'Patient Zero' and the early days of HIV/AIDS - An archive of a Salo Forum thread

Niccolo and Donkey (ND): I've been spending some time researching some history in respect to California during the 1960s and 1970s and it has taken me through events like the Counterculture, Occultism, cults like the Manson Family and Jim Jones' Peoples Temple, the proliferation of serial killers during that time, and the exploding population of homosexuals in San Francisco and the role they played in spreading HIV.

This led me back to a very popular figure in AIDS history, Quebecois flight attendant Gaetan Dugas aka "Patient Zero". Dugas was a very, very promiscuous homosexual who was showing symptoms of what would be later labelled as HIV/AIDS before the virus was discovered and even before they knew it was a virus or even sexually transmitted. He was having sex in bathhouses and other venues in places like New York City, Los Angeles, San Francisco, Vancouver, and Toronto. The CDC in Atlanta interviewed him and a cluster study was done in which he was found to be in the middle of a cluster of 40 of the first 260 diagnosed cases in the USA. (He told them that he first became active in 1972 and had 2,500 sexual partners by that point). These 40 gays were guys who either had sex with Dugas or were someone who had sex with someone else who had sex with Dugas. This cluster study helped prove at the CDC that the disease was sexually transmitted. The CDC continued to fly Dugas down to Atlanta for questioning and observation but they never publicly admitted that Dugas was their "Patient Zero" as per institutional policy in respect to confidentiality.

Dugas as "Patient Zero" appeared first in Randy Shilts' massive book "And the Band Played On" which documented the spread of the disease and the work done to start the fight against it as well as the bureaucratic hurdles that were in the way. Shilts claimed that he received a leaked copy of the cluster study naming Dugas. He then was pressured by his publisher to pump up the Patient Zero story to sex up the book so that it would sell more, which in retrospect was a successful strategy.

Dugas, of course, wasn't the individual who brought HIV to North America as many media outlets said when the book came out in 1987, but the belief that he did continues to be widely held.

Up until two weeks ago, all we had from Dugas were a few photos and the characterization of him in both Shilts' book and HBO movie based on it from 1993.

On July 10th, a Vancouver AIDS group released a video in which Gaetan Dugas can be seen asking very tough questions to a panel of AIDS activists and experts when this group launched in 1983. The group felt that his questions were simply unanswerable and very demoralizing.

This 13 minute video contains never before seen video footage of Gaetan Dugas which begins with a brief intro about him by his physician at the 5:45 mark.

https://archive.ph/o/AJNMS/3030.aidsvancouver.org/1984/*

As one of the first open cases in Vancouver (and Toronto), he would become subject to bouts of shunning at gay bars in those cities as word spread that he carried the disease (which was yet to be named and was still being referred to as "Gay Cancer" or "GRIDS").

Hyperlink, text: Patient Zero Speaks in Never Before Seen Footage, url: http://www.hivplusmag.com/case-studies/activism/2013/07/10/patient-zero-speaks-never-seen-footage OR https://archive.ph/qYpxG

As part of The 30 30 Campaign, which celebrates the organization's 30th anniversary, AIDS Vancouver released unseen footage of Gaëtan Dugas, commonly known as "Patient Zero" of the HIV/AIDS epidemic.

The footage shows Dugas speaking at the first AIDS Information Forum in March 1984 at Vancouver’s Westend Community Centre, asking difficult questions of some of the world’s top experts sitting on the forum’s panel. "So you shouldn't fear someone who has AIDS, or have symptoms of AIDS," Dugas says in the video, leading up to a question on AIDS testing at the time. "It seems like there's kind of a [fear] towards those people here."

“This never before seen footage provides us with a snapshot into the life of one of the most talked-about figures in the early days of the epidemic,” said Dr. Brian Chittock, the executive director of AIDS Vancouver. “For many, the name Gaetan Dugas embodies the start of HIV/AIDS – yet most have never heard his story.”

Noah Stewart, a founding member of AIDS Vancouver, also questions the origins of the "Patient Zero" theory and popular views of Dugas’s life within the video. Dugas has never been definitively pinpointed as the first North American with AIDS by the scientific community, but he gained notoriety as such in San Francisco Chronicle reporter Randy Shilts’s notorious book, “And the Band Played On: Politics, People, and the AIDS Epidemic".

Some of the photos of Gaetan Dugas that have been available for some time:

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Mike: >quoting ND<”I've been spending some time researching some history in respect to California during the 1960s and 1970s and it has taken me through events like the Counterculture, Occultism, cults like the Manson Family and Jim Jones' Peoples Temple, the proliferation of serial killers during that time, and the exploding population of homosexuals in San Francisco and the role they played in spreading HIV.”

Apparently California in the decades after the second world war has been a nexus of greater weirdness than I have taken notice of. I look forward to more threads on these topics.

>quoting ND<”"So you shouldn't fear someone who has AIDS, or have symptoms of AIDS," Dugas says in the video, leading up to a question on AIDS testing at the time. "It seems like there's kind of a [fear] towards those people here."”

It didn't take long for this active homosexual practitioner to take offense to being shunned for having a deadly infectious disease. It's hard to find the words to describe the arrogance of this filthy pervert figuratively wagging his finger at the very medical professionals trying their best to warn the homosexual "community" and to control the new epidemic. His attitude reinforces the idea sometimes bandied about that homosexuality is about narcissistic self-absorption at some deep level. Like many sodomite degenerates, he exhibits a callousness about the world and the fate of those to whom he has spread disease that is as repulsive and reprehensible as the filthy sexual habits themselves.

Here are some snippets from an article entitled Hyperlink, Text: Patient Zero, url: https://www.chicagotribune.com/ct-xpm-1987-11-01-8703230166-story.html*in the Chicago Tribune.

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.

After the examination, as Dugas was pulling on his stylish shirt, Conant mentioned that Dugas should stop having sex.

Dugas looked wounded, but his voice betrayed a fierce edge of bitterness. ``Of course, I`m going to have sex,`` he told Conant

``Nobody`s proven to me that you can spread cancer

``Somebody gave this thing to me,`` he said. ``I`m not going to give up sex.”

He had decided to settle in San Francisco. They had an interferon program at their GRID clinic, and besides, he had always wanted to live there.

It was at this time that rumors began on Castro Street in San Francisco about a strange guy at the Eighth and Howard bathhouse, a blond with a French accent. He would have sex with you, then turn up the lights in the cubicle, and point out his Kaposi`s sarcoma legions.

``I`ve got gay cancer,`` he`d say. ``I`m going to die, and so are you.``

Mind you, this freak is apparently considered some sort of hero or martyr to the homosexual movement. (The 30 30 AIDS Vancouver video is dedicated to him and one other person who croaked from AIDS.) In the end, all that these people care about is sodomy. They should not be considered a normal and responsible segment of civilized society.

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ND >indicating this is in response to Mike<: I'm combing through the Hyperlink, text: Oral History the AIDS Epidemic in San Francisco, url: http://content.cdlib.org/view?docId...60&toc.depth=1&toc.id=d0e801&brand=calisphere, which is a great read. I just came across this quote from Dr. Selma Dritz who worked for City Public Health and who was key in the early days in helping to figure out what was going on in the gay community there.

Hughes- How did you weigh the pluses and minuses of the health hazard versus the civil liberties issues?

Dritz- We were always behind the eight ball. We were always chasing after a good answer, a good way to do it. But if we found that the actions of infected patients were hazardous to their [sexual] contacts, and we had told them what not to do and showed them why they shouldn't and they were still doing it, then I tried to creak down. You couldn't put them in jail, because you couldn't prove what they had transmitted. And you don't do that. But we got at them any way that we could. We could threaten then, "We'll tell your friends that you're infected." We didn't do it. But once in a while, we had to use a little body punch just to keep them from killing somebody else.

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ND: Hyperlink, text: Dritz on Dugas:, url: https://oac.cdlib.org/view?docId=kt...92&toc.depth=1&toc.id=d0e801&brand=calisphere

Gaetan Dugas and the Cluster Study

Hughes- Well, maybe this is the time to introduce Gaetan Dugas, patient zero?<br>

Dritz- Well, he wasn't really patient zero. He was the first one from whom we could more or less prove that it was a transmissible disease. Bill Darrow and Dave Auerbach from CDC were doing interviews in California on patients with AIDS. This was when we were still doing our large questionnaire and trying to find out, is AIDS a transmissible disease, or is it some chemical in the environment?

In their interviews, the CDC asked patients, "Well, whom did you have sexual contact with?" And have them name them. This was before confidentiality became a red flag, and justifiably, perhaps. You have to be politically correct here.

Hughes- Which comes hard, doesn't it?

Dritz- No, not really, but I have to be conscious of it.

So they kept asking about contacts from patients they were interviewing. Several in southern California mentioned that one of their contacts, among many, was this handsome Canadian air steward. They didn't get the name. After maybe thirty or forty interviews, they kept hearing something about a Canadian air steward. And then finally, one man they were interviewing pulled out his appointment book. He said, "Yes, there was this Canadian air steward, and he was here just on Thanksgiving--oh, wait a minute, I think I have his name in my book." And he pulled out the name. "Gaetan Dugas, that's his name."

Now, Dave Auerbach and Bill Darrow had heard the name Gaetan Dugas a long time ago from Linda Laubenstein in New York. She was a cancer specialist there and Dugas saw her for a small purple KS lesion then. Doctors will mention patients' names to each other when they won't use the names in public. It was an unusual name, and they both remembered it. Dave and Bill went back and found that the other two who had mentioned the Canadian steward said, "Oh, yes, that's probably his name." After that, by talking to people who had slept with Gaetan Dugas, or who had slept with somebody who had slept with Gaetan Dugas, they were able to put together what they called their cluster study. I think Gaetan had direct sexual contact with about forty out of two hundred and something, and the others had had contact--second and third degree contact--with him.

So he was the first one for whom they were able to say, "Well, this man we know had AIDS. And these people slept with him"--or whatever they did with him--"and they also have AIDS." They were able to put together a connection. This looked now very, very suspiciously like something being transmitted from Gaetan Dugas to others.

Hughes- When did this happen?

Dritz- It would have been in '82.

Hughes- Before Art Ammann's baby?

Dritz- Yes, that was before, because Art Ammann's baby then was the next nail in the coffin. (I shouldn't talk that way!)

Hughes- Please finish with Dugas, because you had some more dealings with him before he died.

Dritz- Bill Darrow and Dave Auerbach came back up to my office from southern California to talk to me, because I had a whole list of contacts listed on my blackboard there. You've seen pictures of that. Bill came in and he said, "Well, I've got a name now and a contact. Do you know any of these?" And he gave me Gaetan Dugas' name, and I had that name already. I showed him Gaetan Dugas had contact with Michael Maletta, a hairdresser from New York, and there was Dan Turk, who had a clothing store on Polk Street, and one or two other names. I would have to look back at the slides now to be sure. We're talking about almost ten years ago now. And they're dead now.

I knew that Gaetan Dugas was still in town. I couldn't get to him, but I put word out, "If you see Gaetan Dugas, let him know I want to see him." He came up. I told him, "Look, we've got proof now." I didn't tell him how scientifically accurate the information was. It wasn't inaccurate, but it wasn't actually scientifically proven. I said, "We've got proof that you've been infecting these other people. You've got AIDS, you know. We know it's transmissible now, because you're transmitting it." He was the active partner in all this gay business, anal-genital sex. "You've just got to cut it out."

"Don't be silly, I won't cut it out. It's my life. I'll do what I want." I said, "Yes, but you're infecting other people." "I got it. Let them get it." I said, "You've got to cut it out!" "Screw you." He walked out. I never saw him again. It was a pity, because he was apparently an intelligent man, except on this one point. And he was very, very sexually active. He was a presumptive proof that AIDS was something transmissible from an infected person directly to the uninfected person.

Hughes- You mentioned your diagrams of transmission. Was he the first that reinforced the idea of a transmissible agent?

