The Appalling Saga of Patient Zero

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Club Baths, San Francisco, November 1982 . . . When the moaning stopped, the young man rolled over on his back for a cigarette. Gaetan Dugas reached up for the lights, turning up the rheostat slowly so his partner's eyes would have time to adjust. He then made a point of eyeing the purple lesions on his chest. "Gay cancer," he said, almost as if he were talking to himself. "Maybe you'll get it too."

-- Randy Shilts, And the Band Played On

Since the early days of the AIDS epidemic, researchers have reasoned that a handful of people -- maybe even a single individual -- bore the unknowing responsibility for having introduced the disease to North America and its first large group of victims, the homosexual community. By tracing sexual contacts, officials at the Centers for Disease Control in Atlanta in 1982 found a likely candidate: one man who, through his sexual liaisons and those of his bedmates, could be linked to nine of the first 19 cases in Los Angeles, 22 cases in New York City and nine more in eight other cities -- in all, some 40 of the first 248 cases in the U.S. The CDC acknowledged his role with an eerie sobriquet: it called him Patient Zero.

Now Patient Zero is publicly identified for the first time in a stunning new book on the AIDS epidemic, And the Band Played On (St. Martin's Press; 630 pages; $24.95). Zero, says Author Randy Shilts, was Gaetan Dugas, a handsome blond steward for Air Canada, who used to survey the men on offer in gay bars and announce with satisfaction, "I'm the prettiest one." Using airline passes, he traveled extensively and picked up men wherever he went. Dugas developed Kaposi's sarcoma, a form of skin cancer common to AIDS victims, in June 1980, before the epidemic had been perceived by physicians. Told later he was endangering anyone he slept with, Dugas unrepentantly carried on -- by his estimate, with 250 partners a year -- until his death in March 1984, adding countless direct and indirect victims. At least one man indignantly hunted him down. Dugas' charm proved unfailing: he sweet-talked the man into having sex again.

Dugas' identity as the peripatetic Patient Zero was confirmed last week by Professor Marcus Conant of the University of California at San Francisco, a pioneer AIDS researcher. But, Conant adds, "if it hadn't been this man, it would have been some other." Dugas' escapades are just one of many vivid and shocking stories in Shilts' impressively researched and richly detailed narrative. The author has been covering AIDS full time for the San Francisco Chronicle since 1983. Most of his tales underscore a theme that is painfully ; familiar to AIDS researchers: both the Federal Government and the gay community squandered lives and let the disease rage out of control by focusing on ideological preaching instead of public health.

As if to reinforce that judgment, the Reagan Administration demonstrated on two fronts last week how political agendas still burden AIDS policy. Secretary of Education William Bennett disseminated his department's first major recommendations on how to educate young people to avoid the disease. Bennett's 28-page pamphlet, cleared by the White House, is a model of moralizing and seems mainly to be meant as a challenge to Surgeon General C. Everett Koop, an advocate of bluntly practical counsel. Bennett's booklet suggests that schools and parents "teach restraint as a virtue," downplays the use of condoms in sex and does not even mention the importance of clean needles if injecting drugs. Critics condemned Bennett's emphasis on abstinence, noting that by 17, almost half of all boys and nearly a third of girls have had intercourse. Said Congressman Ted Weiss, a Manhattan Democrat: "It's totally out of touch with reality."

The more troubling event was a pair of resignations from President Reagan's advisory commission on AIDS two months before that body was to issue its first report on the "medical, legal, ethical, social and economic impact" of the disease. Since its appointment in July, the 13-member commission has been beset by factional squabbling and accusations that it is heavy on conservatives and light on expertise. The last shortcoming was only intensified by the departures of its chairman, Dr. W. Eugene Mayberry, chief executive of the Mayo Clinic, and its vice chairman, Dr. Woodrow Myers Jr., Indiana's health commissioner. Said Myers: "We did not receive the full degree of support from the Administration." The new chairman is not a medical scientist but retired Admiral James Watkins.

Turmoil in federal AIDS policymaking is anything but new, according to Shilts. His book quotes extensively from internal memos at CDC and the Department of Health and Human Services to show that the very officials who testified before Congress that research scientists had all the money they needed to pursue the disease were privately arguing just the opposite. He quotes a May 13, 1983, note from Assistant Secretary for Health Edward Brandt seeking new funds. "It has now reached the point," the memo reads, "where important AIDS work cannot be undertaken because of the lack of available resources . . . ((which)) will have a detrimental effect on CDC's important prevention programs." The memo, Shilts adds, was written just four days after Brandt testified before a House subcommittee that emergency funding was "unnecessary."

Shilts contends that as part of the Administration's efforts to distract attention from its inadequate financing and poor leadership, the U.S. Government "brazenly" conspired to steal credit for discovering the AIDS virus from researchers at France's Pasteur Institute. He dismisses as a myth the competing claim of Robert Gallo of the National Cancer Institute and, quoting U.S. researchers, strongly implies that Gallo stole the French strain and presented it as his own, a charge Gallo denies. Shilts labels as a "pleasant fiction" a 1987 U.S.-French political accord that settled lawsuits and deemed Gallo and France's Dr. Luc Montagnier "co-discoverers" of the virus.

Shilts, who is openly gay, is equally tough on the gay community, which, he says, transformed its civil rights movement in the '70s into "omnipresent carnality." In the face of rampant disease, he says, gay leaders resisted calling for sexual restraint, fearing that it would threaten their hard-won liberation. He adds that the owners of gay "back room" bars and bathhouses were prominent contributors to gay political groups and major advertisers in gay newspapers, and thus unduly influenced the debate. In one grim scene, a bathhouse owner tells a doctor at San Francisco General Hospital, "We're both in it for the same thing. Money. We make money at one end when they come to the baths. You make money from them on the other end when they come here."

Shilts says he interviewed more than 900 people. He lists dates for eleven interviews with Dr. James Curran, head of the CDC's AIDS program. The most poignant passages recount the first stirrings, before doctors knew there was such a disease. Shilts suggests that the first non-African victim may have been Margrethe Rask, a Danish physician who fell ill in 1976 while working in a primitive village hospital in Zaire and died of AIDS-related pneumonia in 1977. At about the time Rask succumbed, Shilts began interviewing physicians about the health implications of the gay sexual revolution. Often, in private, they noted the spread of various venereal and gastrointestinal diseases and worried about what would happen if a new disease appeared. Dr. Dan William of Manhattan warned, "The plethora of opportunities poses a public health ( problem that's growing with every new bath in town." That was in 1980, just a year before the doctors learned their worst fears had come true.