And the Band Played On

  Weeks after this woman’s death, baffled scientists in Cologne tried to understand why a successful young concert violinist should contract a case of Kaposi’s sarcoma. The German musician was gay and had spent much of the decade traveling across Europe, but this provided no clue as to why he should fall victim to an old man’s disease rarely seen in northern Europe. Nor did it explain why his lymph nodes seemed to explode three months later, as if they were fighting some unseen infection. Answers were no more forthcoming in the excruciating months ahead while doctors helplessly watched the forty-two-year-old’s body be bombarded with disease after disease until finally, in January 1979, he died.

  It was at about that time that Belgian doctors in Zaire began reporting an upsurge in cases of cryptococcosis at Kinshasa’s Memo Yemo General Hospital. By 1980, physicians could document fifteen cases of this disease. The cysts that spread Cryptococcus are found in bird droppings the world over. The problem, therefore, was not the presence of new Cryptococcus germs but of some weakness in the patients’ immunity that let the disease take root.

  In Paris, the first case of the baffling pneumonia also had an African connection, appearing in 1978 when a Portuguese cab driver suddenly experienced difficulty breathing. The short, swarthy man had returned only a year or so before from Angola, where he had served in the Portuguese navy during the Angolan Civil War and, later, as a trucker, driving Angola-Mozambique routes that cut through the narrow coastal spit of western Zaire. Dr. Willy Rozenbaum of Claude-Bernard Hospital was called in to see the man in 1979 and easily diagnosed the parasite Pneumocystis carinii. Unable to fathom what immune problems might have engendered the pneumonia, Rozenbaum enlisted immunologist Jacques Leibowitch to try to solve the problem. Leibowitch was accustomed to seeing bizarre diseases among people who traveled to exotic parts of the world; it seemed he was always treating some airline pilot or steward for some obscure infection. The doctor first tested the man for lymph cancer, the condition that often proves to cause such rare bouts of immune deficiency. But the tests yielded nothing, as did further blood studies. Specialists from all over Paris were trooping to the man’s bedside, drawn both to struggle for a cure and to explore an intriguing medical mystery. Meanwhile, colonies of thick white fungus bloomed in the patient’s mouth and throat, while warts caused by ordinarily benign papovavirus swept over his body, covering his arms and legs.

  The doctors were downright awestricken when the man’s brain became infected with toxoplasmosis, another rare parasite. Nothing they could do yielded any help, however, and in 1980, the man returned to his wife and five children in Portugal to die. As he was nearing death in Iberia, two women were admitted to the intensive care unit of Claude-Bernard with Pneumocystis. One was a Zairian woman, who, like many in the elite of that French-speaking region of central Africa, had sought treatment in the more advanced hospitals of Paris after her African doctors could find no effective treatment for her. The second woman was French, but she, too, had lived recently in Zaire.

  The European fall turned to winter. By the time winter was turning to spring, all of them—the cab driver in Portugal and the two women in Paris—had drowned in the primeval protozoa that had filled their lungs.

  In the United States, unexplained maladies from a mysterious new syndrome would be traced back to 1979. It was on a balmy September day in 1979 that Rick Wellikoff had been sent to Dr. Linda Laubenstein for blood studies. She duly noted the generalized rash that resisted treatment, and the enlarged lymph nodes all over his body. Laubenstein surveyed the man and assumed he had lymph cancer. Later, a dermatologist told Linda that the man’s rash was a skin cancer called Kaposi’s sarcoma.

  “What the hell is that?” asked Laubenstein.

  It didn’t take her long to find out all there was to know about it because the world’s medical literature on the disease didn’t take much time to read. The cancer was discovered originally among Mediterranean and Jewish men in 1871. Between 500 and 800 cases of this disease had been documented in medical books in the last century. It usually struck Jewish and Italian men in the fifth or sixth decade of their lives. In 1914, Kaposi’s sarcoma, or KS, was first reported in Africa, where subsequent studies discovered that it was the most common tumor found among the Bantus, the disease generally remaining within distinct geographic boundaries in the open savannah of central Africa. There, KS patients represented one in ten cancer cases.