Dritz- I had a lot [of indication] that it looked like AIDS could be transmissible. There was all this contact among these men, and they all had the disease, one kind or another. On the other hand, all of these men were having other contacts, too, and we didn't know then that the incubation period was a long number of years in some cases.

Hughes- Right. And they were maybe using the same poppers or—

Dritz- Whatever, yes. And we didn't have the answer on the poppers yet, because CDC was still waiting for money for a statistician to run the computer analysis on the questionnaire. So the problem then was to test the rest of our theories about transmission, and that didn't happen until the end of '82.

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ND: More from Dr. Selma Dritz................

Hyperlink, text: Taking a few steps back, url: http://content.cdlib.org/view?docId...25&toc.depth=1&toc.id=d0e801&brand=calisphere OR https://archive.ph/WLFVU

Hughes- I know the surface and core antibody tests are different, but aren't they testing for the same problem?

Dritz- No, because the surface antibody may disappear. The core antibody doesn't. Now, if the surface antigen has disappeared, you test for that, and the blood seems all right. The core antibody is still there and can be infectious. And we didn't have a test for that until just about that time [early 1983]. The test for hepatitis C has just become available. Until recently, we couldn't test for it. And so we still had transfusion-mediated hepatitis being reported into the city. Although we tested for A and we tested for B, this was hepatitis C, formerly called non-A, non-B, for obvious reason. Now we can test for that, too, so there won't be any more transfusion-mediated hepatitis due to the C agent. There may be a D; we don't know yet.

The New York and the San Francisco blood banks decided they would try to see whether there was a difference in the hepatitis B core antibody in gay versus heterosexual or in high-risk versus apparently low-risk populations. Of course, the apparently low-risk gay population were already heavily infected, too. Not every one, but the numbers were going up, and we didn't--couldn't--know it.

>ND’s bolding< In '78, there were already 4 percent infected. When we went back retroactively and tested the bloods of the hepatitis B vaccine trials, 4 percent of them were already HIV positive. We didn't even know there was such a thing as AIDS then. By '84, 60 percent to 70 percent of a gay population was infected. Now, the general population of males in the city, by the time I retired [1984], was less than 1 percent infected. But among the gays, it was about 3 percent with AIDS. I retired in '84; the test wasn't licensed until March of '85. After they were tested, they found maybe 3 percent of them were sick with AIDS, or presumptively getting the symptoms, but over 60 percent of them were incubating it.

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ND: >Indicated as in response to Grimsrud, but Grimsrud only comments in this thread after this post. Possibly meant as a way to share this thread between users.<
Please note the argument revolving around 'individual rights' and what damage resulted from it.

Hyperlink, text: Dr. Selma Dritz on the Bathhouses:, url: https://oac.cdlib.org/view?docId=kt...3&toc.depth=1&toc.id=d0e1963&brand=calisphere OR https://archive.ph/WeSwL

The Bathhouses

Dritz- Well, number one was the baths, because we knew that was the main source of AIDS transmission. A gay man could pick up one or two partners in a bar, and they'd go off someplace to have their fun. There were back rooms in the bars, in the baths, too. They were called orgy rooms, where ten, fifteen, twenty, thirty, forty men were dancing around with almost no light, and of course, anything happened there. That explained to us why a gay man would say, "I don't know who I got it from. I never saw his face." That sort of thing.

The bars were not the best places to be, but at least, they would limit the amount of contact a man could have. In a bookshop, in a small sex club, out in the park--these places limited the contact. But in the baths... At a four-story bathhouse, Club Baths south of Market I think it was, 350 men would gather on a Saturday night at $10 a crack, and they got their $10 worth. And more. Including drugs in addition to poppers.

Would you permit a child with measles to go to school with a classroom of thirty other children? No! It's a transmissible disease. You exclude him, and if the whole room has been exposed, then you close that classroom--you discontinue that class and send the kids home. There was quarantine for these diseases at one time. In Africa, if one or two patients came up with smallpox, you isolated the village, and you vaccinated everybody. So after the smallpox was finished with that patient or those two patients, it had no place else to go.

We didn't have a vaccine for AIDS. We had the disease spreading wildly. We knew that the numbers were going up geometrically in those first two years. The numbers of new cases were doubling every six months. It was terrible.

Hughes- But times had changed. Society was putting much more emphasis on individual rights, particularly for minorities such as the gay population. It was no longer as acceptable for a government agency to do what some factions regarded as removing individual rights.

Dritz- That's right. It was not only civil rights and individual rights, but the federal government was also saying, "We have too much government now. Let's concentrate on the threat from the Evil Empire overseas." This epidemic was going to wipe us out, and they didn't even care about it.

Any physician who has any sympathy or sense of responsibility toward his patients, to the population, toward his own family, would say, "You don't waste money up in the sky on nuclear weapons against a theoretical threat, when you have the threat right here, right now, killing you, just as deadly as a bomb." Central Africa now we know is going to be wiped out by AIDS just as if they threw a couple of atom bombs in there.

The emphasis was not so much on civil rights as on fear in the gay community that if they were "outed," made known that they were gay, that they would lose jobs, friends, a place to sleep, insurance. All of these things made them resist closing the baths, because their incognito activities in a closed environment in the baths kept them from being known on the outside. >ND’s bolding< Now, there were gay men who were aggressively out, the S& M, sadomasochist, men, the leather boys we called them, who walked up and down Market Street dressed in leathers with leather caps like the old Nazi men, and chains, and leather boots. But they were the ones that died fastest, because generally speaking, they used the most traumatic anal-rectal techniques, and got infected. They had been infected with many other sexually transmitted diseases before then, so they were in no shape even to postpone the activation of the AIDS virus after it hit them.

I can talk about the meeting we had when Dr. Silverman was about to announce that he was going to close the baths, then he didn't, because the mayor and he couldn't get together on it. I wasn't in on that session between the two of them, though, so I can't give you all the details.

Many members from the gay community were at that meeting. Bobbi Campbell, who was already infected with AIDS, was standing at the back. I remember at least three members of the gay community, nude, just with towels around them, holding signs that said, "Today the baths; tomorrow the ovens." They meant that, if we let you close the baths on us, next thing you'll quarantine us, then we'll be in jail, then you'll destroy us, like a Hitler. It was very, very extreme.

Now, through Rick Andrews and Bob Bolan, we could perhaps get through to some of the other members of the medical community dealing with AIDS patients, so that they could all put out the message in comparable terms to their different patients, "Don't do this risky sex practice." But of course, if the men were patients, they were already sick.

Hughes- It was too late.

Dritz- We had to reach those that weren't infected yet. We didn't know that by '83, or even late '82, we already had about 10, 12 percent of the gay community infected. We didn't find that out until we ran the hepatitis B follow-up study later, with Winkelstein's report.

So we were working partly in the dark. We were shedding as much light as we could on the people we were trying to reach. Marc Conant was backing us on trying to close the baths, because he saw from his own patients at UCSF and what he heard from the gay community that too many things were going on that simply would spread the thing beyond anything that we'd ever seen. Well, the Black Death, the plague in the Middle Ages, wiped out one-third of European population over a period of a couple of years. This epidemic eventually is going to wipe out that much of the general as well as gay population unless we can get a vaccine for it and medical treatment.

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Grimsrud: >Responding to ND’s mention< Hilarious to look back on these predictions of an AIDS epidemic amongst normal people. I wonder how many of the doctors and activists waving their arms around about this actually believed it to be a likely scenario.

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ND: Hyperlink, text: Dr. Selma Dritz on dealing with Gay Politics:, url: https://oac.cdlib.org/view?docId=kt...42&toc.depth=1&toc.id=d0e801&brand=calisphere OR

https://archive.ph/yNAtk

Gay Issues

Hughes- Did the issue hang upon homophobia?

Dritz- To a very great degree, yes--homophobia and a fear of death. A woman was afraid that the man next door who gave her dog the bone from his steak might have given her dog AIDS because he was gay, she thought. Because if the dog got AIDS, [she thought] the dog could give it to her. That isn't only homophobia; that is fear of death. I'm not laughing at these people. They didn't know whether the disease was transmissible or not, or how you got it. We were pretty sure we knew how, but then we were doctors; we were trained for it. And trying to put it out into the press, into the media, over the radio as we did, it still didn't register.

We hear some politician during the election campaign, and we tell ourselves, "Oh, that's just politics. I don't believe it." And that's how some of the people in the city here, the heterosexual community, felt about the AIDS epidemic. Remember, there were so many gays in the city, they were so visible, and some of the men were so outrageously gay--the gay parade, for instance, with its transvestites and so on--that it turned off an awful lot of the heterosexual community that wouldn't have been too bothered by the presence of gays if there hadn't been so many and they hadn't been so aggressively "out."

Yet, the gays were being aggressive because they felt so threatened, by the disease and by the increased homophobia which was a result of the disease. The publicity about it just stirred everything up impossibly. City Hall was right in the center of it, and City Hall depended on votes. Of the little over 300,000 voters in the city, about 120,000--100,000 let us say--were gay voters. The other 200,000 were splintered among the different communities--the Asians, the blacks, the East Asians, the Hispanics, the Italians, all the other ethnic groups--the city is a conglomeration of villages. Now, they wouldn't all vote as a bloc, so the 200,000 votes were scattered. On anything that threatened the gay lifestyle, 100,000 would vote as a bloc, so City Hall had to be very, very careful. When some of the more vocal parts of the gay community were saying all the time, "Civil rights, civil rights, confidentiality," City Hall had to listen. And that hampered us at the health department.

Harry Britt, the gay supervisor, was very, very cooperative with us. He tried to help. He interpreted for us what the feeling of the gay community was. Yet he himself was only one of one group. The gays were splintered in other ways. Some of them were very vocal. Some of them were very quiet. There was a whole group of closeted gays, the upper-class gays, that we didn't hear from too much. There was the Alice B. Toklas Club; there was the Stonewall Club; there was the Harvey Milk Club; there were some of the unincorporated groups; there were the S&amp;Ms (sadomasochists); there were the Gay Bath Owners Association of Northern California; there was the Tavern Guild, which was an association of gay bar owners and managers. All of these groups had their own agendas, and some of them could get together and some couldn't.

>ND’s bolding< Unfortunately for us, like the Moral Majority, there were fundamentalist-type gays in the gay community, too, who were very vocal, very reactionary, very entrenched for their own benefit.</b> You couldn't blame them for this, but it didn't help anybody. So it was a mess.

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ND: Some quackery which is bound to happen any time an epidemic breaks out.

Stuart Anderson and Vitamin C

Dritz- Did I tell you about Stuart Anderson and the vitamin C problem?

Hughes- Why don't you mention it now?

Dritz- In the gay community, there were some people--I don't think they were organized in a group--who simply felt that the medical community was so homophobic that we were just pretending to treat them but were actually letting them die because we didn't want any gays to survive. One policeman who came into my office said, "Oh, hell, they're a big problem. I think we ought to take a flame thrower and just clean out the Castro (gay center in San Francisco)." A policeman in uniform! On the other hand, there were other policemen who would give mouth-to-mouth resuscitation without thinking twice, because that was their job.

Anyhow, some of the gays felt that the doctors, the health department, the community didn't want to do anything except kill the gays. As a matter of fact, some of them claimed we had introduced AIDS in order to wipe them out. I don't know how we would have done it; we didn't know what the cause was yet.

Linus Pauling announced that 30,000 units of vitamin C every day would keep you alive-prevent you from catching colds or anything else. I don't know if he said it treats cancer, but it was just about that. He's a very, very famous, very, very marvelous mind, but I think he went off the deep end on that.

Stuart Anderson, an aggressive gay, then came in to my office and said, "We're going to use vitamin C." He was walking up and down Castro Street telling the gays, "Don't go back to those doctors. They're trying to kill you. They only want to kill you. You've got to have vitamin C." He was using 30,000 units. He got quite a number of the gays to leave their doctors and go on vitamin C. Of course, they died--a pity--and he died a year later, too.

