The Coming Plague (57 page)
Authors: Laurie Garrett
San Francisco Public Health Director Mervyn Silverman and New York City Commissioner of Health David Sencer were caught in the middle, forced to decide the fates of local sex parlors and bathhouses while the opposing sides in the gay community issued political threats. The battles would remain heated for over two years, and neither city's leading health officials would survive politically. Eventually the establishments would be closed, though after-hours, semi-clandestine gay sex clubs would continue to exist, albeit illegally, into the 1990s.
“It's sort of depressing,” an exhausted Silverman said just days before the Gay Pride Parade and Stonewall remembrance brought over 300,000 celebrants to San Francisco. “You have individuals who are filled with anxiety about AIDS. And because of that anxiety they are going to the bathhouses and indulging in high-risk sex to relieve that stress. It's very, very paradoxical.”
Bathhouse owner Hal Slate, proprietor of the Cauldron, corroborated Silverman's observation. “So we're caught in a Catch-22 where we're now dealing with an extraordinary level of stress and anxiety and confrontation with death, all of it surrounding the very mechanism that we see as there for us to help us deal with our anxiety and stress,” Slate said.
Though he proselytized about the dangers of AIDS, Bobbi Campbell continued to patronize the baths. He and Michael Callen had created a new self-help and political action group called PWAsâor People With AIDS. He had watched several friends die, and by the spring Bobbi had changed his self-appointed title from KS Poster Boy to AIDS Poster Boy of 1983. He had also suffered more than eight major opportunistic infections, had been in and out of local hospitals several times, and was getting scared.
A few months earlier, Campbell had nursed a close friend named John, who eventually died of AIDS.
“Seeing him in ICU [intensive-care unit] with tubes in his nose was horrifying to me,” Campbell said. “More horrifying than where I was at myself. I could deny sometimes that I was sick. But I couldn't deny it anymore, seeing him lying there. And I could see myself, or others I love, lying there.
“John and I talked, I left, and in a week or so he was dead. I cried and I cried, went out and got drunk. And I said, âI'm alive, goddamnit! I'm alive!' And I am alive, and I want to make that real for myself. I do face death, but until I'm dead, I'm alive, damnit.”
The Gay Freedom Day celebrations took place in New York and San
Francisco, and the bathhouses remained open. Though they were the largest such festivals in U.S. history, participants could feel the change. Who could doubt that the party was over when contingents of men with AIDS marched in the paradeâor were pushed in wheelchairs?
Francisco, and the bathhouses remained open. Though they were the largest such festivals in U.S. history, participants could feel the change. Who could doubt that the party was over when contingents of men with AIDS marched in the paradeâor were pushed in wheelchairs?
Warning signs were posted in gay establishments, bowls of free condoms were placed in gay bars and hotels, Health Department pamphlets were distributed advising men to practice safe sex, and the world witnessed it all on international television. Elegant drag queens, Dykes on Bikes, Whores Against Wars, the Sisters of Perpetual Indulgence, the San Diego Gay Softball League, the Harvey Milk Democratic Club, Women Against Imperialism, and a host of other photogenic gay contingents filled television screens as somber announcers remarked on the odd juxtaposition of such frivolity with an epidemic.
The television coverage ignited backlash. The Reverend Billy Graham cried out that “AIDS is a judgment of God.” Television evangelist and leader of the Moral Majority Jerry Falwell denounced “perverted lifestyles,” saying in a nationally televised sermon, “If the Reagan administration does not put its full weight against this, what is now a gay plague in this country, I feel that a year from now, President Ronald Reagan personally will be blamed for allowing this awful disease to break out among the innocent American public.
“AIDS is God's punishment,” Falwell concluded. “The scripture is clear: We do reap it in our flesh when we violate the laws of God.”
Bobbi Campbell shortly thereafter denounced the religious leaders before the San Francisco Board of Supervisors.
“I don't consider myself a sinner, and I don't think this is God's will!” the AIDS Poster Boy shouted. “I'm angry at Senator Jeremiah Denton from Alabama, who said, âOh, let the faggots die.' I'm angry at the people who fire us and evict us from their homes. It's our crisis. We need support, not hate.”
Some scientists complained that a “Plague of Fear” was overwhelming efforts to control the viral plague rationally.
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Meanwhile, the scientific competition also heated up. Shielded from most of the public turmoil, the laboratories of Jay Levy, Luc Montagnier, and Robert Gallo generated their own controversy as they raced to discover the virus that caused AIDS. Though no further evidence to support HTLV-I came to light, Gallo continued to publicly proclaim it the most likely suspect, even providing elaborate schemes for the virus's evolution and global spread.
