‘‘The Columbus of AIDS’’

T H E I N V E N T I O N O F ‘ ‘ PAT I E N T Z E R O ’ ’

5
Invasion of the Body Snatchers seemed a fitting analog for the
science writer Lance Morrow when he chronicled ‘‘The Start of a
Plague Mentality’’ for Time magazine in 1985. The hiv /aids epi-
demic was growing at a breathtaking rate worldwide when he warned that
the ‘‘plague mentality is something like the siege mentality, only more para-
noid. In a siege, the enemy waits outside the walls. In a plague or epidemic,
he lives intimately within. . . . Life slips into science fiction. People begin
acting like characters in the first reel of The Invasion of the Body Snatchers.
They peer intently at one another as if to detect the telltale change, the
secret lesion, the sign that someone has crossed over, is not himself any-
more, but one of them, alien and lethal.’’∞ Morrow was one of many cultural
observers who worried that the fear generated by the epidemic was more
socially disruptive than the virus. Fear of the disease led to paranoid social
interactions. Yet his account conveyed more than the effect of that fear.
Describing the suspicion as the belief that the infected had become ‘‘alien
and lethal,’’ he captured the fantasy of the transformative nature of devastat-
ing viruses, a fantasy that emerged from the conventions through which
viruses were explained to the public. Implicit in those conventions was the
monstrosity of the infected and their willful perpetuation of infection.
The human immunodeficiency virus jolted scientific researchers and
medical practitioners out of their sanguinity. The new microbe represented
a challenge they had not expected to face in the final decades of the twen-
tieth century, when infectious disease was no longer supposed to pose a
serious widespread health threat in the developed world. The newly identi-
fied retrovirus marked the hubris of contemporary medical science and
terrified a public that had grown dependent on promises.≤
 The epidemic dramatically changed the prestige and funding of medical
specialties. The belief that communicable disease would cease to threaten
the health of the North in the late twentieth century had made it difficult
for the area of infectious disease to draw the top researchers. Virology in
particular, as Cindy Patton notes, was ‘‘considered highly specialized sci-
ence, incapable of generating wide-ranging explanations for disease pro-
cesses.’’≥ Theories of viral sources of cancer had kept some attention fo-
cused on the field, but nothing like the explosion of interest that followed
the identification of the human immunodeficiency virus within the next
decade. hiv /aids not only restored but augmented the attention and
authority that had characterized virology during the Cold War.
The identification first of a mysterious new syndrome and then of its
presumed viral source generated a need for explanatory narratives that
could make scientific and social sense of the unexpected events becoming
known as ‘‘the aids epidemic.’’∂ As Paula Treichler notes, one way of mak-
ing ‘‘sense of a novel cultural phenomenon that is complicated, frightening,
and unpredictable . . . involves framing the new phenomenon within famil-
iar narratives, at once investing it with meaning and suggesting the poten-
tial for its control.’’∑ With the renewed interest in virology came its explana-
tory narratives and other conventions of representation. hiv /aids may
have been new, but viruses and outbreaks were familiar features of human
existence. Morrow drew on those conventions when he dubbed hiv a ‘‘bug’’
with ‘‘ambitions.’’ In turn, scientific and mainstream media discussions of
the epidemic contributed to the evolution of the narrative.
The ever-prescient William Burroughs seemed almost to have foretold
the milieu into which the retrovirus surfaced in his novels from the 1950s,
writing, in effect, a pre-biography of hiv /aids, not so much a prediction
as an analysis of the cultural logic of the outbreak and its accompanying
narratives. Having moved away from the virus theme following the trilogy,
he returned to it in the introduction he wrote for Queer, his novel about a
romantic same-sex obsession, when he finally published it in 1985. He had
abandoned the book in the 1950s because his would-be publisher wanted
him to omit the explicitly queer material, but by the mid-1980s, the literary
landscape had radically changed, and his subject no longer shocked. With
the hiv /aids epidemic, Queer had assumed a new dimension—tragic,
ironic, heroic—and with the virology theme, Burroughs refashioned it as an
aids novel. The epidemic reinvigorated Burroughs’s insights about the de-
humanizing effects of the virus of culture, which, having ‘‘gained access . . .
uses the host’s energy, blood, flesh and bones to make copies of itself.’’∏

214 ‘‘The Columbus of AIDS’’

Neither Queer nor Burroughs’s virus novels contributed to the pubic fash-
ioning of a narrative of hiv /aids, but he became one of the earliest ana-
lysts of the epidemic as a cultural phenomenon. Treichler’s observation that
aids is an ‘‘epidemic of signification’’ is in the spirit of Burroughs, as is
Douglas Crimp’s insistence that ‘‘aids does not exist apart from the prac-
tices that conceptualize it, represent it, and respond to it. We know aids
only in and through those practices.’’π
By contrast, Randy Shilts’s 1987 controversial bestseller And the Band
Played On brought the story of the early years of the epidemic to a main-
stream audience and contributed significantly to an emerging narrative of
hiv /aids. Shilts intended in his work, which the cover advertised as a
‘‘masterpiece of investigative reporting,’’ to offer an analysis of the policies
that facilitated the full-fledged epidemic. But the marketing strategies and
the reviews make it clear that the popular appeal and much of the contro-
versy of the book stem from his dramatic storytelling. And nowhere are the
strategies and consequences of the story he tells more evident than in the
story of the French Canadian airline steward Gaetan Dugas incarnated by
Shilts, and thereby launched into notoriety, as ‘‘Patient Zero.’’ The transfor-
mation of Gaetan Dugas into ‘‘Patient Zero’’ represented the animation of
the virus, which, like the converted pod people, loosed the specter of a
willful scourge.
‘‘Patient Zero’’ is an ‘‘aids carrier,’’ a term used in the medical, scientific,
and journalistic discussions of hiv /aids despite its technical inaccuracy.
aids is a syndrome, a constellation of opportunistic infections that the
medical establishment believes to occur as the result of the human immu-
nodeficiency virus’s effect on the immune system. ‘‘aids,’’ therefore, cannot
be ‘‘carried’’ or transmitted. hiv can, and the distinction is more than
semantic: it affects the perception and treatment of both the disease and
those who test positive for the virus, with and without symptoms. The
confusion, manifest in terms such as ‘‘aids carrier’’ and ‘‘aids virus,’’ is
evident in even the most reputable scientific and journalistic publications,
attesting to Treichler’s ‘‘epidemic of signification.’’ ‘‘Patient Zero’’ as an
‘‘aids carrier’’ illustrates the impact of prior narratives, such as the story of
‘‘Typhoid Mary’’ and The Invasion of the Body Snatchers, on the effort to
make sense of the experience of hiv /aids. The figure silently witnesses
the evolution of the narrative; ‘‘he’’ testifies to its extensions and embodies
its consequences. If for Geddes Smith the carrier brought contagion into
the explanatory realm of the everyday, for Shilts ‘‘he’’ endowed it with the
sinister agency of human retribution.

‘‘The Columbus of AIDS’’ 215

 Shilts intended to analyze the factors that had enabled the outbreak to
expand past the point of containment, but And the Band Played On attests
to the strength of his desire, perhaps not entirely conscious, to write a story
that would imagine its containment: to turn the outbreak into an outbreak
narrative. ‘‘Patient Zero’’ was central to that project. Epidemiologically, the
identification of an ‘‘aids carrier’’ had established the communicability of
the syndrome (or of the microbes that caused it) and brought researchers
closer to a solution. The identification of a virus generated a viral narrative:
the source of the problem was a foreign agent whose behavior posed a
threat to the body politic that required his excision. The story was told not
only by Shilts but also in the journalistic and even scientific literature. And
it was retold in the popular fiction and film that helped to make ‘‘Patient
Zero’’ a mythic figure.
Humanity drains from the gay French Canadian flight attendant during
the course of Shilts’s story, as he metamorphoses into the familiar human-
virus hybrid, haunting San Francisco’s gay bathhouses, intent on ‘‘convert-
ing’’ as many unsuspecting victims as he can find. Like the virus, he was
rapidly Africanized, as is evident in frequent misattributions in the main-
stream media. An announcement of Shilts’s forthcoming book in the New
York Times, for example, which was headed ‘‘Canadian Said to Have Had
Key Role in Spread of aids,’’ explains that ‘‘in retracing the early spread of
aids among gay men, the book says scientists suspect Mr. Dugas brought
the aids virus to this country after having contracted it in Europe through
sexual contacts with Africans.’’∫ Shilts in fact claims only that ‘‘Gaetan
traveled frequently to France, the western nation where the disease was
most widespread before 1980.’’Ω But the hybridity of ‘‘Patient Zero’’ and the
presumed African origins of the disease unleashed narrative conventions of
its own, and the story evolved.
With the evolution, however, the outbreak story began to shift away from
the hiv /aids epidemic. Heroic epidemiologists populate Shilts’s book,
and following its publication, the mainstream media foretold the impend-
ing triumph of science over the virus. But the promised cures and vaccines
were not forthcoming. By the 1990s, the disease was considerably more
manageable in some parts of the world, but its continuing devastation
illuminates social, economic, and political inequities worldwide. Despite
considerable progress in the development of treatments, there is no end-
point from which to look back, not even the possibility of a projected
closure that is necessary for an outbreak narrative. At the same time, as the
epidemic now marks its age in decades rather than years, it is no longer

216 ‘‘The Columbus of AIDS’’

possible to sustain the apocalyptic language that characterized the spread of
the disease in its early years. Its long incubation period, moreover, erodes its
dramatic potential, making it difficult to chronicle specific and immediate
routes of contagion. hiv /aids is not well suited to the formula of an
outbreak narrative. The legacy of Shilts’s depiction of viral agency has not
been evident in the considerable artistic output generated by the hiv /aids
epidemic. aids narratives evolved instead into different kinds of stories,
recounting, for example, the heroism of afflicted individuals in the face of
adversity and the communities that form around them, as in Jonathan
Demme’s 1993 Philadelphia or Paul Monette’s 1988 Borrowed Time: the
tragedy of human suffering and the triumph of the human spirit, rather
than the containment of the virus. Or, as in the case of Rent (1996) and
Angels in America (1993, 1994), the drama of the disease may be in the
service of broader social commentary, increasingly with a global focus.∞≠
Following the heirs of ‘‘Patient Zero’’ actually leads away from the hiv /
aids epidemic and into accounts of species-threatening outbreaks and
even bioterrorism. They are the viral protagonists of popular fiction and
film that deflect as they transpose anxieties about hiv /aids onto the
apocalyptic scenarios of the infections emerging elsewhere, usually in Af-
rica, although increasingly (with the publicity about sars and avian flu) in
Asia. Unlike with hiv /aids, when these fictional viruses erupt domes-
tically, rather than just threatening to do so, they are quickly and heroically
contained with help from the laboratory and as a result of the brilliant
epidemiological detective work that is the cornerstone of the outbreak nar-
rative. As these viruses literally assume human form, they give voice to the
viral representations in Shilts’s and other journalistic and scientific works,
and they enact the story that those works could only imagine: the hiv /
aids outbreak narrative.

INVENTING AN OUTBREAK:
T H E L A N G U AG E O F E P I D E M I O L O G Y

Accounts of the earliest cases of aids feature the epidemiological feat of

their identification. The syndrome presented in a variety of symptoms and
was notoriously difficult to recognize. Shilts attributes its initial identifica-
tion to a few conscientious and astute scientists: an alert cdc researcher
who noticed an unusual number of requests for a drug to treat a rare form
of pneumonia, a few physicians troubled by a strange array of symptoms in

‘‘The Columbus of AIDS’’ 217

their gay male patients. Each new clue made epidemiologists fear that they
were seeing ‘‘the tip of the iceberg’’ (a recurring phrase in their accounts)
and hope that they were approaching answers that would lead to a cure.
Against numbers that rose at an alarming rate, they fashioned stories that
would help them to understand the mysterious illnesses and deaths. Writ-
ten in the language of epidemiology, those stories shaped the cultural as
well as scientific narratives of the early years of the epidemic.
The epidemic reinvigorated the field of epidemiology, bringing renewed
attention to communicable-disease investigation. In 1985 the cdc an-
nounced a new course on applied epidemiology that featured training in
how to collect data, recognize patterns, and fashion them into explanatory
narratives. The description of that training shows how epidemiological
narratives rely on conventions that facilitate the identification of an out-
break, but can also obscure relevant information. It illustrates, moreover,
how those narratives can reproduce cultural conventions that influence
scientific hypotheses.
Classification is a central part of epidemiological training, and one of the
course’s thirteen modules teaches participants ‘‘to categorize cases accord-
ing to given definitions and select which categories to include in an analysis
of a group of cases by time, place, and person.’’∞∞ The ‘‘given definitions’’
emerge from years of careful study of disease and public health; they inevi-
tably reproduce assumptions about populations and social interactions that
can be both helpful and restrictive. They register the cultural narratives that
mediate experiences: the stories that are told, in a variety of media and
forms, about the constitution of the social world and the relations that
comprise it. Within the context of such stories, and the biases they perpetu-
ate, Matthew Bennell and his companions must make sense of the events
through which they are living in Invasion of the Body Snatchers. ‘‘Given
definitions’’ help them to see that something is wrong, but also keep them
from identifying the source of the problem. The description of the cdc
course manifests an awareness of that challenge and includes a promise to
train students ‘‘to formulate initial and refined definitions of their own.’’ But
looking past familiar categories is a difficult task, and the earliest narratives
of any new disease will reflect assumptions about the location, population,
and circumstances in which it is first identified.
The course description constitutes the epidemiologist as primarily an
observer and reporter. The module on ‘‘Characterizing the Multiple-Case
Outbreak’’ begins with the assertion that ‘‘any patterns that can be observed
regarding time of onset of illness, possible exposures and personal features

218 ‘‘The Columbus of AIDS’’

of the cases help to pinpoint an illness’s agent, source, and means of trans-
mission,’’ and it promises to teach ‘‘participants to organize case data ac-
cording to variables of time, place, and person so that these patterns can be
easily identified and interpreted.’’ The passive voice stresses the act of dis-
covery: the patterns are there in the world to be identified. The grammar
downplays both the role of the observer in inventing the patterns and the
conventions that can make those patterns misleading. The emphasis on
discovery and consequent obscuring of invention explains how the epi-
demiological construction of an outbreak narrative reproduces conven-
tions that shape perceptions.
The early years of hiv /aids illustrate how the construction of a narra-
tive about the outbreak at once facilitated and impeded the diagnosis of the
problem. The syndrome first came to researchers’ attention when they
identified disease patterns in previously healthy young men who identified
themselves (or who were identified by their doctors) as ‘‘homosexual.’’ The
patients’ shared sexuality made the patterns more quickly visible to astute
doctors and researchers and offered the earliest clues for them to follow.
But the early identification of the syndrome as gay-related immunodefi-
ciency (grid) obscured cases that were surfacing among individuals who
did not fit into the category of ‘‘homosexual man,’’ which delayed impor-
tant discoveries about the syndrome, including its transmissibility through
sex between men and women and through blood transfusion. It also, of
course, pathologized gay men, and, soon thereafter, it constituted hiv /
aids as primarily transmitted sexually, which has continued to shape its
depiction. Even when other populations were (quickly) identified among
the afflicted (and also pathologized in the United States), including Hai-
tians, intravenous-drug users, and hemophiliacs, the public and even re-
searchers often found it difficult to abandon the earliest assumptions about
the disease. The early years of the epidemic illustrate both the utility and
the danger involved in identifying patterns and in incorporating them into
an outbreak narrative.
The narrative emerged first in specialty publications and then, more
sensationally, in the mainstream media. The cdc’s publication Morbidity
and Mortality Weekly Report (mmwr ) carried the initial harbinger of the
outbreak on 5 June 1981. The report noted a confirmed diagnosis of Pneu-
mocystis pneumonia (pcp), typically seen in immune-compromised indi-
viduals, in ‘‘5 young men, all active homosexuals’’ between October 1980
and May 1981 at three Los Angeles area hospitals.∞≤ The men did not know
each other, and they had no sexual or casual contacts in common; they

