A Scapegoat for the Scapegoats: Investigating AIDS Patient Zero

Erin Doss, Indiana University Kokomo

Twenty-nine years after headlines proclaimed Gaetan Dugas as "Patient Zero" and "The Man Who Brought Us AIDS," Dugas's name appeared in headlines again, this time declaring Dugas was not singularly responsible for bringing HIV to the United States (Howard). A team of researchers in 2016 revisited samples collected from early AIDS patients and found that AIDS in the United States can be traced to multiple sources, including a pre-existing Caribbean outbreak. Although the study did not pinpoint the exact origin point of AIDS in the United States, it did establish that Dugas was not AIDS "Patient Zero," or even the first to demonstrate AIDS symptoms (Woroby et al.). Although Dugas's name has been cleared (32 years after his death), he will always have a significant role in stories of the AIDS epidemic. First identified as Patient Zero by Randy Shilts in his 1987 book And the Band Played On, Dugas was characterized as a beautiful, charismatic playboy who loved attention and casual sex with partners around the world. He was the center of every party he attended and had a wealth of friends and lovers. When he was diagnosed with Kaposi's sarcoma (a form of skin cancer often found in early AIDS patients), and later with AIDS, according to Shilts Dugas continued to pursue his promiscuous lifestyle, infecting hundreds of partners. Dugas's story is interspersed throughout Shilts's chronologically-organized book, a few paragraphs at a time, as relayed to Shilts by Dugas's friends and lovers. Shilts did not argue that Dugas was directly responsible for the AIDS epidemic, but, as reviewer Sandra Panem of Science suggested, this was not made clear to readers until page 439 of Shilts's 629-page book. Panem argued that "anyone knowledgeable knows that to pin a global epidemic on the actions of a single individual is absurd" (qtd. in "National" G2), yet that is exactly what happened in the fall of 1987.

Naming Dugas "Patient Zero" was not Shilts's immediate objective when writing And the Band Played On. Instead, he hoped to illuminate the role the media, the medical community, and the government played in allowing the AIDS epidemic to spread. Shilts was an openly gay reporter and, in the early 1980s, the only journalist in the United States covering AIDS with any regularity. Through his reporting, he became recognized as one of the only homosexual voices advocating for gay AIDS patients in the media. Shilts was the "only reporter in America who made AIDS his beat. … Shilts alone was able to tell when individuals and organizations were telling the truth. He knew the whole story" (Jones 6D). Shilts was at times ostracized by the homosexual community for his decision to write about gay sexual practices, sometimes in graphic detail, and to condemn gay leaders for their lack of effective action in curbing the epidemic (Sterel 13). However, he was known by those outside the community as a "gay activist" (Chase) and was credited with saving countless lives through his AIDS writing (Kinsella qtd. in Shaw, "A Critical" 7D).

When Shilts's book was published, however, the majority of related news coverage centered on Patient Zero. The idea of having a single target to blame for the AIDS epidemic grabbed media attention the way a reasoned, researched condemnation of government policy did not. The (often false) claims made about Dugas and attributed to Shilts created a myth of Patient Zero that I argue served to assuage the fear and guilt felt by both the homosexual community and the larger heterosexual society, and both further divided and in some ways created what Kenneth Burke referred to as "curative unification" (Philosophy 219) between the gay community and heterosexuals. However, I argue that by presenting the media with a scapegoat, Shilts built a narrative based on homophobia and provided society with a reason to ignore his carefully researched argument that the federal government and scientific community were responsible for the spread of AIDS. I build on current scapegoating literature by analyzing the case of a reporter who worked to resist the scapegoating of his community by providing two alternative scapegoats—one consciously and one seemingly unconsciously. I argue that ultimately Shilts failed to remove the gay community from its role as scapegoat and at the same time provided gays and heterosexuals with a common scapegoat, Patient Zero.

I first provide an explication of Burke's scapegoating process as it relates to my analysis and then further explain the situation of Patient Zero and the circumstances and rhetoric through which he became the ultimate AIDS scapegoat.