  Typically, a victim would develop some flat, painless purple lesions and die much later, often of something else. As cancers went, Kaposi’s sarcoma was fairly benign. In more recent years, reports circulated of a new, more aggressive form of the sarcoma in central Africa, but that did not appear to be what had stricken Rick Wellikoff. The lesions were not rapidly covering his body and internal organs, as had been reported among the Africans. Besides, he had never been to such exotic ports. The only characteristic that made Rick mildly different from the typical New York schoolteacher his age was that he was gay.

  Given the rarity of the cancer—and the novelty of a case in such a young, non-Mediterranean man—Linda decided to follow Rick closely and mentioned him to several other doctors. She would have to write it up some day.

  Two weeks after she first saw the schoolteacher, she got a phone call from a colleague at the Veteran’s Administration Hospital, a few blocks south of New York University Medical Center on First Avenue.

  “You’re not going to believe it, but there’s another one down here,” he said.

  Laubenstein quickly went to the VA Hospital to visit the other Kaposi’s patient who seemed very similar to Rick. The man was much more handsome, to be sure; after all, he was a model. But he was thirty-seven years old, homosexual, and, in the strangest twist, the pair shared mutual friends. It was uncanny. Among their acquaintances, they said, was a dreamy blond flight attendant from Canada. He had an unusual name that stuck in Linda’s mind.

  “Gaetan. You should talk to Gaetan,” the first two gay men to be diagnosed with Kaposi’s sarcoma in New York City had told Linda Laubenstein in September 1979.

  “You should talk to Gaetan because he’s got this rash too.”

  October 1

  DAVIES MEDICAL CENTER, SAN FRANCISCO

  Michael Maletta was curt and irritated as he was being admitted to Davies Medical Center, a major medical center on Castro Street, but he had been sick all year and he wanted to get to the bottom of it. His malaise was officially described as FUO—fever of unknown origin. His doctor, however, suspected much worse and ordered up biopsies of his liver, bone marrow, and lymph nodes. Perhaps it was a Hodgkin’s disease that hadn’t surfaced, his internist thought. That would explain the lingering malaise that had bedeviled the hairstylist all year. To be sure, Michael had tried to proceed with his life as normal. He still gave the best parties in town and in June had taken over all four floors of the Market Street building above his hair salon to throw the year’s ultimate bash. Boys cheerfully crammed the four-story outside stairwell, swigging beers, while hundreds more squeezed into the back patios, dancing to the disco deejay. Down in the basement, scores more groped and fondled each other in a large-scale recreation of a bathhouse orgy room. And in the middle of it was Michael, the perfect host, handing out tabs of the drug MDA to all comers. These were grand times to be gay in San Francisco, Michael thought, and he relished the life-style he had built for himself since moving from Greenwich Village after the glorious Bicentennial summer. He sometimes wondered what had happened to his friends there, people like Enno Poersch and his lover Nick who had been so close. Now he wasn’t hearing much from any of the old gang that had spent such hot times together in those months when the tall ships came from all over the world to New York Harbor.

  UNIVERSITY OF CALIFORNIA MEDICAL CENTER, SAN FRANCISCO

  “Too much is being transmitted here.”

  It was getting to be the standard finale to Dr. Selma Dritz’s rote presentation on the problem of gastrointestinal diseases among gay men. She felt her analysis
had particular gravity at this monthly meeting of the sexually transmitted disease experts at the University of California at San Francisco Medical Center. This was one of the most prestigious medical schools in the nation, she knew. These doctors needed to know that something new was unfolding in the bodies of gay men, and they needed to be alert, to see where it might lead.

  This was not how Dr. Dritz, the infectious disease specialist for the San Francisco Department of Public Health, had planned to spend the later years of her career—being one of the nation’s foremost authorities on organisms that were setting up residence in the bowels of homosexual men. Her expertise had started soon after 1967, when she became assistant director of the San Francisco Department of Public Health’s Bureau of Communicable Disease Control.

