AIDS 83

AIDS in the U.S., 1983-1985

In late1982 and early 1983, a special AIDS group, formed by the Centers for Disease Control in Atlanta, told Gay Leaders and Blood Bankers that AIDS (first called GRID, for Gay Related Immune Deficiency) appeared to be caused by a new virus which was spreading years ahead of symptoms, and that there was already an expanding pool of healthy but infected gay men much larger than the 1000 cases so far recognized. Blood transmission had apparently caused a few cases, and gay men were known to be very avid donors. But blood bankers and gay leaders, both of whom the CDC needed for research, got together and convinced the CDC to back off with their alarming, politically volatile picture, until they could offer better evidence to support it. To gay leaders the CDC's claim that AIDS was hitting gays not straights, combined with the claim that AIDS had a long term carrier state with no sign of disease, was the same as saying all gays have AIDS. And that was effectively what the CDC wanted to make policy: that a history of male homosexual sex meant one should consider himself a possible a carrier of the suspected AIDS virus.

The book, And the Band Played On, by the late Randy Shiltz, who was gay, is the only widely known discussion of how gay leaders reacted against the CDC in 1983. The CDC AIDS team was a group of idealistic, motivated, young, open-minded doctors, natural allies for gay leaders in a sea of reaction. This team went to gay leaders on their knees, although they may have been a bit abrupt at the beginning. Curran, Jaffe, Koplan, Francis et. al. were good men. Gay leaders turned angrily away from the CDC and sought an alliance with blood bankers, who were also telling the CDC to back off.

That gay leaders reacted defensively to the CDC's message is understandable, given the fear that such a policy would drive gay men back "into the closet" at the moment in history when homosexuality was first emerging from pariah status, and gay people were first beginning to assert rather than hide their identity. But there is no excuse for gay leaders not passing on to the gay community what the CDC was saying about AIDS. Gay leaders in New York, San Francisco, and Washington D.C. refused to even discuss the CDC AIDS picture with gay men, with the exception of a few individuals, including Larry Kramer in New York and Will Warner (an M.D.) in San Francisco. In the gay journals like the Bar, the N.Y. Native, all that was said about the CDC is that they wanted to call AIDS a gay disease, "skapegoating" the gay community, and that the CDC was callously saying gays had "bad blood." Blood bankers, like gay leaders, did not mention the CDC's "long incubation sate" picture of AIDS when speaking to the media. In the media and before congress blood bankers gave their "one in a million" estimate of AIDS-transfusion risk, a figure based on the several suspected blood bank transmissions put against the huge number of transfusions given in the last year or two. Gay leaders said only the most promiscuous gay men were at risk. But no one heard the CDC's claim, the "long incubation state" idea, that pulled the rug out from under the gay-leader and blood-banker arguments. It pulled the rug out because: if there was an expanding pool of virus carriers, then blood bankers could not fairly estimate the AIDS risk in a transfusion based on the few apparent cases. Likewise the position of gay leaders, that only the most promiscuous gay men were at risk, became a more dubious assumption when you pictured a virus spreading unseen years ahead of clinical disease.

The Philadelphia Inquirer (in a series by Donald Drake) reported on the CDC's alarming claim, and even reported on the tense exchanges occurring between the CDC on one side and gay leaders and bloodbankers on the other. But the San Francisco Chronicle, the Washington Post and the New York Times said not a word about the CDC's picture of AIDS. (If you can find an example contradicting our assertion of a coverup by gay and straight presses, please send it to us.) There is no question that the people at those newspapers knew about the Atlanta meeting, where the CDC pressed their case to various parties.

The Journal of the American Medical Association reported on the meeting, putting the caption "What me worry?" on top of the section that described the claims of gay leaders and blood bankers that the CDC was pushing too fast with an unproven idea. (The long incubation state.) ("What me worry" is the slogan of Mad Magazines mascot Alfred E. Neuman.) But in general medical journals were silent on the CDC's claim of an expanding pool of infected, asymptomatic gay men.