Burke and the Scapegoat

The concept of a scapegoat long outdates Burke, as the term originated in the biblical Old Testament when the Israelites were commanded to sacrifice a goat to atone for their individual and collective sin. Burke recognized the origin of the term and argued that a scapegoat could be denoted and slain symbolically through discourse. In Burke's usage, creating a scapegoat rhetorically involves three relationships between the scapegoat and society. Each of these relationships is imperative to the scapegoating process—guilt, purification, and redemption. If one aspect is missing, the scapegoating mechanism fails to function (Kuypers and Gellert). The first of these relationships is "an original state of merger," in which the scapegoat and the rest of society share the same "iniquities" in religious language, meaning the same feelings of guilt, fear, and/or uncertainty (Grammar 406). Often this guilt arises from the unavoidable hierarchies in society—as Burke noted, order is "impossible without hierarchy" (Attitudes 374). Such hierarchies are often understood in terms of good versus evil and participants must prove themselves worthy of their place in the hierarchy (Carter 9). As the moral order further builds up the hierarchy, it produces a sense of inferiority, which leads to feelings of imperfection and the need for purification. This need is intensified when those within the hierarchy are faced with the very real possibility of their impending death. The fear of death, then, in Carter's interpretation of Burke, is the "real director of the drama" (17). As a hierarchy must come to terms with its own imminent demise, those within the hierarchy begin to abuse power to compensate for their fear and uncertainty, thus creating a greater load of guilt. This guilt, then, needs to be dealt with in one of two ways according to Burke: mortification, the acceptance of guilt by society in an attempt to wash it away, or scapegoating, the process of placing the blame on someone else—the perfect vessel who both shares society's iniquities and embodies those iniquities in some way, whether tangible or through a rhetorical construction. The scapegoat is chosen because they are "worthy" of sacrifice, whether because they are seen as "an offender against legal or moral justice" who deserves punishment or are considered a candidate for "poetic justice," a vessel "'too good for this world'" (Philosophy 40).

Once chosen, Burke's vessel experiences a rhetorical "principle of division," in which the "elements shared in common are being ritualistically alienated" (1969a, p. 406). Through discourse, rhetors in some way shift society's fear, guilt, and/or uncertainty to the scapegoat, who becomes the embodied representative of society's iniquities. The scapegoat is then separated from society—rhetorically and in some cases physically. The scapegoat begins to represent "those infectious evils from which the group wants to be released" (Carter 18). As this happens, the scapegoat is forced out of society's discourse, taking with them the iniquities of society. As the scapegoat takes on the societal guilt, those remaining experience what Burke terms a "new principle of merger," in which society comes together under a new, "pure identity" created in "dialectical opposition" to the sacrifice (Grammar 406). Through this process society is saved by the alienation of the scapegoat, as "antithesis helps reinforce unification by scapegoat" (Language 19).

Although those viewing the situation from the outside may question the creation of a scapegoat, Burke posits that individuals within the situation feel a sense of catharsis as the blame is shifted and society is saved and brought together through the process of victimage. Burke clarifies that he is not saying scapegoating should bring feelings of catharsis and seem normal or natural, but that within literature, history, and rhetoric, this seems to be the result experienced by those within the situation (Permanence 16).

At the center of the scapegoating process is language. Burke argued that language is not neutral, but is "loaded with judgements," making speech an "intensely moral" act that gives hearers social cues about how to act toward objects and individuals (i.e., treating them as desirable or undesirable). Language, then, is a "system of attitudes, of implicit exhortations" (Permanence 177). For Burke, the way a person is referred to in conversation outlines a course of action toward that person. By considering the implications of discourse beyond the conversation or written text, Burke argued that language shapes reality and facilitates action—how a person is spoken about results in actions taken toward that person ("Dramatism" 92). As noted by Carter, seemingly neutral identifiers are "ethically charged," implying "All ought to be this, and none that" (7). Such language is "intensely moral," suggesting that words can be judged according to the actions they suggest, whether morally right or wrong (Permanence 177). In the case of Patient Zero, languages choices made by Shilts and other journalists ultimately impacted not just one man's legacy, but an entire community.

