Tuesday, April 19, 2011

Stop the music

Ronald Reagan is remembered for a lot of things. Whether you venerate or vilify him seems to depend how you feel about taxing the wealthy, but in And The Band Played On, Randy Shilts reminds us of the Reagan administration's other legacy.

I never lived in a world without AIDS. I was born in 1985, the year the first cases of AIDS were discovered in the military, which were attributed to using intravenous drugs or prostitutes (prostitutes and drugs, fine - just don't be gay), but Shilts' book does an excellent job of capturing the confusion, fear, despair, and anger that swept across gay communities in the early 1970s during the emergence of the disease. But just as importantly, Shilts presents a simply astonishing amount of information about how the worst health scourge to emerge in the 20th century - arguably the worst disease to develop anywhere, ever - was ignored, covered-up, or outright denied by America's public health community and the Reagan administration, the very officials tasked with safeguarding public health, up to and including Reagan's bumbling, incompetent Secretary of Health and Human Services, Margaret Heckler. 

It was only through the tireless efforts of a handful of dedicated doctors and virologists, along with a small group of activists, that the administration began moving, however slowly. Yet, as Shilts points out in the politics part of "People, Politics, and the AIDS Epidemic," resistance to education and research came from unexpected quarters, including the very community most affected by the disease.

And The Band Played On opens in Kinshasa, Zaire, in 1976, with Danish doctor Grethe Rask. Dr. Rask was a surgeon in a clinic in Abumombazi - the same area where an outbreak of Ebola claimed nearly 200 lives before the WHO stopped the spread of the hemorrhagic fever. Dr. Rask, suffering from an mysterious disease, returned to Denmark and died of Pneumocystis, a non-fatal form of pneumonia. Pneumocystis killed Dr. Rath, but it wasn't why she died.

Shilts then moves to San Francisco's vibrant gay community in the summer of 1980, still mostly untouched by AIDS, which had started to infiltrate San Francisco and New York City. Shilts introduces the reader to the politics of San Francisco in the aftermath of Harvey Milk's death, a city where, unlike the rest of America, the gay community wielded real political clout, at least at the local level. 

By 1980, AIDS had begun spreading its web in Copenhagen, Zaire, Germany, Portugal, and Paris. Those who died died of common, usually non-fatal diseases, or bizarre ones: cytamegalovirus, Pneumocystis, salmonella, toxoplasmosis. Meanwhile, cases of Kaposi's sarcoma were showing up in New York City. Meanwhile, in San Francisco, a small group of doctors who would become the leaders in the fight against AIDS began to track clusters of unusual diseases.

The early chapters of Shilts' work form a fascinating viral who-done-it, as doctors and researchers struggled to understand a disease unlike anything they'd seen before, a disease that used other infections to do the killing for it. The CDC took the lead in tracking cases of Kaposi's sarcoma, a rare skin cancer that was normally benign. Kaposi's sarcoma began showing up in Los Angeles, NYC, and San Francisco, coupled with more exotic diseases. As the number of infections began to mount, and doctors from both coasts began seeing more coincidences, the stakes got even higher.

Shilts introduces the important political players early, and shows how the gay community in San Francisco, dedicated to protecting their hard-won freedoms, formed a bloc against early efforts to educate people about the disease. In particular, shutting down the San Francisco bathhouses drew a line in the sand, and those who dared to step past it were publicly excoriated and condemned as homophobes, which is sadly ironic given the toll the disease would eventually take.

And from the Reagan administration? Radio silence, as the CDC and other federal agencies begged for funds. It wasn't until over 5,000 people in America were infected (and thousands more worldwide) and AIDS began threatening the heterosexual population that the Reagan administration grudgingly began to move, although its response was disingenuous. Advocates faced resistance from sources as varied as local politicians, the Moral Majority, blood bank owners (who, as Shilts points out, were instrumental in delaying tests to screen blood for AIDS, resisted efforts to disallow high risks donors from donating, and vigorously downplayed the dangers, even as those infected from blood transfusions sickened), and groups like AIDSpeak, who were ostensibly support groups but reacted to AIDS with denial and disinformation.

There is a simply astonishing amount of information in Shilts book. He shifts from New York to San Francisco to Paris to Africa, documenting the inner workings of the CDC and Louis Pasteur Laboratories and the minutiae of endless meetings at various levels of government. At some points, the information can get simply overwhelming and clogs the book's momentum, particularly after the first chapters. It's also heartbreaking - the sheer scale of the waste of life is overwhelming, although there are flashes of compassion, from the San Francisco doctors who valiantly sounded the alarm in the face of much resistance, to the volunteers who stayed with stricken patients as they died.

I can't imagine a world without AIDS - that simply isn't part of my paradigm. But Shilts' book does an invaluable job of explaining how, in the course of less than a decade, the world shifted from Before to After.

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