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And the Band Played On is a 1987 documentary-style novel written by Randy Shilts, who was both an author and journalist who wrote for the San Francisco Chronicle . The novel follows the development of the HIV/AIDS epidemic in San Francisco in the 1980s. The central figures are the politicians...

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And the Band Played On is a 1987 documentary-style novel written by Randy Shilts, who was both an author and journalist who wrote for the San Francisco Chronicle. The novel follows the development of the HIV/AIDS epidemic in San Francisco in the 1980s. The central figures are the politicians (Harry Britt, Philip Burton), medical researchers (Francoise Barre, Mary Guinan), and victims (Michael Maletta, Rick Wellikoff) who were involved with or affected by the outbreak of AIDS as it first came to public attention.

The medical community was at first baffled by HIV symptoms. Mary Guinan leads the charge in research to discover the nature of the disease. The gay community first called it "gay pneumonia" and "gay cancer." A large part of the medical community was reluctant to acknowledge AIDS or devote adequate research funding to it. The Center of Disease Control was thwarted by lack of funding for what was termed a "gay disease."

The book is written in journalistic style, with each chapter title accompanied by a specific date and location. The locales whose events are reported include London, New York, and Los Angeles, with a special focus on San Francisco—the epicenter of the epidemic (and the city with a sufficiently prominent gay population to demand political attention and medical funding to research the disease). Despite the public attention garnered by the heavily afflicted population of San Francisco, fatalities continue undaunted, and there is little in the way of a resolution in Shilts's book. Such lack of resolution showcases both the abiding prejudice against homosexuals and the continued struggle to treat HIV/AIDS.

And the Band Played On

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This book is a masterpiece of investigative reporting. Proceeding chronologically, Randy Shilts lays out the course of the AIDS epidemic from 1976, when the virus seems to have leaped from central Africa to Europe and then from Europe to the United States, to the early months of 1987, when the nation belatedly began to come to terms with the disease’s true seriousness. Shilts, who has covered the AIDS epidemic full-time for the SAN FRANCISCO CHRONICLE since 1982, tells his story by knitting several different strands into a well-integrated narrative. On one level, Shilts graphically portrays the ravaging effects of a slow and relentless death on AIDS victims and their loved ones. Against this “human interest” backdrop, he recounts the nation’s effort to bring AIDS under control, taking the reader on a journey into gay America, the country’s health and scientific establishments, and American politics on the local, state, and national levels.

What emerges from this tour is far from hopeful. Though some doctors, community leaders, researchers, and public officials threw themselves into the fight against AIDS with much vigor and devotion and others were at least sensible and humane, the nation’s overall response was tragically sluggish. Shilts’s account associates this failure with a number of factors: the crippling effects of President Ronald Reagan’s budget-cutting efforts, a news media largely oblivious to AIDS (until Rock Hudson’s death from the disease in 1985), lack of cooperation among scientists and different federal agencies, obstinacy within the gay community, and, underlying these, the American public’s lack of interest in a disease, no matter how deadly, thought to affect only homosexual men.

In the course of doing his research, Shilts doubtless saw more than a few friends lose their lives to AIDS. With this book, he has paid homage to those friends. He has also enabled the American people to make better-informed decisions about AIDS testing and education as they confront a massive medical and political challenge which, unfortunately, has only begun.

Analysis

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The main point of And the Band Played On is to document how the federal government, the media, and the scientific community influenced and shaped the early AIDS crisis in the US in the late 1970s and early 80s. The book describes the power the federal government has over the Center for Disease Control and Prevention (CDC) and the ways in which they ignored the AIDS epidemic by not allocating enough resources and funding to scientific research about AIDS. This reaction arose in part because the government mistakenly believed it to be a disease that only affected gay men, as well as because of the stigma and prejudice surrounding the disease. The scientific community further complicated the situation when, because of competition between scientists (the National Cancer Institute on one hand and the Pasteur Institute in Paris on the other), the Parisian scientists hid their discovery of the origin of the virus for an entire year. The media played their part as well in contributing to the neglect of the AIDS crisis by only covering AIDS regularly once they realized that AIDS was a crisis which did not affect only gay men, but also heterosexuals (and drug users) as well. And the Band Played On thus paints a picture of how all of these various factors played a role in the neglect of the AIDS epidemic and shows the degree to which government, bureaucracy, media, individuals, and the scientific community could have changed its outcome.