  Normally, five or perhaps ten cases of amebic dysentery a year crossed her desk, and they were usually from a day-care center or restaurant. Now doctors were reporting that many a week. She checked the figures again. Nearly all the cases involved young single men, and an inordinate number were diagnosed at the Davies Medical Center on Castro Street. She mentioned to another health department staffer that it was odd because she hadn’t heard any complaints about neighborhood restaurants. Her colleague took Dritz aside to explain that the cases were concentrated among gay men. Dritz didn’t understand the relevance of the observation.

  “It’s oral-anal contact,” he said.

  “It’s what?”

  They didn’t teach these things when Selma was in medical school in the 1940s, but she quickly learned the down-and-dirty realities about enteric diseases. Gay doctors had long recognized that parasitic diseases like amebiasis, giardiasis, and shigellosis were simply a health hazard of being gay. The problems grew with the new popularity of anal sex, in the late 1960s and early 1970s, because it was nearly impossible to avoid contact with fecal matter during that act. As sexual tastes grew more exotic and rimming became fashionable, the problem exploded. There wasn’t a much more efficient way to get a dose of parasite spoor than by such direct ingestion.

  Although all this was common knowledge among gay physicians, the awareness had evaded the public health profession. Earnest health officials at one point dispatched inspectors to Greenwich Village to test water after detecting unusual outbreaks of amoebas in the neighborhood.

  The more expert Dritz became about the health problems of the gay community, however, the more concerned she grew. Gay men were being washed by tide after tide of increasingly serious infections. First it was syphilis and gonorrhea. Gay men made up about 80 percent of the 70,000 annual patient visits to the city’s VD clinic. Easy treatment had imbued them with such a cavalier attitude toward venereal diseases that many gay men saved their waiting-line numbers, like little tokens of desirability, and the clinic was considered an easy place to pick up both a shot and a date. Then came hepatitis A and the enteric parasites, followed by the proliferation of hepatitis B, a disease that had transformed itself, via the popularity of anal intercourse, from a blood-borne scourge into a venereal disease.

  Dritz was nothing if not cool and businesslike. Being emotional got in the way of getting her message across, of making a difference. Her calm admonitions to gay men about the dangers of rimming and unprotected anal sex were well rehearsed by now, although they were out of beat with that era. The sheer weight of her professionalism, however, made Dritz immensely popular among gay doctors. Her children teased her that she was the “sex queen of San Francisco” and the “den mother of the gays.” Gay health had become an area in which Dritz had an unparalleled expertise because she had spent much of the late 1970s meeting with gay doctors, penning medical journal articles, and traveling around northern California to issue her no-nonsense health warnings.

  But here, in 1980, among these venereal disease specialists, Dritz found her message received cooly, at best. She recognized the response. Scientists had a hard time believing that the sexual revolution had turned Montezuma’s revenge and hepatitis B, the junkies’ malady, into a social disease. Dritz calmly repeated the statistics: Between 1976 and 1980, shigellosis had increased 700 percent among single men in their thirties. Only seventeen cases of amebiasis were reported in 1969; now the reported cases, which were only a small portion of the city’s true caseload, were well past 1,000 a year. Cases of hepatitis B among men in their thirties had quadrupled in the past four years.

  These diseases were particularly difficult to fight because they all had latent periods in which they showed no symptoms even while the carrier was infectious—gay men were spreading the disease to countless others long before they knew they themselves were sick. This was a scenario for catastrophe, Dritz thought, and the commercialization of promiscuity in bathhouses was making it worse.

  Dritz looked down from her slide projector to the disbelieving faces in the conference room. These med-school types didn’t believe anything unless they saw it in their microscopes or test tubes, she thought. This, they argued, was “anecdotal” information and they needed data. All this talk about buggery and oral-anal contact didn’t make them any more comfortable either.

  Dritz tried to broaden her point, so the doctors could see that she wasn’t talking so much about this or that disease, or specific sexual gymnastics.