‘‘The Columbus of AIDS’’ 219

shared only their same-sex object choices, their use of inhalant drugs, and
the city of Los Angeles. Characteristic of the mmwr , the report was de-
scriptive but not speculative, suggesting only ‘‘the possibility of a cellular-
immune dysfunction related to a common exposure that predisposes indi-
viduals to opportunistic infections such as pneumocystosis and candidiasis’’
(251). It identified gay men as the afflicted population, however, alerting
healthcare workers to suspect pcp when ‘‘previously healthy homosexual
males’’ presented with certain upper-respiratory symptoms (251).
A month later, in early July, the mmwr reported the appearance of
Kaposi’s sarcoma (ks) and pcp in twenty-six gay men in New York City and
California during the previous thirty months. The ten new cases of pcp
identified in the article meant ‘‘that the 5 previously reported cases were not
an isolated phenomenon,’’ and the cluster suggested an outbreak, although
the authors of the report declared it too soon to determine ‘‘if or how the
clustering of ks, pneumocystis, and other serious disease in homosexual
men is related.’’∞≥ The report was restrained, but it was clear that the au-
thors found the sexuality of the patients too compelling to ignore. While
they conceded that it was not certain that only gay men were affected, that
group comprised the ‘‘vast majority’’ of reported cases, and the report cau-
tioned physicians to ‘‘be alert for Kaposi’s sarcoma, Pneumocystis pneu-
monia, and other opportunistic infections associated with immunosup-
pression in homosexual men’’ (307).
The lead author of the July report, the New York dermatologist Alvin E.
Friedman-Kien, also published a more detailed account in the Journal of the
American Academy of Dermatology, where he speculated about what he
called the ‘‘intriguing’’ question of the appearance of this particular form of
ks ‘‘in a highly sexually active segment of the male homosexual subpopula-
tion.’’∞∂ The appearance of the disease was surprising because it typically
affected elderly men, often of Mediterranean descent, in a less invasive and
less aggressive form. Friedman-Kien expressed his reluctance to posit a
contagious etiology, noting that ‘‘so far only four of forty-one of these ks
patients admitted to having had transient, intimate sexual contact with
other men in this ks group.’’ But with an immediate ‘‘however,’’ he signaled
his conviction that gay male sexuality was likely to be involved, since ‘‘most
of the patients often indulged in anonymous sexual activities at gay bath-
houses, bars, clubs, and gay resort areas’’ (469; emphasis added). Less re-
strained than in the mmwr report, he posited ‘‘the evolution of a new
syndrome of epidemic proportions’’ and enjoined physicians to ‘‘be par-
ticularly concerned with their patients’ sexual orientation so that they can

220 ‘‘The Columbus of AIDS’’

be better prepared to look for possible immunologic defects, genetic sus-
ceptibility and related problems’’ (469). As he heralded the outbreak, he
used the principles of epidemiology to begin to fashion an outbreak narra-
tive. His belief that the common gender and sexuality of the afflicted held
the clue to their affliction led him to posit sex as the means of transmission.
The embellishments that he added with the word indulged and the charac-
terization of the patients’ sexual comportment offer insight into how ste-
reotypes and cultural narratives subtly infuse scientific hypotheses.
The coincidences were already too compelling to ignore and generated
theories about the strange new syndrome. The three featured articles of the
10 December issue of the New England Journal of Medicine later that year
reported on the acquired immunodeficiency in male homosexuals and, in
one of the pieces, male drug abusers. The population was certainly relevant
to theories about the etiology of the syndrome, suggesting to the authors of
the first report ‘‘that a sexually transmitted infectious agent or exposure to
a common environment has a critical role in the pathogenesis of the immu-
nodeficient state. Sexually transmitted infections . . . are highly prevalent in
the male homosexual community.’’∞∑ The proliferation of reported cases
convinced the authors of one of the other articles that their findings were
‘‘part of a nationwide epidemic of immunodeficiency among male homo-
sexuals.’’∞∏ An account of these three articles comprised the sole mention of
the syndrome in the New York Times in 1981.
By the spring of the following year, speculation had turned into a pro-
nouncement of a full-blown ‘‘epidemic.’’ By that time, the categories were
starting to unravel. While the titles of the earliest accounts in the mmwr
announced the identification of a pattern of symptoms ‘‘among homosexual
males,’’ the 11 June 1982 issue offered an ‘‘update on Kaposi’s sarcoma and
opportunistic infections in previously healthy persons.’’∞π Yet, the persis-
tence of the category that seemed to offer the most powerful clue to epi-
demiologists is evident in the editorial notes of the report explaining that
‘‘sexual orientation information was obtained from patients by their physi-
cians, and the accuracy of reporting cannot be determined; therefore, com-
parisons between ksoi [ks and (other) opportunistic infections] cases
made on the basis of sexual orientation must be interpreted cautiously’’
(301). Similarities among the cases prompted a ‘‘laboratory and interview
study of heterosexual patients with diagnosed ks, pcp, or other oi . . .
to determine whether their cellular immune function, results of virologic
studies, medical history, sexual practices, drug use, and life-style are similar
to those of homosexual patients’’ (301). The categories of inquiry continued

‘‘The Columbus of AIDS’’ 221

to be determined by the ‘‘population’’ in whom doctors had first noticed the
symptoms. Because it offered the strongest clues about the nature of the
infection, that classification was hard for researchers to relinquish.
The tenacity of the classification is evident in the earliest accounts in the
mainstream press as well. The 1981 New York Times piece that reported on
the ‘‘cluster of cases in which usually harmless viruses and bacteria can
produce illness, almost exclusively among homosexual men’’ cited the cau-
tionary words of Frederick P. Siegal, an immunologist and lead author of
one of the New England Journal of Medicine pieces from that year, who
noted that ‘‘it may be premature to say it is a homosexual disease. . . .
Whatever the inciting agent is is simply more widely dispersed in that
population.’’∞∫ Yet the piece also claimed that ‘‘studies have shown homo-
sexual men are more susceptible to sexually transmitted disease,’’ and the
headline proclaimed, ‘‘Homosexuals Found Particularly Liable to Common
Viruses.’’
When the syndrome was next mentioned in the New York Times, the
following May, the headline announced, ‘‘New Homosexual Disorder Wor-
ries Health Officials.’’∞Ω In this lengthy piece, Lawrence K. Altman explained
that researchers have named the disorder ‘‘a.i.d., for acquired immu-
nodeficiency disease, or grid, for gay-related immunodeficiency,’’ but he
employed the latter acronym throughout the article. In spelling it out, he
dropped the word disease (the ‘‘d’’ came from the embedded deficiency), as
though the immunodeficiency were not the result of an acquired disease,
but an outcome of homosexuality itself. The message of the piece is alarm
over an epidemic that represents ‘‘ ‘just the tip of the iceberg’ ’’ (c1), tem-
pered by reassurance that the syndrome ‘‘seems to result from an accumula-
tion of risk factors,’’ is not readily contagious, and need not be feared by ‘‘the
general public’’ (c6). Nonetheless, the uncertainty about the cause of the
syndrome, and the horror of its effects as it shut down the immune system,
coupled with words such as epidemic and outbreak, set the stage for the
drama of a major discovery.

THE NON-CALIFORNIAN

The discovery was announced in the 18 June mmwr , just one week after
the ‘‘update’’ on the immune-system collapse ‘‘in previously healthy per-
sons.’’ Earlier accounts had speculated about the infectiousness of the disor-
der, but always with the disclaimer that the afflicted ‘‘had no known contact

222 ‘‘The Columbus of AIDS’’

with each other, had no known sexual partners in common, and had no
known contact with patients’’ suffering from its effects.≤≠ This account
reported on a cluster study of ks and pcp among gay men in southern
California (Los Angeles and Orange Counties). The study was precipitated
by ‘‘an unconfirmed report of possible associations among cases in southern
California.’’≤∞ Here at last was the break for which epidemiologists had been
waiting: the cluster study finally brought an unidentified infectious agent to
center stage by demonstrating connections among person, place, and time.
Epidemiologists could finally begin to fashion a narrative of the outbreak.
‘‘Within 5 years of the onset of symptoms,’’ the report announced, ‘‘9 pa-
tients (6 with ks and 3 with pcp) had had sexual contact with other pa-
tients with ks and pcp‘‘ (305). A breakdown of the contacts follows, and
with it the significant detail that ‘‘2 [patients] from Orange County had had
sexual contact with 1 patient who was not a resident of California’’ (305).
The report established the direct links among nine patients from Los
Angeles and Orange counties as ‘‘part of an interconnected series of cases
that may include 15 additional patients (11 with ks and 4 with pcp) from 8
other cities. The non-Californian with ks mentioned earlier is part of this
series’’ (306). It was the first mention of the figure who would become
‘‘Patient Zero.’’ The report remained tentative about the inferences of the
data, asserting no more than that ‘‘one hypothesis consistent with the ob-
servations reported here is that infectious agents are being sexually trans-
mitted among homosexually active males’’ (306), an assertion that had been
advanced from the earliest observations of the disorder. Nonetheless, it
marked the beginning of an important change of focus, registered in the
altered language of subsequent accounts. The conviction that an infectious
agent caused the syndrome intensified the search for the agent and in-
flected the emerging outbreak narrative. The ‘‘non-Californian’’ was impor-
tant to the infectious-agent theory, and his transformation into ‘‘Patient
Zero’’ would be central to the narrative.
The next day, a New York Times headline blazoned, ‘‘Clue Found on
Homosexual’s Precancer Syndrome.’’ The article’s author, Lawrence K. Alt-
man, informed readers that epidemiologists had found new evidence to
suggest that ‘‘the outbreak’’ of the mysterious syndrome was ‘‘linked to an
infectious agent.’’ While the cdc epidemiologist Harold Jaffe underscored
that the discovery did not imply a solution, he explained that it offered
proof that the disorder was ‘‘ ‘not occurring as a random event among
homosexual men’ ’’ and that it had prompted ‘‘ ‘scientists at the Atlanta
facilities’ ’’ to intensify ‘‘ ‘laboratory efforts to identify a virus, bacteria or

‘‘The Columbus of AIDS’’ 223

other micro-organism as a possible cause.’ ’’≤≤ For Cindy Patton, the new
emphasis resulted from a change in interpretation and perspective rather
than in data, and she located the triumph of virology in ‘‘greater financial
and scientific [rather than explanatory] power.’’ She argued that ‘‘the same
aids epidemiological studies which immunologists saw as evidence for a
social or environmental cause of aids’’ showed virologists ‘‘evidence of a
sexually transmissible pathogen. . . . [I]n aids, etiological agent and im-
mune system breakdown theories were brought into line via the discovery
of an agent which ‘attacked,’ or more accurately, disarmed the immune
system.’’≤≥ The story could certainly be told in multiple ways, and the narra-
tive choices indeed affected the approach and outcome. Yet, as Patton and
Emily Martin both noted, in the decade preceding the identification of
hiv /aids, immunologists enjoyed more explanatory power and prestige
than virologists.≤∂ The emerging story registered a complex interplay of
factors, and the discovery of an infectious agent for aids was dramatically
transformational. Not since the polio epidemics of the 1950s had an out-
break in North America generated such widespread fear.
The early years of the epidemic illustrate the mutual influence of scien-
tific discoveries, socioeconomic factors, and cultural biases as well as the
impact of the narratives they generate. The June announcement of a likely
infectious agent in both scientific and mainstream publications unleashed
the power of the outbreak narrative and, with it, the triumph of virology
that Patton describes. Faced with a terrifying mystery, Altman reassured his
readers that the disorder was not random and that a responsible agent
would be identified in the laboratory. While the familiar features of an out-
break narrative laid the groundwork for the acceptance of the infectious-
disease hypothesis, the contours of that narrative, in turn, were fleshed out
by the theory and augmented by the discovery of the virus. Virology hence-
forth dominated both the research field and the treatment options, and
Patton is justified in her lament that ‘‘virology’s assumption that a virus can
simply be eliminated or blocked . . . misdirected research efforts for . . .
years, denying thousands of people potential therapies which could have
prolonged or improved the quality of their lives.’’≤∑ It also imported a vo-
cabulary that would shape perceptions of the disorder and the people it
affected.
With the discovery of a virus that attacked the immune system came
the renewal of language that had largely gone out of fashion with the Cold
War. One of the earliest accounts from 1981, Friedman-Kien’s piece in the
Journal of the American Academy of Dermatology, had described patients’

224 ‘‘The Columbus of AIDS’’

apparently ‘‘defective immunologic surveillance mechanisms of defense
that render them more susceptible to such infections.’’≤∏ The proliferation
of scientific and popular accounts of the syndrome in 1983 carried tales of
exploding immune systems with detailed descriptions of the consequences
of the lowered surveillance. The battle that was aids entailed the penetra-
tion of the familiarly wily, crafty, sinister invader, but this one, with particu-
lar cruelty, disabled the very defense mechanisms needed for the fight,
leaving the body completely susceptible to all of the other marauders re-
sponsible for the physical devastation that constituted the syndrome.
Military metaphors abounded to explain both the psychological and
physical experience of aids. A 1982 Newsweek article cited the early aids
activist and playwright Larry Kramer’s comparison of life as ‘‘ ‘a gay man in
New York’ ’’ at the time to ‘‘ ‘living in London during the blitz, when you
didn’t know when the next bomb would strike.’ ’’≤π It was the ur-virus,
the epitome and king of what one writer dubbed ‘‘Supergerms: The New
Health Menace.’’ Neither the menace, nor the language was new, but it was
noteworthy that ‘‘after four decades of medical victories, infectious agents
[were] striking back with new intensity between human beings and con-
tagious diseases.’’≤∫ Military language was familiar to the medical world in
the 1980s. Most notably, Richard Nixon’s declaration of a ‘‘war on cancer’’
had helped to refocus approaches to and funding for cancer research in the
previous decade. But the language that introduced the ‘‘mysterious new
killers, such as acquired immune deficiency syndrome (aids)’’ and the
‘‘elusive killer’’ lurking in the recesses of the body’s defense mechanisms,
resurrected the viral foe of the 1950s.≤Ω The language jumped from virus to
host. The viral ‘‘suspects’’ for which the nih researcher Anthony Fauci
described the search were microbial agents, but they readily took human
form in the ‘‘rumors’’ of unnamed victims who were ‘‘purposely trying to
infect as many others as possible.’’≥≠
The incarnation of the threat in gay men was no surprise to those who
were familiar with homophobia in the United States. Haitians, intravenous-
drug users, and hemophiliacs, designated as belonging to ‘‘risk categories’’
in the summer and fall of 1982, were incorporated into the viral equa-
tion, with an accompanying interchange of features for the emerging viral-
human hybrid.≥∞ Those most at risk became perpetrators through vivid
descriptions of their interactions, such as the ‘‘network’’ described in the
New Republic in the summer of 1983, ‘‘where thousands of people [were]
interacting sexually [which offered] as rich an environment for the dis-
semination of disease as one could possibly imagine.’’≥≤ Promiscuity, the

‘‘The Columbus of AIDS’’ 225

intermingling of bodily fluids of all kinds, created a disease environment
that materialized the much-foretold collapse of civilization; ‘‘risk groups’’
were the enemies within.
Stigmatizing is a form of isolating and containing a problem, such as a
devastating epidemic. It is also a means of restoring agency—which, as in
the rumors of willful infectors, melts into intentionality—in the face of the
utter banality of the foe. Nothing better illustrated the strategy or the scien-
tific, medical, and social consequences than the fate of Gaetan Dugas.

