And the Band Played On: Politics, People, and the AIDS Epidemic is a best-selling work of nonfiction written by San Francisco Chronicle journalist Randy Shilts published in 1987. It chronicles the discovery and spread of HIV and AIDS with a special emphasis on government indifference and political infighting to what was initially perceived as a gay disease, that has impacted the United States and the world for decades after. The book is an extensive work of investigative journalism, written in the form of an extended time line, the events that shaped the epidemic presented as sequential matter-of-fact summaries. Shilts describes the impact and the politics involved in battling the disease on particular individuals in the gay, medical, and political communities. It begins in the late 1970s in Africa, with the then first confirmed case of AIDS, that of Grethe Rask, a Danish doctor, and it ends with the announcement by Rock Hudson in 1985 that he was dying of AIDS, when international attention on AIDS exploded.
The title of the book is a reference to the story about the dance band in the first-class lounge of the RMS Titanic, which kept playing as the ship sank, thereby alluding to the multiple agencies and communities who neglected to prioritize a swift medical response to the crisis. After publication of the book, Shilts explained his use of the title: "And the Band Played On is simply a snappier way of saying 'business as usual.' Everyone responded with an ordinary pace to an extraordinary situation."
Judith Eannarino of the Library Journal called it "one of the most important books of the year," upon its release. Randy Shilts described his motivation to undertake the writing of the book in an interview after its release, saying, "Any good reporter could have done this story, but I think the reason I did it, and no one else did, is because I am gay. It was happening to people I cared about and loved."
Shilts focused on several organizations and communities that were either hit hardest by AIDS, were given the job characterized by Shilts as "Sisyphean" of finding the cause of the disease, or begging the government for money to fund research and provide social services to people who were dying.
In New York City, men like Larry Kramer and Paul Popham, who had no desire for public acclaim, were forced by bureaucratic apathy into forming the Gay Men's Health Crisis to raise money for medical research and to provide social services for scores of gay men who began getting sick with opportunistic infections. Shilts described the desperate actions of the group to get recognition by Mayor Ed Koch, assistance from the Public Health Department to provide social services and preventive education about AIDS and unsafe sex.
In San Francisco, particularly in the Castro District, gay community politicians such as Bill Kraus and Cleve Jones found a new direction in gay rights when so many men came down with strange illnesses in 1980. The San Francisco Department of Public Health began tracing the communicable disease and linked it to certain sexual practices, made recommendations to gay men on how to avoid getting sick—stop having sex—a directive that went completely against what the Castro District had fought in favor of for years. Kraus and Jones often found themselves fighting a two-fronted battle: against city politicians who would rather not deal with a disease that affected such an undesirable population as gay men, and the gay men themselves, who refused to listen to doomsday projections and continued their unsafe behavior.
In all of these cities, however, the sizable gay communities themselves in many instances were responsible for raising the most money for research, providing the money for and the actual social services for the dying, and for educating themselves and other high-risk groups up to and beyond 1985. Larry Kramer went on to form ACT-UP as a political activist organization forcing government and media to pay attention to AIDS. Cleve Jones went on to form the NAMES Project.
Shilts reported how the Public Health Department of San Francisco handled this new communicable disease by tracking down people who were sick, and linking them to other people who had symptoms, some of them living in different parts of the country, and he noted how the New York City Public Health Department did very little, when Public Health Director David Sencer refused to call it an emergency and stated that the Public Health Department need not do anything at all since the gay community was handling it sufficiently.
Around the same time gay men were getting sick in the United States, doctors in Paris, France, were receiving patients who were African or who had lived in Africa with the same symptoms as American gay men. Parisian doctors Francoise Barre, Luc Montagnier, and Willy Rozenbaum began taking biopsies of HIV-affected lymph nodes and discovered a new retrovirus. As a scientific necessity to compare it to the American version of HIV, the French doctors who represented the Pasteur Institute sent a French colleague to the National Cancer Institute where Robert Gallo was also working on the virus. The colleague performed a switch on the samples, Shilts reported, because of a grudge he had against the Pasteur Institute. Instead of Gallo comparing his samples with the French samples, he found the very same retrovirus as the French sample, putting back any new results in AIDS research for at least a year.
Departmental ego and pride, Shilts reported, also confounded research as the Centers for Disease Control and the National Cancer Institutes battled over funding and who might get credit for medical discoveries that were to come from the isolation of the HIV virus, blood tests to find HIV, or any possible vaccine. Once AIDS became known as a "gay disease" there was particular difficulty for many doctors in different specialties to get other doctors to acknowledge that AIDS could be transmitted to people who were not gay, such as infants born from drug-using mothers, children and adults who had hemophilia (and later, their wives), Haitians, and people who had received blood transfusions.
The discovery of AIDS in the nation's blood supply and subsequent lack of response by the blood banking leadership occurred as early as 1982. Doctors were able to find evidence of AIDS transmitted through blood transfusions, yet it took until 1985 (when AIDS antibody testing was approved by the FDA) before blood bank industry leaders would recognize that AIDS was in fact transmitted through blood transfusions. Plus, industry leaders said – according to Shilts – screening donors for hepatitis alone might offend them, and the cost of screening all the blood donations provided across the country every year was too high to be feasible.
Although Reagan Administration officials like Health and Human Services Secretary Margaret Heckler and Assistant Secretary Edward Brandt spoke publicly about the epidemic, calling it in 1983 its "Number One Health Priority" no extra funding was given to the Centers for Disease Control or the National Institutes of Health for research. What the United States Congress pushed through was highly politicized and embattled, and a fraction of what was spent on similar public health problems.
