen, her sleep was disturbed by chronic nightsweats, and she felt dog-tired all the time. But she had to work. She didn’t know any other way to make money.

The next morning’s front-page story about a prostitute raised all the profound public policy questions implicit in the case of a working hooker who almost certainly was an AIDS carrier. Dr. Paul Volberding talked about how the prostitute posed a “monster of a public health issue,” with its classical conflict between public health and individual rights. Other news coverage of Silvana Strangis, however, was less delicate.

“A human time bomb is walking the streets of San Francisco,” announced the grim anchor at the top of the local evening news that night. Another newscast likened her to “Typhoid Mary.”

All weekend, television crews trolled the Tenderloin in their Instant Eye vans, trying to interview anxious streetwalkers. Frightened callers to talk shows almost unanimously opined that the police should lock the woman up and quickly discard the key.

Silvana became such an instant persona non grata in her neighborhood that she was literally chased off the streets and into her residential hotel lobby by four angry prostitutes who threatened to have her stabbed to death if she left her hotel again. The news stories, it turned out, hadn’t done much for business. It seemed every John looking for action that weekend started negotiations by asking, “Are you the one with AIDS?”

The uproar illuminated the profoundly heterosexual male bias that dominates the news business. After all, thousands of gay men had been infecting each other for years, but attempts to interest news organizations to pressure the city for an aggressive AIDS education campaign had yielded minimal interest. A single female heterosexual prostitute, however, was a different matter. She might infect a heterosexual man. That was someone who mattered; that was news.

Although evidence of heterosexual AIDS transmission could be dated back to the first epidemiological studies by the Centers for Disease Control in the summer of 1981, it was not until early 1985 that the straight links of the disease garnered much attention. The most disconcerting stories came from Central Africa, where AIDS was simply called “the horror sex disease.” Although image-conscious African governments swore to silence the researchers working within their borders, leaks confirmed that thousands of immune-suppressed people were dying in black Africa, usually from gastrointestinal parasites, the most common opportunistic infections of that region. Unaware of foreign acronyms, Ugandans had dubbed AIDS “slim disease” because of the wasting away that marked the virulent parasitic diseases.

In scientific forums, European researchers working closely with teams in Central Africa were the most outspoken about the heterosexual dimension of the epidemic. These doctors, largely in Belgium and France, had always considered the preoccupation with the gay angle of AIDS to be a strange American idiosyncrasy. Given the experiences of such nations as Zajre and Rwanda, these doctors warned that the Western world should not be complacent about the threat that this new sexually transmitted disease posed to all people.

In the United States, the most aggressive research on heterosexual AIDS transmission came from a most unlikely source, the U.S. Army. From his work at the Walter Reed Army Institute in Washington, D.C., Dr. Robert Redfield had documented the ease of male-to-female sexual transmission of AIDS. Of seven married male sufferers of AIDS and ARC, for example, Redfield found that five had wives who were infected with HTLV-III. Of these five wives, three were already showing clinical symptoms of ARC. The fact that one-third of military AIDS and ARC cases claimed that prostitute contact was their only risk behavior also made Redfield a passionate proponent of the threat posed by female-to-male AIDS transmission. His case, however, was problematical because the military was by now routinely dismissing gay servicemen suffering from the syndrome. That provided powerful motivation for military personnel to blame prostitutes rather than homosexual contacts for their infection.

The question of female-to-male AIDS transmission had exploded in San Francisco not long before, when Dr. Paul Volberding at the AIDS Clinic held a press conference to announce the first two local AIDS cases among heterosexual men who claimed no other high-risk activity than sexual relations with intravenous drug-using prostitutes. In San Francisco, the new cases were something of a revelation because AIDS had remained an almost purely gay phenomenon in that city. More than 98 percent of the city’s caseload were gay or bisexual men; the transfusion AIDS cases and five drug addicts were the exception proving the rule that, in San Francisco, AIDS was a gay disease.