Conspiracy of silence The enemy within Complacency and arrogance make us think we cannot win make us think that the battle has been won But the thunder in the distance says it’s only just begun
—Michael Callen Across the twentieth century, Americans were on the move. The Great Migration (c. 1916–1970) brought more than 6 million Af-rican AmeAf-ricans out of the Jim Crow South and into Northern, Midwestern, and West Coast cities where they hoped to “drink of new and cool rains, bend in strange winds, respond to the warmth of other suns, and, perhaps, to bloom.”1 By the end of World War II there were an unprecedented 8.3 million active duty US soldiers, most away from their homes and families for the first time, many from small towns and rural America. Ironi-cally, the military’s rigorous homosocial environment allowed many closeted gay men and women to explore their same-sex attractions for the first time. After the war, rather than going to back to cities, small towns, and rural areas across the country,
1 Richard Wright, Black Boy: American Hunger, restored edn. (New York:
HarperCollins, 1998).
they settled in the port cities where they returned: New York, San Diego, San Francisco, Los Angeles, and elsewhere. Likewise, LGBTQ+ Americans joined their own Great Gay Migration. Gay enclaves flourished, sometimes in the immediate neighborhoods surrounding the ports, and with them, opportunities for gay sex in cruisy parks, tearooms, bathhouses, and bars multiplied.
Sexual mores were also loosening, in part, because of these demographic shifts, but also due to advances in science and changes in the law. More Americans were having more sex and, as a result, more STIs. During World War II, rates of syphilis and gonorrhea were so high that the US military mounted ag-gressive public awareness campaigns (replete with misogyny, racism, and xenophobia), and across the mid-twentieth century, STI rates increased steadily.2 However, the discovery of antibiot-ics in the 1950s meant that bacterial infections, including com-mon STIs like chlamydia, gonorrhea, and syphilis, could now be readily treated. The widespread availability of legal and effective birth control after 1960 gave women an unprecedented degree of agency over their reproductive destinies, and the 1973 Roe v.
Wade ruling ensured the right to a safe and legal abortion. New STIs, including the human papillomavirus (HPV), were discov-ered in the 1950s, then linked to cervical, anal, and other cancers in the 1980s. The Tuskegee Syphilis Experiment was an espe-cially egregious and racist study that began in 1932 and ended in scandal in 1972 but left a legacy of distrust in Black American communities that influenced the response to the AIDS epidemic and continues to overshadow public health efforts today. Over four decades, more than six hundred Black men, many with wives and children, were deceived into an observational study of untreated syphilis. The disease ravaged their bodies, families, and communities and was only halted after an Associated Press exposé resulted in public outcry. The Tuskegee Syphilis Experi-ment exacerbated distrust between minority communities and
2 See Sevgi Aral, Kevin Fenton, and King Holmes, “Sexually Transmitted Dis-eases in the USA: Temporal Trends,” Sexually Transmitted Infections 83, no. 4 (2007): 257–66.
lIvIng In wartIme medical and public health authorities, and these tensions persist into the present.3
Sex has long been operationalized in US American politics, from laws prohibiting sodomy (a catchall category that, at times, included anal and oral sex as well as bestiality) and restrictions on the sexual agency of women, people with disabilities, and people of color to the fight for marriage equality and the #Me-Too movement. In the 1950s, homophile activists began a fight for legal rights of LGBTQ+ Americans, though these early activ-ists sought to minimize overt discussions of sex and sexuality.4 After the Stonewall uprising in 1969, Gay Liberation activists foregrounded these once taboo aspects of gay life.
“Although the lesbian and gay political agenda was much broader than sex,” Michael “was only interested in the part that dealt with pleasure. One strain of seventies gay liberation-ist rhetoric proclaimed that sex was inherently liberating; by a curiously naïve calculus, it seemed to follow that more sex was more liberating. I should consider myself more liberated if I’d five thousand partners than if I’d had five hundred. Some of us believed we could change the world through sexual liberation.”5 Furthermore, Michael believed that gay men were “promis-cuous by nature,” and he enthusiastically participated in New York’s gay sexual subculture.6
While his general health had never been terrific — he had endured a number of serious childhood and adolescent illness-es — Michael, like many gay men of his generation, gave almost no thought to his sexual health. During his first year at Boston
3 For a timeline of the Tuskegee Experiment, see the CDC’s page, https://www.
cdc.gov/tuskegee/index.html. James Jones’s Bad Blood: The Tuskegee Syphi-lis Experiment (New York: The Free Press, 1993) is a classic account of the experiment’s history. Fred Gray’s The Tuskegee Syphilis Study: An Insider’s Account of the Shocking Medical Experiment Conducted by the Government against African American Men (Montgomery: New South Books, 2002) was written by one of the lawyers who represented plaintiffs in the lawsuits.