The CDC AIDS team was in a tough position. They could go public with their claim, but this would pit them against gay leaders and blood bankers who they needed to do the research to prove their claim. Without good communication with gay AIDS patients the CDC could not establish patterns of transmission. Blood bankers had the records needed to establish donor to recipient transmission, and blood bankers, given the privacy issues involved, did not have to release records to the CDC just because the CDC wanted them. Furthermore blood bankers controlled the FDA "Blood and Blood Products Committee," raising the specter of a public dispute between two government agencies, the CDC and the FDA, about how to describe AIDS risk factors and transmission.

That blood bankers and gay leaders were united in defiance of the CDC was made clear in a January, 1983 meeting that followed the session convened by the CDC in Atlanta. Meeting in Washington, D.C., a group of gay leaders met with the top blood banking agencies, including the American Red Cross and the AABB (American Association of Blood Banks), and drafted a policy statement stating that groups with elements at high risk for AIDS -- meaning promiscuous gay men -- would be targeted with education about blood donation. There was no mention of homosexuality. Blood bankers agreed that it would be wrong to stigmatize gays by doing so.

Gay leaders were ecstatic, and in the B.A.R, Advocate and New York Native they brandished their victory over the CDC. Gay leaders had challenged the "gays-have-bad-blood" bigots and brought reason to bear. They had used common sense to steer the blood industry away from government hysteria. What remained unspoken to the gay community was the source of the CDC's anxiety: an expanding pool of many thousands of gay virus carriers with no disease symptoms.

In March the government countered and issued a policy for deferral of "homosexual and bisexual men with multiple partners." This meant that donation was open to gay men who were monogamous -- the government's way of trying to avoid a backlash say that would accompany a "blanket ban" on gay donors. Dr. Ed Brandt, who was with HHS, wrote this policy to try to appease the gay leaders. The appeasement didn't work, a wave of gay protest swept the country. Congressman Henry joined the clamor by stating that the donor guidelines were based on politics not science.

The CDC was frantically trying to assemble blood bank connections between blood recipients who contracted AIDS and infected donors, and by this route establish that AIDS had a long incubation state. At the end of 1984 they published an article that, for lack of clear data, convinced nobody of anything. They were able to present only six donor/recipient suspected transmissions, and in most of these the recipient had become ill or died while the suspect donor was alive and healthy. It would be expected, of course, that the donors, having been infected sooner, would die before the recipient or be more advanced in disease progression. It was later established that, for unclear reasons, blood recipients run a faster than normal disease progression with AIDS. Letters and editorials in the journals made light of the CDC AIDS group's sketchy, dubious data. It is not clear to what extent blood banks withheld data that would have furnished the CDC with a better article, and if readers know of an article on this issue we would be grateful to receive it.

That the CDC had been spurned by gay leaders and then proven right was discussed in depth only in Randy Shilts 1987 book, "And the Band Played On," which was followed by a movie that was a cover-up for gay leaders. The straight presses reviewed Shilts's book without discussing the importance of gay and straight presses having chosen not to talk about the CDC's 1983 warning. Blood bankers were much lambasted, but gay leaders escaped unscathed, except for Randy Shilts's book. The gay community approved of the the cover-up movie but turned away from the book.

The reason gay men were infected and not heterosexuals was, according to the now accepted view, anal intercourse, much more of a gay than straight practice. The refusal of gay leaders in 1982-5 to address why gays were getting AIDS and not heterosexuals, was based on their contempt for the notion that AIDS was a disease that hit gays but not "straights." Gay leaders talked about promiscuity in gay men as a major AIDS factor, perhaps causing "immune overload" due to serial bouts of STD's (sexually transmitted diseases) , coupled with drug use, e.g. cocaine, amphetamines. But the idea of a virus that was targeting gays and not straights was not considered rational by gay leaders, except for Larry Kramer and Will Warner, who were scorned as pandering to the establishment.

If gay leaders had taken seriously the CDC's picture of a new virus hitting gays much more than straights, and that this virus caused disease only after years of dormancy, then there would have been a compelling reason to push the condom campaign in 1983 rather than in 1986. There were gay activists trying to get condom use going in 1983, but they did not present the CDC picture in their promotion, and thus they failed to advertise the threat to gay men that would encourage them use condoms. As to the argument that there was no proof condoms would prevent AIDS transmission, this was also the case in 1986, but the program took hold anyway because the test had shown healthy carriers were everywhere.