And the Band Played On

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Randy Shilts’s And the Band Played On: Politics, People, and the AIDS Epidemic is the first major history of the Acquired Immune Deficiency Syndrome (AIDS) epidemic. There is no reading this book without feeling intense anxiety about one’s health and the health of one’s loved ones; furious anger toward the organizations and individuals who have cost thousands of lives through their blindness, prejudice, and egotism; enormous respect for the people who have bravely sought to cure this disease; and a bottom-of-the-well despair for the unfathomable suffering this plague has caused and will continue to cause tens and hundreds of thousands of innocent people.

Shilts is exceptionally, perhaps uniquely, qualified to write this book. Not only is he a health reporter, but he is also self-avowedly gay—a fact of critical importance, since the AIDS epidemic was and largely still is identified as a gay disease in this country. Since 1982, Shilts has worked in San Francisco, the gay mecca that would be so hard hit by this epidemic, for the San Francisco Chronicle, perhaps the only newspaper in the United States to recognize the epidemic as a newsworthy topic almost from the first signs of its arrival. Since 1983, Shilts’s sole professional topic has been the AIDS epidemic. And the Band Played On is filled with information that only someone in Shilts’s position could have culled, from doctors and government officials interviewed month by month to early AIDS sufferers now long dead. At more than six hundred pages, the book is a heroic attempt to cover the ramifications of this plague from every possible perspective: political, medical, journalistic, social, and personal. It is also clearly the work of someone who has lived on intimate terms with horror for five very long years.

The book is structured chronologically, beginning in 1976, when Dr. Grete Rask, a Danish surgeon working in Zaire, first fell ill with a mysterious and wasting disease. Shilts concentrates heavily on the period from 1980 through 1985, those critical first years of the American AIDS epidemic, and concludes with a brief update to 1987. Organizing his material under precise date headings, Shilts jumps from topic to topic within his overall subject. In the sections devoted to 1983, Shilts’s entries follow each other with only a few days’ interval—the year was that critical to the AIDS epidemic. Such an approach has its shortcomings: There is an enormous amount of redundancy—something perhaps excusable in a book that documents the redundant, hapless efforts of scientists, gay activists, and a few politicians to save lives. There is also diffuseness, a blunting of some of Shilts’s arguments because of his peripatetic structure. Yet Shilts’s method has one supreme merit: It allows the reader to watch the unfolding of this grisly drama linearly, with a scope and understanding one could not possibly have had while actually living through it. And the Band Played On is not a historian’s book, but a reporter’s, raw and undigested but vital.

The disease that would eventually be known as AIDS first came to attention in the United States in 1980, when men in both San Francisco and New York began to fall ill with a form of skin cancer known as Kaposi’s sarcoma and a pneumonia called Pneumocystis carinii, both rare and deadly diseases ordinarily found in someone with an immune system damaged by birth defects or chemotherapy. It was in December, 1980, when Dr. Donna Mildvan of Beth Israel Medical Center first noticed that these diseases were attacking homosexual men; April, 1981, when Dr. Michael Gottlieb of the University of California at Los Angeles first identified this as a new epidemic; and June, 1981, when the Center for Disease Control’s Morbidity and Mortality Weekly Report published the first paper on the disease. As infants, drug users, transfusion recipients, hemophiliacs, Haitians, and Africans fell victim to the disease, scientists in the United States and abroad struggled to define its nature and to identify the means of transmission.

By December, 1981, French doctors Jacques Leibowitch and Willy Rozenbaum had already concluded that a virus was responsible for the disease. It would not be until April, 1984, however, that an American government official would announce that the new virus had been identified. The delay was the result of a number of factors: insufficient funding to finance medical research, the unconscionable lag in publication caused by the endless reviewing procedures of top medical journals; and the egotism and prejudice of a few doctors themselves.