But there was that kind of resistance, which was a corollary of the confidentiality resistance, so in several different ways, we were hampered in trying to get complete cooperation in the gay community. A lot of them believed us, did what we thought would help them, and cooperated in bringing us information. Without their cooperation, we would have been blind to developments.

But at the same time, there were aspects that hampered us and maybe helped to contribute to the spread of the disease. I know the baths did. End Forum Page One

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Slappy McGherkin said:

Having watched someone die of AIDS in the 80's, I find this very interesting, although I knew about Dugas and read The Band Played On years ago. Back then, AIDS was a literal death sentence. It changed the "gay party life" completely. Contrast that to today and they advertise all the AIDS drugs on TV and how they help you stay "undetectable." Still wouldn't wish it on my worst enemy, but a lot of progress has been made and you don't hear about it being a death sentence anymore. How many years has Magic Johnson had AIDS? Over 30 years now, since the 91/92 season of basketball when he discovered he was poz during his physical.

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L50LasPak said:

This is thread is interesting, but I recommend you split up each forum post by surrounding it with a simple quote box.

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ND: Hyperlink, text: More from Dr. Selma Dritz on the bath houses and the battle to close them:, url: https://oac.cdlib.org/view?docId=kt...7&toc.depth=1&toc.id=d0e3127&brand=calisphere OR https://archive.ph/G8JbM

Hughes- We've talked tangentially about the bathhouse issue, but I thought it would be well to go through it sequentially. As I understand it, the issue began to simmer early in 1983. Is that your perception?

Dritz- Well, the battle to close the bathhouses began to simmer then, but we were aware of the problem and trying to do something at least sub rosa to diminish it long before that in fighting the STD diarrheal diseases there. In '82, we were aware of Gaetan Dugas and the connections between him and so many people that he met here in San Francisco at the baths, and his open announcement that, "Well, I'm off to the baths tonight, and there's nothing you can do about it." He came to my office and said, "It's my right to go where I want to

We were becoming reasonably sure that this was a disease caused by a transmissible agent. It seemed to be concentrated in gay men who were very sexually active. (I'm leaving out the question of the hemophiliacs.) The place where they could be most sexually active, most traumatically active, was in the baths.

We felt that, as with any transmissible disease, you try to diminish the numbers of contacts between the infected person and uninfected people. That was why we had quarantine for smallpox and chicken pox and scarlet fever, for instance. We couldn't quarantine the men here, because we couldn't prove that this really was an infectious disease, and even if we knew it was an infectious disease, we didn't know what was the infecting agent yet.

We became very unhappy about the baths. The bars had activity rooms in the back, the bookstores had activity rooms in the back, but the baths were the ones that were the most openly irritating to any epidemiologist, any physician.

Meeting with the Bathhouse Owners, 1982

Dritz- Some time in mid-'82, late '82, Dr. Silverman finally called a meeting of all the bath owners in San Francisco. I think he even had the manager of the Water Garden, down in San Jose, which I was told concentrated on urine transmission. But that was not in my San Francisco County jurisdiction. Glory holes were another inventive variation.

The Club Baths, the back room of the Mine Shaft, which was on Market around 15th Street--that one's gone, fortunately--the Ambush and the Jaguar bookshops: these were all places for rapid transmission, effective transmission, among many people. The more contacts a man had, the more opportunities he had to be infected, the more the odds were that one of his contacts would infect him.

Well, Silverman met with the bath owners--fifteen or twenty men. I was there. It was a hot meeting. Silverman tried to be politic, calm. He was a very, very good administrator and a good public health man. But these people came primed for battle. He tried to explain the difficulties and that if they could at least tone down the opportunities for infection, raise the level of lighting in the "orgy room" where 100 men could have indiscriminate contact without even knowing who they were being in contact with, if they could take the doors off the cubicles, cut down the privacy a little tiny bit-- They wouldn't have it. There was table-banging, there was anger, and the spokesman for the group said that they were organizing the Northern California Bath Owners Association, that would include, I think, Marin County, although there wasn't anything much there that we knew of. There were some active bars in the East Bay, dealing mostly with sailors and staff from the naval air station there. And there were all the baths here. They were really centralized here in San Francisco. The major gay population was here in San Francisco.

Relying on the Gay Community for Information

Dritz- A few days, perhaps a week, after that, I had word that Gaetan Dugas was active. I have to point out here: if we hadn't had rapport with the men of the gay community, not only their political groups but the men themselves, we would have been blind, because they brought us information. We got word that, "Gaetan Dugas is out again, and he's being extremely active." There was a little risk in this news, too, because we couldn't always be sure that the information that was coming to us was really true.

More than once, my chief would point out, "Well, yes, maybe he's fingerpointing that man, and that man is really doing things he shouldn't do. But maybe also he's not only doing them, but this guy is fingerpointing at him because they were lovers and they had a fight and he wants to get him in trouble." There were informal members of what they call the Street Ministry, one or two or perhaps three men who wore clerical garb and a cross. They were gay men who said they were trying to bring God to the men in the community. We got a call from one who said, "Father John said this man's doing something terrible. You ought to really take him in and just lock him up." We got in touch with that man and he said, "Oh, we're lovers. We had a fight.

So there were different things that we had to be aware of here, aside from the fact that we were trying to do epidemiology and trace down a serious disease. That could have skewed our ability to get a real answer to the question, just as our case-control studies were skewed--we didn't know it--because we thought we had matched gay controls who were not ill. We didn't know that maybe 10 percent of them were already infected and coming down with AIDS. So everything we were getting was Alice in Wonderland with a warped mirror. However, we did make a little progress.

Threat of a Temporary Restraining Order

Dritz- Then, a few days after I had word about Gaetan Dugas' actions in the baths, I began to talk to some of the doctors in the community. Did they know anybody that we could contact in connection with the baths that wouldn't be so aggressive, abrasive actually? One of the baths owners--of the Cauldron, I think--came up to my office. He banged on the desk and said, "<i style="text-align:left;">You can't close us up. " I said, "I'm not thinking of closing you up. I'm trying to figure out how to keep people from getting sick at your place, if they do go.

He said, "We're a business, we've got a license, and you can't close us up. If you close us up, the next morning I'll have a TRO [temporary restraining order]." I had already called the city attorney's office [November 1983] to ask about our chances to close the baths and have them stay closed, and they said, "You have to be able to prove it." I talked to them again, "He's threatening to TRO." Ed Bacigalupi, who was the attorney for the health department in the city attorney's office, said, "You'll have to be able to prove to the judge that that is a definite health hazard, but the information you have is only anecdotal. You can only tell the judge that some men go to the baths, and a lot of men are active, and a lot of people have the disease. That wouldn't be sufficient information to close up a licensed business.

Hughes- But that's what you wanted to do?

Dritz- We wanted to close them, yes. That was one place where there was the most open and the most frequent, the most voluminous, contact. And contact for an infectious disease is the sine qua non for transmission.

Well, it went on for more than a year. Silverman talked about it, and then there would be a meeting, and then of course the meeting was postponed until next month, and then somebody couldn't come to the meeting, so it was postponed for another couple of weeks. Then they couldn't come to a conclusion, so they decided to organize a subcommittee to look into this in more detail--you know how organizations go. It dragged on and on.

Open Hearing at the Health Department, March 30, 1984

Dritz- Eventually, Silverman decided that he really had to close the baths; expecting the gays to stop patronizing them didn't work. So we put out word that he would have an open hearing when he would announce what he was going to do about the baths. That was the time when everybody met in Room 300 at the health department at 101 Grove, including three nude gay men, wrapped only in towels around their middles, carrying a sign that said, "Today the baths, tomorrow the ovens.”

They screamed about their civil rights--which was a justifiable fear for them, but it didn't balance the risk to other members of the population. I went into the meeting too, waiting to hear this announcement.

In the meantime I had had a couple of calls from different men in the gay community. They knew that the meeting was scheduled for this particular day. They said, "Some of the guys are saying they're going to kill him"--Silverman. I had to warn him. I called his office. I said, "Now, this is what I'm hearing. It's probably not so, but I would be remiss in any kind of duty I owe to the department or to you if I didn't tell you about it."

So we waited for about an hour at that meeting in Room 300, and it got more and more restless. The press was there, members of the health community were there, members of the gay community and politicians were there. Finally, after an hour, Silverman walked in--through the back door, all the way to the front, to the podium. This was a big auditorium. He was bracketed by security men. I was glad to see that, because the meeting was very scary.

He got up on the platform, and we realized that he had been talking in his private office right next to Room 300. There were representatives of City Hall there, too. I think [Supervisor] Harry Britt was there. Apparently, an hour's talk hadn't brought any results, because when he got up on the platform, he said, "I'm sorry to tell you, but I will not make an announcement about the baths today. I'm putting this off for a week." And that was it.

Hughes- What had happened?

Dritz- Well, the big fist from City Hall had come down. They wanted the baths closed, but they wanted Silverman to make the announcement so that City Hall, the mayor's office, would not be politically responsible. On the other hand, Silverman just hadn't felt earlier that it would work that way. He had very strongly felt that to close the baths would simply disseminate the problem, that the men would find some other places to go, although the baths were the most effective place to get the most number of contacts in the shortest number of minutes. Minutes, actually.

I didn't get to ask him too much in detail. It was a very tricky question. We were all very busy with other things. So all his intimate thinking about it wasn't evident. But what he had said to us--earlier in the advisory committee, in the office--was, "The gays have got to want to stop this themselves. If we stop it, they'll just find some other place to go. We've got to convince them that it's their responsibility; they've got to stop this. If it isn't on their own initiative, on their own desire, it won't work." But they didn't stop.

Bathhouse Closure, October 9, 1984

Dritz- Larry Littlejohn was an activist there. I didn't like what he was doing; I didn't like what he said, but that's aside from the point. He was pushing hard to close the baths, probably for political reasons, because, as I told you, the gay community was splintered on the issue of bathhouse closure.

The responsible ones--those who I think were the responsible ones--wanted to close the baths. The very aggressive ones wanted to have nothing interfere with their utter freedom to do anything they wanted in their own way, and their own way was to reassert their freedom to be actively, openly gay, any time and any way they wanted to. And that was their right, as long as it didn't kill other people.

Littlejohn made an announcement to the press that if the baths weren't ordered closed by a given day, he was going to arrange for an initiative to be put on the ballot to close the baths. Then we would see exactly who wanted what. Well, that seemed to be the final blow, because if it became an initiative, and the majority of the people voted to close the baths, that would be a black eye for the health department for having delayed closure. It would be a black eye for City Hall, too, because the people would have had to say they wanted the baths closed. On the other hand, if the voters voted to keep them open, then our hands would be completely tied.

Hughes- So there was no way of winning, was there?

Dritz- That's right. It was a no-win situation. So Silverman ordered the baths closed.

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ND: Hyperlink, text: Interesting factoid I just stumbled across, url:

https://nymag.com/news/features/45785/index2.html OR https://archive.ph/KaPF9

While there, the young doctor published studies in prestigious medical journals, mainly focusing on AIDS among marginalized New Yorkers. He conducted the nation’s first HIV-prevalence survey among homeless men, for instance, revealing the startling fact that 62 percent carried the virus—an early indicator that AIDS had jumped the boundaries of the gay community. Partly on the basis of that study, which made headlines in the New York Times in 1989, he was offered the top AIDS job at St. Vincent’s in 1990.

ND: Hyperlink, text: Dr. Mervyn F. Silverman on Gays and the Bathhouses in San Francisco:, url: https://oac.cdlib.org/view?docId=kt...4&toc.depth=1&toc.id=d0e4114&brand=calisphere OR https://archive.ph/gvk1E

Silverman- I was trying to get the gay community to take action, to force the bathhouses to stop allowing unsafe sex to take place in their establishments or close down. The reason why I thought this was possible was because a number of years ago, some gay bars had only one exit. They were obviously a real fire hazard. So people within the gay community tried to get these gay bar owners to put other exits in, and some wouldn't do it. So they picketed them. They actually brought a fire door, got outside of the gay bars, and picketed. And [snaps fingers] almost overnight that was changed. So taking a similar action with the bathhouses was something they could do--if they wanted to.

