And the Band Played On
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And the Band Played On: Politics, People, and the AIDS Epidemic is a book written by San Francisco Chronicle journalist Randy Shilts (original copyright 1987) chronicling the discovery and spread of HIV and AIDS, with a special emphasis on alleged government indifference to what was initially perceived as a "gay disease." The title of the book appears to be a reference to the oft-repeated story about the dance band in the first-class lounge of the Titanic, who kept playing as the ship was sinking.
Contents |
[edit] Book
The book is an extensive work of investigative journalism, written in the form of an extended timeline, with the events that shaped the epidemic presented as sequential matter-of-fact summaries. It begins with a prescient description of the U.S. Bicentennial celebration in New York City: the Tall Ships (and their sailors) came from all over the world, and they came to New York. Some of the sailors were gay, and some of them carried sexually-transmitted diseases and rare tropical fevers. Some of the gay sailors met New Yorkers and other Americans and had sex with them. It ends with the announcement by Rock Hudson in 1985 that he was dying of AIDS, when international attention on AIDS exploded.
The story segues to a classic tearjerker: the first European to catch the disease was Grethe Rask, a Danish surgeon working in a hospital in rural Zaire under primitive conditions. Dr Rask, an open and monogamous lesbian, was from Thisted, north of the Lim Fjord, where her companion lived. Danes from north of the fjord were known for an independent, plain-spoken nature. She chose to work in Africa, rather than Copenhagen, because it gave her a chance to run a department, or even a whole hospital, by herself, without first spending decades under the eye of male supervisors, as she would have in Denmark: she accepted that primitive conditions were the price of working in a Third-World hospital. She couldn't have gotten infected in any of the more common ways, since she was a lesbian living a celibate life in Africa and was not a drug addict; but she was at great risk from needle sticks and similar hazards in a hospital where normally-disposable gloves and needles were resterilized and reused until obviously worn out (which made sterile procedure nearly impossible). In addition, Sub-Saharan Africa is a fertile source of exotic "tropical fevers." Her first symptoms showed during a Christmas Eve celebration for her newly-arrived and homesick colleague, Ib Bygbjerg, and she soon developed symptoms of several now-well-known opportunistic infections, including pneumocystis pneumonia. She soldiered on until she was clearly too ill to continue; and then she returned to Denmark, where the best Western medicine was not good enough to diagnose this novel infection. Her Danish doctors could recognize the opportunistic infections that could only arise after her immune system had been ravaged, but they couldn't understand the significance of this combination of usually-rare, usually-feeble infections, and they had no treatments that worked in the absence of a functioning immune system. She finally gave up and refused to submit to further tests: she returned home and died there, cared for by her long-time companion, a registered nurse. Dr Bygbjerg had also returned to Denmark, where his mentor advised him "Don't bother with pneumocystis: it's too rare to matter." It eventually became less rare, but it was only a symptom, not the whole disease. Dr Bygbjerg then studied lymphocytes, which were at the center of the problem.
Microbiology and biochemistry are described in great detail in the journalistic work as Shilts told how doctors in the US and France struggled to understand what caused normal healthy people to be ravaged by rare and obscure infections that aren't normally seen in the developed world, and who fought with each other to determine who would be named the discoverer of the new virus.
Shilts shows objectively the way epidemiologists tracked down recurring cases of immune deficiency in gay men in 1980 and 1981 in New York City and San Fransisco. As they learned how it was spread in gay bathhouses, Shilts chronicled the political struggle over closing the bathhouses, a symbol of gay liberation and sexual expression, on both coasts. The rallying of the gay communities to educate themselves in New York, San Francisco, and Los Angeles is also featured prominently. These communities were also responsible for raising the first funds for research and medical care for the dying.
The fight to get the nation's blood supply tested was also chronicled in great detail, as the people in charge of making decisions about blood transfusions were slow to be convinced HIV is a bloodborne virus, and they took a "wait and see" attitude toward it.
The book includes extensive discussion of Gaetan Dugas (who died in 1984 [1]), who was labelled the "Patient Zero" of AIDS (a claim which was challenged in later years).
Politics plays a huge role in the book, as doctors and gay activists attempt to earn funding to learn more about the disease, teach others about how it is transmitted, and educate the public about discrimination. City supervisors from San Fransisco, the mayor of New York City Ed Koch, and even the administration of Ronald Reagan used the topic as political fodder, sometimes never addressing the medical crisis at all, as in the case of Reagan, who Shilts noted not once mentioned the disease in public until he was no longer acting president.
Randy Shilts himself died of AIDS in 1994.
The original 1987 St Martin's Press hardback edition was followed by a 1988 Penguin paperback, which had an addendum covering more recent events. It doesn't re-examine the Dugas story, which was questioned by many, including Dr Paul Darrow, who had done the original cluster study that gave Dugas the codename "Patient O" ("Oh," for Out-of-Town), not "Patient Zero," which has a specific meaning in epidemiology. By definition, Patient Zero, or the Index Case, is the first case in an outbreak. Shilts assumed that Dugas was the original source of the infection among gay men in North America. Darrow had not reached this conclusion at the time he had published his first report on the cluster of puzzling infections He later concluded that the study had been flawed. Unfortunately, Dugas died in 1984, before he could confirm or deny Shilts' characterization of him. By that time, Shilts had constructed a number of scenes with Dugas, ascribing thoughts or dialogue that could not be confirmed. If Dugas had lived longer, perhaps his version might have been aired--perhaps in court. The case is moot.
[edit] Film
And the Band Played On was used as the basis for a 1993 HBO Emmy winning movie of the same name, produced by Aaron Spelling, directed by Roger Spottiswoode, and starring Matthew Modine as Don Francis and Richard Masur as Dr. William Darrow, doctors at the Centers for Disease Control, and Alan Alda as real-life controversial viral researcher Robert Gallo. The movie also starred B.D. Wong, Glenne Headly, Swoosie Kurtz, and Ian McKellen as Bill Kraus. The movie featured a plethora of other big stars in supporting and cameo roles, who agreed to appear in the film for union-scale pay, such as Richard Gere, Phil Collins, Tchéky Karyo, Lily Tomlin, Steve Martin, and Anjelica Huston.
Elton John performs The Last Song at the end of the film, appearing during a closing montage featuring many celebrities who died of AIDS, such as musician Freddie Mercury, who also had a song (Play The Game) featured in the film; actors Rock Hudson, Anthony Perkins, Brad Davis and Robert Reed; tennis player Arthur Ashe, nurse and "KS poster boy" Bobbi Campbell; and fashion designer Willi Smith. [2]
[edit] Trivia
- The title is a direct reference to the sinking of RMS Titanic, in which the dance band in the ship's first-class lounge continued to play as the ship sank. It's also a reference to the early-20th-century song containing a lyric in which a young man "waltzed with a Strawberry Blonde/and the band played on." The title may also be alluding to the 1968 play, The Boys in the Band.
- While author Randy Shilts was writing the book, he was tested for the HIV virus, but told his doctor not to tell him if he had it until the book was finished, so it wouldn't affect his objectivity.
