AIDS 'Patient Zero' was a publicity strategy, scholar writes

The 1987 New York Post headline - THE MAN WHO GAVE US AIDS - was arguably one of the most influential of all time.

"Patient Zero" - a promiscuous gay Canadian flight attendant - had spread AIDS from coast to coast. The story sparked sensational media coverage, drove a book onto the best-seller lists, pushed the "gay disease" onto mainstream America's radar screen, and helped jump-start an activist movement, all of which eventually focused more money and scientific brainpower on an epidemic that had already killed tens of thousands.

It was also wrong - intentionally creating a scapegoat to publicize And the Band Played On, Randy Shilts' authoritative chronicle of the early years of AIDS. The book mentioned the case on just a dozen or so of its 630 pages.

"We lowered ourselves to yellow journalism. My publicist told me, 'Sex, death, glamour, and, best of all, he is a foreigner, that would be the icing on the cake,' " Michael Denneny, Shilts' editor, said in an interview. "That was the only way we could get them to pay attention."

How the first serious examination of AIDS policy had to be sold as sordid tabloid fare is described in a new book by Philadelphia University historian Phil Tiemeyer, Plane Queer: Labor, Sexuality, and AIDS in the History of Male Flight Attendants.

When he recently asked students about the media deception, "three-quarters of the class were a bit repulsed," Tiemeyer said. But they don't remember a time when AIDS meant certain death, he said, and preventing it was not a priority for the news media, the Reagan administration, or most of the public.

The 1970s and early 1980s - after New York's Stonewall riots and before AIDS - were the heyday of gay male sexual liberation, with dance bars and steam baths overflowing as meeting places and hundreds of sexual partners a year not that unusual. A new disease surfaced in 1981, but its mode of transmission was then a mystery.

"People were dropping dead left and right of the most horrible, opportunistic infections, no one knew what was happening, and everyone knew that if this was sexually transmitted," they'd be dead, said Denneny, Shilts' editor.

Patient Zero was an actual early case. He just wasn't the first case. And in the book, Denneny said, he "was representing all the people who refused to stop having unprotected sex even after they became ill."

Shilts describes the astonishment of scientists, who were trying to learn how the infection was spread, upon hearing again and again from patients that dying men in different cities had had sex with a gorgeous young flight attendant.

Shilts discusses the 1984 study that demonstrated sexual transmission by diagramming links among cases labeled by location, such as LA9 and NY4. Eight are directly connected to a patient labeled simply 0 - the Patient Zero who, according to a study author, originated as a letter O (for "Out of California") in an earlier study of men around Los Angeles.

And Shilts relays the attitude of that patient - calling him "the Quebecois version of Typhoid Mary" - as he continues to have sex with men in different cities, in chilling scenes like this:

"Back in the bathhouse, when the moaning stopped, the young man rolled over on his back for a cigarette. Gaëtan Dugas reached up for the lights, turning up the rheostat slowly so his partner's eyes would have time to adjust. He then made a point of eyeing the purple lesions on his chest. 'Gay cancer,' he said, almost as if he were talking to himself. 'Maybe you'll get it, too.' "

Shilts, a reporter for the San Francisco Chronicle who died of AIDS in 1994, never actually wrote that Dugas brought the disease to the United States, saying it was "a question of debate." And he resisted using that salacious angle to promote his weighty history, his editor said.

"Randy hated the idea. It took me almost a week to argue him into it," Denneny tells Tiemeyer in the new book.

But there was "terrific animus in the media about covering AIDS at all," Denneny said. The New York Times, Newsweek, and other publications "all told us they were not going to review a book that was an indictment of the Reagan administration and the medical establishment."

So St. Martin's Press produced new publicity materials focusing on the hot flight attendant and fed them to the New York Post. The tabloid's Oct. 6, 1987, headline sparked a media frenzy. Shilts appeared on 60 Minutes. The Times reviewed the book on a weekday and again on Sunday; it was a best seller the following week.

"And then we put Randy on a huge publicity tour, and he spent time switching the attention to the Reagan administration," Denneny said.

Still, the focus on a promiscuous homosexual who knowingly infected others infuriated many in the gay community. They feared - rightly - that they would be blamed for spreading the disease even as they sought to rein in the laissez-faire sexual culture.

Kenneth Mayer, an AIDS doctor and public policy expert now at Harvard University, was at a conference in New York when the Post hit newsstands.

"I remember thinking, this is really unfortunate," he said of the single-villain approach. "It is much more complicated. It is much more about people's willingness to talk to people they have sex with and to change their own sexual practices."

But if that was the only way to get the book to a mass audience, he said, "I guess in the long run they did a service to increase the conversation."

David R. Fair feels the same way. He had just been named head of Philadelphia's new AIDS office and was trying to get the city to take the crisis seriously. "The first thing I did was buy 40 copies of the book and give it to the mayor and department heads," said Fair, now a consultant to nonprofit organizations.

"It's really hard to remember how little attention was being paid to AIDS outside New York and San Francisco," he said. "The book is what led to the creation of a national AIDS activism movement."

Tiemeyer had not planned to write a new book about Patient Zero. Indeed, that story takes up just two chapters (but is, ironically, his publicity pitch). A historian of gay and lesbian communities, he had decided to dig into the impact of gay male flight attendants.

In this seemingly narrow demographic, Tiemeyer finds notable achievements in equal rights, from the first workplace health benefits for domestic partners, in 2001, to a 1984 legal decision forcing an airline to reinstate a flight attendant with AIDS, which he argues was a key step in the run-up to the 1990 Americans With Disabilities Act.

For a time, Gaëtan Dugas was the best-known flight attendant in the world.

"On the one hand, the minute that Randy released this story about Patient Zero, people knew it wasn't true," Tiemeyer said. "On the other hand, the fear was so intense," and so-called "family issues" had become so divisive, that "they wanted a scapegoat, they wanted to believe that this thing that was out of control was caused by gay male sexual excess," he said, "that there was someone who was to blame."

Bill Darrow, a coauthor of the original studies that cited Patient Zero as a link to show sexual transmission, is among Shilts' biggest supporters, and he has few qualms about the selling of And the Band Played On. Darrow, now a professor at Florida International University, teaches a course called Ethical Issues in Public Health.

"Most public health people think that the ends justify the means," he said. He recalled the fights for money and recognition of growing danger during the Reagan administration.

"We had to wait almost five years for anybody to pay attention to this terrible problem. By then it was too late," Darrow said. If they had done so earlier, "we could have saved an awful lot of lives."