Thirty-seven years ago today, the San Francisco Chronicle ran a bracing story based on a study done by two local medical researchers, Dr. Andrew R. Moss of San Francisco General Hospital and Dr. Michael Gorman of the UC-San Francisco. The report concluded that one out of 333 single men over the age of 15 in the city’s Castro district had been diagnosed with AIDS. Factoring out heterosexual men and the long delay in reporting diagnoses of the then-fatal virus suggested that 1 in 100 gay men in that area already had the disease and that a person having 20 sexual partners in a year -- not unusual at that time in the Castro -- stood a 1-in-10 chance of have sex with a man already afflicted with AIDS.
The odds shot up astronomically when researchers considered the larger numbers of infected but asymptomatic men. The author of that piece, and of the influential book that followed four years later, was Randy Shilts. I met Randy while I worked at the San Jose Mercury News and followed his work, as did everyone in the Bay Area. He had his critics, and still does, but judging the body of his work is not difficult for me: Randy was a damned fine reporter. His work enlightened readers -- even those who resisted the facts he unearthed -- and it saved lives.
The current pandemic has me thinking about journalism at the dawn of the AIDS crisis, which I’ll discuss at length in a moment.
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Born in Davenport, Iowa, and raised in Aurora, Ill., Randy Martin Shilts hitchhiked his way out of the Midwest to the West Coast after high school. He attended Portland Community College where he came out as gay, an experience he likened to an epiphany, which he later described this way: “I am right and society is wrong.”
He was talking explicitly about the prevailing view that there was something wrong with homosexuals. Shilts was arguing -- and this is a widely accepted view today even among most social conservatives -- that there is something wrong with a society that doesn’t accept people as they are. It was a line that also foreshadowed Shilts’ doggedness as a reporter. He trained for that calling at the University of Oregon, where he majored in journalism while getting straight A’s, becoming managing editor of the school newspaper, and running for student body president. He didn’t win that election, but he ended up serving in the student Senate after campaigning on the catchy slogan “Come Out for Shilts.”
Although he graduated at the top of his class, no job offers materialized from mainstream news outlets. Shilts moved to San Francisco, where he supported himself by freelancing, mostly for The Advocate. After being resold and re-staffed, the gay magazine had relocated from Los Angeles to the Bay Area. On this date in 1977, the editors announced that they had hired Shilts to report full time on the gay community, while pointedly mentioning that no other West Coast news outlet was doing the same. From there, Shilts went to KQED-TV before landing at the San Francisco Chronicle in mid-1981. Although lacking the experience that would normally have qualified him for a job at the Chron, he worked like hell, had an infectious personality, and was a gay man in an increasingly gay city -- one with no other openly gay reporters. It turned out to be a perfect fit at a time when the gay community in general, and San Francisco in particular, was starting to feel the effects of a health crisis that would become a deadly plague.
The first acknowledgment in any publication of the as-yet-unnamed disease came on May 18, 1981, in The New York Native, a gay-themed newspaper. Written by a gay physician named Larry D. Mass, the piece quoted Centers for Disease Control officials minimizing the scare. It was headlined “Disease Rumors Largely Unfounded.”
Mass’ story was carefully worded to the point that the caveat “largely” in the headline almost seems in hindsight like an inadvertent tipoff. Something was happening that was compromising the health of gay men, but nobody was sure what it was. Mass’ had dutifully called his sources at CDC, but even as he was writing that story, the earth was shifting.
In late April, New York University dermatologist and virologist Alvin Friedman-Kien had discovered an outbreak among young gay men of an extremely rare cancer called Kaposi sarcoma. He called an old friend, fellow dermatologist Marcus Conant, who had a private practice in San Francisco. The following morning, at a monthly conference for doctors based at the University of California Medical Center, San Francisco, Conant asked if anyone had come across Kaposi sarcoma. “I’ve got a case of KS in a gay man over at St. Francisco Hospital right now,” replied a doctor named Jim Groundwater.
That patient was a 37-year-old former ballet dancer named Ken Horne. “My life is falling apart,” Horne had lamented to his doctor. But Groundwater didn’t know how to cure him. No one in the world’s medical community even knew what the affliction truly was.
Meanwhile, in Southern California, Michael S. Gottlieb, a UCLA professor of immunology, had come across of cluster of patients with alarming symptoms. Not just KS, but also fluctuating fevers, weight loss, low white blood cells, fungus infections, and lungs filled with an exceedingly rare protozoa called pneumocystis. Three such patients were admitted by Gottlieb to UCLA’s hospital. It was as if their immune systems had cratered, leaving them vulnerable to infections from microscopic invaders these doctors had only seen before in textbooks.