Scapegoating Patient Zero

To assess the usage of the term "Patient Zero" in reference to Gaetan Dugas, I chose to analyze both Randy Shilts's book And the Band Played On, published in 1987, and related media coverage. I collected 87 articles published between 1985 and 1990 which included the key words, "Patient Zero," "Gaetan Dugas," "Randy Shilts," or "AIDS." The majority of these articles appeared in 1987 (37) and 1988 (23), with all but one of the remaining articles published in 1989 or 1990. Much of the 1987-1988 coverage was directly related to the publication of Shilts's book and the controversy surrounding Patient Zero. Later articles focus on film and television treatments of AIDS stories, including the movie adaptation of Shilts's book.

I adopted a critical rhetoric approach, gathering these fragments of discourse together in a way that provides an understanding of how terms such as "Patient Zero" circulated during this period and ways these texts operate to both create and reinforce power structures (see McGee; McKerrow). In using critical rhetoric as a methodological orientation, I move from a study of public address to a study of the "discourse which addresses publics," taking on the role of an "inventor" who observes the social scene and analyzes communication fragments as "mediated" by popular culture and society (McKerrow 101). To provide a broader understanding of the discourse surrounding Patient Zero my analysis addresses the content of both the book and related media coverage. I first analyze Shilts's attempt to resist the media's scapegoating of homosexuals even as he seemingly unintentionally created the ultimate scapegoat. I then discuss the treatment of Shilts's scapegoat in the media and the ultimate impact of Gaetan Dugas's transformation into "the man who brought us AIDS" (Howard).

Shilts: Creating a Scapegoat

And the Band Played On details the spread of AIDS from its first known contact with the West in 1976 through 1985 and the announcement that Rock Hudson was dying from AIDS. Throughout his book Shilts sought to resist the labeling of AIDS as a gay problem. His introduction argued, "The story of these first five years of AIDS in America is a drama of national failure, played out against a backdrop of needless death" (xxii). Shilts continually placed the blame for AIDS on the Reagan administration's refusal to fund AIDS research, the scientific community's focus on competition and career advancement, public health and local government officials for failing to act, and gay leaders for playing politics instead of working to preserve lives. From a dramatistic perspective, Shilts attempted to change the public narrative of gay men as responsible for AIDS, instead describing a situation in which victims were given incomplete or false information and were allowed to act in unsafe sexual practices that led to contracting AIDS. He described the bathhouses, locations where gay men could have sexual encounters with multiple partners each night, in graphic detail and chronicled the minimal efforts made to shut them down. His description of the scenes allowed to exist in New York, San Francisco, and elsewhere demonstrated that gay men found themselves in a situation custom made for the spread of disease with no government, health, or community leaders willing to intervene.

As Shilts made the case that the government and societal hierarchy was to blame for the rise of AIDS, he also made it clear that AIDS was being overlooked and underfunded because it only affected homosexuals. Part of this blame lay with the lack of media coverage related to AIDS. For example, the New York Times did not run a story about AIDS on the front page until 1983 when the United States had already seen 1,450 cases of AIDS and 558 AIDS deaths, and the Los Angeles Times ran its first lead AIDS story in 1982 with the headline, "Epidemic affecting gays now found in heterosexuals" (Clare, 1988). As Shilts put it, the lack of media coverage about AIDS and the slow response of the medical community and the Reagan administration was "about sex, and it was about homosexuals. Taken together, it had simply embarrassed people—the politicians, the reporters, the scientists. AIDS had embarrassed everyone… and tens of thousands of Americans would die because of that" (And the Band 582). Shilts understood that homosexuals were becoming the scapegoats for AIDS. The language used in media stories related to AIDS demonstrate Shilts's concern about the scapegoating of AIDS victims and their position within the social hierarchy. As more AIDS victims died and threatened to bring the gay community into the forefront of conversation, the media continually refused to write about gay AIDS victims. As Carswell noted, newspapers "sought stories about 'real' people—that is, not homosexuals, bisexuals, drug users and others who were the early unwilling victims of the HIV virus" (4). Shaw also supported this assessment of the media's attitude toward AIDS, writing that "the American media didn't cover AIDS in any meaningful way until it seemed to threaten 'normal' (i.e. heterosexual) men and women and their children" ("A Critical" 7D).