‘ ‘ PAT I E N T 0 ’ ’ A N D T H E C A R R I E R D I S E A S E

The arduous journey that took researchers from the hypothesis of infec-
tivity to the identification of an actual agent was depicted in terms as he-
roic as Miles’s and Becky’s last stand against the pods. With mounting hope
and desperation, public attention turned to ‘‘America’s disease detectives,
whose special calling it is to track invisible killers, to identify mysterious
illnesses that erupt from nowhere to menace life and health,’’ the ‘‘elite cadre
of . . . experts—pathologists and epidemiologists, assisted by a larger army
of lab technicians and doctors—. . . coordinating their skills in an effort to
conquer any new threat: Acquired Immune Deficiency Syndrome, the con-
founding killer known as aids.’’≥≥ The invisible killer had a name. Soon it
would acquire a face and a human form.
A 1984 American Journal of Medicine piece represented an important
step in the creation of the narrative and the figure of the carrier. It re-
ported the results of a study that pursued the sexual links suggested by the
cluster of cases noted in the 18 June 1982 issue of mmwr and confirmed
the ‘‘epidemiologic information suggest[ing] that an infectious agent may
cause aids.’’ The ‘‘non-Californian’’ figures more prominently in this re-
port, which names him into a new identity as an epidemiological index case
with the claim that ‘‘aids developed in four men in southern California
after they had sexual contact with a non-Californian, Patient ≠.’’≥∂ The
numerical discrepancy between this report and the original study can be
attributed to the continuing investigations in which epidemiologists had
pursued the links of ‘‘the non-Californian’’ and acquired more informa-
tion.≥∑ A more significant difference between the reports is the change in
the temporality and causality implied by the word after. While in the first
piece the patients reported having had sex with the non-Californian, the
four men in the second piece developed aids after (and presumably be-
cause of) having had sex with him.

226 ‘‘The Columbus of AIDS’’

 The 1984 account begins to confer a specific identity and role in viral
transmission on the non-Californian, which the researchers signal by nam-
ing him ‘‘Patient ≠.’’ A diagram that accompanies the article corroborates
this transformation. The diagram shows forty linked circles, each repre-
senting ‘‘an aids patient’’ and identified by place (Los Angeles, New York
City, or a state), number, and disease. At the center is a black circle (for ks)
marked simply ‘‘≠.’’ The discussion following the introduction of ‘‘Patient ≠‘‘
explains that he developed lymphadenopathy, a chronic swelling of the
lymph nodes usually associated with disease and a characteristic harbinger
of aids, in December 1979 and was diagnosed with ks the following May.
He could name seventy-two of his 750 sexual partners between 1979 and
1981, which enabled investigators to discover that eight of them—four
each from New York and Los Angeles—had diagnosable aids. ‘‘Because
Patient ≠ appeared to link aids patients from southern California and New
York City,’’ the researchers ‘‘extended [their] investigation beyond the Los
Angeles–Orange County metropolitan area. Ultimately, [they] were able to
link forty aids patients by sexual contact to at least one other reported
patient’’ (489). The diagram represents the linkages, visually placing ‘‘Pa-
tient ≠‘‘ at the center of the forty cases. It means only that he is the epi-
demiological index, the case from whom they tracked other cases; he is
central to their tentative conclusions.
Following the initial introduction of ‘‘Patient ≠,’’ the language of the report
highlights the speculative nature of those conclusions: he ‘‘appeared to
link’’ the Los Angeles and New York cases; he is a ‘‘possible source’’ of the
disease in several other patients (490; emphasis added). The comments at
the end of the report include the observations that aids ‘‘may be caused by
an infectious agent that is transmissible from person to person in a manner
analogous to hepatitis B virus infection,’’ that the ‘‘existence of a cluster of
aids cases linked by homosexual contact is consistent with an infectious-
agent hypothesis,’’ that the ‘‘cluster may represent a group of homosexual
men who were brought together by a common interest in sexual relations
with many different partners or in specific sexual practices, such as manual-
rectal intercourse,’’ and that if ‘‘the infectious-agent hypothesis is true, Pa-
tient ≠ may be an example of a ‘carrier’ of such an agent’’ (490; emphasis
added). The account of the study in the New York Times introduced him
only as ‘‘a homosexual man who may have been a carrier of the disease,
spreading it across the country without knowing he had it.’’ It included the
cdc epidemiologist Bill Darrow’s conjecture that the man whom he and his
colleagues called ‘‘Patient 0 picked up the syndrome from a contact in Los
Angeles or New York and carried it across the country to the others.’’≥∏ It

‘‘The Columbus of AIDS’’ 227

‘‘Sexual contacts among homosexual men with aids. Each
circle represents an aids patient. Lines connecting the circles
represent sexual exposures. Indicated city or state is place of
residence of a patient at the time of diagnosis. ‘≠’ indicates
Patient ≠ (described in text).’’ Reprinted from D. M. Auerbach,
W. W. Darrow, H. W. Jaffe, and J. W. Curran, ‘‘Cluster of Cases
of the Acquired Immune Deficiency Syndrome: Patients Linked
by Sexual Contact,’’ American Journal of Medicine, vol. 76
(March 1984): 488. ∫ 1984, with permission from Elsevier.

228 ‘‘The Columbus of AIDS’’

was nonetheless big news, since the definitive existence of these connec-
tions—and of a Patient ≠—would establish an infectious agent as well as the
network of sexual interactions.
Despite the proliferation of qualifications in the medical journal and in
the New York Times, the initial introduction of ‘‘Patient ≠,’’ and especially his
christening as ‘‘Patient ≠’’ and the accompanying diagram, would eventually
lead to his depiction as the index case and the cause at least of the forty-
person cluster of aids cases. In subsequent accounts of this study, ‘‘Patient
≠’’ would gradually metamorphose from an epidemiological index case (the
source of the study) to the index case and source of ‘‘North American
aids.’’ The transformation lacks scientific validity. The numerous sexual
partners reported by many people with aids, which had been widely re-
marked on in the scientific and mainstream media, combined with the
lengthy latency period that the evidence increasingly demonstrated, would
make it impossible to pinpoint an exact source even for most of the cases
recorded on the chart. Even if the onset of aids symptoms followed the
patient’s sexual contact with ‘‘Patient ≠,’’ it would be difficult to demonstrate
direct causality.
The language and images in the study, however, work against its explicit
claims, showing how the positing and tracking of a ‘‘Patient ≠’’ led to a
diagram of and eventually to a narrative about forty ostensibly linked cases
of aids. Returning to the first study that began to bring the variables of
person, place, and time into focus, the study develops the narrative, fleshing
out the non-Californian as its main character, simultaneously the epidemi-
ological index case and the archetypal carrier of aids. Following the incar-
nation of ‘‘Patient ≠’’ as a carrier in the report, the researchers explain that
the ‘‘existence of an asymptomatic carrier state of aids has been suggested
by a report of aids-like illness in an infant who had received a platelet
transfusion from a man who had no symptoms when he donated blood, but
had aids eight months later.’’≥π But if, as they suggest, an infectious agent
causes aids and the disorder has a long incubation period, then everyone
who gets aids has presumably been an asymptomatic carrier and then
becomes an ailing transmitter. So what distinguishes ‘‘Patient ≠’’?
As illustrated in the diagram, his most distinctive feature is his geograph-
ical designation. While every other aids case in the diagram is marked by
city or state, he is just ‘‘≠,’’ the absence of place: the non-Californian. The
designation prepares him to become the viral incarnation coming in from
somewhere else and initiating an outbreak in the United States. Despite the
qualifications in the report and the New York Times, the lay public, and even

‘‘The Columbus of AIDS’’ 229

many in the scientific and medical communities, failed to distinguish be-
tween the epidemiological index and the index case of an epidemic. Randy
Shilts was one of them, and with the publication of his journalistic account
of the early years of the epidemic, the distinction would be lost. In 1987 the
public would learn that ‘‘Patient ≠’’ was a French Canadian flight attendant
who had traveled to Haiti and who may have brought hiv /aids to North
America from France. It was in 1987, in other words, that the public would
have its flesh-and-blood index case/carrier and its full-fledged carrier—and
would-be outbreak—narrative.
The intervening years had witnessed the intensified animation of the
newly identified retrovirus in the popular press and a renewed attention to
viral mechanisms in the popular media. Announcing the presumed discov-
ery of a viral cause of aids by U.S. and French teams, a Time magazine
piece entitled ‘‘Knowing the Face of the Enemy’’ explained how viruses
‘‘infiltrate a host cell and commandeer its reproductive machinery.’’≥∫ The
piece was accompanied by a diagram of tanks invading a building and
taking over its construction. Calling it ‘‘the toughest virus of all,’’ another
writer deplored ‘‘the virus’ Machiavellian tactics,’’ by which he meant the
rapid mutations of the retrovirus that forestalled the development of an
hiv vaccine.≥Ω The animation amplified the association of the virus with
gay men. ‘‘Now that the Disease Has Come Out of the Closet,’’ asked an-
other Time headline, ‘‘How Far Will It Spread?’’∂≠ Readers learned that ‘‘the
aids virus . . . ‘turns the T cell off from being a lymphocyte and on to being
an aids-virus factory’ ’’ (42). Citing a study from the journal Cell, the au-
thor of the article, Claudia Wallis, explained ‘‘that the virus has a unique
genetic component that allows it to reproduce itself a thousand times as fast
as any other kind of virus. . . . It is a peculiar feature of this disease that as it
progresses, the helper T cells disappear and so does the virus. By then,
however, the patient is invariably beyond recovery’’ (42). The link estab-
lished by the title suggested a connection between the rapidly producing
and devastating virus, a ‘‘ ‘formidable adversary’ ’’ (47), and the mainstream
(and often scientific) media depictions of the reviled promiscuity of its
allegedly suicidal and/or homicidal gay male hosts.

T H E F I N A L M E TA M O R P H O S I S

The incarnation of the viral-human (gay male) hybrid with sinister inten-
tions was complete when ‘‘Patient ≠’’ became ‘‘Patient Zero’’/Gaetan Dugas.

230 ‘‘The Columbus of AIDS’’

Shilts intended to show how homophobia, self-interest, personal ambi-
tions, profit motives, and misguided politics prevented the immediate re-
sponse that could have contained the epidemic and to indict politicians, the
mainstream media, academic scientists, and even some gay activist groups
for the failure. But his effort to understand—and imagine an endpoint for—
hiv /aids led to a shift in his account. As ‘‘Patient ≠’’ was central to the
epidemiologists’ effort to argue for an infectious etiology for aids, ‘‘Patient
Zero’’ was key to the story that Shilts hoped to write.
Shilts recognized in the epidemiological investigation the drama that
would make his analysis widely readable. The cdc task force that handled
the epidemic comprises some of his most heroic characters in And the
Band Played On. Their discovery of Gaetan Dugas is a turning point in their
investigation. During an interview with an ‘‘ailing hairdresser’’ in Orange
County, two members of the task force are interested to hear him invoke an
airline steward, named Gaetan Dugas, who gave him hepatitis and to muse,
‘‘ ‘I bet he gave me this new disease, too’ ’’ (130). Shilts lingers in his story
over the meaningful look exchanged by the cdc researchers. ‘‘Finally,’’ he
writes, ‘‘Auerbach and Darrow had a live person telling them he had had sex
with this flight attendant. It was, Darrow said later, one of the most signifi-
cant moments of the epidemic. The ball had dropped on the game show’’
(130). Darrow looks back in this passage as if from the endpoint of the
epidemic, deciding what in retrospect constituted its most significant mo-
ments: the identification of Gaetan Dugas as ‘‘Patient Zero’’ is the ball at the
end of the game show.
Previews of the book overwhelmingly featured accounts of ‘‘Patient Zero,’’
and his exposure as Gaetan Dugas, to advertise the forthcoming work; few
reviews of the book failed to mention him and many headlined him. In an
interview with a Washington Post reporter, when asked about the reaction
to his book, Shilts called the attention to Gaetan Dugas ‘‘the great irony.
Here I’ve done 630 pages of serious aids policy reporting,’’ he complained,
‘‘with the premise that this disaster was allowed to happen because the
media only focus on the glitzy and sensational aspects of the epidemic. My
book breaks, not because of the serious public policy stories, but because of
the rather minor story of Patient Zero.’’∂∞ It is hard to imagine that Shilts
really did not recognize the importance of his character. He weaves him
throughout the story, tracking his movements as he depicts his increasing
recalcitrance and malevolence. Reviewers singled him out as exemplary of,
in Sandra Panem’s words, the ‘‘sensationalist and seductive devices and
gossip, as well as facile writing [that] draw the reader into the book.’’∂≤ And a

