And the Band Played On: Politics, People, and the AIDS Epidemic, 20th-Anniversary Edition (8 page)

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

October 1

D
AVIES
M
EDICAL
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ENTER,
S
AN
F
RANCISCO

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.

U
NIVERSITY OF
C
ALIFORNIA
M
EDICAL
C
ENTER
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S
AN
F
RANCISCO

“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

N
EW
Y
ORK
C
ITY

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 three 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.