There were already a lot of transmissions by 1983, but by putting the CDC's picture up on the table (rather than refusing to discuss it) gay leaders would surely have galvanized the condom campaign in that year, and thereby averted one to three hundred thousand transmissions. At the same time they probably would have prevented about half the blood bank transmissions, although there were amazingly few donor blood transmissions under the circumstances.

Gays were very avid blood donors, and it appears that gay donors did a very good job of stopping giving blood in 1983-5, given the outcry from gay leaders about the gay right to give blood unless you were extremely sexually promiscuous. The promiscuity level posing a threat was variously enumerated in episodes per week, ranging from 10 to 50. The gay newspapers quoted many self-styled experts on this issue, never mentioning what the CDC was saying. The silence of the gay and straight media on the CDC's picture was another factor seeming to invite a gay blood donor disaster. If 1/3 of gay blood donors deemed eligible by gay leaders had gone on giving blood from '83 to '85, with several donations a year being typical, and with each donation divided into parts, 50,000 to 100,000 blood bank cases would probably have been the resulting number instead of the 10,000 that occurred. I think gay donors good sense goes with decency that made them want to be donors in the first place. Gay leaders, conversely, were trying to be heroes and lost their common sense. Only Larry Kramer and Will Warner tried to speak against the madness.

An illusion that has been floating around, reinforced by the movie version of "And the Band Played On," is that the hepatitis-B core antibody test would have been useful as an AIDS blood screen, justifying the call of gay leaders, in 1983, to "screen blood not people" at blood banks. This position was based on the fact that over 90% of AID patients, by early 1983, tested positive for that "marker," the hepatitis-B core antibody, which shows a past exposure to hepatitis-B virus. It was certainly a risky premise that a test which was not specific for AIDS could be relied on to protect the blood supply. As it turned out, only 8% to 25% (depending on city) of HIV-positive samples of blood stored from 1984 were also positive for the hepatitis-B marker, according to an NIH study done at USC (Dr. Jim Mosely). Like promiscuity, the hepatitis-B core antibody was seen in the early patients at a high rate, but as the epidemic unfolded those identifiers became less common. Another test which was touted as a "surrogate" AIDS screen, showing a disparity in T-helper and T-suppressor cells, would also have been of negligible value.

Gay leaders who dealt with the CDC and blood bankers and others on the blood donor issue argued that donor screening would not work because of bisexuals and gay men "in the closet." A gay man might be presenting himself at work as straight, and he might be married, and thus when a ban on gay donors was announced, he would not want to conspicuously stop giving blood. (Donor groups are recruited in the workplace.) The blood banks came up with a solution to this problem, a "for studies only" option, a check box, which would permit an individual to go on giving blood while confidentially ensuring that his blood would not be given to a patient. Gay leaders, as Larry Kramer pointed out, could have been making policy by getting gay donors off the market, thus freeing up the search for solutions to bisexuality, closet gays, and Haitians. But instead of seeking solutions to these tricky questions, gay leaders chose to become the center stage obstacle, so that all parties had to focus on their obsession with the gay right to give blood. Larry Kramer and Will Warner had the right idea: worry about the blood supply, not the gay right to give blood.

There are many issues that need to be better discussed if we are going to learn from our failures in the early AIDS years. For instance the FDA should be told that they should have done something to stop the rampant selling of plasma by I.V. drug users when AIDS hit the public health screen. The government monitors would show up with their clipboard, look around and walk out. The collection site operators rarely checked for needle marks. Another issue, somewhat later, is that AZT killed people because the dose protocol was too high. But no issue is more important and more hidden from view, in terms of learning from public health mistakes with AIDS, than the cover up of the CDC's picture by gay leaders and blood bankers. "Easy for you to say with hindsight" is a common reply, but this is just an evasive tactic: (1) because their has been no hindsight, regarding gay leaders, except for Randy Shiltz's book, followed by a coverup movie, (2) because hindsight disclaimers involve warnings that were hard to see at a time in the past, clues that were obscure and remote: the CDC's picture wasn't remote, it was in the center, being presented by the people with the authority to shape the public health response, but it was hidden from the public because the CDC backed down to gay leaders and blood bankers, and (3) because gay leaders and blood bankers refused to even present the CDC picture -- the virus spread among gay men first, the clinical disease several years later -- to the gay community.

