This is the most important book that you will never read.
Back in 1981, a young, openly gay journalist named Randy Shilts got a position at the San Francisco Chronicle. His round was “gay issues”, in a city that was more heavily involved in gay liberation and its civil rights than any other in the United States. A city in which two in five adult males were openly gay, and to which about 5000 gay men were relocating every year. Not to mention gay tourism, which attracted thousands of men from all over the world to its precincts, including its infamous bath houses.
The other thing that was happening in San Francisco in 1981 – and, on the other side of the country, in New York City – was that gay men were presenting at their GPs and at hospitals with enlarged lymph nodes, serious pneumonia-like symptoms and ugly skin rashes. And then they started dying.
In the prologue to his book And The Band Played On, first published in 1987, Shilts writes: “AIDS did not just happen to America – it was allowed to happen by an array of institutions, all of which failed to perform their appropriate tasks to safeguard the public health.” And later on: “The story of politics, people, and the AIDS epidemic is, ultimately, a tale of courage as well as cowardice, compassion as well as bigotry, inspiration as well as venality, and redemption as well as despair.”
And over six years, and 600 pages, Shilts documents the AIDS crisis from every imaginable angle – political, personal, scientific, bureaucratic. I seriously doubt there could be a better, more thorough book written on this subject. Its breadth, scope and the meticulous attention to detail is breathtaking. Shilts had access to every major player in the scientific and political communities and no stone is left unturned in the recounting of this devastating period of western medical history.
Shilts opens his book in Zaire in 1976, where Danish doctor Grethe Rask – a specialist in tropical diseases who had worked in Africa for the past decade – is sick and getting sicker. By the following year, aged 47, she would be dead, officially of a rare pneumonia. Nine years later, tests on her blood would reveal she had contracted HIV.
From there, Shilts sets the scene in San Francisco and NYC in the late 1970s, giddy on its giant strides in the hard-fought battle for gay rights and liberation. Presciently, a few members of the community – such as New York playwright Larry Kramer – were sounding early alarm bells and despairing that the battle had degenerated into “fighting for the prerogative of gays to bump like bunnies”.
In both cities, doctors were alarmed at the raft of health issues developing amongst the male gay community; in the early 1980s the medical community referred to AIDS as “gay pneumonia” or “gay cancer”. Add to that in the US, the Republicans, led by new president Ronald Reagan, had just come to power; Reagan had foreshadowed – and then set about implementing – serious budgetary cuts that affected medicine and science and their various bodies.
A perfect storm was brewing.
By 1981 the so-called “gay pneumonia” was turning up in intravenous drug users in New York City. By 1982 it was first detected in hemophiliacs. But it was still causing the most havoc in the male gay community, where everybody knew somebody who was getting sick and inevitably dying – yet few were changing their behaviours, even as their doctors were warning that this disease was being spread through unprotected sex. Those same doctors were also initially castigated for suggesting it also looked like it was a blood-borne disease. They also quickly realised this was a disease with a lengthy incubation period; that it could lay dormant in a person for years, rather than the months originally thought.
Meanwhile the medical and scientific bodies were fighting for funding and resources, and fighting against each other in the race to be the first to claim credit for isolating and naming this new epidemic. The media was largely ignoring what was fast becoming the biggest health crisis of the 20th century. And everybody was caught up in the prevailing political correctness – “don’t offend the gays and don’t inflame the homophobes”.
Collectively, this stunning display of stonewalling, denial and sheer ineptitude – which lasted for more than half a decade and criss-crossed all public and political spheres – would cost hundreds, then thousands, then millions of people their lives.
A San Francisco man who addressed a series of government hearings in 1983 summed it up thus: “There is no reason this disease cannot be conquered … this is not a political issue. This is a health issue. This is not a gay issue. This is a human issue … I came here today in the hope that my epitaph would not read that I died of red tape.”
It’s enough to make you want to bang your head against a brick wall and weep.
By 1984 the retrovirus that causes AIDS had been isolated. Later that year it was concluded that the virus had originated from equatorial Africa, lying dormant in primates until it was transferred to humans. “As efficient a virus as I’ve ever seen,” noted Dr Robert Gallo, the American biomedical researcher who was eventually credited as the “co-discoverer” of HIV.
And by the time it was announced that American movie star Rock Hudson was dying from AIDS-related complications in July 1985 – which is considered a turning point for the US at large to finally sit up and take notice – more than 4300 of more than 9000 people with the virus had died in that country alone.
How relevant is it to today? Well, they say that those who ignore history are doomed to repeat it. And that, for me, is the intrinsic lesson of And The Band Played On.
Also, vale to its author. Shilts died in 1994, aged 42, of complications from the HIV virus, which he didn’t learn he’d contracted until after he’d finished writing his book. Yet another casualty that might not have happened and that certainly didn’t need to happen.
Postscript: We also read American science writer David Quammen’s The Chimp And The River, which came out earlier this year. This small book confirms the speculation from two decades ago – that AIDS was transferred from chimpanzees to humans in Africa at the beginning of the previous century in a “spillover”. Similarly it’s an essential read on this devastating pandemic, which, while no longer an automatic death sentence (not in the wealthy west, at any rate) still kills more than a million people every year and infects many more.
This fight is far from over.