‘‘The Columbus of AIDS’’ 231

1995 review of Laurie Garrett’s The Coming Plague in the Boston Globe,
which compared Garrett favorably to Shilts, nonetheless noted that her
work lacks ‘‘the whodunit pizzazz of Patient Zero.’’∂≥ The phrase captures
both the appeal and the role of the ‘‘Patient Zero’’ story in Shilts’s book.
The portrait of ‘‘Patient Zero’’ conforms to the storyline of early car-
rier narratives. Dubbing Gaetan Dugas ‘‘the Québecois version of Typhoid
Mary’’ (157), Shilts explicitly evokes the earlier story, and it is remark-
able how much this alleged index case behaviorally resembles his prede-
cessor. Despite being told that he ‘‘ ‘may be passing [the immunodeficiency]
around’ ’’ (136; emphasis added), Dugas allegedly refuses to change his be-
havior. To his doctor’s suggestion that he give up sex or at least avoid
exchanging bodily fluids, Shilts’s Dugas responds in a voice that ‘‘betray[s] a
fierce edge of bitterness[,] ‘Of course, I’m going to have sex. . . . Nobody’s
proven to me that you can spread cancer’ ’’ (138). In Shilts’s account the
airline steward never fully accepts the reality of the syndrome, insisting that
he has cancer (ks) and that cancer is not known to be communicable.
Like ‘‘Typhoid Mary,’’ this recalcitrant ‘‘carrier’’ found himself at the cen-
ter of public-health debates about the conflict of rights: his right to make
his own choices and the right of other individuals to be safeguarded. He
embodied the dilemma and crystallized the debate. But Shilts demonized
Dugas even more than Soper vilified Mary Mallon, and the press responded
accordingly. The review of the book for the Washington Post observed that
‘‘Dugas is a character who would have had to be invented did he not already
exist.’’∂∂ I am arguing that ‘‘Patient Zero’’ was invented, that the transforma-
tion of the Canadian flight attendant with the hiv virus into ‘‘Patient Zero’’
was a necessary component of the effort to write an hiv /aids outbreak
narrative and that this transformation had scientific and medical as well as
social consequences. Describing the motivations of one gay activist, Shilts
ventriloquized, ‘‘There was a deadly enemy out there. The fucking thing
didn’t even have a name’’ (161). Gaetan Dugas gave it a name.
Shilts amplifies the conventional journalistic depictions of the virus in his
descriptions of hiv. The virus invades and penetrates; it is a killer (49), a
‘‘viral culprit’’ breeding ‘‘international death’’ (389), ‘‘a guilty virus’’ (451),
‘‘the nastiest microbe humanity had encountered in centuries, if not in all of
human history’’ (552), a ‘‘horribly cruel and insidious virus’’ (621). And its
human embodiment is vindictive, allegedly telling doctors and friends that
he has no obligation to protect others because someone had given it to him.
He steps right into the rumors and urban legends (already circulating in the
press) as reports began in the Castro of ‘‘a strange guy at the Eighth and

232 ‘‘The Columbus of AIDS’’

Howard bathhouse, a blond with a French accent. He would have sex with
you, turn up the lights in the cubicle, and point out his Kaposi’s sarcoma
lesions. ‘I’ve got gay cancer,’ he’d say. ‘I’m going to die and so are you’ ’’ (165).
Selma Dritz, the infectious-disease specialist of San Francisco’s public-
health department and one of the heroes of Shilts’s account, finds the story
of Dugas’s behavior ‘‘one of the most repulsive things [she] had heard in her
nearly forty years in public health’’ (200). Because of these stories he enters
the mainstream press as ‘‘an avenging angel, deliberately infecting everyone
he could find with the disease that was killing him’’; he is ‘‘an airline steward
carrying a disease and a grudge,’’ a ‘‘missing link, the human explosive
whose promiscuous presence may have triggered an epidemic beyond his
imagining,’’ or, as the National Review christened him, ‘‘the Columbus of
aids.’’∂∑
With Dugas’s introduction near the beginning of the account, Shilts omi-
nously describes how, ‘‘when the researchers started referring to Gaetan
Dugas simply as Patient Zero, they would retrace the airline steward’s trav-
els during that summer, fingering through his fabric-covered address book
to try to fathom the bizarre coincidences and the unique role the handsome
young steward performed in the coming epidemic’’ (23). It is hard to know
exactly to what ‘‘unique role’’ refers; for in Shilts’s narrative Dugas plays
more than one: he is—or may be—the index case who brought hiv to
North America, the unwitting carrier whose sexual practices and occupa-
tion (flight attendant) make him an especially efficient vector, the recalci-
trant disseminator who embodies the public-health dilemma and the ma-
levolence of the virus itself. With all of these roles, it is difficult not to see
Dugas as primarily a narrative device. And Shilts certainly takes poetic
license when he imagines Dugas’s thoughts, as when the flight attendant
contemplates his troubled past while examining himself in a steamy mirror
of a San Francisco bathhouse (196).∂∏ There are no historical records that
document exactly what Dugas thought or did in private. And his uncanny
conformity to prior narratives of carriers and journalistic descriptions of
the virus intimate some of the ways in which Shilts’s depiction has been
shaped by them.
His status as index case of the aids epidemic in the United States is easier
to disprove than his motivations. Nothing in the pieces in the 1982 mmwr
or the 1984 American Journal of Medicine actually supports his designation
as an index case of the disease, and as Panem points out in her review for
Science, ‘‘Anyone knowledgeable knows that to pin a global epidemic on the
actions of a single individual is absurd.’’∂π It is, in fact, unimaginable that if

‘‘The Columbus of AIDS’’ 233

hiv entered the United States from without, it did not arrive in multiple
hosts. Lack of documentation of the earliest cases and an unpredictable
incubation period would make it impossible to pinpoint a single index case.
Even Shilts concedes that ‘‘whether Gaetan Dugas actually was the person
who brought aids to North America remains a question of debate and is
ultimately unanswerable’’ (439). Yet he goes on to insist on the details that
give ‘‘weight to the theory’’ (439). Clearly, the Québecois-airline-steward-
turned-viral-invader serves an important function in the narrative. If the
transformation of Gaetan Dugas into ‘‘Patient Zero,’’ like that of Mary Mal-
lon into ‘‘Typhoid Mary,’’ demonizes the ‘‘carrier,’’ it also humanizes the
virus; it gives it agency and makes it comprehensible, attributing to it human
emotions and responses. The metamorphosis represents the authority of
epidemiology and confers that authority on the storyteller. Shilts harnesses
the transformative power of medicine and epidemiology and of the disease
itself (which, after all, performed the initial transformation) to a narrative
that makes sense of that disease. The book and the character captured the
imagination of a public very much in need of that sense-making, even if it
meant believing in monsters.

‘ ‘ T H E G L O B A L - V I L L AG E D I S E A S E ’ ’

Shilts casts the emergence of the microbe as the opening scene of a 1950s
science-fiction horror movie: ‘‘It was November 1, 1980,’’ he writes, ‘‘the
beginning of a month in which single frames of tragedy in this and that
corner of the world would begin to flicker fast enough to reveal the move-
ment of something new and horrible rising slowly from the earth’s biologi-
cal landscape’’ (41).∂∫ The description registers key features of the outbreak
narrative. The image turns the virus primordial and monstrous and sug-
gests its global reach. It becomes apparent through (metaphoric) visual
technologies: single frames flickering fast enough to capture movement and
signal emergence. With this image, Shilts evokes the conventions of epi-
demiological horror to tell the story of the origin of hiv /aids, construct-
ing the primordial monster as the ancestor of ‘‘Patient Zero.’’
The new disease readily lent itself to an assortment of origin theories, but
none gained as much credibility in the medical communities and media of
North America and Western Europe as the African or Haitian origins theo-
ries of hiv. The theories became widespread as soon as the mmwr called
attention to the ‘‘Opportunistic Infections and Kaposi’s Sarcoma among

234 ‘‘The Columbus of AIDS’’

Haitians in the United States’’ in July 1982. Theories of both Haitian and
African origins involved epidemiological patterns and, subsequently, the
ostensible detection of the virus in samples from African cases that pre-
dated the appearance of the disease elsewhere.∂Ω In a special issue of Scien-
tific American devoted to aids in October 1988, Robert C. Gallo and Luc
Montagnier, credited jointly with the identification of hiv, asked where the
virus had been ‘‘hiding all those years, and why [we were] only now experi-
encing an epidemic?’’ Their answer:
The virus ha[d] been present in small, isolated groups in central Africa or
elsewhere for many years. In such groups the spread of hiv might have been
quite limited and the groups themselves may have had little contact with the
outside world. As a result the virus could have been contained for decades.
That pattern may have been altered when the way of life in Central Africa
began to change. People migrating from remote areas to urban centers no
doubt brought hiv with them. Sexual mores in the city were different from
what they had been in the village, and blood transfusions were commoner.
Consequently hiv may have spread freely. Once a pool of infected people had
been established, transport networks and the generalized exchange of blood
products would have carried it to every corner of the world. What had been
remote and rare became global and common.∑≠

Their explanation summarizes nearly a decade of speculating about the

origins and nicely captures how speculation had quickly become received
wisdom, as Shilts’s passage attests. The appeal of the theory stemmed at
least partly from the familiarity of the story.
Journalistic portraits of aids in Africa, as cultural critics have noted,
resemble Joseph Conrad’s Heart of Darkness, ‘‘as if hiv were a disease of
‘African-ness,’ ’’ writes Simon Watney, ‘‘the viral embodiment of a long leg-
acy of colonial imagery which naturalizes the devastating economic and
social effects of European colonialism in the likeness of starvation.’’∑∞ Like
others who have written on the subject, Watney describes the racism in-
volved in depictions of ‘‘African aids,’’ which include a diseased continent,
primitive in its cultural, sexual, and medical practices. Richard Preston
slides subtly into that familiar depiction in The Hot Zone when he describes
Tom Geisbert’s quest to identify not hiv but the hemorrhagic virus that is
killing primates in Reston, Virginia. Peering into his microscope, Geisbert
‘‘could see forms and shapes that resembled rivers and streams and oxbow
lakes, and he could see specks that might be towns, and he could see belts of
forest. It was an aerial view of rain forest. The cell was a world down there,

‘‘The Columbus of AIDS’’ 235

and somewhere in that jungle hid a virus.’’∑≤ The story conflates origin and
cause, as Renée Sabatier demonstrates in Blaming Others: Prejudice, Race
and Worldwide aids .∑≥
Shilts’s Dugas never goes to Africa or has documented contact with Afri-
cans. Yet both ‘‘Patient Zero’’ and ‘‘African aids‘‘ are central to the story
Shilts tells.∑∂ Shilts reinforces the African origins thesis, and Dugas, with his
easy access to travel, is what network theorists call ‘‘a hub,’’ a point of
connection who moves the virus rapidly through the global network. The
image of the peripatetic Dugas/virus itself traveled insistently through the
media, as in the writer and aids chronicler Oscar Moore’s description in
the Guardian Weekend of his own and his culture’s shock at ‘‘the unex-
pected arrival of new violent and sociopathic illnesses which seemed to
have emigrated from distant environments by that most modern of medical
transmitters, the aeroplane.’’ Moore thinks of Dugas among the ‘‘hundreds,
maybe thousands, of sexual tourists’’ to travel what ‘‘the downward plunge
in transatlantic fares triggered by Freddie Laker’’ had made ‘‘the gay trans-
atlantic free- (or at least very cheap) way every summer for four years.’’∑∑
The ‘‘sociopathic illnesses’’—willful, malevolent forces unleashed by a con-
tinent—are further animated in ‘‘Patient Zero,’’ while the sinister decadence
of sexual liberation heralds the fall of an empire (recall Garrett’s microbial
view of Rome in 5 b.c.).
As I noted in chapter 1, the image of the Third World that haunted such
accounts was a Cold War legacy. The Cold War politics that turned de-
colonizing nations into battlegrounds produced not only violence and pov-
erty but also the narrative of struggling nations in need of modernization
conceived as emulation of the First World: wild and primitive landscapes
plagued by uncontrolled violence and ‘‘sociopathic illnesses.’’ The narrative
at once justified U.S. intervention in decolonizing nations and registered
colonial guilt. Ironically, these Third World landscapes in turn loomed in
the U.S. imaginary as harbingers of a potential First World future: a night-
mare vision of the post-apocalyptic United States. Just prior to running the
three pieces on pcp and acquired immunodeficiency in gay men in the 10
December 1981 issue that helped to announce the outbreak, the New En-
gland Journal of Medicine issued a special report titled ‘‘Medical Problems
of Survivors of Nuclear War.’’ The writer offered the stark prediction that
‘‘surviving Americans will experience the underdeveloped world as their
natural habitat for the first time.’’ Americans would be at a distinct disad-
vantage in this landscape: ‘‘Unlike the inhabitants of impoverished lands, . . .
Americans, because of lack of exposure to many organisms, may not have

236 ‘‘The Columbus of AIDS’’

the high natural immunity to a host of dangerous diseases that allows many
in the Third World to survive.’’∑∏
Since this image of the Third World arose to depict devastation and the
need for modernization, it is not surprising that it would be summoned as a
vision of the postnuclear landscape that marked the collapse of the First
World. In this context, however, the fantasy registers the anxious reversal of
hierarchies conceived in the terms of (inverted) social Darwinism, where
the ‘‘civilized’’ are the least fit to survive: previously defeated microbes
arise to claim the victims of those whose lack of resistance ironically reflects
their technological advances. Like the polio virus, which disproportionately
infected the wealthier strata of society, the postnuclear germ landscape
mocks scientific and social progress. This medicalized fantasy updates as it
absorbs concerns expressed in the 1950s by cultural observers as diverse as
Harold Isaacs and William Faulkner about the changing balance of racial
power in the decolonizing world.∑π
‘‘African aids’’ realized the vision of a diseased continent as both a Third
World present and a First World future. As accounts of African aids
conformed to familiar narratives, the metaphor of the Third World slid into
a threat, and geographical boundaries were recast in temporal terms. The
epidemic marked, as columnist George Will put it, the ‘‘lethal mixture’’ of
‘‘modernity and primitivism . . . in Africa.’’∑∫ Another journalist, writing like
Will in the second decade of the epidemic, dubbed ‘‘tropical Africa . . . an
especially fertile petri dish for pathogens.’’∑Ω Hypothesis shifts almost im-
perceptibly into narrative as the obvious connections among disease, vio-
lence, and poverty lead him to posit the origins of the virus ‘‘in Africa along
the border between Tanzania and Uganda after Idi Amin, the notorious
Ugandan dictator, had turned the region into a war zone’’ where the ‘‘vola-
tile mix of refugees, soldiers, prostitutes and the attendant lack of disease
surveillance may have given hiv the jump-start it needed to travel the
world.’’ hiv is a ‘‘clever microbe—a slow, stealthy, incubator’’ that takes
advantage of the mechanisms of globalization for its pathological tourism.
Shilts’s ‘‘Patient Zero’’ is one of those mechanisms, a confederate converted
to the cause. He never had to go to Africa or have sexual relations (directly)
with Africans to import African aids into the United States. The conti-
nent enters his body through the virus, which in turn crosses boundaries
through his body.
The slippage between the Third World as metaphor and the Third World
as threat is evident in Shilts’s depiction of internal agents whose ‘‘lifestyles’’
have made them receptive to the role of ‘‘aids carrier.’’ The well-known

