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Washington D.C.

NARRATOR: The epidemic had begun in the first months of the Reagan administration, which had come to power with a mandate to cut taxes and reduce the size of government.

Pres. RONALD REAGAN: It is time to get government back within its means and to lighten our punitive tax burden. And these will be our first priorities, and on these principles there will be no compromise!

MARGARET HECKLER, Secy. of Health & Human Services 1983-85: The budget was out of control. I knew the country needed to have fiscal restraint. The president was right.

NARRATOR: Margaret Heckler became Reagan's secretary of health and human services in 1983. She says she was looking to the scientists to set her priorities on AIDS.

MARGARET HECKLER: AIDS was a mystery. It was a puzzlement even to the scientists. And before we knew what to do or how much it would cost or anything like that, we needed to find out what the scientists could tell us. And my goal was simply to expedite the process.

NARRATOR: But at the CDC, an agency Heckler supervised, officials said their efforts had been severely hurt by the budget cuts.

WALTER DOWDLE, Ph.D., Director, CDC 1989-90: The Reagan administration had come in, and there was a mandate to cut all government activities, but CDC was slated to be cut by at least 25 percent. There was no travel allowed at all. And so therefore, we virtually had our hands tied.

DON FRANCIS, M.D., CDC 1972-92: My area of responsibility at the time was to establish a laboratory to investigate the cause, develop a blood test, and do all of these things. And we really had nothing for the first two years, essentially nothing. We had to steal equipment from the other laboratories. We had to dig out space, and we had to- this was not an appropriate response to a disease that had a mortality that looked like greater than most other infections that we had to deal with.

NARRATOR: In April 1983, four months into her term, Secretary Heckler told a congressional committee that all the federal agencies researching AIDS had adequate funding.

"In the AIDS situation," she said, "I really don't think there is another dollar that would make a difference because the attempt is all-out to find an answer."

INTERVIEWER: There were a lot of people who felt that more money should have been spent.

MARGARET HECKLER: I disagree with that. I think that we could not have gained anything more by increasing the cash expenditures. We were in the right direction. We were placing the emphasis on those who could provide the answers. And in a peculiar case, this was not a problem that money could solve. It was a problem that the scientists could solve.

Kinshasa, Zaire 1983

NARRATOR: One problem scientists were trying to solve was where the disease had come from. A team of epidemiologists from the CDC flew to Africa to follow up on reports about what they were now calling AIDS, Acquired Immune Deficiency Syndrome. Joe McCormick led the team.

JOSEPH B. McCORMICK, M.D., CDC 1974-93: I met a colleague who began telling me about these few Congolese who had come to Belgium with a disease that looked to him like the Acquired Immune Deficiency. And so we went to the Congo and started looking for patients with typical symptoms of AIDS, and we found them on the wards of the Mama Yema Hospital in Kinshasa.

SHEILA MITCHELL, CDC 1980-87: It was quite a shock to see the poverty, the suffering. The whole team was amazed at how immediately they could identify 10, 20 cases right away that would meet our definition for AIDS. I've never seen anyone before that was dying. And we stood there and watched them. There was nothing we could do.

At the time, the world was thinking that this was a gay men's disease. When we came up with the numbers that half our patients were women, it started to make people think, "Well, maybe this could be a disease that could be transmitted to the general population," and I think it caused quite a bit of alarm.

CDC, Atlanta

NARRATOR: Back at the CDC in Atlanta, Joe McCormick and his team briefed their boss on what they had learned in the Congo.

Dr. JOSEPH B. McCORMICK: He said, "We're going to call the assistant secretary for health and give him this information. He needs to know this."

NARRATOR: As assistant secretary of health, Dr. Edward Brandt was the key administration official on the disease.

Dr. JOSEPH B. McCORMICK: And so I got Dr. Brandt on the phone, and I gave him the data and information and told him that our conclusion was this was a- already probably at epidemic proportions and that it was hetero- primarily heterosexually transmitted. And his response was, "There must be another explanation. This can't be right."

EDWARD N. BRANDT, M.D., Ph.D., Asst. Secy. for Health 1981-84: My reaction was, "I don't understand what's going on. You know, either they've got a different virus, or we're not getting cases reported." The latter seemed reasonable because our focus up until then - and most of the public noise we'd made and everything, and my meetings with medical groups around the country, and so forth - had focused on homosexual men. And maybe by doing that, we were missing female cases.

NARRATOR: In fact, Dr. Gerald Friedland had reported a case of heterosexual transmission eight months earlier.

GERALD FRIEDLAND, M.D., Montefiore Hospital 1981-91: There was a woman who was a sexual partner of someone with AIDS. And we had learned that AIDS was associated with swollen lymph glands, and I felt these massive lymph glands and I said, "Oh, no. She's got it. It is heterosexually transmitted. This is the end." That was a glimpse into the future.

NARRATOR: It was a future that Joe McCormick and his colleagues believed they'd seen in Africa, where they began asking questions about the history of the disease.

Dr. JOSEPH B. McCORMICK: We now know, based on the advanced symptoms that we say, that this disease had been circulating for quite a while. And therefore, we had to understand better where it might have come from, and in particular, where did it go. Somehow, the disease had gotten into the U.S. and Europe. And so the question is, "Well, who would have been at risk and could have taken the disease out of the Congo?"

There were a few choices: Europeans living there, Belgians primarily, but French and others, and Congolese who were leaving the country to go abroad and Haitians, who I had already experienced contact with back when I was a school teacher in the 1960s.

NARRATOR: When independence came to the former Belgian Congo and the Europeans left, the new government contracted with Haiti to bring French-speaking professionals - teachers, nurses and doctors - to fill the jobs left behind.