My feeling was because I was trying to reach the whole community, the action had to go beyond the physical closure of the bathhouses; there had to be an educational impact. The way to get an educational impact would be to have the gay community do it, not the straight community, not the government.

I kept working with the gay community up to July of '84. The reason why that July of '84 is so important is we had the Democratic National Convention here. There was a party that was given by the Gay and Lesbian Caucus, to which I was invited, and I tried there for the final time with a certain number of leaders in the gay community to get them to take an action against the bathhouses. Especially since there were people in the gay community who made it very clear that they didn't like the bathhouses; they thought they should be closed. But if I closed them, they'd man the barricades in defiance of my actions.

And why would they man the barricades? The pervasive argument that turned around even the strongest gay backers I had for closing the bathhouses was, if government closes the bathhouses in San Francisco, which is seen as this bastion of gay liberation, what message does that send to less liberal states and communities? And then the next step is, well, obviously people get picked up in gay bars, so you close the gay bars. And then the sodomy laws would either be enforced or reinstated, depending on what the status was in any given state.

I remember having one very important person in the gay community who had been supporting me for bathhouse closure, who had been active in politics and still is, call me up and say, "Merv, I can't support you any more." I said, "Why?" And he gave me the above argument. That argument was pervasive, and was a very strong argument. The deal was, if the bathhouses closed down because they didn't have any business, or they closed down because we [the gay community] closed them down, that would be one thing. But if you, government, close them down, we just can't have that. Not after all the gains we've made in gay liberation.

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ND: Hyperlink, text: Dr. Donald L. Abrams (who himself is homosexual):, url: https://oac.cdlib.org/view?docId=kt...09&toc.depth=1&toc.id=d0e609&brand=calisphere OR https://archive.ph/A3Qba

Lymphadenopathy

Abrams- In 1979 when I was a junior resident we started seeing a number of gay men who were referred to Dr. Wilkinson's hematology clinic because they had swollen glands. Nobody knew why their glands were swollen. They were being sent to make sure that they didn't have lymphoma or Hodgkin's disease. After I would do all the blood work that you normally do to determine why somebody has swollen glands, we sent a number of these men off to the surgeons for biopsies.

And one after another, their biopsies came back with the same picture under the microscope of very hyperactive glands, of lymphoid hyperplasia, particularly in the B cell area of the lymph node. That's a very nonspecific finding. Most of these patients were sexually active gay men with numerous sexually transmitted diseases and were using a number of the drugs that were popular in the community at that time. So we said, "Listen, we don't know why your glands are swollen, but you're living in the fast lane. Maybe you should slow down and not have so many partners, not get so many sexually transmitted diseases, give your immune system a break and don't use so many recreational drugs, and maybe your lymph nodes will go away.

We biopsied four or five of them. Then we started to see the pattern emerge and decided when we saw new patients with this syndrome that, well, we didn't really need to do a biopsy; they had this "gay lymph node syndrome," which is what it came to be called, after the "gay bowel syndrome" which had emerged in the mid-seventies.

Hughes- When did the term gay lymph node syndrome come into currency?

Abrams- I'm not sure if we actually started using it then or later, probably in '81. We didn't really know what to call this syndrome in 1979. We just saw these cases--<br style="text-align:left;">

Hughes- But you were seeing a pattern.

Abrams- Yes. Kaiser being a place where cost effectiveness is the key, after we saw a number of these guys, then we saw the pattern and we didn't send them all for lymph node biopsies because that's expensive. We knew that chances are that they were just going to have this nonspecific benign reactive pattern.

What we didn't do, which is also unfortunately something that Kaiser is known for, is write up a description of this syndrome for the medical literature. Had we done that in 1979, that would have been throwing up a red flag that something was going on.

Hughes- Did you suspect some immune deficiency at that point?

Abrams- Lymph node enlargement implies that the immune system is hyperactive, and what we saw under the microscope was hyperactivity. So really we were thinking that their immune systems were overstimulated as opposed to deficient. In fact, that's what they were. These were the very earliest stages of HIV infection as we know it today.

Hughes- And it sounds as though you were operating under what later became known as the immune overload theory of AIDS causation.

Abrams- This was two years before we saw AIDS.

Hughes- Were you speculating immune overload?

Abrams- Yes, that these patients were having too many sexual partners. If they were taking in semen from each different person, then that was foreign proteins that their body was responding to. They had histories of gonorrhea, hepatitis, herpes, everything else, so that was a stimulation [to the immune system], and then they were using all these drugs. So that's what I mean: we told these patients to move out of the fast lane and see if their lymph nodes went away.

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Stubby: >quoting ND’s “Interesting Factoid” comment<

maybe the boundaries weren't really jumped at all

Hyperlink, text: San Francisco Gay Homeless Population: 29 Percent Of City's Homeless Are LGBTQ , url: https://www.huffpost.com/entry/san-francisco-gay-homeless_n_3491990 OR https://archive.ph/mxc2W

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ND: More from Dr. Abrams:

First Patient with AIDS

Abrams- I remember in May or June of 1980, my resident on the hematology consult service was a fellow named David Longworth, who's now at the Cleveland Clinic doing infectious disease. I was his fellow and he said, "They've asked us to see this guy with Pneumocystis pneumonia." I said, "Well, does he have leukemia or lymphoma?" He said, "No." So I said, "Well, why are they asking for a consult from hematology?" He said, "Well, just to see what we think he has." I said, "Well, they need to figure it out. If he doesn't have a hematologic malignancy or cancer, then what's the point in getting a hematology or oncology consult?" So he said, "Well, just because it's pretty interesting. It's a young guy who's otherwise healthy." Behaving as a typical fellow at the end of my first year of training, I said, "Why do we need to do this consult?"

But finally we saw the guy who was a youngish gay man and I started talking to him about habits. I said, "Well, do you use poppers?" I'm not sure that my residents or medical students really knew what poppers were or what I was talking about, but these are inhaled nitrites. The guy said, "Yeah." And I said, "Well, how often do you use them?" He said, "Well, every day." I said, "How much do you use?" I forget what quantity he said. I always was concerned about people that inhaled these substances, because I think that they're quite noxious.

When we walked out of the room, I said, "Well, clearly the guy has poisoned all of his alveolar macrophages," the cells in his lung that provide him with some immunity, "and that's why he has Pneumocystis pneumonia." I was very, I know everything, I'm just finishing my first year of my fellowship and I'm pretty glib about it.

And that was my first patient with AIDS. I didn't even realize it. I was even somewhat perturbed to have been asked to consult on the patient. I really missed the impact of the whole thing. To this day, Dr. Longworth reminds me of that.

Because AIDS came about as I was emerging into my professional career, and I didn't have a lot of experience, I missed the impact of some of the firsts that I actually saw, because I didn't realize that these things were unique, because I hadn't been practicing medicine for that long. So that was a disadvantage of my youth at the time.

Hughes- To a seasoned person, Pneumocystis in a young, otherwise healthy person would have stood out?

Abrams- Oh, yes. That's how we first became aware of AIDS, because in June of that same year the five cases from Los Angeles were published in the Morbidity and Mortality Weekly Report. Michael Gottlieb, though, wasn't all that seasoned either; he wasn't that much more advanced in his training than I was.

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ND: Dr. Abrams on a couple of the early patients:

Simón Guzman

Abrams- Simón Guzman, who was another one of my early patients who is mentioned in Randy's book, was a Latino, and much different from me in background. He had a very severe case of Kaposi's sarcoma, unlike Bobbi Campbell. Simón was very disfigured. In fact, I see Simón every time I give a talk on KS. For me, one of the hard things is that the slides that I use for educating are generally of clinical material from my first patients.

Simón had the terrible swelling of his face, the edema that patients with Kaposi's sarcoma get. Whenever I show a slide of bad Kaposi's sarcoma lesions, it's Simón's face on the screen. So it's interesting for me that although he died over ten years ago, he's still there for me and I see him quite frequently.

Here was a man who was in the Latino community, whose family I think didn't know or didn't accept that he was even gay, who had this horrible disfiguring disease with these lesions all over his face, and then his face blew up like a balloon. It was at a time, I think, when the movie The Elephant Man was released, and there were a lot of similarities there, because he was so disfigured.

The thing I remember most about Simón was this diarrhea that he developed where he just produced volumes and volumes of diarrhea to the point where every time he came to see me in clinic on a weekly basis, he was always dehydrated. Finally we sent his stools off [to diagnostic laboratories] all around, and got back the report that was confirmed by the AFIP, which is the Armed Forces Institute of Pathology, and they said that he had cryptosporidium in his stool.

Again, as we discussed before, being young and naive and not having practiced a lot of medicine, I said, "Oh, well." So I read about it, and it was a veterinary pathogen that caused diarrhea in barnyard animals, particularly calves and young chickens. There were some reported cases in humans, but the literature was scant.

Anyway, it turned out that this case really was very historic and significant. I don't think it was the first reported case of cryptosporidium in a human, but it was the first case in a person with AIDS, and the CDC jumped on this and ran away with it, and reported it in the MMWR It was my patient, and I didn't get any acknowledgement on that one either. So it colored me early in my attitudes towards the CDC, that they seemed to run with my information and not give me any credit for it. It turned me off a little towards cooperating or collaborating with the CDC.



Mark Feldman

Abrams- There were lots of other patients early on that I really bonded to. I remember Mark Feldman particularly, who may also have been mentioned in Randy's book. He was an articulate, intelligent Jewish man, who was my first Jewish patient with the disease. He was my age, so I really related to him very strongly, because of our very similar backgrounds. I was seeing him at about the time the decision was made that the patients with KS should be sent over to San Francisco General and that I shouldn't be seeing them at UC. I think Mark was particularly interested in participating in Paul's first interferon trials, so he left UC and went over to San Francisco General, and I lost contact with him. But he made an impression on me. Before he left, he handed me two porno magazines for my examining room to help future patients collect their semen specimens for CMV testing.

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ND: Hyperlink, text: Dr. Marcus A. Conant on the pre-AIDS days and the early days of the disease:, url: https://oac.cdlib.org/view?docId=kt...0&toc.depth=1&toc.id=d0e3460&brand=calisphere OR https://archive.ph/VRxsQ

In my volunteer time at the Haight-Ashbury Clinic, I had started seeing patients with genital herpes. In those days, genital herpes was a disease that had been described, but was diminishingly rare. Less than 5 percent of sexually active adults in San Francisco had genital herpes in the mid-sixties. Today, that number is probably closer to 60 percent. So there was this epidemic of genital herpes that I saw in its infancy. Then for the next twenty years, a lot of my own academic endeavors went to trying to understand, treat, and popularize treatments for genital herpes.

Denial in the gay community:

When we started what we called the Kaposi's Sarcoma [Researh and Education] Foundation, AIDS had not been named AIDS. We started the foundation in the spring of '82, and AIDS did not receive that name for another couple of months. When we started that foundation, one of the people that we asked to be on the board was Bob Ross. Bob is a fine man who is very active in the gay community and is the editor of the BAR [Bay Area Reporter]. The BAR is one of the big gay newspapers. We put him on the board expressly to try to educate him about the epidemic so that he would use the resources of his paper to educate the gay community.

It didn't happen. Mr. Ross, like many others in the community, for a prolonged period of time--this is really not criticism; this is documentation of what was going on--did not want to believe that this epidemic would not go away, that people had to change their behavior.

can remember on one occasion Bob Ross saying something to the effect that, "Well, it's not the people that just go to the bathhouses that get AIDS. It's the ones that don't shower after sex." And I said, "No, no, Bob, that's not right." And he said, "Oh, yes, that's right. I've heard that." You know, classic denial, classic rationalization, an attempt to find some easy talisman that's just going to make it all go away.