‘‘The Columbus of AIDS’’ 237

aids activist Michael Callen, for example, had ‘‘frequented every sex club
and bathhouse between the East River and the Pacific Ocean and had
gathered enough venereal and parasitical diseases to make his medical
chart look like that of some sixty-five-year-old Equatorial African living in
squalor.’’∏≠ When they spread those diseases, figures such as Callen and
Dugas become agents of Africanization, and the virus, as Watney observes,
‘‘threatens to ‘Africanize’ the entire world.’’∏∞ Emerging from a primordial
past, hiv is poised to turn that past into a hopeless global future, and the
Third World, gay male agents, and the conditions of U.S. inner cities in
which the epidemic made early inroads (what Shilts, Garrett, and others
call ‘‘thirdworldization’’) constitute the ‘‘biological landscape’’ that would
germinate and disseminate it. Shilts’s images dovetailed with the emerging
evidence of antibiotic-resistant microbes that threatened, as every discus-
sion of ‘‘supergerms’’ warned, to return the United States to the medical
primitivism of the pre-antibiotic world. The underdeveloped world that
loomed so large in the future of the United States marked the failure of
science, civilization, and modernity.
Mischaracterizations of Shilts’s book in the mainstream media often
seem to pick up on some of its unspoken connections. A careless synopsis
in Florida’s St. Petersburg Times, for example, inadvertently conflated two
features of the work that offer insight into the anxious vision of globaliza-
tion through which the disparate elements of Shilts’s analysis cohere. The
author, Greg Hamilton, told readers that ‘‘it’s all right to hate the disease.
Since July 4, 1976, the nation’s 200th birthday and the day Air Canada
steward Anton [sic] Dugas is believed to have introduced the virus to the
United States, aids has spread like a prairie fire throughout society.’’∏≤ In a
spectacular flourish, Hamilton superimposes Gaetan Dugas on the ‘‘tall
ships,’’ an alternative fantasy of the introduction of hiv into the United
States. Shilts begins the first chapter of And the Band Played On with an
allusion to the tall ships, which were featured in the bicentennial celebra-
tion of the nation in New York City. The reference comes from Bill Dar-
row’s interview with a man whose closest circle of friends had all been
diagnosed with aids; in an effort to determine which summer they had
spent together, the man summons the memory of the tall ships. ‘‘ ‘The
Bicentennial,’ ’’ Shilts writes, ventriloquizing Darrow. ‘‘ ‘Of course. The Bi-
centennial. July 4, 1976. An international festival to celebrate America’s
birthday with ships from fifty-five nations. People had come to New York
City from all over the world’ ’’ (142). The memory of the tall ships represents
a new insight into the disease. Darrow quickly does the math: ‘‘ ‘Nothing

238 ‘‘The Columbus of AIDS’’

happened before 1976,’ ’’ he thinks, ‘‘ ‘but people had started getting sick in
1978 and 1979. It was clear from the other links in the cluster study that the
disease could lie dormant for a long time. People were spreading it all over
in 1977 and 1978, which accounted for so many cases spontaneously ap-
pearing in so many different regions of the country’ ’’ (142).
Ironically, Darrow’s theory about the tall ships implicitly refuted the idea
of Gaetan Dugas as an index case. If the virus came with the tall ships, then
it could not have been brought by Dugas or, in fact, by any single identifi-
able source, nor, for that matter, was Dugas any more than representative in
his capacity as disseminator. But while Dugas and the tall ships are incom-
patible as theories of the origin of ‘‘American aids,’’ they are complemen-
tary features of its narrative. The tall ships are themselves representative for
Darrow, a convenient shorthand for urban cosmopolitanism and New York
City in particular as a global destination. Like the ‘‘Québecoise Typhoid
Mary,’’ they suggest an invasion from without that is enabled by the recep-
tive culture within. ‘‘New York City had hosted the greatest party ever
known,’’ writes Shilts. ‘‘The guests had come from all over the world’’ (3).
And then, somberly: ‘‘This was the part the epidemiologists would later
note, when they stayed up late at night and the conversation drifted toward
where it had started and when. They would remember that glorious night in
New York Harbor, all those sailors, and recall: From all over the world they
came to New York’’ (3).
‘‘It’’ refers to the epidemic, but the grammar of the sentence conflates the
virus with the party. The passage immediately segues into an account of
Christmas Eve in Zaire in 1976 when a Danish surgeon named Grethe Rask,
who ran a clinic in a village in northern Zaire, showed early symptoms of
what would be presumptively diagnosed (retroactively) as aids. The juxta-
position with Rask’s story answers the epidemiologists’ question: ‘‘it’’ started
in ‘‘Africa,’’ where, in words Shilts attributes to Jacques Leibowitch, a French
doctor who saw some of the earliest aids cases in Europe, ‘‘new diseases
tended to germinate’’ (103). Sailors carried it in, and partying spread it.
Sexual transmission enabled it, as the cdc’s Mary Guinan feared from
the outset, ‘‘to penetrate far deeper into the nation’’ (107): Africanization
through decadence.
The bicentennial celebration in New York City moves, in Shilts’s book,
from a man’s hazy memory to the Ground Zero of American aids. Like
‘‘Patient Zero,’’ it is a narrative device that shades into history. It imparts a
national frame to the story he is telling about what Jonathan Mann, director
of the global aids program of the who in the late 1980s, called ‘‘ ‘the

‘‘The Columbus of AIDS’’ 239

global-village disease.’ ’’∏≥ hiv /aids does more than illuminate the routes
of a global network and the susceptibility of the U.S. population to ‘‘foreign’’
microbes. It also gives epidemiological expression to the dangers of the
ideal of democracy.
An analysis implicit in Shilts’s book finds explicit articulation in Alex
Shoumatoff’s 1988 Vanity Fair piece about his journey to Africa, ‘‘In Search
of the Source of aids.’’ Shoumatoff ends the piece with his musing, on a
747 en route to New York City, ‘‘about the unprecedented merging and
mixing and growing together of the world’s population in the last few de-
cades, the tremendous release of people from their traditional confines, the
enormous flow from the villages to the cities of the Third World to the
immediate outskirts of New York, London, Paris, Rome, Cologne, Mar-
seilles’’ (117). Those interactions make him ponder ‘‘how hiv must have
become airborne—airplane-borne—moving on slipstreams from continent
to continent: tens of thousands of revelers flying down to Rio for Carnaval,
for instance’’ and how ‘‘Brazil, one of the world’s most mixed societies,
[now] faces an epidemic potentially as devastating as Africa’s’’ (117). The
crossing of geographic boundaries (the invasion) segues into the break-
down of social ones, as the intermingling of populations leads to (implied)
racial mixture (Brazil as ‘‘one of the world’s most mixed societies’’).
The spreading virus, however, does not cause that breakdown; hiv,
rather, exposes the fiction of containment. The virus cannot be ‘‘contained’’
in ‘‘risk groups’’ because desire cannot be contained by social classifications.
hiv indelibly marks a variety of social interactions, some sexual and illicit,
and it is not unique in doing so: Shoumatoff imagines ‘‘this archetypal
communicable disease traveling along the mutually manipulative interface
of the First and Third Worlds in countless copulations, and like a swallow
dye pill illuminating all the liaisons dangereuses, the thousands upon thou-
sands of marital, premarital, extramarital, interracial, and homosexual en-
counters that must have taken place for it to have spread as far as it has’’
(117; initial emphasis added). hiv makes sex visible; it shows that people’s
desires are not bound by either the social sanction of marriage or the social
classifications of race, gender, and sexuality, and it demonstrates the indif-
ference of those desires, like the virus through which they are manifest, to
national boundaries as well.
Shoumatoff Americanizes the global vision when he notes that ‘‘among
the four hundred passengers winging their way to the great land whose
politically admirable but epidemiologically lamentable motto is E Pluribus
Unum were Indians and Arabs, Venezuelans, Poles, Africans, Israelis, Ital-

240 ‘‘The Columbus of AIDS’’

ians, Turks and Bulgarians, not to mention Americans of assorted hues and
stripes—a rich cross section of the human cornucopia’’ and ‘‘that statis-
tically three people aboard ought to be carrying the virus’’ (117). The epi-
demic turns an emblem of national pride, the consequence of new global
formations that rhetorically culminate in U.S. nationalism, into a national
threat: out of many, one. aids is the disease of (too much) democracy;
epidemiology exposes the danger of the political ideal as a desire that re-
sults in a racialized microbic hybridity.
hiv expresses that hybridity, and it here challenges the reproduction of
(white) Americanism just as diseases such as typhoid and tuberculosis car-
ried the threat of ‘‘race suicide’’ in the early twentieth century. Modernity
and its chief political institution, the nation, are marked, as Alys Weinbaum
argues, by an obsession with race and reproduction.∏∂ The transmission
routes of the virus show why, as they expose the uncontainable force of
sexuality. It is not surprising, then, that the Africanization of the United
States would be accomplished by the ‘‘Third World’’ immune systems of gay
men, inner-city iv-drug users, and (for a time) Haitian ‘‘immigrants’’ (the
epithet assigned to those living in Haitian communities in the United States)
as well as hemophiliacs, who, without the Factor H that was now ‘‘poison-
ing’’ their blood, would not as easily have survived and reproduced.∏∑
Shilts gestures toward a powerful analysis of the epidemic at the end of
And the Band Plays On when he notes the divergence of ‘‘the story of aids
in the gay community . . . from the broader story of aids in America and in
the world’’ (620). He concedes to one of the gay activists in the book the
‘‘romantic’’ vision of a gay community that survives and learns from the
epidemic, which he juxtaposes with ‘‘a naturalistic drama with little that
could be considered heartening’’ for inner-city America and ‘‘the impover-
ished masses of the Third World’’ (620). The distinction turns on the socio-
economic inequities at the heart of the epidemic and the clash not between
the primitive and modern, but between the poverty and wealth that charac-
terizes the modern world. But that analysis is undercut by the epidemiologi-
cal horror story that Shilts has been telling throughout: the transformation
of Gaetan Dugas into ‘‘Patient Zero,’’ which turns hybridity monstrous and
the challenge of democracy mythic. The ‘‘cruel and insidious virus’’ (621)
replaces socioeconomic analysis as the link between the divergent stories of
hiv /aids. He concludes his narrative with a snapshot of African aids: a
primitive, diseased continent, turning hopefully, in the person of a grieving,
desperate Ugandan father, to the United States to save its children. In the
process, Shilts recasts the epidemiological challenge to the political ideal as

‘‘The Columbus of AIDS’’ 241

the apocalyptic battle between the monstrous, primordial viral-human hy-
brids and the heroic scientists and epidemiologists. In the plea of the Ugan-
dan father, he ends his story with an expression of faith in the salvific
powers of contemporary science in the United States. It makes sense, in this
context, that the most memorable detail of Shilts’s work proves to be the
dangerous foreign flight attendant who penetrates the protective borders of
the nation. ‘‘Patient Zero’’ embodies the message of the book, the story that
has emerged and endured: the incarnated sinister virus as national threat.

I N TO T H E L A B

The October 1988 issue of Scientific American, which was devoted to hiv /
aids, included a review of Shilts’s book by William Blattner, chief of the
viral epidemiology section of the National Cancer Institute. Calling And the
Band Played On ‘‘the aids book [that] has been a potent factor in the public
perception of the aids problem,’’ Blattner is critical of Shilts for choosing
sensational storytelling over incisive analysis. ‘‘Patient Zero’’ in particular is
‘‘a useful literary device for helping the reader to understand how the aids
agent spread so rapidly and widely within the gay community,’’ but it is also
evidence of Shilts’s irresponsibility: his ‘‘tendency to personify him leads
him astray.’’∏∏ It is, of course, not Dugas, a person, whom Shilts personifies,
but the hiv virus in what Blattner calls ‘‘a novelistic history of the aids
epidemic’’ (148). The reviewer’s confusion attests to the efficacy of Shilts’s
characterization of the flight attendant. Blattner is critical as well of Shilts’s
depiction of maverick scientists, heroic or villainous, such as Robert Gallo,
whom he identifies only as ‘‘a National Cancer Institute (nci) researcher
whose discovery of the first human retrovirus is passed off as ‘a backward
scientific affair’ ’’ (148). While Blattner defends his nci colleague from
Shilts’s indictment of his unprofessional conduct surrounding the identi-
fication of the virus, he is more concerned with the ‘‘common romantic
stereotype’’ that makes the book readable but inaccurate (148). Shilts spot-
lights individual scientists, he complains, at the expense of ‘‘the accom-
plishments of the scientific establishment in the seven years since the first
cases of aids were recognized’’ (148). Those accomplishments, he argues,
‘‘belie Shilts’s assertions. It is the scientific establishment, not some roman-
ticized science maverick, that has produced the spectacular and timely
current accumulation of scientific knowledge about aids’’ (148). The re-
view offers Blattner a platform from which to laud the ‘‘fundamental invest-

242 ‘‘The Columbus of AIDS’’

ment in basic research made over the past 20 years’’ without which ‘‘the
discovery of the cause of aids might still elude us today’’ and to hold up
that discovery as ‘‘stark testimony to the importance of society’s investment
in the curiosity of scientists’’ and scientific ‘‘instinct’’ as ‘‘crucial to our
ability to address this or any other threat to survival’’ (149).
Blattner believes that Shilts has told a precipitous tale and finds his faith
in the promise of science insufficient. The ‘‘story of aids is still in its early
stages; how it will end cannot be described with anything approaching
certainty. Yet the positive aspects of the response to aids (the agent has
been identified, the blood supply protected and promising chemotherapies
and immunotherapies have been discovered) are the fruits of the scientific
process. If aids and other such challenges to our species are to be met
successfully this process must be understood and fostered by lay citizens as
well as by scientists’’ (150). It is the duty of ‘‘citizens’’ to understand not the
science, but the need to trust the scientific process. And it is the respon-
sibility of scientists and science writers to tell the story properly: ‘‘Shilts’s
position and accomplishments as a journalist who could gain entry both
into the gay world and into the world of science and public policy presented
a unique opportunity. He could have helped his fellow citizens to share in
the effort to cope with aids and to understand the tragedy of those afflicted
with the disease, so that this challenge and others like it can be surmounted.
Perhaps, back in 1987 [this from the perspective of 1988], emotion pre-
cluded the writing of such a book. Perhaps another chronicler will find the
positive threads in the aids story; they are strong enough to produce unity,
and therefore hope’’ (151). The more hopeful story that Shilts could have
written, according to Blattner, entailed a shift in focus from epidemiological
field work to the laboratory, where the story could be written in the future
perfect: an imagined moment when the epidemic will have been contained.
That story emerged from the issue of Scientific American focused on hiv /
aids in which Blattner’s review appeared. Yet, despite the shift in em-
phasis, the narrative in the special issue in fact reinforced two important
features of Shilts’s would-be outbreak narrative: faith in scientific achieve-
ment and an injunction to personal responsibility.
Devoted to presenting ‘‘What Science Knows about aids,’’ the issue fea-
tures articles pitched to a scientifically literate readership, but generally and
broadly accessible. The authors of the introductory essay, Robert Gallo and
Luc Montagnier, are presented in the heading as ‘‘the investigators who
discovered hiv,’’ while the boxed biography at the bottom of the page calls
them ‘‘the investigators who established the cause of aids.’’∏π The juxta-

