Free And the Band Played On: Politics, People, and the AIDS Epidemic, 20th-Anniversary Edition by Randy Shilts Page A

children subjected to overcrowding and poor nutrition or among people whose lymphatic systems were knocked out by cancer. When modern medicine learned how to intentionally suppress the immune system so the body would not reject transplanted kidneys and hearts, Pneumocystis flared sporadically, eager to take advantage of any opportunity to thrive in its preferred ecological niche, the lung. The disease, however, would disappear spontaneously once the immune system was restored. And the little creature would return to an obscure place in medical books where it was recorded as one of the thousands of malevolent microorganisms that always lurk on the fringes of human existence, lying dormant until infrequent opportunity allows it to burst forth and follow the biological dictate to grow and multiply. Humankind’s evolution as a species that could survive diverse continents and climates was due in no small part to its ability to acquire immunity to such pests.
    All this evolution, however, had been short-circuited for the man slowly suffocating in Copenhagen in the chilly days of autumn 1980. Something had created a deficiency in his immune system; this was the easy way to explain how the Pneumocystis microbe had taken such comfortable residence in his lungs.
    Dr. Gerstoft had come from the State Serum Institute, Denmark’s governmental research agency, to study the less easily explained part of the man’s diagnosis. What had happened to this man’s immune system, and, of course, what might help? Intrigued, Gerstoft performed test after test, but nothing could explain why the protozoa had reproduced so prodigiously in the man’s lungs, making him sweat and strain for wisps of oxygen. A review of his recent medical history revealed nothing remarkable. He was an agricultural engineer connected with Denmark’s dairy industry, and in 1979, he had visited New York City to attend training courses in the proper use of milking machines. No clue there. He also was homosexual, but in Copenhagen, one of the world’s most comfortable cities for gays, this was a matter that raised neither eyebrows nor medical suspicions.
    Perhaps it should have, Gerstoft thought later, because just weeks before, he had seen another gay man who, for no apparent reason, was wasting away, suffering from unexplained weight loss and a frighteningly aggressive outbreak of anal herpes. The thirty-seven-year-old man, who was well known in the theater crowd of the Danish capital, had mentioned that his lover was also mysteriously ill.
    Second thoughts, of course, would come much later, because even in our advanced times it is still not uncommon for people to fall sick and even die for unexplained reasons. In any event, the agricultural engineer was the first to die, passing away that September at the Rigshospitalet, not far from where a surgeon named Grethe Rask had succumbed to the same pneumonia a little less than three years before.

    These two deaths in Copenhagen presented their own salient clue to the identity of a killer that quietly stalked three continents in 1980. In Europe, the microbe’s first victims were largely linked to Africa. Just weeks after Grethe Rask was rushed from South Africa to Copenhagen, a thirty-four-year-old airline secretary from Kinshasa took advantage of her employment travel benefits to fly her sickly daughter from Zaire to Belgium. The woman’s three-year-old was suffering from oral candidiasis, a yeast infection of her mouth. One of the woman’s children had already died of a respiratory ailment stemming from strange problems with her immune system, problems that started with a case of this candidiasis. Within a few weeks of her arrival in Brussels, the mother was also suffering from the oral yeast infection. By mid-September, her lymph nodes were swollen, she was rapidly losing weight, and she was suffering from a severe infection of cytomegalovirus. The doctors could do nothing as waves of infection washed over the