Dr. JOSEPH B. McCORMICK: We found very few of the Haitian community still there. It's quite feasible that a number of these people immigrated, not knowing that they had HIV. We have evidence that some of them, at least, got this disease. And we know that some of them went to Europe, to North America, and back to Haiti.

Port au Prince, Haiti

NARRATOR: Haiti, one of the poorest countries in the world, would prove to have few defenses against the disease. It was in the late `70s and early `80s that local doctors noticed that more and more young Haitians were coming to them or seeking healing spells from a local priest for a new wasting disease.

JEAN PAPE, M.D., Founder, Haitian AIDS Commission: Some of those first patients had the look of death on their face. They were so skinny that you could see their bones. This was something totally new to us, and we were not sure what we were dealing with.

NARRATOR: In one of the roughest parts of Port au Prince, Dr. Jean Pape started the first AIDS clinic in Haiti.

Dr. JEAN PAPE: The men we saw, many of them had more contact with women than men. So very early on, the profile, social profile and sexual orientations, were totally different from what was happening in the States.

NARRATOR: Yet Dr. Jean Pape was convinced the disease had been first brought to the island by homosexual tourists from America.

Dr. JEAN PAPE: Haiti was a haven for homosexuals because sex with a male Haitian was very cheap. They didn't call themselves homosexuals because the same Haitians would also have contact with many more women.

NARRATOR: As the virus was spread heterosexually, it turned up in blood transfusions, and confined to the island, it took hold.

Dr. JEAN PAPE: The disease was spreading very fast, and within three years, we are not talking about a disease that was affecting homosexuals anymore, it was a disease that had extended through all stratum of society. This was very, very scary.

NARRATOR: It was also a time when thousands of Haitians were fleeing the island's poverty and corruption. The U.S. media were doing stories about "boat people." And now there were reports of sick Haitians showing up in Dr. Margaret Fischl's hospital in Miami.

Dr. MARGARET FISCHL: One of the local channels called me up and was almost whispering on the phone, said, "Is it true Haitians brought in a deadly disease in the United States?" And I said, "That better not be your headline in tomorrow's paper."

NARRATOR: But those were the headlines when the CDC sent out a warning to physicians about the reports of Haitian immigrants with the disease.

Dr. MARGARET FISCHL: The entire Haitian community was very upset, and I don't blame them.

NARRATOR: In the press, it became a label - Haitians were a risk group - and the impact was felt immediately back on the island.

Dr. JEAN PAPE: It killed tourism in Haiti. Goods manufactured in Haiti could not be sold in the U.S., and Haitians in the U.S. suffered a lot.

NARRATOR: Even today, Haitians remain defensive about the course of the disease and how it came to the island.

Dr. MARGARET FISCHL: I don't think there was any one thing. I think there were multiple things.

NARRATOR: Margaret Fischl went to Haiti in 1982.

Dr. MARGARET FISCHL: The diversity of what we were seeing was incredible. There were gay men vacationing in Haiti. There were Haitians going to Africa. There was likely drug use. So it just really reinforced that there was nothing that was different about a Haitian that was different about an American for that part. It was really, you know, how this virus was being transmitted.

NARRATOR: Back in the United States, it was still being seen primarily as a gay disease, which in San Francisco made it highly politicized. The community was both scared and defensive of their newly-gained civil rights, and no more so than when the city tried to close the gay bathhouses.

ANTHONY S. FAUCI, M.D., National Institutes of Health: Although it looked like a disease of gay men, it was not, it was a disease of sexual transmission. And it just so happened that at the time of the evolving of the permissiveness of sexuality among the gay community back in that period of time, after they had just essentially been able to win their freedom to express themselves sexually as they wanted to do in society- unfortunately, it came at a time when a virus was introduced. And the bathhouse culture was a perfect breeding ground for a sexually-transmitted disease.

NARRATOR: The bathhouse culture was both a symbol of gay community and a place of sexual freedom.

MERVYN SILVERMAN, M.D., M.P.H., San Francisco Health Dir. 1977-85: In a bathhouse, there were orgy rooms. These were rooms where there was music, the lights were down low, even so low that you didn't even know who you were with. What was unique here was that people could come there and have multiple partners, as many as 20 or 30 a night. If you had 30 partners and one of more of those partners was HIV-positive, there was a good chance you were placing yourself at great risk for getting infected.

CLEVE JONES, Founder, The Names Project : When the bathhouse controversy hit San Francisco, I was ambivalent. I was one of the people that had a lot of trouble deciding what to do about it. You have to understand that the whole concept of a gay community was still brand-new. It had not been tested. All of the institutions we take for granted today were just being created.

Dr. MERVYN SILVERMAN: One day, Cleve called me up and he says, "I can't defend if you close the bathhouses." And I said, "How can you say that? You've always said that, you know, you wanted them closed." He said, "I do. I did and I do. But if you, the director of health in the most liberal-appearing city in the country, do this, think of what the impact that's going to have on less tolerant communities."

CLEVE JONES: There was a great fear that if we allowed the government to close these establishments, what was next? The people who opposed closure of the baths were very frightened that this was the first step. You know, how far into our bedrooms will the government be going? And those were not unrealistic fears in this country then or now.

Dr. MERVYN SILVERMAN: These 14 establishments are not fostering gay liberation, they are fostering death and disease.

I was trying to work with the gay community, and I failed. And I acknowledge that I failed, but that would have been the perfect way to have dealt with this in the early years.

Literally, what we're talking about is playing Russian Roulette.

NARRATOR: Silverman did close the baths, but a local judge reopened them two months later.

Dr. MERVYN SILVERMAN: I said in 1983 that AIDS was the most political disease I had ever seen or read about. It was so discouraging to me because here we had a medical mystery that even without any political interference would be a tremendous thing to try and solve and deal with.

posted may 30, 2006

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