Shilts made appropriate comparisons to the government's disparate reaction to AIDS versus the Tylenol Crisis of 1982, and the recent emergence of Legionnaire's Disease in 1977. In October 1982, seven people died after ingesting cyanide-laden Tylenol capsules. The New York Times wrote a front-page story about the Tylenol scare every day in October, and produced 33 more stories about the issue after that. More than 100 law enforcement agents, and 1,100 Food and Drug Administration employees worked on the case. Johnson & Johnson disclosed they spent $100 million US attempting to uncover who tampered with the bottles. In October 1982, 634 people were reported having AIDS, and of those, 260 had died. The New York Times wrote three stories in 1981 and three more stories in 1982 about AIDS, none on the front page. The Tylenol Crisis was a criminal act of product-tampering. Legionnaire's Disease was a public health emergency. Twenty-nine members of the American Legion died in 1976 at a convention in Philadelphia. The National Institute of Health spent $34,841 US per death of Legionnaire's Disease. In contrast, the NIH spent $3,225 US in 1981 and about $8,991 US in 1982 for each person who died of AIDS.
Shilts accused Ronald Reagan of neglecting to address AIDS to the American people until 1987, even after calling friend Rock Hudson to tell him to get well, calling his behavior "ritualistic silence. After Hudson's death and in the face of increasing public anxiety, Reagan directed Surgeon General C. Everett Koop to provide a report on the epidemic. A political conservative, Koop's report was nevertheless clear about what causes AIDS and what people and the US government should do to stop it, including sex and AIDS education provided for all people.
On a civic level, the closure of gay bathhouses in San Francisco became a bitter political fight in the gay community putting the San Francisco Public Health director on the spot to educate people on how AIDS is transmitted, and to close the bathhouses as a matter of public health.
Subsequent books on medical crises including breast cancer, chronic fatigue syndrome, Agent Orange, and continued response to AIDS have been compared to Shilts' book as a standard. Nan Goldberg in The Boston Globe characterized it as a, "groundbreaking book on the history of the AIDS epidemic...every element of a thriller.
And the Band Played On won the Stonewall Book Award for 1988. It earned the 10th spot on 100 Lesbian and Gay Books That Changed Our Lives, compiled by the Lambda Book Report. In 1999, The New York City Public Library topped its list of "21 New Classics for the 21st Century" with And the Band Played On.
In a 1988 book review, Jack Geiger of The New York Times commented that the detail in Shilts' work was too confusing, being told "in five simultaneous but disjointed chronologies, making them all less coherent," and notes that Shilts neglected to dedicate as much detail to black and Hispanic intravenous drug users, their partners and children. Geiger also expressed doubts that a swifter response to the government would have stemmed the spread of AIDS as quickly as Shilts was implying. Woodrow Myers from the Los Angeles Times was frustrated by Shilts not asking the right questions: "Shilts fails to probe the broader questions and stops where far too many of us stop: We don't ask why the Department of Defense and the entitlements like Social Security are getting all the money when the homosexuals and the IV drug abusers with AIDS and the multiple sclerosis patients are not. The Gay Community News in Boston also criticized the book's implications that a diagnosis of HIV indicated that death was sure and imminent. Richard Rouilard, editor of The Advocate in 1992 criticized Shilts for being out of touch with the contemporary style of activism and its sexual overtones.
Shilts is often quoted as claiming that Ronald Reagan neglected to mention AIDS publicly until 1987. However, Reagan briefly discussed the topic in questions and answers during a news conference on September 17, 1985.
When the book was released, Dugas' story became one of the focal points in reviews, and Shilts claimed, "the Canadian press went crazy over the story," and that "Canadians...saw it as an offense to their nationhood." The original study had been completed by William Darrow, but it was called into question by Andrew Moss. Moss wrote in a letter to the editor of The New York Review of Books, "There is very little evidence that Gaetan was 'patient zero' for the US or for California," also stating that Shilts did not overstress the role of Dugas even though he did identify Dugas. A book review published in Science magazine used Shilts' treatment of Dugas as an example of his "glib" treatment of the science involved in the epidemic. Douglas Crimp suggested in 1987 that Shilts' representation of Dugas as "murderously irresponsible" is in actuality "Shilts' homophobic nightmare of himself," and that Dugas was offered as a "scapegoat for his heterosexual colleagues, in order to prove that [Shilts], like them, is horrified by such creatures."
Shilts declared while promoting the book in Australia in 1988 that AIDS in the western world could be eradicated, and by 1994, "AIDS could be as manageable as diabetes." However, in reference to Africa, Shilts noted, "At this point it's inconceivable that there will be an AIDS-free world in Central Africa, as we're looking at a death rate on the scale of the Holocaust. Shilts gave an interview in 1991 where he noticed, "the stellar AIDS reporters in the early years...the people who did the best job -- and the reporters who wanted to cover AIDS but their male editors wouldn't let them -- tended to be women," and made a connection that if more women were allowed to write about the epidemic, media coverage would have been vastly different.
Randy Shilts died from complications of AIDS in 1994. Upon his death he was eulogized by Cleve Jones who said, "Randy's contribution was so crucial. He broke through society's denial and was absolutely critical to communicating the reality of AIDS. Larry Kramer said of him, "He single-handedly probably did more to educate the world about AIDS than any single person.