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ND: Conant on his first encounter with the disease:

Now, my first recollection of AIDS is the first of April of 1981. I learned through Jim Groundwater, who was a dermatologist here in town, that Alvin Friedman-Kien, who was a man I had known for years, was seeing cases in New York, and that these people had Kaposi's sarcoma, which was a dermatological condition. It was interesting on a number of levels. Al and I had been personal friends for fifteen or twenty years then. We both had worked on herpes, so our interests in dermatology were parallel in many ways. Al is much more a laboratory researcher than I am; I do more clinical work. He has done some very good laboratory work

So I called him, and he told me that yes, they were seeing Kaposi's sarcoma, and that it was very interesting. It was in men who were very aggressive sexually and into anal-insertive fisting, which I wouldn't describe as mutilating, but certainly is a bizarre practice. Someone usually uses some drugs like amyl nitrite, gets high, and then one partner inserts his hand into the rectum of the other partner.

The interesting thing, which has never been explained, was that it was the insertive partner, not the receptive partner, who came down with Kaposi's sarcoma. I don't know how that's explained, unless it has to do with aggressiveness--people who are physically aggressive are often socially aggressive and maybe have more partners.

It was interesting to both of us also that the only explanation of Kaposi's sarcoma that had ever been given was that it was in some way associated with cytomegalovirus [CMV] in Africa. And cytomegalovirus is a herpes virus. So you can see the connection: we were both working on herpes, and here was this first-cousin herpes virus that [Gaetano] Giraldo had implicated as the cause of Kaposi's sarcoma in Africa, which had been seen in Africa the decade before as an epidemic

Hughes- Were you familiar with that research?

Conant- Oh, sure. Because of my interest in herpes, I had known about the CMV stuff.

And literally the day after Al and I spoke, I was giving dermatology grand rounds at the university, which would have been about April the first of 1981. I was speaking on herpes, had the five different herpes viruses listed, and was talking about cytomegalovirus. I mentioned that I had spoken to Al Friedman-Kien the night before, and there was this new group of diseases that he was seeing. I said, "Has anyone in the audience seen it?"

Jim Groundwater put his hand up and said, "Yes," and I remember the patient's name. It was Ken Horne. He was in the hospital ill. Also, the editor of the Advocate, which was another large gay periodical, was at Stanford and dying, or had just died at Stanford, of the same thing. So the very first case was literally the day after I started looking for it.

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• https://salo-forum.com/index.php?threads/patient-zero-and-the-early-days-of-hiv-aids.3167/page-2 OR https://archive.ph/dy6Rv Page 10, primary source, Thread Page Two
• https://oac.cdlib.org/view?docId=kt...7&toc.depth=1&toc.id=d0e3127&brand=calisphere OR https://archive.ph/G8JbM Page 10
• https://nymag.com/news/features/45785/index2.html OR https://archive.ph/KaPF9 Page 13
• https://oac.cdlib.org/view?docId=kt...4&toc.depth=1&toc.id=d0e4114&brand=calisphere OR https://archive.ph/gvk1E Page 13
• https://oac.cdlib.org/view?docId=kt...09&toc.depth=1&toc.id=d0e609&brand=calisphere OR https://archive.ph/A3Qba Page 14
• https://www.huffpost.com/entry/san-francisco-gay-homeless_n_3491990 OR https://archive.ph/mxc2W Page 15
• https://oac.cdlib.org/view?docId=kt...0&toc.depth=1&toc.id=d0e3460&brand=calisphere OR https://archive.ph/VRxsQ Page 17

Hellbound Hellhound said:

What for? Condoms exist; PEP exists; PrEP exists. There are now several ways that you can ensure that you A) don't contract HIV, and B) don't pass it onto other people; it shouldn't really need to affect your sex life at all.

The only people in the developed world who could conceivably fail at preventing the spread of HIV at this point are either recklessly irresponsible, or doing it intentionally as part of some fucked up fetish.

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ND: More from the Oral History......................

Hyperlink, text: Dr. Marcus Conant on justifying the opening of a Kaposi Sarcoma Clinic:, url: https://oac.cdlib.org/view?docId=kt...9&toc.depth=1&toc.id=d0e3639&brand=calisphere OR https://archive.ph/EpJ7h

Hughes- What made you think that there would be enough cases to make a clinic feasible?

Conant- Well, I'm sure it was my experience with herpes. For some reason, from the beginning of the epidemic, it seemed clear to me that this was not going to be limited. I think that part of it was my experience living in San Francisco, knowing that the gay community was sexually very active, and if there was anything new in that community that could be transmitted communicably, that it was going to spread like wildfire. It was just foolish to assume that it would not. All the diseases that we'd seen--syphilis, gonorrhea, amoebiasis--everything had spread through that community with tremendous rapidity. That was reason number one.

Number two was, from the beginning, the number of cases of this problem was beginning to increase. From the very beginning, New York saw a few, and then a few weeks later it had a few more, and a few weeks later, more. And the same was true here in San Francisco. Everywhere we looked, we began to be able to find it.

When I was a kid, my dad constantly played this game--he loved it--of handing you a penny, and saying, "Which would you rather have: a million dollars, or for me to double this penny every day for a month?" Of course, the kid would immediately say, "A million dollars." And then he'd make you sit down and calculate it out. You realize that if you take a penny and if you double that every day, the next day you have two pennies, and the next day you have four pennies. If you double that every day for a month, you have more than a million dollars. What you've got is an exponential curve. It's going up at an incredible rate. It doesn't have to double many times before the numbers you're dealing with are just astronomical.

And this epidemic, from the beginning, was doubling, and it was doubling in about six months at that point. So we realized, wait, if you've got two pennies today, you're going to have four pennies in six months, and you're going to have eight pennies in a year. Hang on, because the numbers before long are going to get just astronomical.

On linking Kaposi Sarcoma with Pneumocystis:

Conant- Michael Gottlieb recognized the first cases of Pneumocystis in February of '81. It was not really put together until later that year that we were both seeing the same epidemic. The first MMWR [Morbidity and Mortality Weekly Report] that began to put it together was in the summer of '81.

I and Friedman-Kien and Mike Gottlieb--this is when I first met Mike Gottlieb--went to a meeting which, as I recall, was in September of 1981 at the National Institutes of Health. We were all presenting the parts of the elephant that we were looking at, and it became really clear to all of us that we were dealing with the same epidemic.

Hughes- How did you realize it was the same thing?

Conant- Both diseases were occurring in gay men who were in the fast lane, if you will, had multiple sexual partners, and were living in New York, Los Angeles, and San Francisco. So not only was it gay men, but it was gay men whose behavior was exactly the same in both groups. Both of them were incredibly rare, new--if you will—conditions. Pneumocystis was as rare for the infectious disease specialists as KS was for us in dermatology.

By that time, we knew that the KS patients and the Pneumocystis patients were both immunosuppressed. We could do helper-suppressor T cell ratios, and when you looked at those, you found that their immune systems were depressed. So it was the same group of people in the same areas engaged in the same behavior with unusual diseases that indicated immunosuppression. So it then began to come together.

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ND: Hyperlink, text: Dr. Marcus Conant on Gaetan Dugas:, url: https://oac.cdlib.org/view?docId=kt...3&toc.depth=1&toc.id=d0e3639&brand=calisphere OR https://archive.ph/45Jxk

Hughes- Do you care to say anything about Gaetan Dugas?

Conant- Yes, I'll tell you something about him.

Hughes- You saw him in April, 1982 for the first time.

Conant- Well, let me say first that when Randy Shilts found out that there was such a patient, Randy went nuts trying to get the name out of me as to who the patient was. Randy and I by that time had become close friends, and of course, I was trying to give him as much information as I could. But I wouldn't give him Gaetan Dugas' name. I can remember calling Randy one day and he said, "You don't have to tell me. I've got it." So I don't know where he finally got the name from, but he got the name.

The young man [Dugas] saw me after he had for a time been reported to the KS Foundation. The first I learned of him was when I was chairman of the board of the KS Foundation. We had a hotline which was well advertised in the [gay] community. If you wanted information about AIDS, then called Kaposi's sarcoma, you would call this number. That's the number where we would talk to them about insurance. We'd say, "Do you have insurance, and what kind is it?" Then we'd say, "If you don't have insurance, go get insurance right now." There are thousands of men today in San Francisco who are getting cared for because of that advice. That was probably the best advice we could have given. That [hotline] was Frank Jacobson's idea. He put that in place, and it was absolutely brilliant.

Well, this young man, this young Canadian, would come to San Francisco, and he would have sex. He was very perverse about it. He would do it with the lights out, and then after they had concluded the act of sex, he'd stand up and cut the lights on. He was covered with lesions of Kaposi's sarcoma. He'd say, "I have the gay cancer, and I'm going to die, and you probably have it too." And he would leave. I have talked subsequently to the man who he used to room with when he came here, an old friend of his who he would stay with. The friend would say that he was just absolutely obsessed with sex. He lived to have sex. That was the thing.

Tom Coates and Leon McKusick have taught us that there are people who are sexually obsessed, and that when they get stressed or frightened, what they do is they have sex. Now, think about that in terms of the AIDS epidemic. For those of us who have trouble dieting, when we get stressed, we go and eat. And for those of us who smoke, when we get stressed, even when we know we shouldn't, we go out and have a cigarette. These people, when they get frightened about dying of AIDS, go out and have sex as a way of dealing with it. And as I look back at that young man, unfortunately I think that was the pathology. It's hard to say that he was a wicked, evil person. He probably was truly obsessed with sex, was terrified of what was happening to him, and used sex as a way of dealing--as perverse as it is--with his own anxiety. He did see me in consultation on at least one occasion I can remember, perhaps two. The only thing that I can remember being struck with was how attractive he was. He was a stunningly beautiful man, just truly, truly one of those people whom you want to immediately hold, because he just looks so sweet.

I called Al Friedman-Kien in New York shortly thereafter, as memory serves, and I said, "I know he's here in town having sex because the hotline for the foundation is getting calls, `What can we do?'" Al said, "We've called the New York police. We can do nothing. There is nothing that can be done." There is no quarantine law; there is no way that anything can be done. In retrospect, the director of public health probably could have had him restrained. But of course, he was a flight attendant; he would have just left town.

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ND: Hyperlink, text: Dr. Marcus Conant on the Bathhouses:, url: https://oac.cdlib.org/view?docId=kt...5&toc.depth=1&toc.id=d0e5575&brand=calisphere OR https://archive.ph/Vo3mJ

Hughes- Dr. Conant, the bathhouse issue began to simmer in the first months of 1983. Do you remember when you first began to speak out publicly on the issue of closure?

Conant- The first recollection that I have was probably a talk I gave at the Harvey Milk Gay and Lesbian Democratic Club in the spring of 1983. That evening, I was invited to talk about AIDS issues in the community. I can remember it, because the talk, like many of my talks, got a lot of criticism. My message was, I've spent a lot of time in the last year criticizing physicians for not being interested in the epidemic, and criticizing Washington for not making the commitment that it needs to make. I think that the gay community needs to look at itself and see what role it's playing in the transmission of this disease--what's going on in the gay community that is causing the epidemic to continue.

Bathhouses were clearly one of the foci, where people were going late at night, after having had a lot to drink, and having anonymous sex. That's what they were there for. And everybody was having a great time. The problem was that they were walking into bathhouses and getting infected.

I can recall about that same time seeing a patient who was a young Ph.D. scientist from the Peninsula [south of San Francisco], a very good-looking man with Kaposi's sarcoma who I was caring for. He had AIDS. He was sitting in my clinic on Parnassus. He was kind of impatient. I said, "I'm sorry I'm running late; I can tell you're impatient. What's wrong?" He said, "I wish you'd hurry up; I'm going to the bathhouses." My reaction was, "Wait a minute."

