And The Band Played On

At the CDC offices in Atlanta, Sandra Ford “filled five orders for adult male patients with unexplained Pneumocystis” for pentamidine (61). When the same doctor keeps asking, she becomes puzzled, as the “drug works and the Pneumocystis goes away” (63). Ford becomes doubtful of the physician’s competency. Since the Food and Drug Administration (FDA)strictly controls pentamidine, she is worried as to how to explain the sudden surge of the requests and the “many unexplained diagnoses on her annual FDA report” (63). A few days later, after a conversation with a doctor about “those five cases of bone sarcoma in homosexuals” (66), she writes a memo to her boss, who is the director of parasitic diseases, discussing the gossip and the frequent drug orders. Ford becomes one of the first people that “alerted the federal government to the new epidemic” (66).

In Los Angeles, Dr. Michael Gottlieb gets his fourth patient with the Pneumocystis carinii pneumonia patient at UCLA and “could now identify […] all the typical symptoms: swollen lymph nodes, fevers, weight loss, and a wicked case of candidiasis” (62). He calls on his friend and colleague, Dr. Wayne Shandera, to discuss the puzzling situation. Shandera decides to call Dr. Mary Guinan, his friend at the CDC venereal disease division, to write a report, along with Gottlieb, which they title “Pneumocystis pneumonia in homosexual men—Los Angeles” (67).

When Guinan sends the report to her boss, Dr. James Curran, he responds “Hot Stuff. Hot Stuff” (67). At a medical conference in San Diego, where Dr. Ostrow is also present, Curran announces that upon publishing the report in the Centers for Disease Controls weekly newsletter, the Morbidity and Mortality Weekly Report (MMWR), they will be setting up a task force to investigate the cases. Later, CDC veteran Harold Jaffe, Ostrow, Curran, and other gay doctors meet separately to discuss the reasoning around the outbreak and hold a “hypothesis, far more frightening: It could be an infectious disease” (68).

On Fire Island, Rick’s funeral is held; Paul Popham and his other friends pour his “white gritty ashes” into the “cold gray Atlantic” (66). 

Curran returns to Atlanta, to join the Kaposi’s Sarcoma and Opportunistic Infections (KSOI) Task Force with Harold Jaffe and Mary Guinan. They share their notes to discuss the causes of the epidemic:

First, there could be some substance common to the environment of these patients causing their immune problems. The leading candidate was poppers, or nitrite inhalants, though almost any bad batch of drugs might be to blame. The second explanation, of course, was that this was the effect of some infectious agent, either one new virus or some combination of old microbes working together in a new way (71).

After the publication of the MMWR report on Pneumocystis, the news services begin to refer it as “gay pneumonia” (72). Reading the same report in Paris, Dr. Willy Rozenbaum recognizes that he has seen patients with similar symptoms in the past.

At the CDC’s Hepatitis Laboratories in Phoenix, Dr. Don Francis, an expert on epidemics, notes that the sarcoma victims suffer from depleted T-lymphocytes, similar to feline leukemia, and he believes the cause could be a retrovirus, “a subgroup of viruses […] a quaint and exotic group of viruses” (73). Although it is yet an unproven idea, Francis is certain “that a new virus that could be spread sexually was causing immune deficiencies in gay men” (74).

In San Francisco, Marcus Conant proposes in establishing a KS clinic: “If Alvin Friedman-Kien is correct, we should see 40-50 cases of Kaposi’s sarcoma in males here in the next 12-18 months […] Half of these patients will have fulminant disease and may die” (76).

In New York, Paul catches Gaetan and suggests that he visits Jack Nau at the hospital. Gaetan goes with his friend, and both are not “prepared for how wasted the once-handsome patient would be” (79). 

Curran is faced with the repercussions of the national health budget cuts as it means that the limited funding available to the CDC would be “a major reduction in force” for those working on the epidemic and could also be “fired any day” (80). Curran and the task force hope for a simple answer in that the “diseases could be traced to poppers” (81).

The members of the task-force agree to do a case-control study by sending out field agents to investigate and speak to every affected patient, knowing that it would “take weeks to get the questionnaire and protocol worked out” (82) and time was not a luxury that the team had.

In New York City, Guinan begins the process throughout Manhattan and discovers that some of the cases are drug addicts and not gay men. However, the drug addicts got the “far more virulent Pneumocystis” and not Kaposi’s sarcoma (83). During her investigations, she decides to monitor hemophiliacs and recipients of blood transfusions. At one point, she comes across Gaetan coming out of the shower of one her interview subjects. Upon questioning, she discovers that he has had 2,500 sexual partners and that he slept with Jack Nau. However, because he is Canadian, he is “lost to immediate follow-up by the CDC” (84), as the case-control included only those in the US.

