Good investigative work requires dogged determination. Running an enigma to ground can take years. Occasionally, medical mysteries initially thought solved are found later to have very different truths at their cores.
One such mystery concerned the
AIDS epidemic in America. As long as the killer remained comfortably within the gay community not much was done to investigate. As soon as AIDS
found its way into the heterosexual population, though, suddenly America’s interest in ferreting out the cause was paramount. Panic stricken virologists and other epidemiologists worked feverishly to isolate the source of this sexually transmitted disease first endemic among homosexual men.
AIDS is what defined the decade of the 1980s, a decade that lived in fear beneath the penumbra of a certain and tortuous death from a highly communicable pathogen. Somewhere, there was a
Patient Zero, the
epidemiological well-spring from which this plague spewed forth.
“I’m Candy – Fly Me!”
There is an interesting correlation between homosexuality and the airline industry. At least, there is a publicly perceived correlation as it pertains to airline flight attendants.
The very first air flight attendants (in the 1920s) were men. These positions were desirable; the men who did these jobs executed their duties more like up-scale, futuristic train porters and ship
stewards than as menials. As with many professions (especially in service jobs such as telephone operators, bank tellers,
et al) the sky porters known as “stewards” were exclusively male. World War I saw the shift from male to female telephone operators and bank tellers; with a dearth of male workers during World War II, employers turned to the fairer sex to fill their employment needs in the airline industry, too.
The commercial airlines recognized the goldmine presented by hiring female “stewardesses”. Certainly, they were paid less. There was also marketability to women that men did not have – women could be hawked by an airline as possible sex partners for the discriminating male traveler choosing its service over another.
The airline industry developed glamour. The titillation of a sexy stewardess in uniform, pandering to any business traveler’s ego, was priceless. These were women without boundaries, women who went anywhere, anytime. Therefore, they
must be promiscuous. The unspoken possibility of sex with a globe-trotting gal was also alluring. Married women were aggressively discouraged from working as stewardesses. The single women, all within a certain preferred range of body type, height, and attractiveness, were wanton women (in the minds of the average male of the day). Although
morbid obesity was not the problem in the 1940s it is today, there were no “big girls” on board.
Thus, by the late 1940s male flight attendants were not only undesirable, they were
suspect as well. Occupying a job with women that devoted itself to customer service, good manners, and fine grooming, the stewards garnered
suspicions of being “queer.”
By the 1950s, this
homophobia was rampant, and in the
conservative times of Eisenhower and McCarthyism, men were slowly pushed out of the steward jobs. As further incentive to not hire men as flight attendants, the death of a gay steward in 1954 became a scandal sufficiently great to lead to a rash of “
fag bashings” (both gay men and
lesbians were targeted) in Miami, Florida. It was one of the nation’s worst anti-gay outbreaks in history. Homophobia was so great by the late 1950s almost no airlines in the United States would hire men as flight attendants – even Eastern and Pan Am stopped hiring stewards. Stewardesses were marketed as young, beautiful, and sexually available—this was hardly an acceptable career choice for any he-man. In the same way that the sexual orientation of male nurses was suspect, only “
pansies” wanted to be stewards.
The discrimination in the labor market meant the United States Supreme Court had to step in and force airlines to hire male flight attendants. This happened in 1971 after nearly 20 years of female-dominated service. Even then, the Court’s decision forcing US airlines to hire men was greeted with derision in the press. It also raised homophobic fears of placing men in such a servile and sexualized role.
Air Canada
For one gay man, however, being a steward was all he’d needed to satisfy both his wanderlust and his physical lust.
Gaëtan Dugas was a French-Canadian born February 20, 1953. His life was on a collision course with history. In 1972, Dugas first became sexually active. [He would later claim he had over 2,500 sexual partners in his
lifetime, whether all male is unknown. He may have been bisexual.] In 1977, he was legally married in Los Angeles, California, in an illegal attempt to gain United States citizenship. He found work as a flight attendant on Air Canada. This career choice allowed him the freedom to move around the world, visiting exotic locales, and meeting many strange men for anonymous sexual encounters.
The hedonism of the 1970s raged unchecked, and by the middle of the decade “gay” culture became pop culture. Gay and straight partiers found their Valhalla in New York City in a
crummy little club in the 1970s called Studio 54. This rat hole was converted into a hot spot known all over the world. Celebrities fell all over themselves to get in and be seen there. Its allure was its faux air of exclusivity. No club before or since carried the cachet of Studio 54. Co-founded and owned by a cabaret-style, (almost a caricature) flamboyantly gay man, Steve Rubell, and a straight-laced heterosexual lawyer, this kitschy club defined hipsters in the Seventies.
