And the Band Played On: Politics, People, and the AIDS Epidemic is a 1987 book by San Francisco Chronicle journalist Randy Shilts. The book chronicles the discovery and spread of the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) with a special emphasis on government indifference and political infighting—specifically in the United States—to what was then perceived as a specifically gay disease. Shilts's premise is that AIDS was allowed to happen: while the disease is caused by a biological agent, incompetence and apathy toward those initially affected allowed its spread to become much worse.
The book is an extensive work of investigative journalism, written in the form of an encompassing time line; the events that shaped the epidemic are presented as sequential matter-of-fact summaries. Shilts describes the impact and the politics involved in battling the disease on particular individuals in the gay, medical, and political communities. Shilts begins his discussion in 1977 with the first confirmed case of AIDS, that of Grethe Rask, a Danish doctor working in Africa. He ends with the announcement by actor Rock Hudson in 1985 that he was dying of AIDS, when international attention on the disease exploded.
And the Band Played On was critically acclaimed and became a best-seller. Judith Eannarino of the Library Journal called it "one of the most important books of the year" upon its release.Eannarino, Judith (November 15, 1987). "And the Band Played On (book review)". Library Journal, 112 (19), p. 71. It made Shilts both a star and a pariah for his coverage of the disease and the bitter politics in the gay community. He described his motivation to undertake the writing of the book in an interview after its release, saying, "Any good reporter could have done this story, but I think the reason I did it, and no one else did, is because I am gay. It was happening to people I cared about and loved." The book was later adapted into an HBO film of the same name in 1993. Shilts tested positive for HIV while he was writing the book; he died of complications from AIDS in 1994.
Background
Shilts decided to write And the Band Played On after attending an awards ceremony in 1983 where he was to receive a commendation for his coverage on AIDS. As described in the book, television announcer Bill Kurtis gave the keynote address and told a joke: "What's the hardest part about having AIDS? Trying to convince your wife that you're Haitian."p. 384, And the Band Played On Shilts responded to the joke by saying that it "says everything about how the media had dealt with AIDS. Bill Kurtis felt that he could go in front of a journalists' group in San Francisco and make AIDS jokes. First of all, he could assume that nobody there would be gay and, if they were gay, they wouldn't talk about it and that nobody would take offense at that. To me, that summed up the whole problem of dealing with AIDS in the media. Obviously, the reason I covered AIDS from the start was that, to me, it was never something that happened to those other people." After publication of the book, Shilts explained his use of the title: "And the Band Played On is simply a snappier way of saying 'business as usual'. Everyone responded with an ordinary pace to an extraordinary situation."Engel, Margaret. "AIDS and Prejudice: One Reporter's Account of the Nation's Response." The Washington Post, December 1, 1987, p. Z10.
Summary Shilts focuses on several organizations and communities that were either hit hardest by AIDS—and were given the task of finding the cause of the disease—or begging the government for money to fund research and provide social services to people who were dying. He often uses an omniscient point of view to portray individuals' thoughts and feelings.
Gay community AIDS in the United States most notably struck gay communities in Los Angeles, New York City, and San Francisco. This was largely due to the general public's limited knowledge of the importance of protected ("safe") sex and IV drug using practices in preventing the transmission of diseases in the 1970s and 80s. Shilts's sources in the gay community tried to remember the last time everyone they knew was healthy, which was the United States Bicentennial celebration in 1976 when sailors came from all over the world to New York.pp. 142–143 And the Band Played On Some of them carried sexually transmitted diseases and rare tropical fevers. A marked difference in these cities arose in two phases of consciousness in the gay community: "Before" in 1980, and "After" by 1985. "Before", according to Shilts, was characterized by a care-free innocence, preceding the period when gay men were aware of a deadly infectious disease.p. 12, And the Band Played On "After" signified the realization that gay men knew most or all of their friends were infected with AIDS, and the syndrome became pervasive throughout the media.pp. 585–590, And the Band Played On
In San Francisco, particularly in the Castro District, gay community activists such as Bill Kraus and Cleve Jones found a new direction in gay rights when so many men came down with strange illnesses in 1980. The San Francisco Department of Public Health began tracing the disease, linked it to certain sexual practices, and made recommendations—stop having sex—to gay men to avoid getting sick, a directive that defied the chief reason why many gay men had migrated to the Castro, and for what gay rights activists in San Francisco had fought for years.pp. 38–40, 154–155 And the Band Played On Kraus and Jones often found themselves fighting a two-fronted battle: against city politicians who would rather not deal with a disease that affected gay men, who were seen as an undesirable population, and the gay men themselves, who refused to listen to doomsday projections and continued their unsafe behavior.pp. 152–154, 167, 180, 200, 209–210, And the Band Played On
In New York City, men like Larry Kramer and Paul Popham, who had previously shown no desire for leadership, were forced by bureaucratic apathy into forming the Gay Men's Health Crisis to raise money for medical research and to provide social services for scores of gay men who began getting sick with opportunistic infections.p. 133–134, 166–167, And the Band Played On Shilts describes the desperate actions of the group to get recognition by Mayor Ed Koch and assistance from the city's Public Health Department to provide social services and preventive education about AIDS and unsafe sex.pp. 309–311, And the Band Played On
In these cities, however, the sizable gay communities in most instances were responsible for raising the most money for research, providing the money for and subsequently the social services for the dying, and educating themselves and other high-risk groups. Kramer would go on to form AIDS Coalition to Unleash Power (ACT UP), a political activist organization that forced government and media to pay attention to AIDS."Larry Kramer." Contemporary Authors Online, Gale, 2009. Reproduced in Biography Resource Center. Farmington Hills, Mich.: Gale, 2009. Jones formed the NAMES Project that created the AIDS Memorial Quilt, the largest folk art display in the world."Cleve Jones." Gay & Lesbian Biography. St. James Press, 1997. Reproduced in Biography Resource Center. Farmington Hills, Mich.: Gale, 2009.