4 For more, see Eric Cervini, The Deviant’s War: The Homosexual vs. The United States of America (New York: Farrar, Straus, and Giroux, 2020).
5 Michael Callen, Surviving AIDS (New York: Harper Perennial, 1993), 4.
6 Ibid., 3.
University, he had contracted his first case of gonorrhea. In New York, the frequency with which Michael had sex increased as did his number of different sexual partners; so, too, did the fre-quency with which he was diagnosed with STIs. At this point, he reasoned, he’d only slept with a few hundred men — what was the worst that could happen? Things began to snowball quickly:
First came hepatitis in 1976. Then more gonorrhea and NUS [sic, NSU, or Non-specific urethritis]. In 1977, amoebas and Hepatitis B. More [NSU] and gonorrhea. 1978: more amoebas.
And my first case of shigella. And of course more VD. Then in 1979, hepatitis yet a third time: this time, non-A, non-B.
More amoebas, adding giardia this time. And an anal fis-sure. And my first case of syphallis [sic]. And of course more gonnorhea [sic]. In 1980: the usual gonnorhea, shygella [sic]
twice/more amoebas.7
By age twenty-seven, Michael could count more than three thousand different sexual partners, a figure he arrived at by means of simple arithmetic. As he explained,
I have been having gay sex in tearooms, bathhouses, book-stores, backrooms, and movie houses since I came out at 17. I estimate, conservatively, that I have had sex with over 3,000 different partners. I arrived at this figure by taking a long, hard look at the patterns of my sexual activity. I estimated that I went to the baths at least once a week, sometimes twice, and that each time I went in I had a minimum of 4 partners and a maximum of… well, let’s just use 4. And let’s not count this last year because I have stopped promiscuity entirely. So, that’s 9 years of active promiscuity. 52 weeks in a year, times 4
7 Michael Callen, “The Luck Factor,” unpublished speech, c. 1983, typewrit-ten original, in the Michael Callen Papers at The LGBT Community Center National History Archive (henceforth, MCP).
lIvIng In wartIme people a week, is 208 different partners a year. Times 9 years is 1,872. And that’s just the baths.8
To that figure he added another thousand or so men he met in assorted bookstores, sex clubs, orgies, cruisy theaters, and parks around the city. Although he felt three thousand was probably a conservative estimate, Michael believed that his experience typi-fied the sex lives of many men on the urban gay circuit.
Michael had been inspired by the rhetoric of gay leaders, including writer Edmund White, who encouraged gay men “to wear their sexually transmitted infections like red badges of courage in a war against a sex-negative America.9 Michael saw himself as a frontline soldier in the war against sex negativity.
“Every time I got the clap,” he reasoned, “I was striking a blow for the sexual revolution!”10 However, “by 1981, [he] got some combination of venereal diseases EACH AND EVERY TIME [he]
had sex and [he] finally contracted herpes.”11 As a result, Mi-chael was beginning to doubt his commitment to sexual war-fare. He signed up for a class at The New School called “From Gay Ghetto to Gay Community,” anxious to hear his hero, Ed White, speak about gay liberation and sexual politics. As White called for gay men to proudly display their “badges” won on the battlefield of sex, Michael sat in the audience, a moist herpes lesion oozing pus down his lip. Frustrated and, frankly, grossed out by the fetid blister, Michael felt the stirrings of discontent.
Leaving the lecture, he fantasized about scooping a wad of pus
8 Callen, “The Luck Factor.” CDC figures from the same period suggested that gay men had an average of 1,160 partners, which Michael calls an under-estimate. He reiterated a similar sexual inventory in numerous articles, speeches, and interviews across the next decade, and his friends and former lovers lovingly confirm his status as the biggest of bottoms.
9 Jeffrey Escoffier and Michael Callen, “My Rise from Complete Obscurity,”
in In My Time: Essays and Sex, Science, and AIDS by Michael Callen, ed.
Jeffrey Escoffier, unpublished manuscript, 1993, Richard Dworkin Private Archive (henceforth, RDA).
10 Michael Callen, Surviving AIDS (New York: Harper Perennial, 1990), 4.
11 Michael Callen, “The Luck Factor,” MCP. Allcaps in original.
from his lip, hurling it at Ed White, and yelling out, “Here, Ed!