The music was disco, the dance beat adapted from gay men and their party scene. The
mock S&M dance moves, the sweaty bodies, the throb of the music, the drugs consumed, and the fact that not just anyone could get in heightened its allure. The term “velvet rope” came into existence then – a red velvet rope became the literal and symbolic barrier between the plebes on the street and the hipsters within. Each night crowds gathered outside Studio 54’s doors; admission was granted whimsically by a group of door men and many times by Steve Rubell himself. The criteria for entry were pure sadism: one night only women might be allowed in; other times, a sloppily dressed man might be sent away while another, looking exactly like that man but “famous”, would be let in. Gay-
themed parties were held there often, and casual sex in the bathrooms and the “exclusive” privacy lounge was common among all attendees.
The music scene was fueled by this gay celebration, none more blatantly than by a vocal group of disco hustlers calling themselves “The Village People”. They dressed in favorite and stereotypical gay icon costumes – a policeman, a construction worker, a cowboy, a gay biker, and a Native American. They were hugely successful for a short time with big sellers “In the Navy”, and “YMCA”. More subtly,
Donna Summer performed her brand of dance music that was embraced by the gay community as was she.
In conjunction with Studio 54, other bars for gay men to frequent thrived. Another meeting place were the bathhouses still found in many larger cities. Once serving the utilitarian function for neighborhood residents to bathe (considering most homes up until the late 1920s did not have indoor plumbing) these quaint reminders of The Good Old Days were social gathering places for gay men. They were prevalent in New York City and in San Francisco. [Bette Midler, a great favorite among gay men, got her start singing in gay bathhouses; her piano player in those days was
songwriter/musician Barry Manilow).
On October 31, 1980 – ominously enough, Halloween night – the gay male steward Gaëtan Dugas visited a gay bathhouse for the first time on a layover in New York City.
The Road to Zero
Gaëtan Dugas fit right in with the gay community of the bathhouses. He was blond, voluble, and open. Sex for him was a series of anonymous engagements, many times conducted hastily in bathroom stalls. He took on whatever he felt like. As well as many other men, he was developing what would become known as “The Clone Look”: close-cropped hair, largish but well-groomed mustache, muscle shirts, short shorts. [The quintessential version of “The Clone Look” would be Freddie Mercury (
rock band Queen’s lead vocalist who died of AIDS) after about 1981.]
A strange disease lurked among the gay denizens and creepers of the bathhouses, though. Men began dying of pneumonia and other respiratory illnesses, but only after drastically losing weight and developing horrific skin lesions on their faces, necks, backs, and chests. This disease became known in the gay community as “
gay cancer”. It was particularly volatile, and it progressed rapidly. Dugas caught it early, possibly with his first encounter in the Ney York gay bathhouse on Halloween 1980.
Meanwhile, as a symbolic sign of the coming Armageddon, Studio 54 was forced to close its doors for liquor license violations and tax evasion; entrepreneurs Steve Rubell and his business partner were sentenced to short terms of imprisonment. [Rubell later died of AIDS.]
The End of Days was seemingly at hand.
Concern for dying gay men was not paramount on America’s mind. As more cases of the mysterious killer emerged, the name was changed from “gay cancer” to “gay-related immune deficiency” (GRID). This, at least, was an open recognition that whatever was causing the disease was compromising a body’s immune system. It didn’t explain, however, the rather esoteric choice of gay men (and soon discovered, IV drug users) as victims. It wasn’t until the first heterosexual cases of “gay cancer” emerged that the disease was examined more closely.
Dugas, meanwhile knew he was sick. But one can’t spread cancer, of course, because cancer isn’t contagious. He indiscriminately continued having sex with men as his whims overtook him. His “advantage” was his mobility – as a flight attendant, he might be in any part of the US, Canada, or the world on a moment’s notice. His bitterness about having gay cancer crossed over into his attitude about his lackadaisical attuned as well.
First denying he was sick, he later
willfully and maliciously spread the disease to unsuspecting partners. After having casual sex in a darkened room once, a male interviewee later reported he had turned on a light in the room where Dugas lay naked on a bed. This man spotted the lesions (Kaposi’s sarcoma) that were the classic earmarks of “gay cancer” on Dugas’ chest. When he remarked upon it, Dugas replied sardonically, “It’s gay cancer. Maybe you’ll get it.”
