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Higher Education Modules

Patient Zero and the Early North American HIV/AIDS Epidemic

Class 4: And the Band Played On: Randy Shilts’s History of the American AIDS Epidemic

Randy Shilts, a gay journalist living in the Castro district of San Francisco, began reporting nearly full-time on AIDS in 1983 as the epidemic was ravaging the community in which he lived, killing his friends and acquaintances. By the end of 1984, Shilts had become dismayed by what he saw as the pervasive homophobia limiting a full governmental response to the crisis, and by his inability to influence change through journalism. He subsequently set out to write a book to shift the national debate on AIDS, to shine light on the heroes and villains of the epidemic, and to humanize those who had been affected by the disorder. In the course of conducting hundreds of interviews for And the Band Played On, Shilts uncovered the identity of Gaétan Dugas, the man the CDC had labelled as “patient 0.” In addition to entertaining the possibility that Dugas may have been “the person who brought AIDS to North America,” the journalist became convinced, albeit on highly questionable evidence, that this French-Canadian flight attendant had been determined to spread his disease deliberately. When his editor feared that the national media’s unwillingness to review Shilts’s book would leave it unsold in warehouses, a plan was set in motion to promote the book with a news story that suggested Dugas, whom the journalist rechristened as “Patient Zero,” had triggered the epidemic in America. Newspapers around the world followed the New York Post 's lead, and in November 1987, tens of millions of television viewers tuned in to a 60 Minutes news special which reproduced Shilts’s claims and profiled Dugas as “a central victim and victimizer” of the American epidemic.

The readings convey the controversy surrounding the book’s promotion and mainstream success. Crimp articulates the anger of AIDS activists who saw “Patient Zero” as the articulation of a dangerous stereotype of gay men’s sexual behavior, which played into the hands of political opponents, like Senator Jesse Helms, who were successful in their efforts to deny funding to gay organisations undertaking AIDS prevention work. Babineau contextualizes the creation and promotion of And the Band Played On, drawing on interviews with Shilts’s editor and people who knew Dugas, including one friend who felt deceived by the journalist. Wald notes the similarity of Shilts’s representation of Dugas to other historical infectious carriers and suggests that the character of a dangerous disease spreader is a necessary feature of an “outbreak narrative,” a story which celebrates the power of epidemiology and medical science to identify and contain an emerging infection.

Students are encouraged to compare two events that Shilts describes based on retrospective interviews with participants—the December 1, 1982 meeting at the National Cancer Institute, and the March 12, 1983 forum organized by AIDS Vancouver—with primary sources in the Additional Resources section.


Babineau, Guy. “Gaétan Dugas and the ‘AIDS Mary’ Myth.” Xtra West, November 7, 2004.

Crimp, Douglas. “How to Have Promiscuity in an Epidemic,” October 43 (Winter 1987): 237-71. JSTOR (3397576).

Shilts, Randy. “Prologue,” “Glory Days,” and “Notes on Sources.” In And the Band Played On: Politics, People, and the AIDS Epidemic. New York: St. Martin’s Press, 1987, pp. xxi-xxiii, 11-24, 607-13. Also read indexed pages relating to “Dugas, Gaetan” [11, 21-23, 38, 41, 47, 78-79, 83-84, 92, 124, 129-31, 136, 137-38, 141, 146-47, 157-58, 165, 196-97, 198, 200, 208, 246-47, 251-52, 262, 348, 391, 412, 413, 438-39, 596-98] and “as Patient Zero” [23, 147, 156, 157, 257-58, 438, 460].

Wald, Priscilla. “‘The Columbus of AIDS’: The Invention of ‘Patient Zero.’” In Contagious: Cultures, Carriers, and the Outbreak Narrative. Durham and London: Duke University Press, 2008, pp. 213-63.

Additional Resources

Bergman, Lowell. “Patient Zero.” 60 Minutes video, 14:07. Televised November 15, 1987 by CBS.

“The Forum.” 30 30 Campaign video, AIDS Vancouver, 12:43.

“The Man Who Gave Us AIDS.” New York Post, October 6, 1987, pp. 1, 3.

“Presentations at the NCAB Meeting December 1, 1982.” [unpublished meeting transcript] In Their Own Words...NIH Researchers Recall the First Years of AIDS.

Discussion Questions
  1. Randy Shilts’s abilities as an observer and chronicler of the AIDS epidemic have received strong praise and vocal criticism. What are the strengths and weaknesses of his history? Compare his telling of events with the primary sources included in the Additional Resources section. What do you notice when you compare them? Why were these primary sources created? How might they differ from individuals’ long-term memories? What cautions do historians need to bear in mind when working with sources like these?
  2. In what ways did Randy Shilts misconstrue the cluster study’s findings?
  3. Notice how the cluster study diagram is animated in the 60 Minutes video, with the connections growing outwards from the single starting point of “Patient 0.” How might this modification have affected the meanings conveyed by the cluster diagram and interpreted by millions of viewers?
  4. What similarities does Shilts’s depiction of Gaétan Dugas share with earlier stories of individuals charged with spreading disease? How might you explain this?
  5. What factors might have motivated Shilts to suggest that a single person could have introduced AIDS to the United States? Why did this prove to be such a popular story? How might it have changed—or confirmed—what the public already thought about AIDS?