Have some medals!”12
Michael began hearing whispered rumors of a new deadly
“gay plague” and a killer “gay cancer” among New York’s gay residents. It was initially labeled “GRID,” an acronym for Gay-Related Immune Deficiency, because the first cases reported were among gay men.13 At first, he shrugged off the rumors as hysteria and paranoia. How could a cancer target just gay men, anyway? Even doctors played down the rising concern among the city’s gay community. In the New York Native, a gay weekly newspaper, Dr. Lawrence Mass attempted to alleviate anxieties among New York’s gay population, writing that “there were ru-mors that an exotic new disease had hit the gay community in New York. Here are the facts […] the rumors are, for the most part, unfounded.”14 The curious qualifier “for the most part”
worried some readers, who watched friends, lovers, and former tricks waste away and die in the prime of their lives. They were certainly worried. Others, however, put their trust in Mass and those like him; after all, they were doctors.
Just a few weeks later, in June of 1981, the CDC reported five sexually-related cases of Pneumocystis pneumonia (PCP) among
“active homosexuals” in Los Angeles in its Morbidity and Mor-tality Weekly Report (MMWR), a professional newsletter that
cir-12 Richard Berkowitz, interview with author, 8 June 2020.
13 Initial cases were diagnosed among white gay men in urban areas who had access to healthcare. Cindy Patton identifies cases of PCP pneumonia among intravenous drug users in the 1970s, though because drug users are usually afraid to interface with healthcare over fear of arrest, these deaths were largely overlooked. See Patton, Inventing AIDS (New York: Routledge, 1990), 128. Almost immediately, “GRID” was also diagnosed among straight women who inject drugs or were the sexual partners of men who injected drugs as well as among the children of women who inject drugs, though women would not become part of the official epidemiological picture of the epidemic until many years later. For an excellent overview, see Gene Corea, The Invisible Epidemic: The Story of Women and AIDS (New York: Harper Collins, 1992).
14 Lawrence Mass, “Disease Rumors Largely Unfounded,” The New York Na-tive, 18 May 1981. Emphasis added.
lIvIng In wartIme culates among research scientists and healthcare professionals, not the general public.15 July brought more ominous news:
During the past 30 months, Kaposi’s sarcoma [KS], an un-commonly reported malignancy in the United States, has been diagnosed in 26 homosexual men (20 in New York City; 6 in California). Eight of these patients died within 24 months.16
With each passing week, more young gay men in New York, San Francisco, Los Angeles, and other gay meccas succumbed to unusual cancers and pneumonias. A pattern was forming, and Michael recognized himself in the emerging epidemiological picture. Deep down, he later wrote, “there was no doubt in my mind that I would get GRID.”17
Later that summer, severely dehydrated and jaundiced, Mi-chael stumbled into the Gay Men’s Health Project (GMHP) at Sheridan Square, a volunteer STI clinic founded by gay men’s health activists Leonard “Lenny” Ebreo, Marc Rabinowitz, and Perry Brass. GMHP was a safe haven for gay men to avoid homo-phobic doctors and receive treatment without judgment. Joseph Sonnabend happened to be a volunteer physician on duty at GMHP that day, and although he was “just the first warm body [Michael] found,” their serendipitous meeting set into motion a series of events that would alter the destinies of both men and save millions of lives.18
15 Centers for Disease Control and Prevention, “Pneumocystis Pneumo-nia — Los Angeles,” Morbidity and Mortality Weekly Report 30, no. 21, 5 June 1981, 1–3.
16 Centers for Disease Control and Prevention, “Kaposi’s Sarcoma and Pneu-mocystis among Gay Men — New York City and California,” Morbidity and Mortality Weekly Report 30, no. 24, 4 July 1981, 305–8.
17 Callen, Surviving AIDS, 4.
18 Ibid. David France provides a beautifully nuanced history of Sonnabend’s career and his role in the early years of AIDS in How to Survive a Plague: The Inside Story of How Citizens and Science Tamed AIDS (New York: Knopf, 2016). However, a comprehensive biography of Joseph Sonnabend remains an important project awaiting the right medical historian.