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But both Levy and Montagnier were certain by summer's end that HTLV-I was
not
the cause of AIDS.
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not
the cause of AIDS.
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In September hostilities between the French and Gallo's group escalated from the level of rivalry common to competing laboratories to something markedly worse when Gallo and Montagnier each addressed a virology meeting at the Cold Spring Harbor Laboratories in New York. Gallo presented
his arguments in favor of an HTLV-I role in the disease, garnering polite applause from colleagues. Montagnier, however, dropped a bombshell, announcing five crucial accomplishments. First, he said, a new virus (hinted at in his earlier paper in
Science
but now clearly identified) had been discovered and dubbed LAV, lymphadenopathy-associated virus. Second, LAV was successfully cultured from the cells of five pre-AIDS patients who had profoundly enlarged lymph nodes and from three people with AIDS (a gay man, a Haitian woman, and a man with hemophilia). Further, LAV had an affinity for infecting T cells, particularly helper cells that had CD4 receptors on their surfaces. Using a specially made screening test, Montagnier's group had shown that in 63 percent of pre-AIDS cases and 20 percent of full AIDS cases, antibodies against LAV could be found. Montagnier suggested that the lower antibody response in sicker people was due to LAV viral destruction of their immune systems.
his arguments in favor of an HTLV-I role in the disease, garnering polite applause from colleagues. Montagnier, however, dropped a bombshell, announcing five crucial accomplishments. First, he said, a new virus (hinted at in his earlier paper in
Science
but now clearly identified) had been discovered and dubbed LAV, lymphadenopathy-associated virus. Second, LAV was successfully cultured from the cells of five pre-AIDS patients who had profoundly enlarged lymph nodes and from three people with AIDS (a gay man, a Haitian woman, and a man with hemophilia). Further, LAV had an affinity for infecting T cells, particularly helper cells that had CD4 receptors on their surfaces. Using a specially made screening test, Montagnier's group had shown that in 63 percent of pre-AIDS cases and 20 percent of full AIDS cases, antibodies against LAV could be found. Montagnier suggested that the lower antibody response in sicker people was due to LAV viral destruction of their immune systems.
Finally, he insisted that all forms of analysis of LAV showed that, far from being a close cousin to HTLV-I, it was a member of the lentivirus family, which included a number of slow-killing veterinary diseases, such as visna in sheep and equine infectious anemia (EIAV) in horses.
An extremely controversial thirty-minute exchange between Montagnier and Gallo followed. It would haunt them, and science as a whole, for over a decade. Gallo asked his French rival eight questions, as was his right in such a meeting. Gallo would insist more than ten years later that his queries were meant to point out inconsistencies or weaknesses that might merit further investigation. Montagnier, however, found Gallo's remarks rude and insulting, and felt the American was throwing down an unmistakable gauntlet. Other scientists in the room were taken aback by the unusually naked competition. Gallo's line of questioning was aimed at disproving the causative role of LAV or, failing that, at undermining Montagnier's assertions that LAV was a lentivirus rather than a sibling in the HTLV-I family.
What ensued over the following twelve months was a race to the finish line, with the three laboratories exchanging nicetiesâeven viral samples âwhile fighting tooth and nail. Right to the moment he crossed that finish line, well after Montagnier announced the LAV findings, Gallo would continue to insist that HTLV-I was the likely cause of AIDS, and his efforts to prove it would be backed up by the CDC imprimatur in the form of Harold Jaffe, Don Francis, Jim Curran, and other members of the AIDS Task Force.
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Essex would continue walking a middle line, finding antibody evidence that 10 to 12 percent of people with AIDS were also infected with HTLV-I, but constantly underscoring that “we certainly don't have any proof that this agent causes AIDS.”
Andrew Moss reflected as the year 1984 approached that “there was an enormous PR boom about HTLV, which a lot of people thought would be the AIDS agent, and it's turning out not to be. I think this year has been mostly about PR, funding, and politics. It seems to me that the history of
the science of the AIDS epidemic is that there was this wave of science done by people before there was funding. Which was done by scientists mostly by bootlegging and using what they had.”
the science of the AIDS epidemic is that there was this wave of science done by people before there was funding. Which was done by scientists mostly by bootlegging and using what they had.”
Moss chuckled and rolled his eyes at the new computer on his office desk. Then he added with a sigh, “That's what we didâwe scuffled for funds for a whole year. Now that the funds have been gotten, many people will finally be able to do some research.”