If one said gay leaders should have agreed completely with the CDC, one might say, "easy for you to say with hindsight." But that argument doesn't work when it comes to a coverup, a refusal to present a description of what the CDC was warning. There is no excuse for this silence. Will Warner and Larry Kramer were using common sense. All the rest, including Dr. Larry Mass, Dr. Bruce Voeller, virginia Apuzzo, and Jeffry Levi were hiding from their public health responsibility for political reasons.

As to the possibility that a right wing lab made the AIDS virus, if that is the case, then gay leaders and blood bankers were unwittingly acting as agents of that lab. The crucial information which would alert the gay community to the threat at hand was the long-incubation state idea, the CDC picture, which gay leaders, along with their pals the blood bankers, actively suppressed.

We would like to touch again on the FDA's March 1983 blood donor policy, as an example of how off-kilter things were pertaining to AIDS at the time. "Homosexual and bisexual men with multiple partners," were asked to stop giving blood. What is a bisexual man without multiple partners? "Multiple male partners" is what was meant by Dr. Ed Brandt, who wrote this policy attempting to appease the wrath of gay leaders who had promised they would not support a blanket ban on gay blood donors. So the idea was to leave donation open to monogamous gay men, showing that the government was not trying to say that homosexuality in and of itself constituted and AIDS risk. It seemed a better bet to risk some monogamous gay men giving blood than to risk hostility and non-compliance by gay donors over a "blanket ban." But when the policy was issued there was a nationwide protest on the part of gay activists holding to the line that only the most promiscuous were at risk, that limiting donation to only monogamous gay men was therefore unfair. The scientific solution was to screen blood with the hepatitis test, activists claimed, and congressmean Henry Waxman was quoted in the Advocate as saying the new policy was based on political considerations, not scientific ones. When the Washington D.C. chapter of the Red Cross tried to impose a "blanket ban" on gay blood donors, saying that the FDA policy was not good enough, local gay leaders, threatened non-compliance and the Red Cross backed down.

In the New York Native (a gay press) one of the very few published objections to gay leaders' position on blood donation was from one Dennis Pidgeon, in a letter. He pointed out that "society has a right to protect itself from a danger in its midst. How ironic that we, who have been regarded with suspicion from the beginning, should make ourselves an real threat rather than an imaginary one." At a July, 1983 meeting of AIDS activists in Colorado Will Warner tried to present the same idea, following Virginia Apuzzo to the podium. Ms. Apuzzo had declared that with respect to blood donation gays would not be treated as "second class citizens," to a rousing round of applause. Dr. Warner countered that first class citizens do not take risks with the lives of others, and was shouted down. It is a fortunate thing that gay blood donors did not think like gay leaders. It is also unfortunate that gay men did not take the same precaution to protect themselves that they took to protect the public.

Perhaps the low point in blood-related rhetoric came at a press conference called at a New York hotel by AIDS activists after the National Hemophilia Foundation called for an exclusion of all plasma donors (paid donors) with a history of male homosexual sex. Ms. Appuzo, lamenting a policy that would unfairly stigmatize all gay men, noted that hemophiliacs and gay men were both victims of AIDS, and thus the NHF policy was, sadly, "pitting victim against victim". If fact there wasn't much of a threat from gay men selling plasma, although Hugh Rice, head of the gay Eddelman clinic in Los Angeles interviewed young men with sexually transmitted diseases who were selling themselves sexually, and found that some of them were selling plasma. He advised them to stop. But the main issue on the plasma front, I.V. drug users, was ignored by the National Hemophilia Front.