See, I was being a typical physician. We all in this society forget--and I think physicians are the worst--that when people are diagnosed with a fatal disease, all of the desires and longings and drives that they had the day before they were diagnosed are still there. Everybody believes that patients who are dying of AIDS are no longer sexual. I have patients that have sex the day before they die. I encourage them to do that. And people believe that women who have had breast cancer are no longer intimate or have longings to be intimate. We need to begin to relate to people and realize that those human, very human, desires don't go away because you have now had a label of "AIDS victim" stuck on you.

But being the typical doctor, it just never occurred to me that he was still out there having sex. He had Kaposi's sarcoma--AIDS, this horrible new, fatal disease. My line to him was, "Somebody must think you're smart, because they gave you a Ph.D. How come you're still going to the bathhouses?" He said, "There's nothing wrong with that. I probably caught it there, and so my view is, it's there and I'm going to have sex." I said, "Are you telling the people that you're having sex with that you're HIV-positive"--it wasn't even called HIV then--"that you have AIDS?" He said, "No. I figure that they ought to be smart enough to understand that there's AIDS out here, and that they can catch it. It's their responsibility as much as mine." I think that that, more than any other single event, called into focus for me the notion that someone needs to speak out.

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ND: Hyperlink, text: The First Kaposi Sarcoma discussions and 'Fisting':, url: https://oac.cdlib.org/view?docId=kt...9&toc.depth=1&toc.id=d0e3639&brand=calisphere OR https://archive.ph/k2nL5

Hughes- Do you remember what the gist of the conversation was?

Conant- Yes, some of it. I remember that Friedman-Kien said that they were seeing a group of these patients at NYU, that he had identified the patients, and that Bernie Ackerman had confirmed that they were in fact Kaposi's sarcoma. And Al was amazed by the fact that most of these men were into insertive sex, that they were into "fisting," where one partner would put his fist into the anus of another partner.

And it was the insertive partner who was coming down with AIDS. Al was questioning, "I wonder why it's the insertive partner?" You would think it would be the receptive partner who would get injured or hurt or more susceptible to disease, and in fact it was the assertive partner--the insertive partner. I suggested that perhaps the insertive partner was a more assertive person and went out and had sex with far more partners, and was just putting himself at greater risk.

ND: *note - the Stewart mentioned in this segment was said by Dr. Moss to have been waiting for Gaetan Dugas to return to San Francisco to "kill him", most likely figuratively

Hyperlink, text: Dr. Andrew R. Moss, Epidemiologist, on the first case-control studies and building the questionnaires:, url: https://oac.cdlib.org/view?docId=kt...&toc.depth=1&toc.id=d0e10200&brand=calisphere OR https://archive.ph/m7HNt

The Questionnaire

Moss- At the end of 1982, we started developing a questionnaire. I got my gay informants together. Stewart Anderson was one of my first informants about gay sexuality and what we ought to be asking people about. I talked to a lot of people. I rounded up a working group, and we met in the evenings over on Gough Street in my office. I got a lot of gay men into it. Michael [Gorman], whom I hired-- How did I do that? I must have had him on brain tumor money. I was using my brain tumor study budget to fund AIDS. That's what I did; that's what everybody did; I bootlegged it.

I hired Michael, and Wally Krampf, a gay doctor who still works with us and has a gay practice. I hired Louise Swig and other people that worked with us as interviewers and volunteers. We invited people to sit in on the discussions. I had an open process. Partly I wanted word to get out to the gay community about what we did, and I didn't want it to be seen as closed or secretive. Trying to win support in the gay community is what we were doing, and I figured since we were doing all this sexuality stuff that we should try and open it way out. So we did. We made it totally open. Anybody who wanted to sit in on these discussions was welcome, and a lot of people came.

We had this process of developing questionnaires whereby we iterated them. We started with something, and then we'd all take it out in the field and do one or two interviews, and then come back and discuss the questionnaire and change it. It takes a long time, but we worked through all the gay sexual issues. >bolded by ND< I had key informants. I had my sadist, my masochist, and my water sports expert, and Stewart who was my fist-fucker expert. I had all these people that I would go to--it was great. My main motivation for being an epidemiologist is curiosity, voyeurism. A very big part of my motive was, Ooh, this is interesting. Let's have a look at this. The wall was down between the gay world and the straight world. You could peer into this taboo territory, where all this very extreme sex by heterosexual's definitions was going on. Homosexual sexuality in that era was almost a cult phenomenon; it was like a sex cult. It was very different from what goes on in the straight world, so we were penetrating into this weird world.

We were extremely thorough. We masked our prurience with Teutonic thoroughness, and investigated everything, and generated this gigantic questionnaire which asked about every possible sexual activity.

Hughes- Just sexual activities?

Moss- Mostly, not totally. Residence, history, places. We asked about places; we were very interested in where people did this. We were still under the epidemiological delusion that you could identify the place where transmission occurs. Of course, it's really going on everywhere, but we had this fantasy that you could identify place. Did we think in terms of tens or thousands of deaths at that point? I don't know. It's hard to reconstruct. Seeing what was going on in the bathhouses or the sex clubs, one strategy was to ask people where they had done their stuff.

It's probably the best case-control study of AIDS risk factors anybody ever did, because we got obsessive about it. Our coping strategy for the fact that we were so psychically out of our depth was Germanic thoroughness. [laughing] It was a huge questionnaire; it took an hour to do the interview, and it covered every sexual activity and a lot of other stuff as well. It covered places and exposures and God-knows-what.

Hughes- Was it indeed more comprehensive than other questionnaires?

Moss- Yes, it's probably the best one developed for use in studies in gay men. It's definitely better than the CDC questionnaire, which we started off with.

Hughes- How much did you modify it as time went on?

Moss- Oh, we just went through a big development process. We took months to develop it. Dennis Osmond, Louise Swig, who was actually a field director for studies like this, and I piloted it. We were all obsessive about this particular part of the process, so we did it a long time. Also, it's how you get yourself into the issue, get yourself thinking about it.

We're doing it now with TB histories. You work yourself into what's going on--that's how you talk to your first patient. You get people of very varied backgrounds to comment, and you start with a draft questionnaire, and then you all go and interview an AIDS case. That's what we did.

So I interviewed my first AIDS case, an unbelievably creepy experience. I'll find notes on that: that will be worth reading. [laughs] It was an incredibly creepy and frightening experience, but also a bonding experience, a commitment experience. We all did it, we all came back, our eyes were opened, and we were exhilarated and terrified. We'd all done it, so we'd all get deeply into discussing what we were doing with studying this strange sexual stuff.

Quick-and-Dirty Studies

Moss- While we were going on the road with the AIDS incidence study, we were developing this case-control one. A census tract study is a quick-and-dirty study. I did it that way deliberately. I knew this would be a quick way of getting some data out. I did two things very quickly: the AIDS incidence study and a survival study, how long people diagnosed with AIDS lived. They were dying very rapidly. Peter Bacchetti and I finally did that study formally.

Eleven months was the average survival with AIDS in those days, eleven months from diagnosis to death. So that's another easy study that we were also doing. It wasn't so easy, but we were doing that too.

See, with no money, you have to do cheap studies. So I did cheap studies we could do with existing resources, and development work on this big case-control study, which was several hundred thousand dollars for the full study. We eventually interviewed 600 people in the case-control study, 300 AIDS cases, 300 controls.

Hughes- Give me an idea of what sort of questions in the questionnaire worked, and what sort of questions didn't work?

Moss- Well, you're trying to measure things, like number of sexual partners. You're trying to come up with how many sexual partners the person has had in the last week, month, year, ten years, lifetime. How do you group it? Zero-one, one-two, two-three, three-five?

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ND: Hyperlink, text: Dr. Moss on studying drug users in 1984:, url: https://oac.cdlib.org/view?docId=kt...&toc.depth=1&toc.id=d0e10627&brand=calisphere OR https://archive.ph/dq1CS

It took a lot of maneuvering. In that program, we tested 2,351 intravenous drug users, which is probably more than anybody outside Baltimore. There are estimated to be 13,000 drug users in San Francisco, so we tested about one in four or one in five. >ND’s bolding< “We found out the main thing associated with HIV in drug users was intravenous cocaine use, not heroin. I went to NIDA and told them, but they didn't believe it; nobody believed it. The reviewers didn't believe it; we had to fight the paper into JAMA [Journal of the American Medical Association]. But it turned out to be true. It's cocaine injection that gives people AIDS.”

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Azimuth: >Quoting ND’s “Dr. Moss on studying drug users in 1984:” comment.< This makes sense considering queers, their promiscuity practically a defining element, are more likely to be cokeheads rather than junkies. After all, from what I understand, sex is about the last thing one desires when on heroin.

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ND: >Responding to Azimuth< I wonder if it has anything to do with what was in the cut cocaine at the time? Lots of toxicity, no doubt.

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Azimuth: >Responding to ND< Good question. It's quite possible the coke was cut with something that helped suppress the immune system, something cocaine alone already does (it's common for coke users to come down with colds after binges, for example).

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ND: >Responding to Azimuth< I've got a lot more coming on this thread as I've collected a lot of primary sources, many of which will deal with the lifestyle gays were living in San Fran (and by extension, NYC and LA). From what I've seen already, these guys had a shitload of venereal diseases already swimming through their systems and were on all sorts of illegal drugs, plus a lot of penicillin. There is no way that these weren't co-factors in what later became AIDS. In NYC, there were gay doctors that were going to Fire Island and stocked up with penicillin and were shooting it into themselves and their friends before they went out to parties and got high.

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El Greco: >Responding to “plus a lot of penicillin.” From ND’s last comment< Keith Preston from AttackTheSystem.com did an entire podcast on the history of HIV/AIDs and brought up the antibiotic abuse angle that I never knew of until listening to his show. Here's a link to the podcast which is just sort of an hour, definitely worth a d/l ... url: http://attackthesystem.files.wordpress.com/2012/09/attack-the-system-on-science.mp3

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ND: Hyperlink, text: Dr. Paul Volberding on asking very private questions in the early days:, url: https://oac.cdlib.org/view?docId=kt...4&toc.depth=1&toc.id=d0e4333&brand=calisphere OR https://archive.ph/ElRDe

Taking Patient Histories

Hughes- Did you feel any hesitation in what people might construe as interfering in the most private lives of individuals?

Volberding- Well, early on we didn't know anything. So we took very detailed questionnaires: how many times have you had sex, how many people have you had sex with, what kind of sex have you had, where have you put your organs in other people--down to excruciating detail. I think it was important to do that early on. I think increasingly as we worked with this disease, it felt more and more voyeuristic, because there was in truth nothing we as clinicians were going to do with that information. It didn't change my treatment of the patient to know that he was gay or not.

Hughes- But it could have changed his behavior, certainly in terms of the transmissibility.

Volberding- Sure. There are two things. First of all, I think for a real epidemiologist to ask those questions, it was important, and it still is important. We still are learning something about Kaposi's sarcoma, because it turns out that it might be related to fecal-oral contamination. And you're not going to learn that unless you ask those questions. For the clinicians, I think that it's not important to know specifically the details of somebody's sexual life as long as you're able to identify the fact that the person is having same-sex contacts, or is using intravenous drugs. I mean, I do think it's important to identify the risk factors to permit counseling on safer behavior. You're right.

Hughes- Was the questioning generally well received?

Volberding- Yes, absolutely. I can't recall a patient where asking was a problem, although the answers I received may or may not have been accurate. Again, the patients--especially the ones we saw early in the epidemic--were really stereotypically very sexually active gay men who were fully out about their homosexuality. There wasn't a lot of shame about their sexual orientation, so we felt comfortable asking questions and they seemed to feel comfortable answering them.