While phrases in media coverage such as "real people," "normal," and "gay plague" clearly separated homosexuals from the heterosexual population, Shilts presented gay leaders as "real" people in their own right. The majority of his book deals with the men and women trying to fight the spread of AIDS. Shilts chronicled the few successes and many setbacks in AIDS research and the attempts to raise awareness of AIDS through the eyes of these men and women. He presented each of them as a person attempting to make a difference against a seemingly unbeatable foe. Instead of framing homosexuals as the scapegoats responsible for AIDS, Shilts described them as victims caught in a horrible situation and looking for help. By switching the focus from gay men as the agents to gay men as the victims of the scene, Shilts resisted the scapegoating of homosexuals and provided an alternate scapegoat—the federal government and scientific community, both of which he argued had failed to deal with AIDS in any real way. As noted by Foy, scapegoats rarely have the opportunity to resist the scapegoating process, as their voices are usually silenced (105). Shilts, however, refused to be silenced and used his position as a journalist to argue that homosexuals were the victims of AIDS rather than its perpetrators.

While Shilts's motive in writing the book seems clear—resisting the public's view of AIDS as a gay problem and focusing instead on the need for research and funding—he also included the perplexing story of Patient Zero, Gaetan Dugas. In a book about victims and heroes struggling to fight death, Dugas enters in the shadows of the story, making his first appearance on page 11 and quickly becoming the villain of Shilts's contradictory narrative. Even as Shilts described in detail the failings of the government and scientific community, his treatment of Dugas played on the homophobia of the broader society and provided a single, tangible evil to blame for AIDS. Dugas is first referred to as "Patient Zero" on page 23 when Shilts wrote about Dugas's "unique role" in the epidemic, one which included intentionally spreading AIDS (198). In a reversal from his strategy of focusing on scene over agent, Shilts painted Dugas as an evil agent with the knowledge of what he was doing and the desire to spread suffering. Although Dugas's story only takes up 46 pages of Shilts's book, Patient Zero became the focus of media coverage, overshadowing Shilts's careful resistance narrative.

Newspaper headlines read "Patient Zero: The airline steward who carried a disease and a grudge" (Shilts "Patient Zero") and numerous articles referred to Dugas as "Patient Zero" (see Associated Press; Carswell; Dunlop; Lehmann-Haupt; "MDs Doubt Claim,"; O'Neill). While a few articles described Shilts's reporting of Dugas's behavior accurately, most chose to focus on the idea conveyed by the term "Patient Zero." Headlines in October 1987 read "Canadian blamed for bringing AIDS to US" (Bremner), "Book singles out steward as AIDS culprit" ("Book"), and "Seductive steward blamed for spread of AIDS to US" (Hill). The New York Post even ran the headline, "The man who gave us AIDS" (Howard), a conclusion that was not supported by Shilts's discussion of Dugas or by any study conducted at the time. Shilts discussed the attention given Patient Zero and the irony of media focused on the dramatic story rather than policy (Engel; Sipchen): "Here I've done 630 pages of serious AIDS policy reporting with the premise that this disaster was allowed to happen because the media only focus on the glitzy and sensational aspects of the epidemic. My book breaks, not because of the serious public policy stories, but because of the rather minor story of Patient Zero" (qtd. in Engel). As Shilts recognized, media coverage of AIDS was shaped by the social, political, and economic climate in the United States (see Hardt). Deeply entrenched homophobia had created an environment where reporters weren't interested in writing about an embarrassing disease that impacted less than 10 percent of the population ("an aberrant 10% at that"), where political and scientific careers were threatened if they gave AIDS too much attention, and where the government and other funding agencies were loath to spend money or resources to study a "gay disease" (Shaw, "Anti-gay Bias"). In this climate neither the media nor the public was ready to accept Shilts's argument that the government and scientific community allowed the unchecked spread of AIDS. Instead, the narrative that resonated with the media—and presumably the broader public—was that of Shilts's alternative scapegoat: Patient Zero.

