Hard to Say Who's to Blame for 'Patient Zero'?

Gaëtan Dugas
Gaëtan Dugas

In the diagram, he is represented by a black circle -- black, for Kaposi sarcoma. Unlike the others, there is no city or state accompanying this information; in fact, the "0" is actually an "O" meant to represent "outside California" or "outside of the U.S.," and his placement at the center of the diagram is arbitrary. Two years later, the "0" and its placement in the diagram would take on all-new, sinister significance as "Patient Zero" in Randy Shilts' book, And the Band Played On: People, Politics and the AIDS Epidemic. "0," or Shilts' preferred term, "Patient Zero" was Gaëtan Dugas.

"But, who was Gaëtan Dugas," I wondered. Pondering the last item on the list of things I might write about, I set up a search string on a dedicated app and let it work uninterrupted for two weeks to find out.

Gaëtan Dugas was born in Quebec City, Quebec, on February 20, 1953. At 20, he moved to Vancouver to work and learn English. At 21, he was an airline steward with Air Canada stationed out of Halifax and Vancouver, among other Canadian cities. Described as "breathtakingly beautiful," he was charming, well-travelled and exotic. Shilts describes him as "the man everyone wanted, the ideal for this community, at this time and in this place."

The book touches on many other topics: the inaction of the Reagan administration (the first reports of AIDS were in June 1981, but Reagan didn't even mention AIDS until 1987 ... the same year he proposed cutting funding for the disease by 11%) and the life and death of Grethe Raske (b. 1930, d. 1977, a Danish physician who worked in what is now the Democratic Republic of Congo and is confirmed to have died of AIDS-related causes), among others. But what stuck with the media and the general public most of all, was the image of Gaëtan Dugas as AIDS' "Patient Zero."

From the beginning, researchers and medical experts had doubts. In addition to the salacious headlines that helped cement Gaëtan Dugas as Patient Zero in the public consciousness, headlines such as these ran in Canada, and similar ones ran in the U.S.:

  • "Experts Doubt Plane Steward Brought AIDS" (Ottawa Citizen, October 7, 1987).
  • "MDs Doubt Claim that Canadian Carried AIDS to Continent" (Toronto Star, October 7, 1987).
  • "First AIDS Patient Story Dismissed" (The Gazette, October 17, 1987).
  • "First AIDS Victim Still Unidentified" (Windsor Star, October 21, 1987).

Harold Jaffe, M.D., at the Centers for Disease Control and Prevention in Atlanta said: "It's not a correct interpretation to say one person is responsible for introducing it to North America or California or Canada. We'll never know that and it probably doesn't even matter." (From the Windsor Star article, emphasis mine.) Shilts' book, even, says as much: "Whether Gaëtan Dugas actually was the first person who brought AIDS to North America remains a question of debate and is ultimately unanswerable" (p. 439).

Tim Murphy writes in New York Magazine:

I can vividly the shock and revulsion I felt toward Dugas in that moment. How could someone be so indifferent, so selfish, so vengeful? It was, like so much of Shilts' book, a sordid, dark picture of pre-AIDS gay sexuality, one that had almost made me relieved that a brutal epidemic had replaced erotic abandon with prudence, restraint, and responsibility.

A rather nasty side effect of the mislabeling and vilification of Gaëtan Dugas as Patient Zero, the ultimate villain in the burgeoning epidemic: Shilts essentially created the skewed lens that people with HIV/AIDS continue to be viewed through today. In Shilts' book, it is heroes versus villains: Gaëtan is a villain, as is AIDS itself. In society, it is the myth about guilt and innocence: those who deserved an AIDS diagnosis versus those it never should have happened to. A dangerous myth that continues to impede standards of care, stigma prevention, and societal understanding of the disease, as well as possibly giving immortality to a variety of other myths such as that gay men are somehow born with dormant HIV (spoiler alert, they're not). Unsurprisingly, the heroes and villains angle of Shilts' book is intentional: He promised as much in his pitch, which was rejected multiple times before finding a publisher -- the same publisher who published his book about Harvey Milk.

For weeks while researching this piece I don't think I have an opinion; I ping between neither are villains and the popular, Shilts-as-villain angle that gains and loses traction with me depending on my mood.

And then, I saw my hairstylist, Jeff. In place of our easy mix of political and celebrity gossip, I rush into how I don't think I have an opinion on this piece. Jeff says maybe there isn't a right or wrong in this story. I mull it over. "Yes, but ..." But what?

Shilts knew what he was doing when he agreed, reluctantly or not, to capitalize on the Patient Zero angle. He even knew what he was doing when he wrote that, after a sexual encounter at the Club Baths in San Francisco in November 1982, Dugas "made a point of eyeing the purple lesions on his chest. 'Gay cancer,' he said, almost as if he were talking to himself. 'Maybe you'll get it too.'"

