When I first read Randy Shilts’ AND THE BAND PLAYED ON: Politics, People and the AIDS Epidemic, I saw it as a current-events book that would be worth reading as history in decades to come. Rereading it recently I still think so, with one large exception (discussed in Killing Patient Zero further on).
As the book begins, gay men in San Francisco and New York — two hotspots for gay life at the time — start coming down with Kaposi’s sarcoma, a skin cancer that typically affects elderly Jews and grows slowly. These cancers did not. Other victims are hit with baffling bacterial growth in the lungs or brain diseases. Before long it becomes clear that something is killing gay men but is it drugs? An STD? How can it be stopped? And what do you call it: what started as “the gay cancer” became Gay-Related Immune Deficiency and then Acquired Immune Deficiency Syndrome.
Shilts’ book is fueled by rage at pretty much everyone. Gays who refused to believe their sex life was the issue, and refused to practice safe sex. Government officials in both cities who sat on their hands about doing anything to help gays, or refused to close gay bathhouses for fear of offending gay supporters. Media that had zero interest in writing about some disease killing those icky people (the first stories focused on It Might Affect Straights!!!). Blood banks that resisted taking precautions against tainted blood — their blood does not have gay cooties! And it would be expensive to test! The Reagan administration lied through its teeth saying, over and over, that they’d funded every possible AIDS research and mitigation project when requests for funding were piling up. University administrations refused to expedite research requests by staffers and punished anyone who made an end run.
The result? Years wasted, lots more people dead. I’m not sure if AIDS was, as many people describe it, the most terrifying disease of the century (was it scarier than the Spanish flu or the possibility of kids getting polio?) but it was a horrifyingly lethal one. It might have been even worse if Rock Hudson, closeted Hollywood gay, hadn’t come down with AIDS. Here was a star who could put a face on the disease (though TYG says for people her age, young Ryan White getting AIDs from a transfusion was a much bigger deal): if a Hollywood icon and manly man could get AIDS, nobody was safe!
All that said, Shilts writes about a number of admirable figures too: people who fought for funding, researched the disease, pushed for safe-sex measures and struggled to save lives (right wing Senator Orrin Hatch was, to my surprise, one of them). Plus those who died, whether with dignity, resignation, fury or tears (or a mix of all of them). It’s the mix of individual experience and big-picture worldview that makes the book so effective.
Even though I lived through the era it feels unreal to me now. Shilts, writing in 1987, talks about how our lives are broken into Before the epidemic and After which is how it felt at the time. It was a seismic shock that made it suddenly acceptable to talk about condoms on TV (a big taboo previously) but now it’s a musty memory (keep in mind I was a straight guy living a low-risk life so I didn’t go through the harrowing some of the book’s subjects did). It makes me appreciate how the Spanish flu and polio have receded into history. It also makes me see some of the covid insanity with fresh eyes. Religious conservatives insisting their right to hold superspreader services — who knows if covid’s even real? — aren’t that far off from the reactions some gays had to the news sex could kill them.
The one place Shilts blows it is his portrayal of Gaetan Dugas, the man he fingers as Patient Zero, the gay dude 
who brought AIDS to America and spread it through a promiscuous lifestyle that kept going even after his symptoms became obvious. Except as KILLING PATIENT ZERO (2020) shows, AIDS had a much longer latency period than first appeared, taking as much as a decade to destroy people’s immune systems; that meant it was established in the American gay population well before Dugas, a Canadian flight attendant, supposedly began spreading it.
Dugas was, like many gay men, skeptical about AIDS being spread by STDs (one of the things better funding might have confirmed sooner); the movie points out that for many gays, sexual freedom in the 1970s was proof they were no longer the love that dare not speak its name and they didn’t want to withdraw from that. Dugas, ironically, came off looking like the prime mover because he cooperated so much with the CDC, providing lots of information about his sexual contacts; had other men been as forthcoming the map of who infected whom would have looked very different. And Patient Zero — a term that didn’t exist before AIDS — was really a misinterpretation of “Patient O” in one file, short for “Out of California.”
Shilts’ editor (the author himself has passed) says he seized on Dugas as a way to put a face on the epidemic; giving readers and the media a Typhoid Mary figure (and Typhoid Mary herself was nowhere near the lethal carrier legend has made her out to be) would generate enough attention people outside the gay community would read the book. Giving them a Typhoid Gay guaranteed right-wing media would flag the book as one of interest (right-wing outlets, as I recall from the time, took great glee pointing out it was All Gays’ Fault for their lechery, but ignoring Reagan’s role). Shilts didn’t like demonizing Dugas but he went along with it and the tactic worked. The documentary does a good job painting Dugas as human being rather than a deviant monster. I’d recommend anyone who reads Shilts’ book follow up with the movie. “It seems to me reality shouldn’t come ready-packed with metaphors.”
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