It should be noted that some contamination of the clotting factor for hemophiliacs was inevitable, because each batch was made from thousands of units from different donors. Hemophiliacs were in a sad predicament, the powdered clotting factor was a new wonder that had transformed their care. The prior method, cryoprecipitate -- a residue of frozen plasma developed by Judith Poole at Stanford -- required large volumes and was relatively inefficient, and still carried an AIDS risk. (The earlier method of getting factor VIII into hemophiliacs was whole plasma. Huge volume was required, and still patients died from bleeding, and congestive heart failure from the treatment put a limit on the volume.)

Before powdered factor VIII hemophiliacs died in their teens and early twenties, from internal hemorrhages that could follow any kind of blow to the body or head, or just occur spontaneously. They often could not walk, using wheelchairs. So hemophiliacs could retreat to prior methods and die, or continue with powdered factor and get AIDS. One issue in this context that should be further clarified involves heat treatment of factor VIII to make it virus free. There were delays in using heat treatment, and the selling of untreated factor-VIII rather than lose money by throwing it away. (For an article on this issue click here.)

For a discussion of current AIDS issues involving similar lapses in public health process click here.

AIDS, 1983-1985 ....(U.S.)

AIDS '83-'85..In 1982-3 a special AIDS group, formed by the Centers for Disease Control in Atlanta, told Gay Leaders and Blood Bankers that AIDS (first called GRID, for Gay Related Immune Deficiency) appeared to be caused by a new virus which was spreading years ahead of symptoms, and that there was already an expanding pool of healthy but infected gay men many times as large as the 1000 cases so far recognized. Blood transmission had apparently occurred in a few cases, and gay men were very avid donors, but blood bankers and gay leaders, whom the CDC needed for research, got together and convinced the CDC to back off with their alarming, politically volatile picture, until they could offer better evidence. To gay leaders the CDC's claim that AIDS was hitting gays not straights, combined with the claim that AIDS had a long term carrier state with no sign of disease, was the same as saying all gays have AIDS. And that was effectively what the CDC wanted to make policy: that a history of male homosexual sex meant one should consider himself a possible a carrier of the suspected AIDS virus.

That gay leaders reacted defensively to this message is understandable, given the fear that such a policy would drive gay men back "into the closet" at the moment in history when homosexuality was first emerging from pariah status, and gay people were first beginning to assert rather than hide their identity. But there is no excuse for gay leaders not passing on to the gay community what the CDC was saying to them. Gay leaders in New York, San Francisco, and Washington D.C. refused to even discuss the CDC picture with gay men, with the exception of a few individuals, including Larry Kramer in New York and Will Warner (an M.D.) in San Francisco. In the gay journals like the Bar, the N.Y. Native, all that was said about the CDC is that they were insensitive government agents intent on using AIDS to stigmatize the gay community and say that gays had "bad blood." And blood bankers also zipped their lips. In the media and before congress blood bankers gave their "one in a million" estimate of AIDS-transfusion risk, gay leaders said only the most promiscuous gay men were at risk, but no one heard the CDC claim, the "long incubation state" idea that pulled the rug out from under the gay leader and blood banker arguments. It pulled the rug out because -- if there was an expanding pool of virus carriers, then blood bankers could not fairly estimate the AIDS risk in a transfusion based on the few apparent cases. Likewise the position of gay leaders, that only the most promiscuous gay men were at risk, looked like a risky assumption when you pictured a virus spreading unseen years ahead of clinical disease. The Philadelphia Inquirer reported on the CDC's alarming claim, and even reported on the tense exchanges occurring between the CDC on one side and gay leaders and bloodbankers on the other. (In a series by Donald Drake.) But the San Francisco Chronicle, the Washington Post and the New York Times said not a word about the CDC's picture of AIDS. (If you can find an example contradicting our assertion of a coverup by gay and straight presses, please send it to us.)

The AIDS test that came out in 1985 showed, after a year of research, that that about half a million gay men had become infected, as the CDC had approximately forecast based on a hepatitis-B analogy. Almost no heterosexuals besides I.V. drug users were found to be infected. That the CDC had been spurned and then proven right was discussed in depth only in Randy Shilts 1987 book, "And the Band Played On," which was followed by a movie that was a cover-up for gay leaders. The straight presses reviewed Shilts's book without discussing the importance of gay and straight presses having chosen not to talk about the CDC's 1983 warning.