Dugas: The Scapegoat Rotten with Perfection

The concept of identifying a "patient zero" was not original to AIDS. The goal of discerning a single person as the starting point of an epidemic can be seen in other cases, such as the treatment of "Typhoid Mary" Mallon, who was identified as a typhoid carrier and quarantined for nearly three decades (Leavitt). The actual term, however, originated in 1984 during a cluster study completed by the Centers for Disease Control and Prevention (CDC). Researchers interviewed the first 19 AIDS patients in southern California and found that four of them had sexual contact with a non-California AIDS patient, who was also a sexual partner of four New York AIDS patients. The study, which linked 40 patients in 10 cities by sexual contact, demonstrated that AIDS was an infectious disease spread through sexual contact. The study identified Dugas as "Patient 0" and included a cluster graph charting the spread of AIDS between sexual partners (Auerbach, Darrow, Jaffe, & Curran 488). The study did not identify Dugas as having brought AIDS to the United States. Instead, it demonstrated the connection between Dugas's sexual activity and AIDS diagnoses. Dugas was first referred to as Patient "O," meaning his residency was outside California. However, as the results were clustered, the abbreviation was misinterpreted and Dugas became known as Patient "0," a clear error when Dugas's file named him "Patient 057," the 57th patient whose records were sent to the CDC (Worobey et al. 4). Labeling Dugas "Patient 0," however, provided a much different implication—an instance of Burke's "impersonal terminology" (A Rhetoric 32). The danger of using impersonal terminology is that it strips away the moral implications of humanity and contributes to the "satanic order of motives"—the process in which scientific investigation, and potential bias, can lead to treating individuals as less worthy of attention and aid, and, in extreme cases, as an evil to be eradicated (A Rhetoric 32; see also Mackey-Kallis and Hahn 13)

By the time Dugas's name became synonymous with the spread of AIDS, he had already died from AIDS-related complications. In fact, Dugas died the same month he was (anonymously) identified as "Patient 0" (March 1984), and three years before Shilts narrated his activities. Any information known about Dugas came from CDC interviews, which focused on his sexual encounters (he boasted of sleeping with nearly 2,500 partners), and from Shilts's book. In his narratives about Dugas, Shilts described him as "what every man wanted from gay life" (439), the man who thought himself "the prettiest one" and wanted to "have the boys fall for him" wherever he went (21). Shilts's description of Dugas fit perfectly with the gay stereotype already associated with AIDS, making Dugas's promiscuity and lack of concern about spreading his disease seem indicative of the entire homosexual community. According to Shilts, after Dugas was diagnosed, first with Kaposi's sarcoma, and later with AIDS, he continued to visit the bathhouses and told friends he was going to keep having sex because no one had proven that AIDS was sexually transmitted. Later, in 1982, there were reports of a man who would have sex in the bathhouses, then turn up the lights to reveal his Kaposi's sarcoma lesions, saying, "I've got gay cancer. I'm going to die and so are you" (And the Band 165). In these examples and others Dugas is portrayed as vain, angry, and unwilling to take responsibility for his actions. He is described as being angry he got AIDS and feeling justified in spreading it to others. "'Somebody gave this thing to me,' he said. 'I'm not going to give up sex.'" (And the Band 138). When Shilts wrote about Dugas's death he highlighted the irony of Dugas's life, that what had made him the epitome of the perceived gay ideal was quickly destroyed by AIDS. As Shilts wrote, "At one time, Gaetan had been what every man wanted from gay life; by the time he died, he had become what every man feared" (439). Shilts's suggestion that Dugas's promiscuity and irresponsibility were the ideal of gay culture characterized both Dugas and the gay community as the immoral evil many Americans already assumed them to be. Just as Burke noted that "enslavement, confinement, or restriction" must be present as the dialectic that allows us to locate freedom (Philosophy 109), so Shilts provided the narrative of a villainous gay man for society to oppose.