‘‘The Columbus of AIDS’’ 243

position is telling; the issue moves the focus of both the present and future
of aids further into the laboratory. The equation of the discovery of hiv
with the discovery of ‘‘the cause of aids’’ witnesses the determined viro-
logical thinking that Patton decries, excluding other factors that arguably
caused the epidemic. A consistent rhetorical indistinction between hiv
and aids throughout the issue, moreover, conflates virus and syndrome,
turning ‘‘the aids virus’’ into a biological entity that is best understood and
treated through scientific research rather than socioeconomic analysis. The
first paragraph of the introduction rehearses the progress of the science of
infectious-disease research as it traces the contours of what was already the
familiar narrative of the virus’s disruption of its sanguinity:
As recently as a decade ago it was widely believed that infectious disease was
no longer much of a threat in the developed world. The remaining challenges
to public health there, it was thought, stemmed from noninfectious condi-
tions such as cancer, heart disease and degenerative diseases. That confidence
was shattered in the early 1980s by the advent of aids. Here was a devastating
disease caused by a class of infectious agents—retroviruses—that had first
been found in human beings only a few years before. In spite of the startling
nature of the epidemic, science responded quickly. In the two years from
mid-1982 to mid-1984 the outlines of the epidemic were clarified, a new
virus—the human immunodeficiency virus (hiv)—was isolated and shown to
cause the disease, a blood test was formulated and the virus’s targets in the
body were established. (41)

The monster reared its head, but science has identified and all but con-
tained it. The phrase ‘‘science responded quickly’’ underscores the point of
the paragraph, the article, and the issue: the virus has challenged but will
not defeat science. Scientific authority is reaffirmed, and modernity and
humanity are preserved.
The coauthors of the introduction, and the story they tell, are relevant to
that reaffirmation. The previous year, readers of And the Band Played On
had learned in considerable detail about the bitter disagreement concern-
ing who had actually first identified hiv, which bordered on an inter-
national incident but was not covered in such depth in the press at the time.
Charges and countercharges flew across the Atlantic, with nationalist un-
dertones and whisperings, as Shilts puts it, of ‘‘a scientific scandal of im-
mense proportions’’ (529). It was publicly resolved, through the help of no
less an ambassador than Jonas Salk, with the attribution of ‘‘partial credit
for various discoveries on the way to isolating’’ the virus, with the epithet
for each ‘‘ ‘co-discoverer’ ’’ of the virus, and with the christening of the virus

244 ‘‘The Columbus of AIDS’’

not, as Gallo wished, htlv-iii, nor as Montagnier hoped, lav, but as the
compromise hiv (593). Shilts calls the resolution ‘‘a pleasant fiction’’ ac-
complished ‘‘because none of the mainstream press had pursued the con-
troversy in any depth’’ (593).∏∫ Gallo’s and Montagnier’s performance as
coauthors of what the journal labels ‘‘their first collaborative article’’ consol-
idates the story as it seeks to restore to ‘‘science’’ the authority that accounts
of the infighting (especially Shilts’s) may have challenged.∏Ω In the introduc-
tion the authors recount the role each one played in the search for the virus
in an effort (visible to a reader familiar with their story) to restore their own
potentially damaged reputations and authority.
Everything about this introduction leads to the laboratory, including the
photographs and illustrations, which demonstrate how ‘‘science’’ has made
hiv visible (the first step in controlling it), and a chart offering ‘‘evidence
that hiv causes aids.’’ Amid the photographs and charts, they embed,
almost as an aside, the theory of the African origins of hiv, which traveled
into the global village when a way of life, rather than a virus, underwent
important changes. By association, the virus is primitive and will, in the
end, prove no match for contemporary science. Gallo and Montagnier con-
fidently advise against panic—most obviously, they chide, because ‘‘panic
does no good,’ ’’ but also because ‘‘it now seems unlikely hiv infection will
spread as rapidly outside the original high-risk groups in the industrial
countries as it has within them’’ and because ‘‘this disease is not beyond the
curative power of science’’ (47). Imagining an endpoint that is not actually
in sight, Gallo and Montagnier insist that ‘‘although current knowledge is
imperfect, it is sufficient to provide confidence that effective therapies and
a vaccine will be developed’’ (47). The cover depicts ‘‘a particle of the human
immunodeficiency virus (hiv) forming at the outer membrane of an in-
fected cell’’ (6) that resembles the opening sequence of Invasion of the Body
Snatchers. This image of scientific expertise illustrates what the issue will
argue throughout: that laboratory research offers the most important in-
sight into ‘‘What Science Knows about aids.’’ The first article, a well-
illustrated piece titled ‘‘The Molecular Biology of the aids Virus,’’ explains
the genetics of hiv and concludes with the assertion that ‘‘surely this [mo-
lecular] description contains the seeds of hiv’s eventual defeat.’’π≠
The subsequent article uses that (genetic) information to posit ‘‘The Ori-
gins of the aids Virus.’’ Scientific research showing that ‘‘the aids virus is
not unique’’ leads to the reassurance that Nature may participate in the
containment of the epidemic, since ‘‘studies of related viruses indicate that
some have evolved disease-free coexistence with their animal hosts.’’ Sci-
ence can facilitate that process: ‘‘The origin and history of the aids viruses

‘‘The Columbus of AIDS’’ 245

themselves may provide the very information that is critical to the preven-
tion and control of aids.’’π∞ Epidemiology remains an important part of the
battle, and two articles on epidemiology and disease survival on national
and international scales follow. But their message that epidemiology even-
tually leads back to the laboratory is reinforced by the succeeding two
companion pieces, entitled ‘‘hiv Infection: The Clinical Picture’’ and ‘‘hiv
Infection: The Cellular Picture,’’ which underscore the importance of the
discovery of the virus that is the theme of the issue.
The importance of the discovery is further dramatized in a full-page
photograph that adjoins the first page of ‘‘hiv Infection: The Clinical Pic-
ture.’’ The photograph depicts a white and obviously middle-class family,
the Burks, whose intertwined hands and arms are prominently featured.
The caption explains that the photograph is from 1985 when the Burk
family ‘‘looked like a typical U.S. family.’’π≤ The family, it turns out, both is
and is not typical. These typical parents, with their clasping, protective
arms, have been unable to protect themselves or their children from the
invisible killer. The father, a hemophiliac, contracted hiv from a trans-
fusion and unknowingly passed it on to his wife, and she to their son. Only
their daughter is not ‘‘infected,’’ yet one look at her painfully sad eyes, as she
leans her entire body into her father, shows that she is certainly affected. At
the time of the photograph, father and son both had aids; by 1988, both
had died. The juxtaposition of the photograph with the title of the article
suggests dueling pictures, the photographic and the clinical. The photo-
graph represents what can be seen by ‘‘typical’’ people, while the ‘‘clini-
cal picture’’ refers to what scientists can see and the means by which they
make that information visible. Oddly, given the size and prominence of the
photograph, the Burks are never mentioned in the article, but according to
the caption, their ‘‘story underscores two important facts. Anyone, regard-
less of age, sex or sexual orientation, can contract hiv if exposed to it
through a known transmission route. And there usually are no symptoms
of early infection; many people transmit hiv to others before they know
they are ill. For these reasons the authors recommend that anyone who
thinks he or she has been exposed to hiv seek an early diagnosis’’ (91). The
caption, like the blood test that enables early detection, exposes what the
nonscientists cannot see, and the story of this unwitting carrier illustrates
the message of the article: that ‘‘the focus should be on the full course of the
viral infection, not solely on aids’’ (90). The article ends, like the others,
optimistically enjoining ‘‘doctors and patients’’ to ‘‘keep in sight the day
when medical science will reduce the hiv infection to a curable disease. . . .

246 ‘‘The Columbus of AIDS’’

‘‘burk family, shown in 1985, looked like a typical
U.S. family.’’ Scientific American, October 1988, 91.
∫ Lynn Johnson/Aurora Photos.

If we persist and are methodical,’’ the authors promise, ‘‘we shall unques-
tionably succeed in curing hiv infection’’ (98). The subsequent piece, on
the cellular picture, explains how the information researchers have ac-
quired since the discovery of the virus will lead to the therapies and even-
tually the vaccine that are described in the issue. The two pieces that follow
describe the ‘‘aids Therapies’’ and ‘‘aids Vaccines’’ that the discovery of
hiv promises: the evidence and hope of scientific success.
Despite the prominence of the laboratory, science alone cannot solve the

‘‘The Columbus of AIDS’’ 247

problem, and the photograph of the Burks also reinforces the message of
personal responsibility that runs throughout the issue. From the outset, the
Gallo and Montagnier introduction to the issue concedes that while the
virus will ultimately not prove resistant to medical knowledge and treat-
ment, as the identification of the virus and the ‘‘securing’’ of the blood
supply have shown, ‘‘there are parts of the epidemic where’’ even the long
arm of science cannot go and ‘‘humanity will be tested. Users of intrave-
nous drugs, for example, are notoriously resistant to education campaigns
alone.’’π≥ The introduction concludes accordingly with an injunction. While
awaiting a scientific resolution, everyone ‘‘must accept responsibilities: to
learn how hiv is spread, to reduce risky behavior, to raise our voices against
acceptance of the drug culture and to avoid stigmatizing victims of the
disease. If we can accept such responsibilities, the worst element of night-
mare will have been removed from the aids epidemic’’ (48). The point of
the issue is to supply the necessary information that could have saved the
Burk family. In the story that the issue tells about hiv, the epidemic can be
contained by a change in behavior. Those who do not accept the delineated
responsibilities are not ‘‘victims,’’ but perpetrators, becoming the resistant
viral agents and testing humanity. The story shifts responsibility onto indi-
viduals when it gets too close to a critique of the social and economic
conditions that affect drug use as well as healthcare and contribute to the
notorious ‘‘resistance’’ to education campaigns.
The issue moves toward that critique in the final article, ‘‘The Social
Dimensions of aids,’’ in which the (then) dean of the Harvard School of
Public Health, Harvey V. Fineberg, explains that the ‘‘aids epidemic ex-
poses hidden vulnerabilities in the human condition that are both biologi-
cal and social.’’π∂ Global and local inequities find expression in the ‘‘sharp
variation in geography, racial and gender composition’’ (129) that charac-
terizes the epidemic. It ‘‘compels a fresh look at the performance of the
institutions we depend on and brings society to a crossroads for collective
action’’ (128). The epidemic, however, is not, in his reading, the result of
those inequities, but their cause. Blame falls on the virus, which becomes
familiarly animated under the social microscope: ‘‘hiv is insidious. It cor-
rupts vital body fluids, turning blood and semen from sources of life into
instruments of death. The virus insinuates itself into the genetic material of
selected cells, where it may remain quiescent for prolonged periods of time.
When it is active, the virus gradually undermines the body’s immune sys-
tem. . . . hiv infection remains at the present time incurable, a pointed
reminder’’ not of the socioeconomic inequities that find expression in the
disproportionate susceptibility to disease, but ‘‘of humanity’s thrall to the

248 ‘‘The Columbus of AIDS’’

tyranny of nature’’ (128; emphasis added). The (familiar) threat of a return
to the past is evident in the observation that ‘‘as if to taunt progress in the
life sciences in the twentieth century, hiv not only has caused the disease
most feared in America near the end of the century but also has fueled a
resurgence of tuberculosis, the disease most feared at the beginning of the
century’’ (133). Against the tyranny of nature and the threat of the past,
there is science rather than profound social change.
Fineberg does not entirely retreat into a scientific solution; his analysis of
the epidemic includes the ‘‘social dimension’’ that his title promises. Fear
and stigmatizing exacerbate the ravages of the virus, and the photographs
that accompany his article dramatize his argument. ‘‘Fear of contagion’’ is
conveyed, for example, in a juxtaposition of two photographs, one model-
ing the body suit and face mask worn by French physicians during an
outbreak of plague in the early eighteenth century, and the other depict-
ing similar biocontainment suits worn by emergency medical technicians
in contemporary (late 1980s) Hong Kong. The caption calls the fear moti-
vating this return to the past ‘‘unjustified’’ in the case of hiv. Other photo-
graphs highlight more constructive public-health and social responses:
from practical measures urged in a pediatric aids ward and a poster from
an education campaign to a magnificent display of the aids quilt and an
aids awareness march, both in New York City. The photographs illustrate
the components of the response that Fineberg advocates throughout the
article: the need for compassion and an aggressive education campaign and
scientific response. They are worthy goals, but they depart from the struc-
tural and institutional analysis toward which the article initially gestures
when it alludes to the potential exposure of hidden vulnerabilities. Instead,
the illustrations underscore Fineberg’s emphasis on personal responsibility
with which Gallo and Montagnier similarly end their introduction. Com-
mendable in its injunction to work for a compassionate and humane re-
sponse to the epidemic, Fineberg’s closing article nonetheless reinforces the
message of the whole: social responsibility entails cooperating with public-
health officials who through information and education campaigns and the
establishment of safety practices based on scientific information will ulti-
mately control the epidemic. The behavioral and scientific solutions that he
prioritizes and the animated virus that he indicts as the cause of the epi-
demic reproduce the features that in their more extreme forms, as in Shilts’s
narrative, result in the pathologized human-virus hybrids, or ‘‘aids car-
riers.’’ He does not pursue the causal dimensions of the ‘‘hidden vulnerabili-
ties in the human condition.’’
Even the advertisements in the issue reinforce the message that individuals

‘‘The Columbus of AIDS’’ 249

DuPont advertisement in Scientific American, October 1988.
Reprinted with permission of DuPont.

can respond to the threat posed by hiv only through responsible behavior,
which entails acting on the information that science dispenses. An adver-
tisement for DuPont features a photograph of a bag of transfusion-ready
blood and a heading that reads, ‘‘The difference between saving life and
threatening it’’ (49). The text below the photograph moves from an accident
scenario in which ‘‘you’’ (the reader) need a transfusion through DuPont’s
‘‘highly accurate method of testing to help protect the nation’s blood supply
from the deadly aids virus’’ to the assertion that ‘‘perhaps the most impor-
tant weapon in fighting this disease is information’’ (49). The passage con-
cludes with a number to call in order to receive a complimentary copy of

250 ‘‘The Columbus of AIDS’’

DuPont’s booklet, Understanding aids . The assumption informing the ad-
vertisement, and the issue as a whole, is that readers should have faith that
scientific information (the right information) will lead to containment of
the virus, but also should cooperate by acting responsibly. The continued
spread of the epidemic will signal not the failure of science or the conse-
quences of social and economic inequities, but the pathological behavior of
deviant individuals. ‘‘Patient Zero’’ exemplifies the antithesis of the socially
responsible citizen.