Sonnabend was uniquely qualified to respond to a new epi-demic of immune deficiency. Born in South Africa in 1933, he had studied medicine in Johannesburg and Edinburgh before embarking on a promising career at London’s National Institute for Medical Research. In 1977, he relocated to New York City with a generous research grant which allowed him to set up his own lab at Mt. Sinai Hospital. There he studied Interferon [a signal protein in the immune system] and moonlighted at the New York City Health Department and the Bureau of Ve-nereal Disease Control where he saw first-hand the explosion of STIs. On Monday nights, he volunteered at GMHP.19 In 1978, Sonnabend’s research grant at Mt. Sinai was unexpectedly not renewed, so he took his experience in venereal diseases and a
$25,000 loan and opened a private practice on W 12th St. in Greenwich Village, where his clientele consisted predominantly of gay men among whom “the rates of syphilis and gonorrhea […] were simply staggering.”20
Packed into a small apartment and littered with massive piles of scientific research journals and “furniture that wasn’t worthy of a low-rent garage sale,” Sonnabend’s office embodied
“everything most people believe competent medical treatment isn’t.”21 Patients often waited for long periods, and they “some-times rearrange[d] the order of seeing based on [their] collec-tive assessment of who needed to see him first or who had other appointments to get to.”22 Michael half-joked to friends that they should bring a copy of War and Peace to the doctor’s of-fice “because you might finish it in the waiting room before you get seen!”23 Still, Sonnabend’s patients adored their doctor, who would “easily spend an hour examining patients, unconcerned about the impact on his cash flow or the bottleneck it caused in the waiting room.”24 Long delays, they reasoned, “were a small
19 Sean Strub, “The Good Doctor,” POZ, July 1998.
20 Ibid.
21 Escoffier and Callen, “My Rise from Complete Obscurity.”
22 Strub, “The Good Doctor.”
23 Escoffier and Callen, “My Rise from Complete Obscurity.”
24 France, How to Survive a Plague, 25.
lIvIng In wartIme price to pay for his attentiveness, his reassuring telephone re-ports, his willingness to make house calls, and his heartfelt in-terest in their journeys through gayness.”25
What many of those patients, including, at first, Michael, failed to realize was that Joe Sonnabend was more than a prima-ry care physician. He was a world-class virologist, epidemiolo-gist, microbioloepidemiolo-gist, and researcher, someone whose phone calls would be answered by leading researchers like Stuart Schloss-man at Harvard, who co-invented the T-cell test that helped define AIDS; David Purtillo, a leading expert on Epstein–Barr Virus at the University of Nebraska; and wealthy philanthro-pists, like Mathilde Krim (1926–2018) who was a researcher at the Sloan-Kettering Institute for Cancer Research. Unlike many of the other so-called “clap doctors” in New York, Sonnabend had been a research scientist before opening a private practice.
Accordingly, he subscribed to medical journals from around the world, which he read to keep abreast of not only developments in his research fields but in medicine more broadly; thus, the piles of papers in his office. The expense of conducting research on his own dime added another layer to the doctor’s indifference to décor and tidiness. “Each dollar that came in went toward spiraling research expenses — FedEx bills for shipping blood samples to Nebraska, lengthy phone calls to Europe,” and rent and utility bills for his home and his office (both of which were often past due).26 There were times when Sonnabend had to borrow money from affluent patients to cover his own grocery bill, as well as Mathilde Krim, who recognized his brilliance and kept Sonnabend financially afloat more than once.
To Sonnabend, healthcare was a basic human right, not a market commodity, and he understood that health was holistic.
So, he took time with each client, performing comprehensive evaluations in order to understand their psychological, emo-tional, financial, and physical situations. As time went on and the epidemic grew, Sonnabend also made visits and telephone
25 Ibid.
26 Ibid., 74.
calls to his patients who were in hospitals around the city. Sean Strub (founding editor of POZ magazine, and, later, Sonna-bend’s patient) described those who saw Sonnabend as some of
“the most promiscuous gay men in the city,” adding that many men received their healthcare elsewhere in order to avoid the stigma of “being linked with those Village clones.”27 Within a few years, however, these distinctions disappeared, and Sonna-bend’s clients were simply the “sickest gay men in New York.”28 By the summer of 1981, Sonnabend was working an exhausting and mind-numbing schedule. During the week, he saw “fright-ened young men with a confounding array of symptoms,” often until late in the evening, and on Saturdays he “studied their sera under microscopes in his borrowed NYU Medical Center lab.”29 For gay men in New York, there simply was no other doctor like Joe Sonnabend.
AIDS — as the new syndrome was christened in September 1982 — was uncharted territory for scientists, healthcare profes-sionals, patients, and community and political leaders. No one knew what caused this frightening and deadly syndrome. Causal theories abounded, ranging from the plausible to the ridiculous and the conspiratorial. Was AIDS environmental? Dr. Yehudi Felman of the NYC Bureau of VD Control suggested “it could be the bugs out of the pipes in the bathhouses.”30 Was it caused by
AIDS — as the new syndrome was christened in September 1982 — was uncharted territory for scientists, healthcare profes-sionals, patients, and community and political leaders. No one knew what caused this frightening and deadly syndrome. Causal theories abounded, ranging from the plausible to the ridiculous and the conspiratorial. Was AIDS environmental? Dr. Yehudi Felman of the NYC Bureau of VD Control suggested “it could be the bugs out of the pipes in the bathhouses.”30 Was it caused by