The Media's Scapegoat

The scapegoating of Dugas as Patient Zero began with Rock Hudson's death in 1985. At that point it became apparent that heterosexuals might not be safe from AIDS. As stated in a USA Today editorial, "With Hudson's death, many of us are realizing that AIDS is not a 'gay plague' but everybody's problem" (qtd. in Shaw, "A Critical"). Shilts and others suggested that the threat to those outside the gay community may have been exaggerated at points to "get the government and reporters moving," resulting in increased AIDS funding by 1989 as the broader society began to worry about contracting the virus (qtd. in Neuharth). These anxieties and worries about the potential of AIDS to affect the general population created the feeling of disorder Burke described when something changes in the hierarchic order (A Rhetoric). When the disease began to receive greater coverage and invade news broadcasts and front pages of "normal" people it broke the hierarchy of safety and the heterosexual community began to see themselves as susceptible to AIDS. This feeling of susceptibility to the disease and the fear of death brought heterosexuals into the realm of identification with the gay community—something most of society was not willing to accept—the "original state of merger" in Burke's scapegoating process, where both gays and heterosexuals lived in fear of contracting AIDS. Although the homosexual and heterosexual communities did not often identify, the shared fear of death brought by AIDS served as a "special case of identification"—an identification that quickly led to division (Hartzog 527).

When Shilts narrated the story of Gaetan Dugas he seemed to be setting up the perfect scapegoat for AIDS: a stereotypical gay man whose promiscuity threatened the pieties of heterosexual society. As Burke explained, pieties are "loyalty to the sources of our being," and are formed throughout an individual's experiences, both in childhood and through more formal education (Permanence 71). When these pieties are violated or challenged by others they become more pronounced (Daas 83). For the heterosexual society of the early 1980s, religious pieties and conservative ideas of what constituted proper and improper sexual practices were dominant, what Cloud termed <family values> (283).

Because Dugas's behavior was so antithetical to these pieties and societal values, it was easy—even rational—to blame him for AIDS. At the same time, however, whether or not those in the heterosexual community recognized it, the act of continuously attempting to ignore AIDS and its effect on the gay community both reinforced the moral hierarchy and created apprehension about the disease spreading beyond homosexuals. Society was steeped in Burke's iniquities—fear, guilt and uncertainty—related to AIDS. Perhaps they felt at least partly responsible for gay men's suffering, and certainly they feared for their own lives and experienced a nagging guilt about what might happen if the disease continued unchecked. This guilt and fear, born of hierarchy and domination, then, required purification. Because humans nearly always prefer to blame someone else then to take responsibility for their guilt (Mackey-Kallis 3; Walch 63), society needed a scapegoat and Dugas became the obvious choice.

Once Shilts's book was published, news coverage shifted from highlighting the risk of AIDS for heterosexuals to focusing on the larger evil, the villain responsible for single-handedly bringing the scourge of AIDS to the United States. Dugas was "rotten with perfection" (Burke, Language 16) as the vengeful demon who brought terror and disease to the gay community, the epitome of a "powerful" sacrificial goat (Brummett 67). Media articles depicted Dugas as using "his good looks and French-Canadian accent to lure handsome American men, even after he was diagnosed with AIDS in 1980" (Associated Press). The term "lure" framed Dugas as malevolent and suggested he took away the free will of his "victims" and then forced his disease on them. Likewise, by pointing out that Dugas slept with "handsome American men," the article highlighted Dugas's otherness as both a homosexual and a Canadian—someone who traveled the world to bring fresh horrors to the United States. Highlighting the "otherness" of a scapegoat by pointing out all the ways he is different from the rest of society allows for the principle of division to function—the more different the scapegoat becomes, the larger his or her division from society grows (Butterworth 156). Dugas's "otherness" included his homosexuality, his national origin, his promiscuity, and his desire to spread AIDS to others—the last of which became a focus of several news articles. Dugas was described in one article as "a Canadian airline steward who spread AIDS from coast to coast in the early 1980s." (Wade A34).

