Book Review: And The Band Played On

I finally finished the monster book And The Band Played On: Politics, People, and the AIDS Epidemic by Randy Shilts. I say “monster book” because it was 605 pages of small print, jam-packed with anecdotes, statistics, policy analysis, and science. It was, however, an extremely readable and accessible book and the length of time I took to read it says more about the fact that I’m a slow reader than it does about Shilts’ skill as a narrator. He walks us through the arrival of AIDS to North America and chronicles the response from the medical community, the gay community, the media, and all levels of government. It is extremely interesting to read a detailed account of the disease’s spread and the medical challenges associated with its diagnosis and treatment. It is equally devastating to read how maligned and homophobic much of the response, or lack thereof, was.

Although his book is well-balanced it is not completely free from bias. He was, after all, a gay man living in San Francisco who would later die of AIDS. In his account of the fierce debate surrounding gay bath houses in San Francisco, for instance, it is clear which side he was on. Still, he supports his position with evidence and does an adequate job of representing the opposing viewpoint. Moreover, he stands aside and lets the voices of others make the strongest points for him. Some of the book’s most devastating quotes come from the people he interviewed.

Which brings me to another strong point in the book. Although Shilts does an admirable job of weaving science and politics into his comprehensive narrative, what makes his book so compelling is that it ultimately revolves around people. Early AIDS victims become more than statistics in Shilts’ book and he bears witness to the end of their lives with stunning honesty and empathy. The challenges AIDS activists and scientists faced, both with each other and with the outside world, are recounted with nuance. Shilts resists the urge to editorialize anyone into the role of hero or villain and we are thus left with the impression that the early years of the AIDS epidemic were as complex as they were confusing and frustrating.

And The Band Played On offers many takeaways but one that particularly stood out to me was how both fear of being perceived as homophobic and actual homophobia hindered a more productive response to the growing epidemic. This was further complicated by the fact that the gay community and gay rights activists were extremely divided on how to respond to pressing AIDS-related issues. Once the medical community established that AIDS (or more accurate HIV, though that discover would come later) could be transmitted via blood, there was a push to screen blood donors for the disease. Blood donation clinics were reticent to screen blood and deny gay men the right the donate blood for several reasons. They were skeptical of the connection between blood transfusions and AIDS, and did not want to cut off a vital source of blood donation (Shilts describes many gay San Franciscans as being especially “civic minded”). But they also expressed fear that the decision to not accept blood from gay men would be construed as homophobic. One report that emerged from a blood policy workshop stated that, “The quarantine of blood is an ominous first step towards further social, political, economic and even physical quarantine of a community already denied many basic civil rights protection.” (p. 326)

It is interesting to contrast this position with contemporary debate surrounding the ethics of banning blood donation by gay men. Today, blood tests can confirm whether or not an individual (gay, straight, or otherwise) has HIV and many argue that the policy of excluding gay men from donation on the basis of their sexuality is outdated. I’m inclined to agree with this contemporary argument but I note with some discomfort that I agree with Shilts that the ban on gay men donating blood in the mid 1980’s was a necessary policy that should have been implemented earlier. The idea of screening blood on the basis of one’s sexual history feels wrong to me, and yet I’m not sure there was an alternative at the time given the lack of blood test and basic understanding of HIV.

Of course, actual homophobia played a huge role in the slow response to the AIDS crisis. According to Shilts, the issue only gained traction in the media once heterosexual people began getting sick. Being an AIDS researcher in those early days also lacked prestige, to put it lightly. One researcher recalls a university dean remarking that, “At least with AIDS, a lot of undesirable people will be eliminated.” (p. 522) Government funding for AIDS was also dismally low during those early years despite the fact that the Reagan administration claimed AIDS was its number one health priority. Shilts also claims that when HIV testing became possible, members of the gay community were fearful that widespread testing would be akin to creating a government list of homosexuals. The government did little to assuage such fears when it failed to enact confidentiality measures. Apparently the administration felt this would be seen as “coddling” gays which was against their hard line.

Shilts’ account of the early years of the AIDS epidemic is a deeply important read that is made all the more impressive when you consider that it was written during those early years (the book was published in 1987). I learned a ton of interesting and often surprising facts about AIDS and its evolution as a social, political, and medical issue. Shilts was one of the few journalists covering AIDS at the time and, though we cannot say for sure, it appears that his dogged coverage of the crisis has ensured that key details about the early days of the epidemic were not lost. For this, we owe him our gratitude.