The reason gay men were infected and not heterosexuals was, according to the now accepted view ("dogma"), anal intercourse, much more of a gay than straight practice. The refusal of gay leaders in 1982-5 to address why gays were getting AIDS and not heterosexuals, was based on their contempt for the notion that AIDS was a disease that hit gays but not "straights." Gay leaders talked about promiscuity in gay men as a major AIDS factor, perhaps causing "immune overload" due to serial bouts of STD's (sexually transmitted diseases) , coupled with drug use, e.g. cocaine, amphetamines. But the idea of a virus that was targeting gays and not straights was not considered rational by gay leaders, except for Larry Kramer and Will Warner, who were scorned as pandering to the establishment.

If gay leaders had taken seriously the CDC's picture of a new virus hitting gays much more than straights, and that this virus that caused disease only after years of dormancy, then there would have been a compelling reason to push the condom campaign in 1983 rather than in 1986. There were gay activists trying to get condom use going in 1983, but they did not present the CDC picture in their promotion, and thus they failed to advertise the threat to gay men that would encourage them use condoms.

There were already a lot of transmissions by 1983, but by putting the CDC's picture up on the table (rather than refusing to discuss it) gay leaders would surely have galvanized the condom campaign in that year, and thereby averted one, two, or even three hundred thousand transmissions. At the same time they probably would have prevented about half the blood bank transmissions, although there were amazingly few donor blood transmissions under the circumstances.

Gay blood donors, who were very avid blood donors, did a very good job of stopping giving blood in 1983-5, given the outcry from gay leaders about the gay right to give blood unless you were extremely sexually promiscuous, variously enumerated in episodes per week, and given the overall silence on the CDC's picture of healthy virus carriers. If 1/3 of gay blood donors deemed eligible by gay leaders had gone on giving blood from '83 to '85, with several donations a year being typical, and with each donation divided into parts, 50,000 to 100,000 blood bank cases would probably have been the resulting number instead of 10,000.

An illusion that has been floating around, reinforced by the movie version of "And the Band Played On," is that the hepatitis-B core antibody test would have been useful as an AIDS blood screen, justifying the call of gay leaders, in 1983, to "screen blood not people" at blood banks. This position was based on the fact that over 90% of AID patients, by early 1983, tested positive for that "marker." But it was certainly a risky premise that a test which was not specific for AIDS could be relied on to protect the blood supply. As it turned out, only 8% to 25% (depending on city) of HIV-positive samples of blood stored from 1984 were also positive for the hepatitis-B marker, according to an NIH study done at USC (Dr, Jim Mosely). Like promiscuity, the hepatitis-B core antibody was seen in the early patients but did not hold true as an AIDS criterion in the long run.

Gay leaders who dealt with the CDC and blood bankers and others on the blood donor issue argued that donor screening would not work because of bisexuals and gay men "in the closet." A gay man might be presenting himself at work as straight, and he might be married, and thus when a ban on gay donors was announced, he would not want to conspicuously stop giving blood. (Donor groups are recruited in the workplace.) The blood banks came up with a solution to this problem, a "for studies only" option, a check box, which would permit an individual to go on giving blood, while confidentially ensuring that his blood would not be given to a patient. Gay leaders, as Larry Kramer pointed out, could have been making policy by getting gay donors off the market, thus freeing up the search for solutions to bisexuality, closet gays, and Haitians, whose risk had been identified amid tricky questions about Haitian culture and donor screening. But instead of seeking solutions gay leaders chose to become an obstacle, so that all parties had to focus on their obsession with the gay right to give blood, when everyone should have been working together on tributary issues like closet gays and bisexuals. Larry Kramer and Will Warner had the right idea: worry about the blood supply, not the gay right to give blood.