Emerging as a shadowy figure in the medical drama is Dr. Robert Gallo, a retrovirologist with the National Cancer Institute in Bethesda. According to Shilts, Gallo threatened colleagues who left his domain to work for other researchers and relentlessly fought with French doctors pursuing the same line of work. Ultimately, the Pasteur Institute filed a lawsuit against the National Cancer Institute, resolved only in 1987 out of court by Jonas Salk. Four years after French scientists had applied for a patent on the AIDS virus, the American government finally allowed them to share credit for the discovery with Gallo. Yet Gallo’s behavior is the exception in Shilts’s history; much more often, the medical profession acts with selfless determination and energy, bravely confronting this frighteningly enigmatic disease.

More controversial than Shilts’s treatment of the medical profession is his depiction of the gay community. Shilts is anything but soft on this topic. A longtime proponent of health over politics, Shilts describes with a fascinated repugnance the 1970’s promiscuity that followed in the wake of gay liberation. He is angry that gays continued to have orgiastic sex in back room bars and bathhouses while doctors such as Selma Dritz warned of possible health hazards, and he is angrier still that gay activists insisted on defending their rights to such orgies long after the AIDS virus had reared its ugly head. Much of Shilts’s book focuses on the controversy over closing the bathhouses once it became apparent that AIDS was being transmitted sexually. He has little sympathy for the San Francisco community leaders who worried that locking the bathhouse doors might be the first of many measures denying gays their civil rights and even less for the New York gay leadership, whom he charges with being more concerned with keeping their jobs than with stopping a modern plague.

Although Shilts is very convincing in arguing the need for closing the bathhouses, his voice here is much more strident than when discussing the medical profession. Given the long latency period of the AIDS virus, figures indicate a phenomenally responsible reaction by the gay community as a whole, almost from the time the first facts about the disease came to be known. Yet Shilts prefers to dwell on the relatively few gays who straggled to the baths in the mid-1980’s, knowing full well that they were playing a kind of Russian roulette. In particular, he dramatizes at great length the story of Gaetan Dugas, the French Canadian airline steward known to the medical profession as Patient Zero. Flying from city to city across the globe, relishing sex everywhere he went, Dugas was proven before he died to have had a sexual connection with at least forty of the first 248 gay men diagnosed with AIDS. The ugliest part of the story is that the steward continued his behavior even after he became aware that he was infecting his sexual partners with a deadly disease.

Once again, there are positive examples here to counterpoint the negative. Particularly moving are Shilts’s portraits of Gary Walsh, a psychologist stricken with AIDS who helped organize victims of the epidemic, and Bill Kraus, a political aide who fought for victims’ rights in Congress before himself falling victim to the disease. Yet the positive gay figures are always presented as mavericks in Shilts’s book, outsiders fighting self-destructive fools who defend promiscuity with inane political rhetoric. Apparently a firm believer in monogamy, Shilts seems to see the AIDS epidemic as a kind of corrective to the rampant sexual freedom of the 1970’s. At times, as when he praises Larry Kramer’s play The Normal Heart (1985) for advocating gay marriages, Shilts confuses the moral with the medical. One cannot help wishing that And the Band Played On were less shrill in dealing with gay issues and more compassionate toward the victims of this horrible disease, no matter how they contracted it.

A member of the journalistic as well as the gay community, Shilts is equally hard on his colleagues for their behavior during the AIDS epidemic. This time his criticism seems warranted: Citing figures for the amount of coverage given the disease, Shilts shows how little interest newspapers across the country had in the epidemic when it was strictly a disease of homosexuals and drug addicts. The repeated cry of editors and reporters was, “Show us an angle for the heterosexual community and then we will be interested.” It is only in 1984, with the growing awareness of AIDS transmission through transfusions, that newspapers began to pay the disease serious attention. That and the death of a celebrity, Rock Hudson, finally made a disease that had already killed thousands of people “newsworthy” to journalists.