  “Too much is being transmitted,” she said. “We’ve got all these diseases going unchecked. There are so many opportunities for transmission that, if something new gets loose here, we’re going to have hell to pay.”

  October 31

  NEW YORK CITY

  Ghosts swooshed their way through the winding streets of Greenwich Village, followed by double-jointed skeletons dancing behind misshapen spirits of darkness in the Halloween parade. All Hallows’ Eve had for generations stood out as the singularly gay holiday. Sociologists noted that it made sense because it was the day for concealing identities behind masks, a penchant that social conventions had long made a homosexual norm. New York, however, is one of the only cities to mark this day with a parade, which is appropriately centered in its most famous gay enclave. That last night of October was filled with all approximations of grisly death. Larry Kramer didn’t take much to costumes, but he joined in the parade with Calvin Trillin and a large group of writer friends, hooting and hollering at the flamboyantly freaky costumes along the route.

  That night, the gay hot spots came alive with masquerades and special parties. At the Flamingo, one of the choicest private clubs where A-list gays discoed to dawn, Jack Nau enjoyed the revelry and tried to pick out friends behind the costumes. His boyfriend Paul Popham was out of town, which made it all the more tantalizing when Jack saw a familiar face. A blond smiled back in a particularly winning way, and before long Jack and Gaetan Dugas slipped away from the crowd and into the night.

  “He’s had some kind of seizure.”

  Uptown on Columbus Avenue, Enno Poersch frantically tried to revive Nick. A friend who had been staying with the ailing youth said tearfully that he had heard a shriek from Nick’s room before Nick lapsed into unconsciousness. Enno had raced over and was kneeling beside the bed, trying to raise a flicker of awareness.

  “We’ve got to get him to a hospital,” Enno cried.

  Even if he’s unconscious, Enno thought to himself, I should explain it to him. Nick might be aware but just unable to talk.

  “We’re dressing you so we can take you to the hospital,” he said.

  Nick threw up a clear, yellowish liquid and had a bowel movement. Enno cleaned him, dressed him, and cradled him gently as he carried his lover down four flights of stairs.

  “We’re taking you downstairs, out the door,” Enno shouted.

  Cabs raced along the Upper West Side streets. None would stop for the tall man who was holding the wasted form in his arms. Enno realized that, because it was Halloween, the cabbies probably assumed they were drunks from some costume party.

  The next morning, Dr. Michael Lange peered into Nick’s room at St. Luke’s-Roosevelt Hospital. A neurologist had found thre
e massive lesions on the young man’s brain during a CAT scan. Lange had been called in as an infectious disease specialist. Nick was slumped to one side of the bed. His gray eyes were covered with a milky white film and the left side of his face seemed to sag. His fever was escalating. Nick had been dying in slow motion for a year, the doctors told Lange, and nobody could say why.

  The sight lingered with Lange for years, long after such deathly visages had become familiar and Lange became an international authority about such things. Lange would always recall that first moment, staring into the hospital room at Nick, as the event that separated his Before and After. Years later, Lange could instantly remember the date, the way he could recall the anniversary of his marriage or his kids’ birthdays.

  It was November 1, 1980, the beginning of a month in which single frames of tragedy in this and that corner of the world would begin to flicker fast enough to reveal the movement of something new and horrible rising slowly from the earth’s biological landscape.

  FREEZE FRAMES

  November 1980

  UNIVERSITY OF CALIFORNIA, LOS ANGELES

  Finally, something interesting.

  Dr. Michael Gottlieb’s four-month career as an assistant professor at UCLA had proved anything but scintillating. Fresh from his training at Stanford, the thirty-two-year-old immunologist had done what ambitious young scientists are supposed to do when they get their first job at a prestigious medical research center: He went to work with mice. Gottlieb had dutifully brought his own mice from Stanford to UCLA and planned to study the effects of radiation on their immune system, but the damned rodents kept dropping dead from viruses they had picked up in Los Angeles. Gottlieb wasn’t terribly enthralled by bench work anyway, so he put out the word that his residents should beat the bushes for something interesting—some patient that might teach them a thing or two about the immune system.