Medical community Doctors were the first to deal with the toll that AIDS would take in the United States. Some—like Marcus Conant, James Curran, Arye Rubinstein, Michael S. Gottlieb, and Mathilde Krim—would also realize their professional lives' courses in dealing with patient after patient who showed up in their offices with baffling illnesses, most notably lymphadenopathy, pneumocystis carinii pneumonia, Kaposi's sarcoma, toxoplasmosis, cytomegalovirus, cryptosporidiosis, and other opportunistic infections that caused death by a grisly combination of ailments overtaxing a compromised immune system. With no information on how the disease was spread, hospital staff were often reluctant to handle AIDS patients, and Shilts reported that some medical personnel refused to treat them at all.pp. 150, 321–322, 374–375 And the Band Played On.
Shilts praised the Public Health Department of San Francisco's handling of the new communicable disease as they tracked down people who were sick and linked them to other people who had symptoms, although some of them were living in different parts of the country. He criticized the New York City Public Health Department for doing very little, specifically when Public Health Director David Sencer refused to call AIDS an emergency and stated that the Public Health Department need not do anything because the gay community was handling it sufficiently.p. 310, And the Band Played On
Around the same time gay men were getting sick in the United States, doctors in Paris were receiving patients who were African or who had lived in Africa with the same symptoms as the Americans. Parisian researchers Jean-Claude Chermann, Françoise Barre, Luc Montagnier, and doctor Willy Rozenbaum began taking biopsies of HIV-infected lymph nodes and discovered a new retrovirus.pp. 219, 229, 237–238, And the Band Played On As a scientific necessity to compare it to the American version of HIV, French doctors representing the Pasteur Institute sent a colleague to the National Cancer Institute, where Robert Gallo was also working on the virus. The colleague switched the samples, Shilts reported, because of a grudge he had against the Pasteur Institute.pp. 238, 239–240, And the Band Played On Instead of Gallo comparing his samples with the French samples, he found the very same retrovirus as the French sample, putting back any new results in AIDS research for at least a year.pp. 264, 386–388, 401, 409, 418–420 And the Band Played On
Departmental ego and pride, according to Shilts, also confounded research as the Centers for Disease Control and the National Cancer Institutes battled over funding and who might get credit for medical discoveries that were to come from the isolation of HIV, blood tests to find HIV, or any possible vaccine.pp. 429–430, 434–435, 444–445, 447–448, 450–452, 460–462, And the Band Played On Once AIDS became known as a "gay disease" there was particular difficulty for many doctors in different specialties to get other medical professionals to acknowledge that AIDS could be transmitted to people who were not gay, such as infants born from drug-using mothers,pp. 103–104, And the Band Played On children and adults who had hemophilia (and later, their wives),pp.115–116, 160–161, And the Band Played On Haitians,pp. 124, 135–136, And the Band Played On and people who had received blood transfusions.
The discovery of HIV in the nation's blood supply and subsequent lack of response by blood bank leadership occurred as early as 1982,pp. 195, 220–223, And the Band Played On yet it was not until 1985, when HIV antibody testing was approved by the Food and Drug Administration (FDA), that blood bank industry leaders acknowledged that HIV could be transmitted through blood transfusions.pp. 307–309, 332–333, 344–346, And the Band Played On Shilts's coverage revealed the feeling among blood bank industry leaders that screening donors for hepatitis alone might offend the donors, and that the cost of screening all the blood donations provided across the country every year was too high to be feasible.p. 223, And the Band Played On
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