Not long after I'd begun reading Patient Zero and the Making of the AIDS Epidemic I came across an interview that the fiction writer Imogen Hermes Gowar gave to The Guardian in which she described how her reading of Jean Rhys's Wide Sargasso Sea made her interrogate an existing text – Charlotte Brontë’s Jane Eyre – of which she had been a huge fan. The interview struck an immediate, if slightly uncomfortable, chord because it exactly captured my reading experience of Patient Zero, the pre-existing text in my case being And the Band Played On by Randy Shilts.
Even now I can remember being absolutely ‘blown away’ (to borrow a very American expression) by this book, when I, then a newly minted science writer myself, read And the Band Played On sometime in 1994 or 1995. It was a long-haul reading project, to be sure, and not always easy to keep track of all the people and institutions whose stories Shilts tracked through its pages. But it was an absorbing and completely immersive read, by turns exhilarating and depressing, and made me excited to have chosen the profession I was in at the time. Amid the confusing and large ensemble cast of characters there were some that stood out, but none was quite as intriguing or fascinating to me as Gaetan Dugas, the eponymous ‘Patient Zero’ of Richard McKay's book. For those unfamiliar with And the Band Played On, Dugas was the homosexual French Canadian air steward who, at the beginning of the book in the summer of 1980, had just been diagnosed with Kaposi's sarcoma, then known as the ‘gay cancer’. As portrayed by Shilts, Dugas reacted to his diagnosis with a fair degree of anger and hostility towards the medical and public-health establishment, and rather than heeding advice to limit his sexual activity, deliberately went out and infected as many other men as he could before he died in 1984. Impressed as I was by what I considered Shilts's honesty and courage in being willing to criticize his own community, I was guilty of unquestioningly buying into his portrayal of Dugas, if not as a complete ‘sociopath’ then at least as someone who was socially irresponsible. I have emerged from my reading of Richard McKay's carefully researched history in Patient Zero somewhat chastened about my blind acceptance based on admiration, as well as a renewed determination to follow my frequent edict to students to be critical readers and to carefully consider the possibility of interpretations other than those presented by the author.
McKay himself sets an admirable example in this regard for he gives the reader more than one window into the ‘lived experience’ of Dugas, whom he felt strongly was treated unfairly by Shilts. There is his own analysis backed by a formidable amount of careful research, far too detailed to even attempt to summarize here. Instead I will exhort readers to read his book for themselves. Even more powerful, however, is the touching description of Dugas offered by Ray Redford, one of his former lovers and friends, who preferred to write his thoughts down rather than be interviewed orally. McKay offers the entity of Redford's written reminiscences in the Appendix, giving the reader automatic access to at least one voice other than his own (pp. 367–376).
The restitution of Gaetan Dugas is not McKay's sole objective in this book, although it may be the one that stands out the most. Indeed, he lists it as the last of four issues that he sought to address, the other three being questions about the origins, rapid and wide dissemination and continued resonance of the idea, or rather myth, of ‘Patient Zero’, which was, as he explains, ultimately a deeply flawed epidemiological idea that was used in ways that were outright wrong (pp. 3–4). McKay works at these objectives through seven chapters and an epilogue of extensively researched and thoughtfully analysed history. Although dense with facts and analyses, the narrative flows easily, which will make Patient Zero accessible to a much wider audience than is usual for an academic book. Such an outcome is admirable under any circumstances, but what is more impressive in this particular case is that this book is McKay's first.
Of course, no gem is without its flaws, and given the tone and theme of Patient Zero, I would be remiss if I did not at least attempt to apply the lessons learned from it to an analysis of itself. There were times while reading the book that I couldn't help but wonder if McKay in his turn had treated Shilts in a similar vein as the journalist did the air steward, casting him as a villain posthumously, long after he could defend himself or his choices one way or another. What Redford said so poignantly of Dugas holds just as true for Shilts: he ‘was no ogre and no saint’ (p. 375). Dugas was certainly not the only, or even the most egregious, villain in And the Band Played On; at the time that I read the book, for instance, I can remember being far more horrified by the likes of the then US president Ronald Reagan, and for very different reasons by the researcher Robert Gallo. Has McKay's indignation over the unfair portrayal of Dugas allowed him to ignore some of the real groundbreaking achievements of And the Band Played On in sounding an alarm and raising awareness about AIDS from ‘within’ the community, so to speak? There is a tension in Patient Zero that I feel comes in part from the debt it owes to And the Band Played On – because without the earlier book the latter could not have been written – but also, I think, from the differences between the historical and journalistic perspectives. On the whole, however, I feel that McKay richly deserves the various accolades he has received for his book, including being shortlisted as a finalist – quite ironically – for the 2018 Randy Shilts Prize.