Gay men realized the danger. Many made the intuitive leap early that perhaps certain activities, such as anal intercourse, might be transmitting the causative agent. Higher-profile gay men began dying as well as underground sub-culture members; most notably was the early AIDS death of the most macho of men, The Marlboro Man. The Marlboro Man was an advertising icon of the popular cigarette brand, Marlboro. This blond “cowboy”, a homosexual actor, featured heavily in print ads. He was the quintessential rough and tumble outdoorsman. He wore The Clone Look of his day, the same sandy-blond hair and mustache affected by Gaëtan Dugas.
By April of 1982, 248 cases of the disease were reported. A virus was isolated in 1983 and later named Human Immunodeficiency Virus or HIV. The disease it spawned was rechristened, in light of its indiscriminate virology, to Acquired Immune Deficiency Syndrome or AIDS. That same year, 248 cases of the disease were reported and local health departments in conjunction with the Center for Disease Control (CDC) in Atlanta began investigating.
Of the 248 cases known before the detection of the virus, interviewing led to the shocking revelation that at least 40 AIDS victims had one thing in common: all had either had sex with a certain blond, gregarious Air Canada flight attendant, or they had sex with someone who did. This networking connection was made in 1984, and it was critical – it meant medical and public health officials investigating the source of AIDS might have finally gotten the breakthrough they needed.
Gaëtan Dugas, the narcissistic and embittered flight attendant, alternately feeling morose and spiteful about his condition, was given the code name “Patient Zero”, the source of the AIDS epidemic in North America. AIDS now had a face.
Omega Man
There is an apocryphal story that Patient Zero was really Patient “O” (as in the 15th letter of the English alphabet, first letter of the word “Omega” for the last letter of the Greek alphabet, Ω). Furthermore, it was alleged that a journalist misinterpreted the “O” (for “Ω”), and instead wrote up his report, referring to the AIDS’ source as “Patient 0” [“zero”] instead.
This makes little sense. The Greek letter “Ω” always refers to the end of an event or series, not its beginning. Dugas was “Patient Zero”, not “Patient Ω” – if the intent was to use such a Greek designation, he would have been named “Patient Alpha” (“Α” or “α”) for “the beginning”.
Running Dugas to ground, however, was pointless. At the time, there were no criminal laws penalizing the willful spread of a known fatal disease (since then, law changes allows charges of
attempted and pre-meditated murder to be brought in many states against anyone who is HIV-positive purposefully engaging in unprotected sexual intercourse with an unwitting partner).
Dugas remained unrepentant. He originally denied that whatever disease it was he had could be transmitted sexually. His own words on the subject: “Of course I'm going to have sex. Nobody’s proven to me that you can spread cancer.” His depraved indifference to his sexual partners’ well-being was summarized with “It’s their duty to protect themselves. They know what’s going on out there. They’ve heard about this disease.” The last element of his bitterness was voiced by his wish to take others with him: “I’ve got gay cancer. I’m going to die and so are you.”
Gaëtan Dugas died in Quebec City, Quebec, Canada, on March 30, 1984, at the age of 31. His cause of death was kidney-failure brought on by his weakened condition from an onslaught of infections and ailments from AIDS.
In his wake, one of the unfortunate legacies he left was a renewed homophobia relative to male flight attendants. They became a lightning rod for America’s fear and anger over AIDS and its links with homosexuality. “Patient Zero”, Gaëtan Dugas, was reviled; in death he was even accused of bringing HIV to North America and spreading it around the country.
Less Than Zero
Years later, once medical science, and particularly genetics testing, had reached a greater level of technological advance, a revision of the “
Patient Zero” findings of 1984 seemed necessary. What was learned by later research was both fascinating and horrific simultaneously. It turned out, HIV had not only been in the world for over a century, but it had been in the United States as early as 1966.
Almost any medical professional worth his or her license, whenever a patient dies of a strange ailment, takes the precaution of preserving tissue and blood samples for future research. It is extremely fortunate that some doctors going all the way back to the late 1950s had been so far-sighted. Working backward and re-examining suspicious or otherwise unresolved deaths from contagion globally proved enriching in piecing together the history of AIDS.
In 1979, before Dugas was infected, a bisexual German concert violinist, Herbert Heinrich, died. In 1989, after testing of medical samples from his body, it was learned he was HIV-positive.