Shilts is particularly angry about newspaper neglect because, he persuasively argues, newspaper attention might have spurred the government to do something about this devastation. On all levels—federal, state, and city—the government needed spurring. Shilts demonstrates indubitably that only the government of San Francisco recognized the AIDS threat early and cared enough to do something about it. Torn between her hetero- and homosexual constituency, Mayor Diane Feinstein certainly did not have a clear path to follow, but, according to Shilts, she, with assistance from congressmen Phil Burton and Henry Waxman, provided facilities for specialized health care and AIDS education many long years before the rest of the country allocated funds for the disease.

Alongside San Francisco, New York seems particularly remiss. Although New York was the source of the epidemic in the United States, although the number of New York AIDS patients dwarfed those elsewhere, the city, under Mayor Ed Koch’s nominally liberal administration, failed to provide adequate funds for an AIDS clinic, long-term services, or education. Finally, in April, 1985, Kramer’s play The Normal Heart criticized the Koch administration harshly enough to provoke action. Governor Mario Cuomo was equally remiss, threatening in 1983 to veto the Republican-dominated state senate’s push to appropriate $5.2 million for AIDS research, education, and prevention. As late as 1985, Massachusetts governor Michael Dukakis submitted a $3.3 billion health and human services budget that failed to allocate one cent for AIDS. As Shilts illustrates, labels such as liberal and conservative, Democrat and Republican became almost irrelevant when dealing with the AIDS epidemic.

Yet it is the Reagan Administration that is the target of Shilts’s strongest criticism. Once the disease began to kill drug addicts and gay men, the administration simply chose to ignore it. As Shilts points out, public health threats such as Legionnaires’ disease and Toxic Shock Syndrome had been dealt with instantly, with great public fanfare. Yet long after it had claimed many more lives than both of those diseases combined, AIDS was still being shrugged off. The difference, as Waxman pointed out at a budget hearing, was that Legionnaires’ disease had hit a group of predominantly white, heterosexual, middle-aged members of the American Legion, whose respectability had brought them a degree of attention and funding. Yet AIDS victims were not typical, Main Street Americans. They were drug addicts and gays.

As Shilts shows, people such as Dr. Edward Brandt, Assistant Secretary for Health of the Department of Health and Human Services, pleaded desperately behind the scenes for more federal AIDS funding. In public, however, they were coerced by the administration to make statements reassuring the country that AIDS research had all the money it needed. Meanwhile, people across the country were catching AIDS through transfusions, because blood banks lacked the resources and encouragement to screen blood. Significantly, the president himself did not speak to the nation about the AIDS epidemic until May 31, 1987—more than six years after Dr. Gottlieb first diagnosed the disease. By that time, 36,058 Americans had fallen ill with AIDS, and 20,849 had died of it.

Understandably, And the Band Played On is not a coolheaded book. Its subject is a disease whose toll in this country is rivaling that of the Vietnam War. Its overriding implication is that many of those lives could have been saved had the United States not been awash in a sea of reactionary prejudice. Shilts undertook a herculean endeavor in trying to distill so much of one decade between the covers of one book. There is much that is wrong with And the Band Played On. The writing is often slovenly, the structure problematic, and the tone sensational and lurid. Yet it is also a book of great and wide-ranging significance—an informed book, a convincing book, and a heartbreaking book, for those who care to read it.

Bibliography

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Chicago Tribune. October 18, 1987, XIV, p. 3.

Kirkus Reviews. LV, September 1, 1987, p. 1303.

Library Journal. CXII, November 15, 1987, p. 71.

Los Angeles Times Book Review. December 6, 1987, p. 6.

The Nation. CCXLV, November 7, 1987, p. 526.

The New York Times Book Review. XCII, November 8, 1987, p. 9.

The New Yorker. LXIII, December 28, 1987, p. 124.

Newsweek. CX, October 19, 1987, p. 91.

Publishers Weekly. CCXXXII, September 11, 1987, p. 72.

Time. CXXX, October 19, 1987, p. 40.

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