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ND: Hyperlink, text: Volberding on the infamous meeting with the bathhouse owners:, url: https://oac.cdlib.org/view?docId=kt...3&toc.depth=1&toc.id=d0e6205&brand=calisphere OR https://archive.ph/gNRfg

A Meeting with Bathhouse Owners, Early 1984

Hughes- I know of one meeting, that's reported in Randy Shilts' book, where you met with the bathhouse owners.29

Volberding- Yes. That was pretty remarkable. Donald Abrams and Andrew Moss and I were especially involved in some of these discussions. We thought, It must just be that the bathhouse owners don't understand the nature of the problem. So we were going to be civic leaders and invited the bathhouse owners here to our clinic, so that we could talk with them and present them with a slide show about the disease.

We noticed several things: they arrived in business suits with lawyers at their sides, and here we were in our white lab coats. There was a feeling of hostility that I hadn't anticipated. We really went into this naively, thinking this would be a welcome educational forum. They came into it feeling, understandably so, that this was one of a series of attempts to shut their businesses down. That's really the way they approached the whole discussion. We weren't allowed to give a lecture about the disease.

Toward the end of the discussion one of the bathhouse owners turned to me and said--as I remember it, this is exactly the truth--"Look, we're both in it for the money. We make money from them having sex, and you make money when they get sick." It was as though, "No big deal. We understand each other." We [professors] kind of shook our heads--I did at least--and said, "I don't understand that at all." I think there was still denial, the belief that this was a disease like gonorrhea or syphilis. And it's not. It's a disease unlike any other we've seen. And these people weren't just getting sick; they were dying from the disease. Furthermore, we weren't making any money from it, so the statement was wrong on all counts. >This excerpt was not in a spoiler and thus was archived with original formatting. This transcript has slightly modified the formatting to conform with the transcript as a whole. Actual text and contents are unmodified.<

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Team Zissou (TZ): Interesting unasked question: what demography were the bathhouse owners? I'm reminded of drug dealers, who tell their kids don't get hooked on your own product.

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ND: >Responding to TZ< From what I've read thus far most of them weren't homosexuals. But it's a very good question and could use some more investigating.

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Vuk: Hyperlink, text: Cocaine Use Can Make Otherwise Resistant Immune Cells Susceptible to HIV, url: https://archive.ph/wAxAn

University of California, Los Angeles (UCLA), Health Sciences, October 1, 2013

In many ways, the spread of HIV has been fueled by substance abuse. Shared needles and drug users’ high-risk sexual behaviors are just some of the ways that narcotics such as cocaine have played a key role in the AIDS epidemic in much of the world.

There is, however, relatively little research into how drugs can impact the body’s defenses against the virus. But a new UCLA study published in the October issue of the Journal of Leukocyte Biology examines how cocaine affects a unique population of immune cells called quiescent CD4 T cells, which are resistant to the virus that causes AIDS.

The results: cocaine makes the cells susceptible to infection with HIV, causing both significant infection and new production of the virus.

“The surprising result was that the changes cocaine induced on these cells were very minimal, yet they were sufficient to fuel infection,” said Dimitrios Vatakis, assistant professor of medicine in the division of hematology/oncology at the David Geffen School of Medicine at UCLA and the study’s senior author. “We found that cocaine mediates its effects directly, inducing minimal changes in the physiology of these cells and utilizing the same pathways it uses to target the brain.”

For the year long in vitro study, the researchers collected blood from healthy human donors and isolated quiescent CD4 T cells. They exposed the cells to cocaine, then infected them with HIV. They harvested the samples over different time points to trace the cells’ susceptibility to infection at different stages of HIV’s life cycle, comparing the infected cells with untreated cells.

They found that a three-day exposure to cocaine made the cells more susceptible to HIV infection by stimulating two receptors in the cells, called σ1 and D4. The findings suggest that cocaine use increases the pool of T cells in the human body that can become infected by the virus.

The researchers caution that, as with all in vitro studies, the results may be skewed. Also, they based their research on an acute—that is, brief--cocaine exposure set-up; by contrast, typical drug users are chronic users, meaning that they take the narcotic over extended time. They do, however, have data from their animal models that support and strengthen their observations.

“We have shown that cocaine modulates the permissiveness of quiescent cells to HIV,” the researchers conclude. “The potential for cocaine to augment the pool of HIV target cells with a commensurate increase in the viral reservoir has significant implications for HIV seropositive individuals who abuse or use stimulants such as cocaine.”

The next stage in the research will be to more closely examine the means by which cocaine makes these once resistant cells susceptible to infection and if the drug does indeed lead to a higher viral reservoir, and to use humanized mouse models to study how drug abuse affects HIV infection as well as the efficacy of Highly Active Antiretroviral Therapy (HAART). >This article was not in a spoiler and thus was archived with original formatting. This transcript has slightly modified the formatting to conform with the transcript as a whole. Actual text and contents are unmodified.<

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ND: Let's jump in the Salo Forum Time Machine and fast forward to 2013................... Hyperlink, text: CDC: 62 Percent Of HIV-Positive Men Have Unprotected Sex, url: https://archive.ph/V0Q1n

Data released last week found that 62 percent of American men who self-reported being HIV-positive said they had unprotected anal sex with a male partner in the last 12 months.

The Centers for Disease Control hyperlink, text: report, url: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6247a4.htm?s_cid=mm6247a4_w#tab1 OR https://archive.ph/ER1mE, “HIV Testing and Risk Behaviors Among Gay, Bisexual and Other Men who have Sex with Men,” noted that the population of men having sex with men (MSM) is a small proportion of the US population; however, this group represents the majority of people diagnosed with HIV.

In 2011, men who had sex with men accounted for at least half of persons diagnosed with HIV in all but two states. Anal sex is cited by the CDC as having the highest-risk practice for HIV infection.

“High HIV prevalence, lack of awareness of HIV-positive status, and unprotected anal sex” between gay, bisexual and other men are cited by the CDC as contributing to continued new infections among this population.

However, only 67 percent of sexually active MSM reported getting an HIV test in the past year.

The researchers found that some men attempt to decrease their HIV risk by only engaging in unprotected sex with those “perceived” as having HIV or not. However, this practice is risky because some may not disclose or may not know they are infected with the virus.

Unprotected anal sex among MSM increased from 2005 to 2011, and in 2011 one-third of HIV-positive MSM who did not know if they were infected reported unprotected sex with a partner who said they were HIV-negative or did not know either.

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ND: The original cluster study with Gaetan Dugas as "Patient Zero", mapped:

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ND: We'll pick this up with a nice little one-liner summary from Hyperlink, text: Constance B. Wofsy, url:https://oac.cdlib.org/view?docId=kt...5&toc.depth=1&toc.id=d0e8885&brand=calisphere OR https://archive.ph/b4Wr7 about how the early days looked from her perspective as an Infectious-Diseases Specialist:

Because I was in ID, I was also part of the infectious disease clinic. There, we were seeing a lot of gay men with swollen lymph nodes. And, at that time, the very beginning of the epidemic, there was the question mark, could these be associated with PCP and KS? But not the assumption. They appeared to be three separate entities: gay men with swollen lymph nodes, this rare case of PCP, and Kaposi's sarcoma.

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ND: Hyperlink, text: Wofsy on early Etiology debates:, url: https://oac.cdlib.org/view?docId=kt...3&toc.depth=1&toc.id=d0e8748&brand=calisphere OR https://archive.ph/bhO7r

Wofsy- Oh, the theories! God, the discussions! Hours given over to them, with slides and intricate graphs, and arrows going here and arrows going there, and poppers in the right-hand corner of the slide. Oh, multiple antigen stimulation, and syphilis, and chlamydia down there in the corner, and arrows going right and left and up and down. Then sometime in the late 1983 or what have you, you'd see one of these mixmaster slides where everything happened, and if you were just in the wrong place and the arrows all converged, your immune system went to pot.

And then you'd see slide B, unifying infectious agent. Which would explain that rather than the mixmaster causing immune deficiency, something caused immune deficiency, and then the immune deficiency could take different pathways: opportunistic infection, Kaposi's sarcoma, yabba yabba. Then we'd debate those back and forth, back and forth, back and forth. There were strong opponents of either model, and it was very slow to come to the inevitable realization that it was a single agent and a new agent.

Hughes- What was the mixmaster model?

Wofsy-Multiple agents causing immune deficiency. If you had herpes and hepatitis and CMV, they all slashed away at the immune system and left you susceptible, either to an agent or they triggered some sort of immune disorder cascade that then made you susceptible to Pneumocystis. I can see the headline, 1984, so I know that that's when Gallo discovered the AIDS virus. So it must have been by '83 that we--by we, I mean just most of us around here--were pretty sure that there must be a single entity of some kind.

Hughes- Was that single causal entity in your mind a virus?

Wofsy- Yes. Nothing else could have caused this disease.

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• https://salo-forum.com/index.php?threads/patient-zero-and-the-early-days-of-hiv-aids.3167/page-4 OR https://archive.ph/pMjVt Page 25, primary Source, Thread Page 4
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• https://archive.ph/wAxAn OR http://www.newswise.com/articles/co...-cells-susceptible-to-hiv#.UkuB3A0vhlo.reddit Page 26,May 16, 2015 Archive
• https://archive.ph/V0Q1n OR http://atlanta.cbslocal.com/2013/12/03/cdc-62-percent-of-hiv-positive-men-have-unprotected-sex/ Page 27, March 6, 2017 Archive
• https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6247a4.htm?s_cid=mm6247a4_w#tab1 OR https://archive.ph/ER1mE Page 27
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  Edit- Added Thread Page 4

Aero the Alcoholic Bat said:

too far gone to be deterred by the wrath of God.

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ND: She continues with the Hyperlink, text: Heptatitis B Study Cohort:, url: https://oac.cdlib.org/view?docId=kt...4&toc.depth=1&toc.id=d0e8748&brand=calisphere OR https://archive.ph/yM28z

Wofsy- In 1979, since San Francisco has a large population of gay men and they're very organized, and the hepatitis vaccine was at an investigational stage, CDC gathered together a cohort of a large number of gay men, collected blood, and gave some the investigational hepatitis vaccine, and to others they didn't. They followed them over time to see if the vaccine was protective, and how many who were vaccinated got hepatitis. Because CDC is organized, because we have a very good STD [sexually transmitted disease] clinic, there was very good follow-up with a lot of gay men in San Francisco. There was blood drawn every six months.

So when 1983 or so came around, and somebody--and it may well have been Don Francis, which may be why he's eulogized--said, "Excuse me, we have sera from gay men in San Francisco starting in 1978." So when the HIV test became available anywhere in the world, it was the best organized batched blood with a lot of demographic information on gay men. So the famous quote, that it's an average of ten years from infection until AIDS, comes from that hepatitis vaccine study.

The study was ongoing over a decade, and it was very well run and managed, and the people who were involved in it, by coincidence or design, became part of the "in" group of the San Francisco consortium of UC, San Francisco General, health department, et cetera. So the vaccine study really was the country's prima epidemiology study of HIV that was coincidentally there just by the grace of--who knows.

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ND: I think I've mentioned the documentary "We Were There" which is about the gay community in San Francisco and how it was devastated by AIDS. One of the main people being interviewed mentioned how his boyfriend, an immunologist, battled to get onto the clinical trials for Suramin, a very nasty and toxic drug. The guy being interviewed couldn't handle the side-effects and went off of the trials early and is still alive to this day. His boyfriend, like all those that took part in the Suramin clinical trial, died quickly. I wonder if Hyperlink, text: this 'difficult patient' mentioned by Wofsy, url: https://oac.cdlib.org/view?docId=kt...&toc.depth=1&toc.id=d0e10471&brand=calisphere OR https://archive.ph/chHLi was him:

A Difficult Patient

Wofsy- I remember one particularly difficult patient who was particularly demanding of getting onto clinical trials, felt that we were overly cautious, that we weren't realizing people were dying, that we needed to be more aggressive, get out there, study, study, study, study things. He ultimately got on a trial, suramin, that taxed our ethics about whether to embark on it, because it had known toxicity in other populations. But it also had laboratory benefit, which was the story of immunomodulators for about five years: Something that would work in the lab, you'd put it into humans, and it would be toxic.