Larry Kramer visits Dr. Friedman-Kien to inquire further about the cancer written about in The New York Times and is startled to see an acquaintance at the office, who admits to Larry that he has “funny purple spots” (84). Later, Friedman-Kien asks Larry for help in fundraising for research and advises him that if he were a gay man, he would “stop having sex” (84).

At the National Cancer Institute, Dr. James Goedert draws the blood of a sample of fifteen healthy gay men in the Washington area and finds that half have abnormalities in their immune system. Understanding that it could be “widespread,” he wants to test if the cause is a “toxic agent and suspected poppers” (85).

In San Francisco, Harold Jaffe’s interviews only outline two possibilities: Ambush poppers and the number of sexual partners. Jaffe tests Ambush poppers, which are amyl nitrite and “had been around a century without killing anybody” (87).

On Castro Street, Gary Walsh and Joe Brewer are gay psychotherapists, business partners, and friends who “virtually invented gay couples’ therapy” (89). Gary believes in being sexually liberated, while Joe steers toward long, committed relationships. Later, Gary cancels a planned weekend trip due to a yeast infection.

At a meeting in Larry’s apartment, Friedman-Kien gives a talk to “la crème de la crème of New York’s A-list gay nightlife” (90), who are shocked. In the next months, Larry, Paul, Enno, and a few others attempt to fundraise at Fire Island, which ends up being a “disaster” as their efforts total $124, and most people are apathetic to their cause. Days after, Paul receives news of Jack’s death. 

On September 15, a conference is called by the National Cancer Institute (NCI) at the National Institutes of Health (NIH) in Bethesda, Maryland to discuss Kaposi’s sarcoma and the infections by bringing in “fifty leading clinicians treating the problem” (93) including Michael Gottlieb, Linda Laubenstein and Marc Conant.

Although the CDC’s work is vital, they can use the interest and assistance of the National Cancer Institute that has “older hands and three times the money of the CDC, that could bring in the heavy artillery” (94). However, the NCI conference proves futile because the federal cancer researchers “simply would not believe the CDC’s assertion that the new appearances of Kaposi’s sarcoma and Pneumocystis were even related,” while the NIH doctors had a “condescending attitude” toward the CDC team (95). 

In San Francisco, a baby boy who required blood transfusions keeps getting sick and suffering from immune dysfunction. His 47-year-old donor goes to the doctor “complaining of swollen lymph nodes” (95).

As Guinan carries out her questioning in San Francisco, she faces obstacles in the case-control study. Out of the four controls, the hardest is to find a gay control that would be a patient’s friend with whom he had not had sex. Guinan expresses her fears of a “deadly viral disease” (97) to Conant since the “only factors that seemed to distinguish cases from controls was the number of sexual partners, the incidence of venereal disease, and attendance at gay bathhouses” (96).

Paul Volberding, the cancer chief of San Francisco General Hospital, promises to assist Conant in his clinic by treating any patients affected by the “strange new diseases” (98), while another young professor at USCF, Donald Abrams, also signs up, certain that “these lymph node problems were somehow related to the new diseases” (98).

Ken Horne becomes the first reported case of KS to die of what “would later be called Acquired Immune Deficiency Syndrome” (100). 

In Paris, Dr. Jaques Leibowitch reads Michael Gottlieb’s article about pneumonia in gay men and Alvin Friedman-Kien’s article on KS. He calls Rozenbaum and his sister, a professor of dermatology, to confirm. He suspects a virus and the “African connection immediately suggested a viral agent (103).

Dr. Arye Rubenstein, a pediatric immunologist in the Bronx, treats a drug addict with immune deficiency, infections, and swollen lymph nodes. He discovers that her child has the same symptoms, leading him to believe that the infectious disease spread among gay men could also be spread to drug addicts and their children. Scientists and other medical professions tell him otherwise: “Gay pneumonia and gay cancer were diseases of homosexual men” (104).

At the CDC offices in Atlanta, Guinan is prepared for drug addicts to be “the next major pool of immune deficiency cases” (106). Although the task force works diligently, the lack of funding hinders their research at “its most crucial juncture" (106). The director, Dr. Bill Foege implores Assistant Secretary for Health Edward Brandt for further funding. Brandt agrees to see if there is money in the National Institutes of Health budget, “but no word came from the NIH” (106).

In San Francisco, Bobbi Campbell becomes the “KS poster boy” (108) to raise awareness of the disease and his diagnosis. Cleve Jones meets with him to offer services from the city and for the first time, he realizes that KS was “not a figment of some demented headline writer’s imagination” (108).

Larry Kramer becomes frustrated with the lack of media coverage and official attention to the epidemic in New York City despite that fact that “[t]wo new cases of KS are being diagnosed in New York each week” (109).

At ABC studios, Jim Curran prepares to speak about the epidemic, marking the first time that AIDS is mentioned on a major national news network. Curran hopes that his interview will gear attention toward the diseases and funds for his research, but to his disappointment, “it was cut to 150 seconds because of unrest in Lebanon” (110).