After one of the three patients died on May 3, 1981, Gottlieb feared something big -- and quite terrible -- was happening. He called the New England Journal of Medicine and told an editor there that he thought something worse than Legionnaire’s Disease was on the loose. He was told that the fastest the journal could go public with such news was three months, so the editor suggested he consider publishing in the CDC’s weekly newsletter, the Morbidity and Mortality Weekly Report. The MMWR wasn’t as prestigious, but it was widely read -- and it had a very short lead time. And Gottlieb knew a CDC infectious disease expert stationed in Los Angeles, a doctor named Wayne Shandera.
Gottlieb called Shandera and suggested he ask around. Immediately, Shandera found a patient with similar symptoms and a similar profile at a hospital in Santa Monica. On Sunday, May 17, while Larry Mass’ reassuring story was preparing to go to print, Gottlieb and Shandera were collaborating on the first official warning that a new sexually transmitted disease was capable of triggering a new type of lethal pneumonia.
Their MMWR article appeared on Friday, June 5, 1981. The following day, the San Francisco Chronicle ran the first story in the media confirming the existence of what would ultimately be called acquired immune deficiency syndrome (and later HIV). The unbylined story, which ran on Page 4, wasn’t written by Randy Shilts -- he wouldn’t join the newspaper until the summer -- it was written by legendary Chronicle science writer David Perlman. It began this way: “A mysterious outbreak of a sometimes fatal pneumonia among gay men has occurred in San Francisco and several other major cities, it was revealed yesterday.”
On July 3, the New York Times ran a piece by medical writer Lawrence Altman, a former CDC doctor himself, headlined “Rare Cancer Seen in 41 Homosexuals.” That story also ran inside the paper. On July 27, Larry Mass returned to the topic in a front page piece in the Native, but it seemed to many on the front lines that the country was putting politics ahead of health.
Gay activists in San Francisco fought closing the city’s bathhouses. Christian conservatives brayed on about God’s wrath. Most politicians hesitated talking about it publicly. With the exception of Shilts and a few others, the press didn’t distinguish itself, either. In his book, “And the Band Played On,” Randy Shilts contrasted how the federal government and the media roused themselves to immediate action after seven Americans were killed by someone who tampered with Tylenol in Chicago area stores.
“The crisis showed how the government could spring into action, issue warnings, change regulations and spend money, lost of money, when they thought the lives of Americans were at stake,” Shilts wrote. “By comparison, 634 Americans had been stricken by AIDS by October 5, 1982. Of these 260 were dead. There was no rush to spend money, mobilize public health officials, or issue regulations that might save lives.”
California Congressman Henry Waxman agreed with this critique while fighting for more federal money for treatment and research. “There is no doubt in my mind,” Waxman said at the time, “that if the same disease had appeared among Americans of Norwegian descent, or among tennis players, rather than among gay males, the responses of the government and the medical community would have been different.”
It wasn’t clear to me at the time what tennis players or Norwegians had do to with anything, but I wondered why the elite media weren’t more on the job. (The Village Voice actually attacked Dr. Altman for his July 3 piece in the Times.) Randy focused on that, too.
“The institution that is supposed to be the public’s watchdog, the news media, had gasped a collective yawn over the story of dead and dying homosexuals,” he wrote. “In New York City, where half the AIDS cases resided, The New York Times had written only three stories about the epidemic in 1981 and three more stories in all of 1982. None made the front page. Indeed, one could have lived in New York, or in most of the United States for that matter, and not even have been aware from the daily newspapers that an epidemic was happening, even while government doctors themselves were predicting that the scourge would wipe out the lives of tens of thousands.”
In the end, AIDS killed a lot more people than that. The World Health Organization estimates that since 1981, AIDS has claimed 32 million lives, including 700,000 Americans. One of them was Randy Shilts, who died in 1994 while putting the finishing touches on “Conduct Unbecoming: Gays and Lesbians in the U.S. Military.”
It was a definitive work published just as President Clinton was fashioning his “don’t ask, don’t tell” compromise. America has moved beyond that now, but Randy’s last book had a message that remains relevant. It’s an essential lesson, really, if we want to come through this current pandemic with our society intact. What Randy found in his research was that during wartime, those engaged in combat don’t much care about the sexual orientation of their comrades. They care who will fight, who is resourceful, who is cooperative, who is brave.
The troops in the trenches know they are in this together. Kind of like how Americans are today, as we face our own pandemic, and our own demons.