There are many issues that need to be better discussed if we are going to learn from our failures in the early AIDS years. For instance the FDA should be told that they should have done something to stop the rampant selling of plasma by I.V. drug users when AIDS hit the public health screen. The government monitors would show up with their clipboard, look around and walk out. The collection site operators rarely checked for needle marks. Another issue, somewhat later, is that AZT killed people because the dose protocol was too high. But no issue is more important and more hidden from view, in terms of learning from public health mistakes with AIDS, than the cover up of the CDC's picture by gay leaders and blood bankers. "Easy for you to say with hindsight" is an evasive tactic (1) because their has been no hindsight, regarding gay leaders, except for Randy Shiltz's book, followed by a coverup movie, (2) because hindsight disclaimers involve issues that were hard to see at the time, obscure and remote -- the CDC picture wasn't remote, it was in the center, being presented by the people with the authority to shape the public health response, but it was hidden from the public because the CDC backed down to gay leaders and blood bankers, and (3) because gay leaders and blood bankers refused to even present the CDC picture -- the virus spread among gay men first, the clinical disease several years later -- to the gay community. If one said gay leaders should have agreed with the CDC, one might say, "easy for you to say with hindsight." But that argument doesn't work when it comes to a coverup, a refusal to even put a description of what the CDC was saying in the gay presses or blood banking publications.

As to the possibility that a right wing lab made the AIDS virus, if that is the case, then gay leaders and blood bankers were unwittingly acting as agents of that lab. The crucial information which would alert the gay community to the devastating outcome in the making was the long-incubation state idea, the CDC picture, which gay leaders, along with their pals the blood bankers, actively suppressed.

As an example of how off-kilter things were pertaining to AIDS around 1983, consider the government policy on blood donation that was handed down by the FDA in March 1983. "Homosexual and bisexual men with multiple partners," were asked to stop giving blood. What is a bisexual man without multiple partners? "Multiple male partners" is what was meant by Dr. Ed Brandt, who wrote this policy attempting to appease the wrath of gay leaders who had promised they would not support a blanket ban on gay blood donors. So the idea was to leave donation open to monogamous gay men, showing that the government was not trying to say that homosexuality in and of itself constituted and AIDS risk. It seemed a better bet to risk some monogamous gay men giving blood than to risk hostility and non-compliance by gay donors over a "blanket ban." But when the policy was issued there was a nationwide protest on the part of gay activists holding to the line that only the most promiscuous were at risk, that limiting donation to only monogamous gay men was therefore unfair. The scientific solution was to screen blood with the hepatitis test, activists claimed, and congressmean Henry Waxman was quoted in the Advocate as saying the new policy was based on political considerations, not scientific ones. When the Washington D.C. chapter of the Red Cross tried to impose a "blanket ban" on gay blood donors, saying that the FDA policy was not good enough, local gay leaders, threatened non-compliance and the Red Cross backed down.

In the New York Native (a gay press) one of the very few published objections to gay leaders' position on blood donation was from Dennis Pidgeon, in a letter. He pointed out that "society has a right to protect itself from a danger in its midst. How ironic that we, who have been regarded with suspicion from the beginning, should make ourselves an real threat rather than an imaginary one." At a July, 1983 meeting of AIDS activists in Colorado Will Warner tried to present the same idea, following Virginia Apuzzo to the podium. Ms. Apuzzo had declared that with respect to blood donation gays would not be treated as "second class citizens," to a rousing round of applause. Dr. Warner countered that first class citizens do not take risks with the lives of others, and was shouted down. It is a fortunate thing that gay blood donors did not think like gay leaders. It is also unfortunate that gay men did not take the same precaution to protect themselves that they took to protect the public.

It should be noted that some contamination of the clotting factor for hemophiliacs was inevitable, because each batch was made from thousands of units from different donors. Hemophiliacs were in a sad predicament, the powdered clotting factor was a new wonder that had transformed their care. The prior method, cryoprecipitate -- a residue of frozen plasma developed by Judith Poole at Stanford -- required large volumes and was relatively inefficient, and still carried an AIDS risk. The earlier method of getting factor VIII into hemophiliacs was whole plasma. Huge volume was required, and still patients died from bleeding, and congestive heart failure from the treatment put a limit on the volume.

For a discussion of current AIDS issues involving similar lapses in public health process click here.