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. 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. "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. 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. 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. 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. 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. 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. Jones formed the
NAMES Project that created the AIDS Memorial Quilt, the largest folk art display in the world.
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. 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. 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. 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. 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. 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. 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, children and adults who had
hemophilia (and later, their wives),
Haitians, 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, 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. 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.
Political and governmental agencies The Centers for Disease Control (CDC), the agency responsible for tracking down and reporting all communicable diseases in the U.S., faced governmental apathy in the face of mounting crisis. Shilts reported how CDC epidemiologists forged ahead blindly after being denied funding for researching the disease repeatedly. Shilts expressed particular frustration describing instances of the CDC fighting with itself over how much time and attention was being paid to AIDS issues. Although Reagan Administration officials like
Health and Human Services Secretary
Margaret Heckler and Assistant Secretary
Edward Brandt spoke publicly about the epidemic, calling it in 1983 its "Number One Health Priority", no extra funding was given to the Centers for Disease Control or the National Institutes of Health for research. What the U.S. Congress pushed through was highly politicized and embattled, and a fraction of what was spent on similar public health problems. Shilts made comparisons to the government's disparate reaction to the
Chicago Tylenol murders, and the recent emergence of
Legionnaires' disease in 1977. In October 1982, seven people died after ingesting
cyanide-laced
Tylenol capsules.
The New York Times wrote a front-page story about the Tylenol scare every day in October, and produced 33 more stories about the issue after that. More than 100 law enforcement agents, and 1,100
Food and Drug Administration employees worked on the case.
Johnson & Johnson disclosed they spent $100 million attempting to uncover who had tampered with the bottles. In October 1982, 634 people were reported having AIDS, and of those, 260 had died.
The New York Times wrote three stories in 1981 and three more stories in 1982 about AIDS, none on the front page. The Tylenol Crisis was a criminal act of product-tampering; Legionnaires' disease was a public health emergency. Twenty-nine members of the
American Legion died in 1976 at a convention in
Philadelphia. The
National Institutes of Health spent $34,841 per death of Legionnaire's Disease. In contrast, the NIH spent $3,225 in 1981 and about $8,991 in 1982 for each person who died of AIDS. Shilts accused Ronald Reagan of neglecting to address AIDS to the American people until 1987—calling his behavior "ritualistic silence"—even after Reagan called friend Rock Hudson to tell him to get well. After Hudson's death and in the face of increasing public anxiety, Reagan directed
Surgeon General C. Everett Koop to provide a report on the epidemic. Though Koop was a political conservative, his report was nevertheless clear about what causes AIDS and what people and the U.S. government should do to stop it, including sex and AIDS education provided for all people. On a civic level, the closure of
gay bathhouses in San Francisco became a bitter political fight in the gay community. Activists put pressure on the San Francisco Public Health director to educate people about how AIDS is transmitted, and demanded he close bathhouses as a matter of public health.
News media Shilts was assigned to AIDS full-time at
The San Francisco Chronicle in 1982. It was from this unique vantage point that he repeatedly criticized the U.S.
news media for ignoring the medical crisis because it did not affect people who mattered; only gays and drug addicts. Shilts noted most newspapers would print stories about AIDS only when it affected heterosexuals, sometimes taking particular interest in stories about AIDS in
prostitutes. AIDS was not reported in
The Wall Street Journal until it involved heterosexuals. Many stories called AIDS a "gay plague" or "homosexual disease" in articles that pointed to it showing up in new populations, like
hemophiliacs or people who had received blood transfusions. Shilts recounted the irony of a reporter commenting on how little was reported about the disease, then linking it once more to rarer instances of transmission to non-drug-using heterosexuals. On the other end of the extreme, a general
phobia of AIDS was exacerbated by the news media who erroneously reported that AIDS could be contracted by household contact, without checking any facts in their stories, which prompted mass hysteria across the United States. ==Critical reception==