This individual got onto that study, signed the consent form, and was handled with kid gloves, because he was a challenging personality. He was one of the people that got a totally unexpected and very severe toxic reaction. I remember--this is all filtered through the sands of time--how loudly he shouted about the lack of proper concern for patient safety, and taking care and time before rushing into these trials. It was hard to believe that the words were coming from the same mouth.

What it really underscored was how emotional a disease it is. Difficult personality that he was, he was totally in control of his faculties--it was the degree of the emotion, not that he wasn't thinking clearly. He died early on.

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ND: Next up is Don Francis of the CDC in Atlanta, immortalized by Matthew Modine in the movie "And the Band Played On".

Hyperlink, text: Hepatitis B Vaccine Trials in the United States, 1979-1980, url: https://oac.cdlib.org/view?docId=kt...23&toc.depth=1&toc.id=d0e623&brand=calisphere OR https://archive.ph/BU2aE

Hughes- Talk about the Phoenix laboratory and hepatitis.

Francis- All right. I had worked with hepatitis as a general epidemiologist in Oregon, but never knew too much about it.

I didn't even know much about Phoenix, Arizona, even though by that time my mother had moved from Marin County to Prescott, Arizona. One of the reasons I came back from WHO was because she was diagnosed as having cancer, so it all kind of fit. Good thing to be near her at that time.

So I started learning hepatitis. Now, there were two remarkable things about hepatitis B at that time. One, there was a large epidemic in gay men, because of, again, an ecological change, not a virus change; the virus had been around for ages. But the ecology of homosexual activity had changed with commercialization and urbanization of homosexual activity, so that gay men were having a lot more contact with a lot more gay men. The spread of sexually transmitted diseases was just astronomical--gonorrhea, syphilis, even gastrointestinal diseases, and hepatitis B.

So I started this large vaccine study in gay men. The group at CDC in Phoenix was already studying the spread of hepatitis B in five cities--San Francisco, Los Angeles, Denver, St. Louis, and Chicago--and Wolf Szmuness and Cladd Stevens were doing similar studies in New York City. So we all started immunizing these gay men, half with a placebo and half with the vaccine, and then followed them over time to see if the vaccine would protect. And indeed, it was a highly effective and safe vaccine.

But in the meantime, in doing these studies, I got to know, at least peripherally, the whole homosexual scene. I say peripherally--it was really in great sexual detail, but I didn't understand homosexuality necessarily, except it was a lot of men having sex with a lot of men. As a straight man, I couldn't understand it totally, but they did it, and I accepted it. In California, we can be very tolerant. [laughs] I guess we should bring politics in here about this time, because with the completion of those trials, we started seeing that the efficacy of the vaccine was really quite phenomenal.

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ND: Hyperlink, text: Dr. Francis on narrowing down the general causes:, url: https://oac.cdlib.org/view?docId=kt...2&toc.depth=1&toc.id=d0e1163&brand=calisphere OR https://archive.ph/PMmn1

Francis- The unknown aspects of it. It was investigation, trying to figure out what it was, and you needed people to collect data, you needed information to be able to make your hypothesis of what kind of a disease it was. So the first year was spent actually doing an investigation of gay cases. Harold Jaffe designed and implemented a case-control study. I think the vast majority of all living AIDS cases in the United States were actually contacted by one of these young epidemiologists and interviewed, with a huge form; I remember it well. Your pets, and your sex, and your drugs that you took, a huge thing, trying to throw a very broad net to investigate risk factors for individuals who had the disease. Then in each one of the cities in which a case lived, controls were taken in the same community, and the same questions were asked of the controls, trying to see what the cases did that the controls didn't. It rapidly fell out that it was sexual activity.

Now, a similar study in New York showed that it was sexual activity, yes, but the use of amyl and butyl nitrite was also associated. That was "poppers"--a drug that causes vasodilatation, used for cardiac disease, that also was supposed to be wonderful for sexual orgasm. Poppers were very popular, and were sold over the counter as a deodorant for gyms or locker rooms--I don't know how. [laughing] I don't know if they were ever used for a deodorant, but that was the marketing ploy. People would just use them as a sexual stimulant.

Harold Jaffe rapidly said that the New York conclusion was wrong, that the primary issue here was sex, and people who have lots of sex look for sexual stimulants and use the drug. The risk was sex and the drug use that carried along with it.

Hughes- Why did he say that?

Francis- Well, there are very elaborate statistical techniques that are used to try to tease out primary versus confounding risk factors associated with any disease. Modern computers have allowed us to do that, where you can just run the data over and over and over again, pulling out different parameters. If someone is positive or negative for this question, you can actually pull him out and analyze that group separately, as if they did or did not exist. From this multivariant analysis, Harold concluded--and I think logically--that poppers were a secondary factor instead of a primary one.

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ND: Hyperlink, text: The Mystery of the Early Haitian Cases in the USA solved:, url: https://oac.cdlib.org/view?docId=kt...0&toc.depth=1&toc.id=d0e1163&brand=calisphere OR https://archive.ph/selZ3

Hughes- Did knowledge of the heterosexuality of the African disease affect your perception of the disease in this country?

Francis- Well, the earliest were the Haitians in this country, which brought a tropical nature to it. The issue of the Haitians was confusing, though, and wasn't sorted out for years, actually. We knew that gay men from New York were commonly coming down to Port-au-Prince for vacations, and hiring local youths for sex. Haiti had a very close connection to Africa, and indeed Zaire, because post-colonial Zaire needed school teachers and imported Haitians for that. The question was, did it come into Haiti and then get into the gay population through Haitian interaction with gay men in New York, or were the Haitian cases a result of gay men who were infected giving the virus to Haiti?

The latter turns out to be the case, but initially we thought that an African bug went to Haiti and then got into the gay population. Obviously, it probably was an African virus--gay men visiting Africa picked it up and got it into the bathhouses in Europe and the United States, and then it spread like crazy.

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ND: Hyperlink, text: Gays as bellweathers and leaders in sexually transmitted diseases:, url: https://oac.cdlib.org/view?docId=kt...0&toc.depth=1&toc.id=d0e1163&brand=calisphere OR https://archive.ph/hu0OL

Hughes- What I'm trying to get at is, the early perception of AIDS is linked with the gay population. It is seen by most people as a gay disease.

Francis- No. When we see a disease in the gay community, our initial instinct is that it is infectious, that it's sexually transmitted, not that it's a gay disease. So the assumption, I think, of all of us at CDC was it's just a matter of time before it spreads out [into the general population]. Gay men were the flagship of any sexually transmitted disease. We knew that. They were always the leaders, because of their numbers of sexual partners.

ND: Hyperlink, text: Merle A. Sande on his initial thoughts about what he was seeing in San Francisco in 1981:, url: https://oac.cdlib.org/view?docId=kt...1&toc.depth=1&toc.id=d0e5593&brand=calisphere OR https://archive.ph/6LFDt

Sande- Yes. See, that didn't make any sense. Then you said, "Why would a gay male be different? Why would they be developing these diseases?" Particularly Pneumocystis that had only really been seen in very young undernourished children, or patients undergoing cancer chemotherapy, or who were on high doses of corticosteroids, who had immunosuppression.

So then the thoughts were, Well, there is certainly no evidence that gay men were genetically different. There were some theories that perhaps through their sexual activity they were getting large doses of different antigens, and somehow these antigens were turning on one part of the immune system, and maybe suppressing another part of the immune system. There was some suggestion that maybe the parasites that they were acquiring were immunosuppressant. There was some data to suggest that the sperm itself might be immunosuppressant, so perhaps gay men who were experiencing very promiscuous behavior might be developing an immunosuppression that set them up for opportunistic infections and malignancies. But nothing really made any sense.

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ND: Hyperlink, text: On Demographics (the view from 1993):, url: https://oac.cdlib.org/view?docId=kt...4&toc.depth=1&toc.id=d0e5593&brand=calisphere OR https://archive.ph/LiZgT

Sande- Well, no. I think I understand it. About 50 percent of the gay male population in San Francisco was infected before 1983, if the studies are correct, and I think they probably are. And there has not been a lot of transmission since 1982. So now that's thirteen, fourteen years, and the incubation period is about ten years. So half of them would be six to ten to ten and a half years after infection. So now, 60, 70 percent of them are developing symptoms, if they haven't died already. Now, that's the population that education clearly worked for, because transmission of AIDS dropped way down.

But since that time, the proportion of cases in the intravenous drug-abusing community, the crack-smoking community, has started drifting up, particularly in women. It's becoming more of a problem now than it was before. Ninety percent of our patients are still gay males, or gay males who are also intravenous drug users.

ND: Hyperlink, text: Dr. John Ziegler on "Immune Overload":, url: https://oac.cdlib.org/view?docId=kt...6&toc.depth=1&toc.id=d0e9661&brand=calisphere OR https://archive.ph/zwY4U

Hughes- Did you ever give any credence to some of the other theories that were floating around? Immune overload, for example?

Ziegler- Yes. Actually, Jay Levy and I wrote a paper before the virus was discovered. It was a sort of accepted theory at the time that somehow gay men, because of their immense promiscuity, were overloading their immune systems with viruses and amoebas and various other things. Then we tried to explain the same thing by saying that it was immune overload in hemophiliacs, and immune overload in people with blood transfusions, and immune overload in IV [intravenous] drug abusers who were continuing pushing foreign antigens into their bloodstream.

But if immune overload were the case, why would the epidemic start in 1981 when these people had been immune overloaded for decades? So although immune overload was always held out as a co-factor, and I think it probably is a co-factor, the concatenation of all of those things simply didn't explain the explosive rise of the epidemic.

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ND: Their systems were revved up and in overdrive...................Hyperlink, text: On Immunostimulation:, url: https://oac.cdlib.org/view?docId=kt...9&toc.depth=1&toc.id=d0e9974&brand=calisphere OR https://archive.ph/AzD5B

Ziegler- Our explanation for that was that these patients were already very immunostimulated. Again, I guess more or less in hindsight, we always think of immunosuppression/immunostimulation as kind of an on/off toggle switch, which is dead wrong. In point of fact, what we should have known all along and which everybody is rediscovering is that when somebody is immunostimulated, it doesn't mean they have a strong immune system. In point of fact, their immune system is probably diverted from what it should be doing.

We learned that years ago when we were studying malaria in Africa. Malaria is a disease that causes a very massive stimulation of the immune system: Spleens get big, immunoglobulins go up, these patients are very turned on immunologically. But they're not necessarily healthier. In fact, they're very unhealthy. If you have someone with acute malaria and try to give him a tetanus shot, he won't develop antibodies. He just doesn't respond to vaccines. If somebody has bad malaria, he is more susceptible to getting bad pneumonia. If you have malaria and measles together in children, you've got a lethal combination--25 percent of them die of pneumonia.

So while we were thinking immune stimulation is a great thing, gets the system revved up and that sort of thing, it's totally wrong. A stimulated immune system causes a functional immune suppression.

Ziegler- What Don Abrams was noticing in his men with lymphadenopathy syndrome were patients who were massively immunostimulated. If you take the lymph nodes out and slice them up, they are filled with lymphocytes. Well, you would have thought, "Great, lots of lymphocytes, lots of immunity." Wrong. Lots of lymphocytes, all stimulated, not doing their job. And in fact, by getting stimulated, the lymphocytes were putting out all these cytokines and making people feel lousy, like they had the flu.

So that's sort of a sidebar, but it does help explain that we were kind of on the wrong track when we were talking about immunostimulation/immunosuppression. Basically, immunostimulation equals immunosuppression.

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• https://oac.cdlib.org/view?docId=kt...4&toc.depth=1&toc.id=d0e8748&brand=calisphere OR https://archive.ph/yM28z Page 29

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