Though he at last had some research funding of his own, Moss remained angry. He was uncomfortably aware that his forecasts of the AIDS toll on San Francisco's gay population were coming true, and that he, an epidemiologist and statistician educated at Stanford and the London School of Economics, was now cast as a death counter. “Well, if it's numbers you want, San Francisco had the real plague in 1907, and it caused hysteria because sixty people died. Well, we will have more than a hundred AIDS deaths in San Francisco this year, and next year [1984] we will see between two and three hundred AIDS deaths. That's really a very large number. And it is inconceivable to me that we would be facing such a prospect and frankly, as a society, not be alarmed about it if it were not an epidemic of a stigmatized group of people.”
In Atlanta, Jim Curran also ended the year counting deaths: 2,042 cumulative AIDS cases reported since May 1981, and 1,283 were already dead. He predicted that the epidemic would continue to expand in 1984, but not at 1983's rapid pace.
On April 7, 1984, the Pasteur group published details on some of the cases Montagnier had described at Cold Spring Harbor seven months earlier, as well as evidence that LAV was in the French blood supply.
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This revelation sparked no policy action on the part of either French or American blood industry authorities. It did, however, prompt the CDC to send coded blood samples to the Paris laboratory, which quickly returned verdicts: 90 percent of the samples that the CDC later confirmed came from AIDS patients were positive for antibodies for LAV.
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This revelation sparked no policy action on the part of either French or American blood industry authorities. It did, however, prompt the CDC to send coded blood samples to the Paris laboratory, which quickly returned verdicts: 90 percent of the samples that the CDC later confirmed came from AIDS patients were positive for antibodies for LAV.
“I think it looks very good,” declared an obviously excited Don Francis. “The French work is very exciting.”
At the National Institute of Allergy and Infectious Diseases, located a stone's throw from Robert Gallo's lab, Dr. Malcolm Martin was even more ebullient, declaring LAV “the best game in town right now.”
Gallo and Essex were unconvinced.
“I think HTLV has to be considered the leading candidate at this time,” Essex told
The Wall Street Journal
,
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hinting that proof would soon be forthcoming from Gallo's lab. Gallo declined to comment directly, but “informed sources close to Gallo” told
The Washington Post
that a major announcement was imminent.
The Wall Street Journal
,
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hinting that proof would soon be forthcoming from Gallo's lab. Gallo declined to comment directly, but “informed sources close to Gallo” told
The Washington Post
that a major announcement was imminent.
And it was. On April 23, 1984, HHS Secretary Margaret Heckler convened a press conference in the agency's offices in Washington, D.C., to announce discovery of the virus that caused AIDS. She was not there to
sing the praises of the French effort, but to declare victory for her agency's National Cancer Institute. With Gallo at her side, Heckler announced, “Today we add another miracle to the long honor roll of American medicine and science.
sing the praises of the French effort, but to declare victory for her agency's National Cancer Institute. With Gallo at her side, Heckler announced, “Today we add another miracle to the long honor roll of American medicine and science.
“Today's discovery represents the triumph of science over a dreadful disease,” Heckler averred, forecasting development of an AIDS vaccine within five years.
Gallo's group had discovered a retrovirus in people with AIDS, dubbed HTLV-III. And the group had created a cell line that, unlike the system in use at the Pasteur Institute, could grow permanently in the presence of the virus. So his team needn't transfer fluids from one culture dish to another for weeks on end to get a viral sample. The cell line, designated HT, would easily serve as the basis for a rapid AIDS blood test, Gallo said, because it was now possible to make mass quantities of viruses for human antibody screening.
The Gallo group noted the prior French LAV finding and was ambiguous about whether HTLV-III and LAV were different microbes. It was, they said, impossible to say for certain, because the poorly characterized French virus “has not yet been transmitted to a permanently growing cell line for true isolation.”
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Gallo then predicted that an AIDS vaccine would “be available within two years.”
Responding to word that the Pasteur Institute and the French press had not taken Gallo's anointment as “Discoverer of the AIDS Virus” kindly, Gallo told the
Journal of the American Medical Association
that “there was not, is not, and never has been any fight or controversy between us and the French group.”
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Journal of the American Medical Association
that “there was not, is not, and never has been any fight or controversy between us and the French group.”
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The French and American labs would present mountains of point-counterpoint research papers over coming months supporting an etiological role for LAV or HTLV-III, respectively. Because the National Cancer Institute group had developed the virus-producing HT cell line, they were rapidly able to screen blood samples for infection using a simple antibody test called an ELISA (enzyme-linked immuno-absorbent assay). By November 1984, the ELISA test was being used by researchers in both the United States and Europe to test blood samples for infection and to experimentally screen blood donations.
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