‘‘THE DENTIST WITH AIDS’’

As the epidemic moved into its second decade, the hope of containment,
and the outbreak narrative, became more elusive. The laboratory was pro-
ducing answers, but they were not leading to the promised cure, and aids
cases were growing exponentially in the United States and abroad. The
story of a figure who almost became a ‘‘Patient Zero’’—he was known at the
cdc as ‘‘Patient A’’—suggests the shift away from signal features of the
outbreak narrative in accounts of the hiv /aids epidemic, as individuals
and the public generally struggled to live with its effects.π∑ In 1987 a dentist
from Florida named David Acer learned that he had been infected with
hiv. In May of that same year, the cdc had announced the first cases of
hiv-positive healthcare workers with no other risk factors.π∏ Although
David Acer was a dentist, he was also bisexual, and sexual transmission was
determined to be the most likely route of his infection. The story would
have been unremarkable, except that between the fall of 1987 and spring of
1989, Acer was the dentist of a college student named Kimberly Bergalis,
who would be instrumental in his metamorphosis into the cdc’s ‘‘Patient
A’’ and his inscription in history as ‘‘the dentist with aids.’’
In 1990 the public learned of a female college student with aids whose
alleged absence of risk factors made her bisexual dentist the presumed
source of her infection. The possibility of this route occurred to Bergalis
and her mother because she lacked other risk factors, and they had heard a
‘‘rumor’’ that ‘‘he had aids.’’ππ A press conference held in early September
introduced Kimberly Bergalis as the college student and the now-deceased
David Acer as the dentist.π∫ The considerable public attention that this case
received registers the fear that it generated; if Acer had infected Bergalis, it
meant that healthcare providers not only themselves risked infection from
their patients but actually might pose such a threat in return. As the health

‘‘The Columbus of AIDS’’ 251

and privacy needs of people with aids made trust in healthcare providers
an issue of particular concern, the idea that they could be the source of
infection with hiv was especially disturbing; Bergalis was an outspoken
and compellingly tragic ‘‘victim’’ who could not have suspected that her
dentist might infect her with hiv. The Bergalises wanted someone to take
responsibility for Kimberly’s infection, and they focused first on David Acer.
The Bergalises were not alone in their efforts. One of Acer’s acquain-
tances suggested that Acer had deliberately infected Bergalis and several
other patients, including a grandmother in her sixties, in order to draw
more attention to the disease. Here was a ‘‘Patient Zero’’ ready for incarna-
tion, and there were speculative depictions of the homicidal dentist, the
murderous monster who sought to take the ‘‘innocent’’ down with him. But
they did not catch on and were subordinated to the medical puzzle of the
route of transmission in the media accounts of the incident. Acer had
stopped practicing dentistry and was close to death by the time Bergalis’s
infection was tracked back to him. He maintained until his death that he
had no idea how (or indeed whether) he had transmitted the virus to his
patients, but he assumed responsibility for them when he took out an ad in
the local paper announcing his serostatus and advising them to be tested.
His culpability was subsequently ascribed to his failure to safeguard his
patients: his disturbing but unintentional carelessness. The difference be-
tween the fates of David Acer and Gaetan Dugas stem in part from Acer’s
evident concern for his patients as well as the timing of the discovery of
Bergalis’s infection (after he was no longer practicing dentistry or circulat-
ing in society). But it also suggests that the epidemic had begun to move
beyond the reaches of the outbreak narrative and the problems, solutions,
and villains it depicted.
The fear the story evoked in the media coverage lay in the banality of the
route of transmission: the routine extraction of a college student’s wisdom
teeth. Media coverage centered on Bergalis’s tragedy rather than the crimi-
nality of her dentist. When the dying Acer was cast as pitiable rather than
monstrous, the Bergalis family sought to turn their personal tragedy into
policy by emphasizing the vulnerability of ‘‘the general population’’ and
their terrifying dependence on healthcare providers who are themselves,
after all, disturbingly ordinary human beings, subject to careless mistakes.
The dentist’s intentions were not relevant to those goals and became in-
creasingly less important. Indeed, the ordinary and accidental nature of the
transmission was much more threatening than if it had been intentional
because an accidental infection was more likely to happen again to others.

252 ‘‘The Columbus of AIDS’’

It therefore would make the Bergalises’ plea for mandatory testing more
pressing. As the first case of transmission from a healthcare provider, ‘‘Pa-
tient A’’ posthumously became the center of policy debates about manda-
tory testing and disclosure for healthcare providers.
Bergalis’s personal struggle with aids, her determination to testify at the
congressional hearings, and the policy debates made good copy. But the
mystery of the story lay in the means of transmission, and the search for
answers led to the laboratory. When intensive field epidemiologic inves-
tigation failed to turn up any convincing explanation for Bergalis’s infec-
tion other than Acer, and when five of his other dental patients similarly
emerged with him as the presumed source of their infection, the cdc
sought answers from a new laboratory technology that could address the
question of whether and how Acer had transmitted the disease to his pa-
tients. The technique involved performing genetic analyses on the viruses
carried by each infected person; the theory was that because of the ten-
dency toward rapid mutation of hiv, strains of the virus in individuals who
shared its transmission would show significantly more similarity than those
in individuals whose infection was unrelated. For scientists, the new tech-
nique meant a more laboratory-based tracking system and a more exact
picture of hiv. Ultimately, the studies suggested that Acer and his patients
carried the same strain of hiv, but researchers could not definitively estab-
lish how—or even whether—Acer had transmitted the virus to them.
While the story of Gaetan Dugas turned ‘‘Patient Zero’’ into the virus
incarnate, the account of David Acer attested to its disembodiment. As the
shift in the Scientific American issue had forecast, the drama of the epi-
demic and the hope of containment had moved to the laboratory; in the
Bergalis-Acer case, the more accurate snapshot of the virus had replaced its
animation in human form that was so essential for the epidemiological
narratives. Mark Carl Rom points out that at the time of Bergalis’s diag-
nosis, ‘‘aids was a reportable disease in Florida and all the other states’’
while ‘‘hiv . . . was a reportable disease in less than half of them.’’πΩ It was
these policies rather than the federal regulation of health practitioners that
the Bergalis family sought that would change.
David Acer was never definitively established as the cause of Bergalis’s
disease. Reports of the case that the cdc published in Science in 1992 were
inconclusive, and Rom, who was investigating the cdc’s handling of the
Acer case for the General Accounting Office, acknowledges that he ‘‘began
the study expecting to find that the cdc had made major mistakes in its
work’’ (159), but found the incident ‘‘a mystery without an ending’’ (10). In

‘‘The Columbus of AIDS’’ 253

the end, the investigation focused more on the virus than on the man, but
the laboratory could not solve the terrifyingly ordinary mystery that was
raised by the case, which left the public without a villain and an outbreak
narrative. While the Florida dentist with aids and the public debate sur-
rounding the testing of healthcare workers received much broader publicity
than the handsome stranger with the French accent who was deliberately
spreading aids in the Castro—and ‘‘infected physicians’’ became, accord-
ing to a piece in Newsweek, ‘‘a national obsession’’—‘‘Patient A’’ never ri-
valed ‘‘Patient Zero’’ for a central place in the story of aids.∫≠

ZERO’S AFTERLIFE

From his first media appearance into the present, ‘‘Patient Zero’’ has clearly
captured the public imagination, summoned each time renewed attention
falls on the threat of emerging infections. Like ‘‘Typhoid Mary,’’ his status as
scapegoat has been noted and lamented, yet it persists. The scapegoating,
however, is only part of the problem marked by this persistence. The cen-
trality of ‘‘Patient Zero’’ to the story of the epidemic, like that of ‘‘Typhoid
Mary,’’ marks a shift in the attribution of blame and a deflection from the
structural analysis of the epidemic. A dismayed Shilts wondered why, de-
spite his comprehensive analysis of the institutional and governmental poli-
tics that created the conditions of the epidemic, the media focused so
heavily on his depiction of ‘‘Patient Zero.’’ What he did not seem to con-
sider was the conceptual power of the outbreak narrative, which he helped
to evolve, to shift the terms of the analysis.
The scapegoating of ‘‘Patient Zero’’ and the distortion of the story it
produced is the subject of the Canadian filmmaker John Greyson’s 1993
avant-garde film, Zero Patience. Greyson uses the unexpected genre of the
musical spoof to indict not only Shilts but also the medical, business, and
journalistic forces responsible for the irresponsible story they told about
Dugas and hiv /aids as well as the unethical practices that the story en-
abled. Greyson centers his own story on a love affair between the ghost of
Zero and Richard Francis Burton, the famed British Victorian adventurer,
explorer, man of letters, and sexologist whose ‘‘unfortunate encounter with
the fountain of youth’’ has ‘‘extended his life indefinitely.’’ The film, which
also includes a character named Mary Typhus who calls herself ‘‘Typhoid
Mary,’’ chronicles the evolving story about the epidemic that follows from
the demonization of the French Canadian flight attendant.∫∞

254 ‘‘The Columbus of AIDS’’

 From his emergence in the middle of a steam bath in an early scene in the
film, the ghost of Zero (visible only to Burton) begs to have his story told; he
wants not only to be exonerated of the blame that has consigned him to a
living death but also to exist as something other than a caricature. Burton
wants to comply at least with the request to tell his story, but it is not
initially the story for which Zero asks. When Zero encounters him, Burton
is in the process of making a documentary about ‘‘Patient Zero’’ for an
exhibit in the Hall of Contagion that he is constructing for the Natural
History Museum where he works. The film exposes the conflict between
the sensational story Burton wants for his exhibit and the story that Zero
and everyone who knew him—from his mother and co-workers to the
epidemiologists who first encountered him—tries to tell.
Greyson depicts Burton’s gradual awakening to his complicity in per-
petuating an irresponsible and inaccurate story of blame as well as his
growing dismay as he discovers that he cannot control the story. Greyson
filters his didacticism through the campy wit of the film, but the pedagogy is
apparent and hard hitting, as in a conversation between Zero and Miss hiv
(played by Michael Callen), through which Greyson offers a pointed cri-
tique of the faulty assumptions that led to the creation of a ‘‘Patient Zero.’’
By the end of the film, Zero accepts that no story will present him as he
deserves to be presented, and he persuades Burton to destroy the docu-
mentary and let him disappear.
Greyson’s ‘‘mission is to rewrite gay history,’’ claimed a reviewer for the
Guardian, ‘‘to document legalised and illicit homophobia and, in Zero Pa-
tience, to call into question fundamental medical and sociological assump-
tions about Aids.’’∫≤ The film is explicitly critical of the institutions—from
the medical establishment and pharmaceutical industry to the news and
entertainment media—that exploit the epidemic for profit. But, ultimately,
Greyson focuses his analysis on how social transformations of the late
twentieth century permeate medical theories in the epidemiological story
of hiv /aids and why the metamorphosis of a gay male French Canadian
flight attendant into ‘‘Patient Zero’’ is at the center of that story.
Greyson insightfully performs that analysis through the love story be-
tween Burton and Zero. Shilts had called Gaetan Dugas ‘‘the man everyone
wanted,’’ and Normand Fauteux plays Zero with an enchanting charm.∫≥ But
Shilts’s narcissistic Dugas is monstrous in his refusal to abstain from the
indiscriminate sexual contacts that define him, and Shilts makes him repre-
sentative of a ‘‘promiscuous’’ segment of ‘‘gay culture’’ that his book helped
to make a characteristic feature in discussions of the epidemic. In contrast,

‘‘The Columbus of AIDS’’ 255

Greyson’s Zero is the boy next door. Burton is drawn to the uncanny famil-
iarity of this stranger. Zero’s innocence and vulnerability surprises the im-
perial Briton, whose attraction to the ghost teaches him the lesson of the
epidemic. Through the lens of Greyson’s film, their relationship turns the
promiscuity that Shilts condemns into a paradigm of the erotics of encoun-
ters in a shrinking world: Shoumatoff’s liaisons dangereuses. Zero Patience
shows—as Simmel had claimed—that estrangement attests to the disturb-
ing familiarity more than the radical difference of the ‘‘stranger.’’ The mi-
crobe circulates along the circuits of desire in an interconnected world, but
governmental indifference and corruption and corporate exploitation turn
the outbreaks of disease into a global pandemic (which is where Greyson’s
and Shilts’s analysis converge). When Burton tries to revise his account, he
learns the strength of the stigmatizing story that obscures governmental
and corporate responsibility. It places blame on the behavior of individuals
and ‘‘populations’’ rather than institutions. The tenacity of Shilts’s depiction
of ‘‘Patient Zero’’ in the mainstream media attests to the aptness of Grey-
son’s analysis.
Unlike his cinematic avatar in Greyson’s film, Shilts’s character has not
been allowed to disappear. In 1994, the year Preston published The Hot
Zone, the Boston Globe described how, ‘‘in horror straight from Jacobean
melodrama, [Dugas] took revenge by knowingly pumping the virus to as
many partners as he could, reportedly 2,500 men.’’∫∂ In the summer of that
same year, readers of Glasgow’s Herald were reminded that ‘‘Aids is thought
to have been introduced to America by Gaetan Dugas,’’ a ‘‘voraciously pro-
miscuous homosexual who luxuriated in the spectacular sexual laxity of
contemporary San Francisco.’’∫∑ Even those who understood the science fell
into the narrative, as in Oscar Moore’s 1996 description of Dugas as ‘‘the
infamous Patient Zero who, having become one of the first people to be
diagnosed hiv-positive (hence his statistical appellation), then decided to
take as many down with him as he could’’; he was, Moore observed, ‘‘the evil
mascot of this era.’’∫∏ And Duncan J. Watts summons him in his study of
social network theory to illustrate the principle of an epidemiological net-
work. ‘‘Just as hiv crawled its grisly way down the Kinshasa highway from
its birthplace in the jungles,’’ he writes, ‘‘and somehow, probably in one of
the coastal cities, found Gaetan Dugas—the Canadian flight attendant,
better known as patient zero—who brought it to the bath houses of San
Francisco and introduced aids to the Western world, so too could the
right chain of events free Ebola from its shackles.’’∫π Invariably, in the nu-
merous accounts of ‘‘sexual predators’’ and ‘‘supertransmitters’’—people ac-

256 ‘‘The Columbus of AIDS’’

cused of carelessly or knowingly spreading hiv —Gaetan Dugas’s name will
surface, as well as either his originary status, his alleged revenge motive, or
both. He is a stock figure in the history of hiv /aids, but, like Mary Mallon,
he has also migrated out of a specific pandemic. Separated by a century,
Dugas and Mallon are both invoked characteristically in the media, as in the
sars example, in the midst of a new outbreak. Both figures are narrative
devices that signal the effort to fashion an outbreak narrative.
Throughout this book, I have shown how novels and films animate the
language, images, and storylines of the scientific studies and journalistic
portraits of the threat of disease emergence. Figures of speech and images
come to life and hypotheses are explored in the extended scenarios that
fiction can imagine. Horror stories in particular draw out the anxieties
embedded in the chance remarks and illustrations of the scientific, jour-
nalistic, and even less fantastical fictional accounts. The infectious zombies
of such films as Resident Evil (2002) and 28 Days Later (2002) and especially
the more psychologically developed human-virus protagonists of Chuck
Hogan’s 1998 The Blood Artists and Robin Cook’s 1997 Invasion dramatize
the transformative impact of a virus; they are the monstrous fictional proto-
types of the metamorphosed carrier, tracing a lineage from ‘‘Typhoid Mary’’
through the body snatchers to ‘‘Patient Zero.’’∫∫ The contemporary epi-
demiological horror stories that feature them show how the conventions of
horror and myth color the imagined experience of an outbreak at the turn
of the twenty-first century, explaining both the fascination elicited by this
cultural narrative and its consequences. These stories conspicuously turn
the threat of disease emergence into an apocalyptic battle between heroic
scientists and the hybrids who embody the threat. Against the backdrop of
the uncontrolled spread of the rapidly mutating human immunodeficiency
virus, of profound human suffering, and of the failed promise of scientific
medicine, they complete the story that Shilts was trying to tell: the outbreak
narrative of disease emergence. These stories are doubly reassuring as they
depict the containment of viruses that are potentially more devastating
than hiv /aids and as they restore the promise and authority of science in
the heroic service of a threatened ‘‘Humanity.’’∫Ω
The Blood Artists offers an especially vivid example—reading almost as a
blueprint—of the outbreak narrative. An epigraph to the novel explains that
‘‘a virus does not want to kill. It does not even want to harm. It wants to
change. It wants that part of it that is missing. It wants to become.’’Ω≠ When
the extremely mutable (unstable) retrovirus enters a human host, it quickly
enacts that desire. The novel opens with the emergence of a newly identi-