A year earlier, a Portuguese man known only as Senhor José died under mysterious circumstances. He was treated at the London Hospital for Tropical Diseases to no effect. In later years, examination of preserved tissues verified he died of AIDS; the causative virus, HIV-2 was present, making him the first known confirmed victim. Genetic research on the virus indicated he probably contracted the disease in 1966 in Guinea-Bissau (on the northwest coast of Africa). Three gay men in California and six Haitian immigrants to the United States were later confirmed as AIDS victims from that same year.
Grethe Rask was a Danish surgeon who had traveled to Zaire in 1972 to lend medical aid for the sick there. She returned to Denmark in 1976 and became unrelentlessly ill. Her symptoms confounded her colleagues. She died in December 1977. Several years later in 1984, it was confirmed through testing she was HIV-positive. During her time in Zaire, it was known she was directly exposed to blood – it is believed this was the source of her infection.
In 1976, a Norwegian sailor, designated with the alias “Arvid Noe”, died; his wife and nine-year-old daughter died the next year of the same wasting disease. In 1961, the 15-year-old Noe had sailed on his first voyage to Africa. He worked a merchant vessel that plied along Africa’s west coast from mid-1961 to mid-1962; during this voyage he was treated for gonorrhea. He sailed again to Africa in 1964, with a port of call in Kenya in eastern Africa. In 1966, Noe started suffering from chronic joint pain and recurrent lung infections. By 1968, he could no longer pass a physical to sail, so he worked as a long-haul truck driver.
Noe’s condition stabilized, but then flared up again in 1975 (coincidentally the same year a strange disorder called “
slim disease” was reported in Africa for the first time, the beginnings of epidemic AIDS). In addition to the respiratory condition and joint pains he developed motor skill problems and dementia before he died. Both his wife and daughter developed an illness that mimicked his symptoms, and they died in 1977. Doctors, helpless to find the cause of death for the Noe family, preserved some tissue samples. In 1988, further testing showed Noe, his wife, and his daughter had all been HIV-positive
Gateway to the West
In America, the results of further research lead to the conclusion that Gaëtan Dugas had not been the true “Patient Zero” after all. Dugas may have personally, and directly, been responsible for dozens of AIDS cases (and no telling how many more indirectly), but he did not bring AIDS to the US, nor was he the first confirmed AIDS victim. As noted, several California men and some Haitian immigrants were found later to have succumbed to the disease before Dugas.
That dubious distinction of being America’s “Patient Zero” – the first documented and verifiable case of AIDS in the country – belongs not to Dugas but to a mildly mentally retarded black teenager named Robert Rayford (born ca. 1952-1953).
He also had a chlamydia infection (a parasitic venereal disease), clearly indicating he was sexually active. He led doctors to believe his activities were strictly heterosexual, even claiming at one point to having a girlfriend (who failed to surface). Diverting conversations occurred between Rayford and his primary care giver when questioned about his sexual activities: “Yeah, I’m the stud all the time”, was one such response. His doctors had not considered homosexuality initially; they thought he was referring to relations with girls. He always refused a rectal exam. It seemed clear based on his behavior and physical problems that he was, indeed, a homosexual prostitute (assuming the submissive role in anal intercourse).
His first months in the hospital were spent with his doctors cutting back on his water and salt intake, and they wrapped and raised his legs, all to cut the swelling. Despite this, the inflammation moved up his body and into his lungs. Antibiotics were tried in varying dosages, but Rayford’s condition continued to deteriorate.
The teen seemed stabilized by late 1968. In March 1969, however, all of his symptoms reappeared and rapidly worsened. His breathing labored; his white blood cell count (as part of routine blood work) was noted to have dropped dramatically. The only thing concurred at the time was that Rayford’s immune system had been somehow compromised. He developed a fever and died either in the late hours of May 15, 1969, or the early hours of May 16 (sources differ). His primary physician recalled, “Eventually his entire body constituted almost one wave of hard lumps and watery swellings.”
Because of the baffling nature of his case, doctors preserved several tissue and blood samples for later evaluation. In 1987, eighteen years after his death, molecular biologists at New Orleans’ Tulane University tested specimens of Rayford’s preserved blood and tissues. Their findings were stunning: a virus “closely related or identical to” HIV-1 was detected. Further confirmation testing in 1989 proved Robert Rayford (teenage male homosexual prostitute of St. Louis, Missouri) was the earliest confirmed victim of AIDS in North America.
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