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."

Subject

Randy Shilts decided to write the book after attending an awards ceremony in 1983 when he received an award for his coverage in the San Francisco Chronicle. In an anecdote that is included in the book, television announcer Bill Kurtis gave the keynote address and told a joke: "What's the hardest part about having AIDS? Trying to convince your wife that you're Haitian. Shilts responded to the joke by saying that it "says everything about how the media had dealt with AIDS. Bill Kurtis felt that he could go in front of a journalists' group in San Francisco and make AIDS jokes. First of all, he could assume that nobody there would be gay and, if they were gay, they wouldn't talk about it and that nobody would take offense at that. To me, that summed up the whole problem of dealing with AIDS in the media. Obviously, the reason I covered AIDS from the start was that, to me, it was never something that happened to those other people."

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.

The gay community

AIDS in the US first struck gay men and IV drug users in Los Angeles, New York City and San Francisco. Shilts' sources in the gay community tried to remember that last time everyone they knew was healthy, which was the Bicentennial celebration in 1976 when sailors came from all over the world to New York. Some of them carried sexually transmitted diseases and rare tropical fevers. There was a marked difference in these cities between Before in 1980, and After by 1985, for the gay community. Before, a time gay men looked upon with a sense of care-free innocence, marked the period before gay men knew someone who was infected or dying. After became the time when gay men knew most or all of their friends were infected with AIDS, and when the term was pervasive throughout the media.

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.

The medical community

Doctors were the first to deal with the toll that AIDS would take in the United States. Some, like Marcus Conant, James Curran, Arye Rubenstein, Michael Gottleib, and Mathilde Krim would realize their life's courses in dealing with patient after patient who showed up in their offices with baffling illnesses, most notably lymphadenopathy, pneumocystis carinii pneumonia, Kaposi's Sarcoma, toxoplasmosis, cytomegalovirus, cryptosporidia, and other opportunistic infections that caused death by a grisly combination of ailments overtaxing a nonexistent immune system. With no information on how the disease was spread, hospital staff were often reluctant to handle AIDS patients, and Shilts reported that some medical personnel refused to treat them at all.

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.

The political and governmental agencies

The Centers for Disease Control (CDC), responsible for tracking down and reporting all communicable disease in the US, faced governmental apathy in the face of mounting crisis. Shilts reported how CDC epidemiologists forged ahead blindly after being denied funding for researching the disease repeatedly. Particularly frustrating were instances of the CDC fighting with itself over how much time and attention was being paid to AIDS issues.

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.

The news media

Shilts was a San Francisco Chronicle newspaper reporter assigned to AIDS full time in 1982. It was from this unique vantage point that he repeatedly criticized the US news media for ignoring the medical crisis because it didn't affect people who mattered, only gays and drug addicts. Shilts noted most newspapers would print stories about AIDS only when it affected heterosexuals, sometimes taking particular interest in stories about AIDS in prostitutes. AIDS was not reported in the Wall Street Journal until it involved heterosexuals. Many stories called AIDS a "gay plague" or "homosexual disease" in articles that pointed to it showing up in new populations, like hemophiliacs or people who had received blood transfusions. Shilts recounted the irony of a reporter commenting on how little was reported about the disease, then linking it once more to rarer instances of transmission to non-drug-using heterosexuals. On the other end of the extreme, a general phobia of AIDS was assisted by news media who erroneously reported that AIDS could be contracted by household contact, without checking any facts in their stories, which prompted mass hysteria across the United States.

Criticism and recognition

And the Band Played On became a commercial success, contrary to Shilts' own expectations. It remained on the New York Times Bestseller List for five weeks, was translated into seven languages, was nominated for a National Book Award, and made Shilts an "AIDS celebrity." Reviews of the work were generally positive, noting, "Shilts has the ability to draw the reader hypnotically into the personal lives of his characters. That, and his monumental investigative effort, would have made this a best-selling novel - if the contents weren't so horribly true." One reviewer agreed, saying, "And the Band Played On reads like a mystery thriller. The fact that it is non-fiction adds to the intensity but also increases the rage the reader is left with. The Los Angeles Times called it, "An important, masterful piece of investigative reporting. Anthony Clare in The Times stated in a review, "And the Band Played On is a formidable chronicle of wasted time, petty intrigue, bigoted posturing, blind faith and suffering," before warning the United Kingdom their response to AIDS was drawing too close a parallel to the United States'. Joan Breckenridge in The Globe and Mail gave the book high praise for "an excellent piece of both investigative and political journalism," and for the style of writing, although cautioning that at more than 600 pages casual readers might be overwhelmed.

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.

Gaëtan Dugas as "Patient Zero"

The book includes extensive discussion of Gaëtan Dugas, who died in 1984. Dugas was labeled the "Patient Zero" of AIDS - meaning he was responsible for spreading it across the US and Canada, and after he was told of his ability to infect others, continued to have unprotected sex. At least one reference to the book takes liberties to assume Dugas brought the virus from Africa to North America, which Shilts never stated in the book, instead writing, "Whether Gaetan Dugas actually was the person who brought AIDS to North America remains a question of debate and is ultimately unanswerable ... there's no doubt that Gaetan played a key role in spreading the new virus from one end of the United States to the other. However, a press release by St. Martin's Press did make that connection in its title, but not its text.

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."

After publication

While Shilts was writing the book he was tested for HIV but told his doctor not to tell him if he was positive until the book was finished so it wouldn't affect his objectivity. He observed that everyone he knew who got a positive test became an activist; he wished to remain a journalist. On the day he sent the final manuscript to the publisher, he got the HIV-positive diagnosis. He also revealed that he received abuse from gays for the articles he wrote for the San Francisco Chronicle supporting the bathhouse closures, as well as for And the Band Played On, saying it was common for him to be spat upon in the Castro District. He was also "worshiped" by many in the gay community for writing the book, but also seen as someone who pandered to publicity.

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.

Film

And the Band Played On was used as the basis for a 1993 Emmy-winning HBO 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. The film was released the same year as Philadelphia and Angels in America, which prompted one reviewer to note it a triumph and a loss: 12 years after the epidemic had begun, such works of art were necessary still to draw attention to it. Reviews of the film were mixed, claiming that it was a noble try, but failed to be comprehensive enough to cover all the intricacies of the response to AIDS. However, And the Band Played On, along with other well-received films at the time, was noted for raising the standards of HBO-produced films.

See also

• Timeline of early AIDS cases
• Zero Patience
• Hot Zone
• Faggots a novel written by Larry Kramer, published in 1978
• Sexual Ecology written by Gabriel Rotello published in 1997

Editions

This is a partial list of published versions of the book.

• Shilts, Randy (1987). And the Band Played on: Politics, People, And the AIDS Epidemic. First Edition, St Martin's Press.
• Shilts, Randy (2000). And the Band Played on: Politics, People, And the AIDS Epidemic. Paperback(Revised), St Martin's Press – Stonewall Inn Editions.
• Shilts, Randy (2007). And the Band Played on: Politics, People, And the AIDS Epidemic. 20th-Anniversary, St. Martin's Griffin.

References

External links

• Photographs of the real people from Randy Shilts' history of the AIDS crisis "And the Band Played On"
• Lyrics to "The Band Played On"
• Shilts' obituary from the Los Angeles Times
• Gay Men's Health Crisis Website
• San Francisco AIDS Foundation Reported by Shilts originally as the San Francisco KS Foundation, started by Cleve Jones and Dr. Marcus Conant.