With a few more years of medical knowledge and advancement than Gaëtan benefited from, Shilts knew definitively that HIV/AIDS was a sexually transmitted disease. That's something it is easy to forget about in 2016. The experts thought it was transmitted through sex, but for a long time, certainly most of the time in which Dugas was sexually active, that wasn't verifiable fact: "[San Francisco Public health official Selma] Dritz herself admitted that when she confronted Dugas with the demand that he stop having sex, it involved stretching the available evidence" (Andrew Stoner) .

Also, when Gaëtan Dugas was first diagnosed, he was diagnosed with Kaposi sarcoma, a cancer. To his mind, he was a cancer patient and had trouble wrapping his head around the idea that a cancer could be sexually transmitted. "It may be that his skepticism about his cancer's infectiousness afforded him a calmness as he described a bodily condition to which he had grown accustomed" (Stoner).

In Andrew Stoner's dissertation "Reconsidering Randy Shilts: Examining the Reportage of America's AIDS Chronicler," he writes that Shilts' editor takes full blame for the exploitative "Patient Zero" idea. The editor says to Stoner in a personal communication:

I feel guilty about this because Randy took so much shit because of this, and God knows how many essays have been written about Patient Zero and Gaëtan Dugas, and there are chapters in various medical books about it. There are all these writers in Canada who have taken up that issue, one of them wrote a 40-page essay on just that whole thing, critical of Randy. ... I feel somewhat guilty because Randy has always taken abuse for this when in fact he was very reluctant and I basically had to twist his arm like mad to get him to agree with this approach. He really shouldn't have to take the responsibility for this. I have tried any number of times to publicly say, 'Hey, if you're going to blame someone (for Patient Zero), blame me.' It should be aimed at me and I have no problem with that. I stand by it today (M. Denneny, personal communication, November 23, 2011).

Which echoes the account given in Plane Queer: Labor, Sexuality, and AIDS in the History of Male Flight Attendants.

Shilts, then, maybe doesn't deserve all the blame levied at him, but he does deserve at least some of the blame and criticism. He wrote the book. He promised heroes and villains in a nonfiction account of the early days of a burgeoning epidemic.

By the time Shilts began And the Band Played On, he had already lost the objectivity he feared losing if he knew of his own diagnosis before the book was finished. He said that everyone who gets AIDS winds up an activist, but he already had. He had a very black-and-white view of the world with regards to morality, sexuality and the AIDS epidemic, bred at least part from his own experience with hepatitis in 1976.

And, in this world, Gaëtan Dugas was the perfect villain and irresistible to the media: "other" enough with his French name, French Canadian accent and exoticness to assure a skittish public that what happened to him could not happen to them. And, by the time Shilts' book came out, he was dead: "The one person Shilts will never have to face is also the person who has, so far, stirred the most media interest in the book: 'Patient Zero'."

Shilts vilified sexual practices and ways of life that were more or less the norm for gay men of Gaëtan Dugas' generation, at that time in history, and he used Dugas as a figurehead to do it, fictionalizing portions of his life in his nonfiction book to make his book enticing, salable and to fulfill his promise of villains, "a pathogen-borne killer with no morality."

He went on to seek press for his enticing tale of heroes and villains of the AIDS epidemic. In this effort, he did not focus on what he claimed was the most important angle of his book -- government inaction -- but on what he instead said was a "minor" part: Gaëtan Dugas.

To the press, he said that "Gaëtan was someone who had never accepted himself as a human being, hated the part of himself that was gay, hated other gay people, externalized that self-hatred, and became what in effect was a psychopathic killer" (Stoner).

To me, judging by the candids widely available on the internet, the PDFs of theses and dissertations that contain far more objective information about Dugas than Shilts' book, and even from Shilts' own book, Gaëtan Dugas accepted himself just fine. The person who doesn't seem to is the one writing the book, who succeeded in skewing the perception of people with AIDS for years after his own death from the disease.

Finally, Shilts, in an interview, said:

I feel that the problem with the epidemic now -- and the reason for the hysteria -- is that so much about AIDS has remained so mysterious. ... I felt that by saying these are flesh-and-blood people with real names, I would bring home the reality of the epidemic and make it less frightening (Richard A. McKay).

In the end, he did the opposite. Instead of humanizing the AIDS epidemic, he vilified Gaëtan Dugas and countless other human beings, simply for being themselves in a confusing, frightening time.

But I'll stop short of calling him a villain. Who among us can say definitively what we would do if faced with government inaction and an epidemic that is decimating our friends, lovers and community? I can say resolutely, certainly not what Shilts' did, but faced with it, who knows? After all, Joseph Goebbels' 105-year-old secretary, Brunhilde Pomsel, says: "Those people nowadays who say they would have stood up against the Nazis -- I believe they are sincere in meaning that, but believe me, most of them wouldn't have." So, it's hard to say.

Sources and Further Reading