Medicine: The Appalling Saga of Patient Zero

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Club Baths, San Francisco, November 1982 . . . When the moaning stopped, the young man rolled over on his back for a cigarette. Gaetan Dugas reached up for the lights, turning up the rheostat slowly so his partner's eyes would have time to adjust. He then 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."

-- Randy Shilts, And the Band Played On

Since the early days of the AIDS epidemic, researchers have reasoned that a handful of people -- maybe even a single individual -- bore the unknowing responsibility for having introduced the disease to North America and its first large group of victims, the homosexual community. By tracing sexual contacts, officials at the Centers for Disease Control in Atlanta in 1982 found a likely candidate: one man who, through his sexual liaisons and those of his bedmates, could be linked to nine of the first 19 cases in Los Angeles, 22 cases in New York City and nine more in eight other cities -- in all, some 40 of the first 248 cases in the U.S. The CDC acknowledged his role with an eerie sobriquet: it called him Patient Zero.

Now Patient Zero is publicly identified for the first time in a stunning new book on the AIDS epidemic, And the Band Played On (St. Martin's Press; 630 pages; $24.95). Zero, says Author Randy Shilts, was Gaetan Dugas, a handsome blond steward for Air Canada, who used to survey the men on offer in gay bars and announce with satisfaction, "I'm the prettiest one." Using airline passes, he traveled extensively and picked up men wherever he went. Dugas developed Kaposi's sarcoma, a form of skin cancer common to AIDS victims, in June 1980, before the epidemic had been perceived by physicians. Told later he was endangering anyone he slept with, Dugas unrepentantly carried on -- by his estimate, with 250 partners a year -- until his death in March 1984, adding countless direct and indirect victims. At least one man indignantly hunted him down. Dugas' charm proved unfailing: he sweet-talked the man into having sex again.

Dugas' identity as the peripatetic Patient Zero was confirmed last week by Professor Marcus Conant of the University of California at San Francisco, a pioneer AIDS researcher. But, Conant adds, "if it hadn't been this man, it would have been some other." Dugas' escapades are just one of many vivid and shocking stories in Shilts' impressively researched and richly detailed narrative. The author has been covering AIDS full time for the San Francisco Chronicle since 1983. Most of his tales underscore a theme that is painfully ; familiar to AIDS researchers: both the Federal Government and the gay community squandered lives and let the disease rage out of control by focusing on ideological preaching instead of public health.