‘‘The Columbus of AIDS’’ 257

fied retrovirus from an illegal uranium mine in the ‘‘primordial’’ jungles of
Central African Congo. It is initially devastating to human beings, and the
cdc epidemiologists sent to contain it are almost successful, until one,
Stephen Pearse, succumbs to his humanity and allows an asymptomatic
woman to break quarantine. When the dying woman eventually wanders
into the solitary camp of Oren Ridgeway, a botanist working for the en-
vironmentalist group Rainforest Ecology Conservation International, she is
already part viral and literalizes the viral desire of the epigraph with a
passionate kiss that turns Ridgeway into a carrier par excellence. The un-
suspecting Ridgeway unwittingly produces the initial outbreak in the U.S.
in his hometown of Plainville, Massachusetts, which gives the virus its
name. But the infection transforms both progenitors (virus and human
being), and the evolving hybrid becomes vengeful and calculating, wanting
nothing less than the extinction of the human species. Ridgeway/Plainville
deliberately infects Pearse, whom ‘‘he’’ blames for ‘‘his’’ infection, and the
hybrid commences to seed outbreaks as ‘‘he’’ embarks on an apocalyptic
master plan to save the planet by annihilating humanity.
Pearse’s infection connects him psychically to Ridgeway/Plainville, whom
he and his colleague Peter Maryk call ‘‘Patient Zero’’ or just ‘‘Zero,’’ and
Maryk keeps Pearse alive to gain insight into their foe. Pearse can therefore
narrate the horrifying transformation; the ‘‘ ‘character of a virus endowed
with human traits,’ ’’ he tells Maryk, is ‘‘ ‘a being uninhibited by any obliga-
tions, social or moral. Combine the worst elements of a serial murderer, a
rapist, an impulsive arsonist. Hyperaggressive, hypersexual, homicidal, ego-
centric, pathological. An unqualified sociopath. The ultimate deviant ter-
rorist mentality. All Zero wants to do is infect, infect, infect’ ’’ (249). The
synthesis is dramatic: a virus has no social instinct, but when combined with
a human being, it develops conscious agency and becomes a sociopath—
one of the many charges leveled against Gaetan Dugas—and a bioterrorist.Ω∞
If human traits make the hybrids vengeful, their viral progenitors be-
queath their occult status. The legacy of scientific speculation of viruses’
relation to the origins of life continues to prompt scientists to wonder
whether viruses may have been the first life form, even the (willful) genera-
tors of subsequent organisms. ‘‘What could be a more beautiful supposi-
tion,’’ asks the virologist Jaap Goudsmit, ‘‘than that viruses no longer saw a
future for themselves as independently living organisms and created their
own host in order to be able to extend their lives to the end of time?’’Ω≤ In the
misty haze of ‘‘the rna world’’ (156) of this speculative creation myth,
viruses are not just primitive, but primordial, holding the secrets of the

258 ‘‘The Columbus of AIDS’’

origin of life and a privileged relation to a pristine Earth. Many of the hybrid
protagonists explicitly extend this relation into a righteous indignation for
the lack of respect that human beings have shown to their surroundings,
which turns them into avenging spirits who speak for a mute Earth. The
hybrids’ articulation of their position remarkably echoes the language of
many of the scientists and science writers that I discussed in chapter 1, as
in Maryk’s explanation of the ‘‘Message’’ of Plainville/Ridgeway that the
‘‘ ‘Earth is a cell we are infecting. And nature is the Earth’s immune system,
just now sensing the threat of our encroachment, and arming itself to fight
back. Macro versus micro. Viruses are the Earth’s white blood cells. We are
the Earth’s disease’ ’’ (224). This characteristic articulation invigorates the
mythic status of the hybrids, who become earth demons with apocalyptic
intent. The extension of their environmentalism into a program of planned
genocide, moreover, undermines the environmental analyses that are cen-
tral features of discussions of disease emergence.
As embodied (partial) viruses, the hybrid protagonists pose the problem
of disease emergence in medical terms. They have a distinctly epidemiolog-
ical appeal, offering a clear and concentrated solution to the problem of the
outbreak. As Hogan explains, the ‘‘threat of a mutant virus gifted with
human intellect and cunning posed hazards exceeding Maryk’s worst imag-
inings. But all he envisioned was its one great advantage. Epidemic control
had never been simpler. Zero was like a tumor Maryk could go in and
surgically remove’’ (240). The hybrids are enemies that can be compre-
hended, fought and defeated, and they allow medical science and epidemi-
ology to do the work of containment in these epidemiological horror sto-
ries, all of which feature a state-of-the art laboratory. The cure for the virus
so hopefully promised by Gallo and Montagnier in the co-edited issue of
Scientific American comes in these versions from the lavishly described
laboratories of these accounts. While Outbreak’s opening tour of the bio-
containment laboratory prepares the audience for the implausible produc-
tion of an antidote that saves Cedar Creek from annihilation, the hero
protagonists in Invasion and The Blood Artists even more dramatically
forestall full-fledged viral apocalypse with the kind of engineering feats an-
ticipated by Gallo and Montagnier. The bioengineered viruses with which
the protagonists defeat their viral foes in Cook’s and Hogan’s novels repre-
sent the researchers’ deliberate harnessing of microbes. They are feats of
science rather than, as in War of the Worlds, accidents of the environment.
The scientist heroes in these and other fictional accounts renovate Miles’s
unearned triumph at the end of Finney’s novel.Ω≥ Their ingenuity reaffirms

‘‘The Columbus of AIDS’’ 259

scientific authority, and their achievements are successful versions of strat-
egies that contemporary scientists are in fact exploring.
The mythic features of the outbreak narrative complement rather than
contradict the authority of scientific medicine. The scientists and epidemi-
ologists who battle the primordial and supernatural hybrids are more than
successful in their fight to contain an outbreak; they are triumphant in their
archetypal battle against apocalyptic forces of destruction that are not only
not new, but that return to the beginning of time and represent an ongoing
threat. Lederberg refers to an ‘‘eternal competition’’ between human beings
and microbes, and the archetypal nature of the battle turns that competi-
tion into a timeless and ritualized story of renewal in which Humanity is
reaffirmed as it is redeemed by Science.Ω∂ While the particular microbes
described in accounts of ‘‘emerging infections’’ may be ‘‘new’’ to human
beings, these novels show how an old story structures the idea of disease
emergence. Myths, as Bruce Lincoln explains, characteristically summon
‘‘sentiments—above all those of internal affinity (affection, loyalty, mutual
attachment, and solidarity) and external estrangement (detachment, alien-
ation and hostility)—[that] constitute the bonds and borders that we reify
as society.’’Ω∑ They can reinforce or break down social borders. The out-
break narrative registers at once the tenacity and the porosity of national
boundaries, among other social borders, and thereby manifests—and medi-
calizes—the tension of the changing spaces and social groupings of global
modernity.
Virology supplies a scientific vocabulary for the danger of hybridity. The
most dangerous viruses are themselves frequently hybrids: the mutant
strains produced when animal and human viruses recombine in animal
hosts. In viral terms, hybridity is dangerous because it combines newness
and familiarity; in their new incarnations, hybrid viruses can jump the
species barrier (be ‘‘recognized’’) and produce outbreaks of especially viru-
lent and untreatable diseases. Viral hybridity is a key term in the vocabulary
of disease emergence. Scientific explanations of the concept and the be-
haviors and practices that enable it abound in discussions of sars, avian
flu, and other ‘‘emerging infections.’’ Speculations about activities and con-
ditions that may have led to the barrier crossings show how the concept of
viral hybridity slides into characterizations of afflicted people and how the
imagined practices and behaviors of those people are racialized and sexual-
ized. Images of perversion are explicit or implied, as in the theory that cir-
culated in the early years of the hiv /aids epidemic that the virus jumped
species when Africans had sex with monkeys or in the disgust evident in

260 ‘‘The Columbus of AIDS’’

accounts of Asian peasants’ sharing their domestic spaces with their ani-
mals and in Soper’s report of Mary Mallon’s alleged fondness for her dog
(evidence for him of her lack of hygiene). Deadly diseases mark the danger
of ‘‘inappropriate’’ and transformational practices and behaviors; their im-
plicit racialization and sexualization accounts for (white aids activist) Mi-
chael Callen’s ‘‘third-world’’ immune system in And the Band Played On.
The monstrous hybrids in the contemporary epidemiological horror sto-
ries are not strangers, but transformed familiars—literally, as in body
snatchers, the boys (and girls) next door. They embody the dangerously
transformative nature of global networks that undergirds the vocabulary of
disease emergence. sars accounts, for example, emphasized the spread of
the disease less through strangers than through travelers who brought it
home to their families and communities; the superspreaders were charac-
teristically featured in their roles as children, parents, spouses, and doctors.
As the spreading disease displays the contours of a contracting world, the
estrangement evinced by the monstrous hybrids (as in Georg Simmel’s
formulation) heralds the deferred but imminent affinities of new social
formations and the mutability of human populations. The hybrids show
how formatively superspreaders medicalize the breakdown of conventional
taxonomies and the social hierarchies they name. They also illustrate how
myth infuses this medicalization of global networks.
The mythic frame of the outbreak narrative subtly complements the
more explicitly stigmatizing terms through which landscapes and people
are portrayed as dangerous, dirty, and diseased. In the introduction to this
book, I showed how the depictions of impoverished spaces as ‘‘primitive’’
temporalized the uneven development of global modernity and obscured
the socioeconomic conditions of ‘‘disease emergence.’’ The mythic tem-
porality of these fictional outbreak narratives works similarly. As the im-
poverished spaces that amplify outbreaks dissolve into the mythic terrain
on which the apocalyptic battle is waged, the landscape becomes not just
primitive, but primordial. Associated with primordial landscapes and vi-
ruses, the inhabitants of these spaces can be implicitly incorporated, collec-
tively as populations, into the prehistory of ‘‘humanity’’ and thereby made
expendable (always ‘‘regrettably’’ so). Arguing for the priority of contain-
ment at all costs, which entails expedited annihilation of the dying village in
the Congo, Maryk explains, ‘‘ ‘This is Andromeda. . . . The Holocaust para-
digm: bombing the rail yards to cut the transport lines, martyring those
already in the cattle cars to the millions who would die in the gas chambers.
That’s what disease control is all about: trading the dead for the living’ ’’

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(43). But which dead are invariably exchanged for which living? Sacrificing
the citizens of Cedar Creek, California, is unthinkable in Outbreak. When,
in The Hot Zone, the virus hunter Karl Johnson tells Richard Preston that
‘‘ ‘a virus that reduces us by some percentage. By thirty percent. By ninety
percent . . . can be useful to a species by thinning it out,’ ’’ he speaks with the
dispassion of a long-term perspective.Ω∏ The effect on a ‘‘species’’ (or a
‘‘population’’) can only be measured from the perspective of a distant fu-
ture. When we speak of the effect on ‘‘humanity,’’ we are back in the present.
A mythologized population—a group that is anachronistic in the present
moment—exists precariously in a future past (grammatically, the future
perfect). Anachronistic populations can be rhetorically excluded from poli-
tics and history, fading into myth where, like Oedipus, they are absorbed (or
recuperated) as sacrificial blessings—Nurse Mayinga’s life-giving blood, but
also ‘‘Patient Zero’s’’ epidemiological revelations—in the Land of Science.
The danger, as I have argued throughout this book, lies not in scientific
research or epidemiological investigation per se, but in stories, in the con-
ventions of representation that infuse the images, phrases, and narratives
through which we make sense of the world. They inflect—and yes, infect—
every aspect of the scientific and epidemiological processes from the collec-
tion and interpretation of data to the social and medical diagnoses of the
problem. In the afterword to The Tipping Point, a contemporary study of
‘‘epidemics’’ and social contagion, Malcolm Gladwell recounts the curious
rumination of an epidemiologist who had spent his professional life ‘‘bat-
tling the aids epidemic’’ and who wonders ‘‘ ‘if we would have been better
off if we had never discovered the aids virus at all?’ ’’Ωπ Gladwell explains
that, after his initial surprise, he realized that what troubled the epidemi-
ologist was the thought that the identification of hiv may have prevented a
more effective management of the epidemic. Convinced, he muses that ‘‘the
aids epidemic is a social phenomenon. It spreads because of the beliefs
and social structures and poverty and prejudices and personalities of a
community, and sometimes getting caught up in the precise biological
characteristics of a virus merely serves as a distraction; we might have
halted the spread of aids far more effectively just by focusing on those
beliefs and social structures and poverty and prejudices and personalities’’
(261–62).
Gladwell shares with Greyson, Shilts, and many other analysts of hiv /
aids the conviction that the predominant focus on the virus might have
medicalized the approach to the pandemic at the expense of a more com-
prehensive social analysis. Yet his brief anecdote shows how tempting the

262 ‘‘The Columbus of AIDS’’

medical focus is. The virus is a compelling and easily identified villain for
epidemiologists ‘‘battling the aids epidemic’’ and also for those asking
where ‘‘we’’ went wrong. For the epidemiologist’s colleagues, the virus is the
source of the pandemic; for him, its identification is the source of the
problem. That focus leads him to express regret for a ‘‘discovery’’ that, as
Gladwell quickly concedes, led to more reliable diagnoses and blood tests
and to significantly more effective treatments. The ‘‘distraction’’ that rightly
troubles them both, however, does not come from the identification of hiv;
it comes, rather, as Greyson’s film makes clear, from the powerful conven-
tions of a mythico-medical story of disease emergence, global networks,
and social transformation worldwide through which the identification of
hiv and the phenomenon of disease emergence generally are understood.
That story—the outbreak narrative—affects which social structures and
whose beliefs, poverty, prejudices, and personalities become the focus of
analysis, as well as who is included in the ‘‘we’’ who might have been better
off had the virus not been identified. By failing to take the story into ac-
count, Gladwell and the epidemiologist risk reproducing its terms.

‘‘The Columbus of AIDS’’ 263