The Protection Racket

And the band plays on

By his own account, his first forays in his job as a venereal disease investigator were dicey. He's still embarrassed when he recalls acting as an "arrogant bureaucrat" one time by relentlessly pressing a 38-year-old gay man with syphilis to admit that he'd had hundreds of sex partners. He drove the man to tears.

In the early 1960s, the CDC, then called the Communicable Disease Center, began working toward the eradication of syphilis. Darrow joined that effort, under the tutelage of Raymond Forer, a sociologist who had recently set up the first social/behavioral science unit at the CDC, which was partly established to study sexual behavior.

"The program was to introduce the idea of behavioral research into public health and communicable disease control," Darrow says. "Had more to do with people than microbes." The work as a "cub sociologist" inspired him to get a master's degree in the field in 1967. He ultimately received a doctorate from Emory University studying medical sociology; his dissertation examined how the use of condoms affects the spread of venereal disease.

The chances of getting HIV infection vary widely among Hispanic subgroups, says Guillermo Prado, an AIDS researcher at FIU.
The chances of getting HIV infection vary widely among Hispanic subgroups, says Guillermo Prado, an AIDS researcher at FIU.
Kenneth Obiaja and Claudia Uribe (following) are among the few researchers remaining with the prevention-oriented Reach 2010 in Broward after the federal government slashed funding.
Kenneth Obiaja and Claudia Uribe (following) are among the few researchers remaining with the prevention-oriented Reach 2010 in Broward after the federal government slashed funding.

Through the 1970s, Darrow investigated the source and spread of a penicillin-resistant strain of gonorrhea by interviewing prostitutes and their sex partners. In 1977, he joined a CDC team studying the incidence and prevention of hepatitis B among gay men in five cities, including Miami.

"I went to bars and clubs and bathhouses as part of my work," Darrow says. "I knew about these underground activities, and some sociologists were writing about them, some weren't."

So when the CDC began hearing about cases of immune deficiency among gay men on both coasts in the early '80s, the agency tapped Darrow for the Task Force on Kaposi's Sarcoma and Opportunistic Infections. (Kaposi's sarcoma is a type of cancer that affects many AIDS patients.)

Today, more than a generation since AIDS first appeared in America, it's sometimes hard to grasp how little was known about AIDS in the early years. In fact, most Americans weren't even aware of the problem for the first couple of years that the team investigated what was initially called gay-related immune deficiency, or GRID.

At that point, the only thing the CDC team knew was that the malady was affecting only gay men. Darrow and others suspected it was a sexually transmitted illness, but others believed it might be caused by an environmental agent in bathhouses, perhaps by breathing in something, as was the case with the 1976 Legionnaires' disease. Some in the National Cancer Institution suspected the cause was tainted "poppers," drugs used to enhance sexual experience.

"First, we had to find the cases," Darrow explains. "What does the San Francisco case have in common with the case in New York and the case in Los Angeles? The evidence started coming in, and it was our job to put it all together and explain what the hell was going on to whoever was interested."

For Darrow, the only nonmedical doctor in the unit, the aha! moment came only after the partner of a hospitalized man in L.A. quietly took a CDC field doctor aside and advised, "You asked my partner all kinds of questions about his sexual activities — what he did, where he went — but you didn't ask who he was having sex with. You probably don't know this, but two or three of the people who are in the same hospital were his sex partners."

Darrow quickly rushed from Atlanta to L.A. to question as many ill men — some near dementia and death — about their sexual partners. By the time he was done in the spring of 1982, Darrow had found sexual ties among 40 men in ten U.S. cities.

"We only included people in this network if one person named the other and the other named him back," he recalls. In the center of that fatal version of connect the dots was a French-Canadian flight attendant named Gaetan Dugas who could be sexually linked with 40 of the first 248 gay men diagnosed with GRID in the United States.

In the network diagram presented to his colleagues, Darrow had designated Dugas as "O," which stood for a sexual contact who lived "Out of California." But his fellow scientists began referring to him as Patient Zero, a designation that would eventually lead to a widespread myth.

"There's a conventional wisdom that he started the whole epidemic, but that's not true," Darrow says. "Nobody said he was the first case. You had a few people in L.A. who had AIDS. They didn't have sex together, but they had sex with this guy, so he was important. He linked it. That was the whole idea of social networks, which I happened to know about then and is now a big thing in disease control."

Evidence that this was a sexually transmitted illness strongly suggested that a virus was at the heart of this new plague. "We tried to convince our colleagues, the medical community, and we were hoping we could convince the new administration that they had a real big problem on their hands."

How did that go? "Not well," Darrow mutters. "It's still not going well." The CDC had earned its reputation by researching epidemics and then bringing them under control with vaccines. "They were very successful with smallpox and polio," he says. "They were good at vaccine-preventable diseases. But dealing with condoms, sexual behavior — boy, that was going to be tough. Still is. Sex and morality and all that. It's very contentious. Politicians don't like to get involved in that kind of thing."

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