A brief article published in 1987 under the headline, "AIDS: The man they blame" frames Dugas as a mass murderer:

Sex-crazed air steward Gaetan Dugas . . . brought AIDS to the western world after taking an incredible 250 male lovers… The randy Air Canada steward sentenced thousands to death . . . the callous homosexual continued to seduce young men even after he had been diagnosed as the first American AIDS sufferer. . . . It is believed that Dugas, a French Canadian, originally caught the disease in Europe after having sex with Africans. In March 1984, aged 31, Dugas died of AIDS-related kidney failure—four years after he started spreading the gay plague. (emphasis added)

Though this description of Dugas is based on facts from Shilts's book, the language used conveys far more blame, describing Dugas as "sex-crazed," "randy," and a "calloused homosexual," all of which focus on the salacious aspects of the story. The writer even remarked on Dugas's number of sexual partners, "an incredible 250 male lovers" (though, in fact, Dugas claimed 250 lovers per year for a total of 2,500). This phrasing denoted Dugas as immoral and aberrant, failing the test of piety both in the sheer quantity of his sexual appetite and in the multiple references to his homosexuality. Such description stressed that Dugas was not like the majority of readers, regardless of sexual orientation. The article moved beyond these moral concerns to describe Dugas as the man who "brought AIDS to the western world," who "continued to seduce young men even after he had been diagnosed," who spread the "gay plague," and who, ultimately, "sentenced thousands to death." Although numerous aspects of this brief article are incorrect (i.e., the clearly racist reference to Dugas "having sex with Africans," further labeling him an outsider who brought a foreign disease to the United States) the article clearly conveys the claims made against Dugas: he alone was responsible for spreading AIDS. Although not stated implicitly, the article implied that Dugas's death was what he deserved for "spreading the gay plague." In short, the coverage of Dugas gave Americans "an object of hate, an individual whom we can comfortably 'blame' for AIDS" (Carswell 4).

Dugas was the perfect scapegoat—the absolute villain with no redeeming qualities. Even as members of society could identify their fear of AIDS with him long enough to come to an original state of merger, as Burke described it, Dugas's behavior and lack of remorse set him apart as the perfect vessel to blame, to set aside, and to alienate as the root of fear and suffering. For heterosexuals beginning to feel the impact of AIDS—the number of deaths, the possibility that their inaction had allowed AIDS to spread, the guilt of those not directly affected by the disease—Dugas provided a perfect opportunity to assuage their guilt. Reading these descriptions of Dugas's behavior, heterosexuals could believe he deserved his fate in a way they never would.

Dugas as the Face of Homosexuality

One result of the media's focus on Dugas's homosexuality and promiscuity was fresh attention to the homosexual lifestyle. The Patient Zero story created an opportunity to blame not only Dugas, but the entire homosexual community, a further attempt to return to the previously ordered moral hierarchy. Dugas became a symbol of homosexuality—a synonym for promiscuity and immorality. The connections between Dugas's behavior and feelings toward homosexuality in general can be found in multiple news items, such as this letter to the editor: "Homosexuality does seem to be synonymous with promiscuity… it is also an inescapable fact that these same homosexuals brought on the crisis in the first place and for the most part refuse to curtail the activity that is spreading it exponentially" (Christy 3D). With sentiments such as these, the scapegoating of Patient Zero became the scapegoating of the homosexual population in general, separating gays from the rest of society and completing the division of the scapegoat from society. As explained by gay activist Eric Sawyer, "It stigmatized gay men…like vectors of infection that would be responsible for spreading HIV and other horrible diseases, and that they should be avoided at all costs. It created a hysteria, which resulted in gay men being fired from their jobs, evicted from apartments, denied public accommodations and denied health insurance" (qtd. in Neese). Rather than resisting the scapegoating of homosexuals, Shilts's book ultimately ensured that the gay community would forever be connected to the spread of AIDS.

In Burke's third step of the scapegoating process, the sacrificial offering is completed and a new principle of merger exists in which a new, purified identity is revealed (A Grammar 406). For Americans in 1987, blaming Dugas for AIDS provided a way to separate themselves from the panic and worry of the epidemic. Focusing on the homosexual community and Dugas in particular as being responsible for the disease made it easier to move AIDS back into the "gay plague" status of the early 1980s, moderate feelings of societal guilt related to AIDS, and stop worrying about its impact on the heterosexual population. Although, of course, nothing changed in the spread of the epidemic, the rhetorical act of alienating the scapegoat provided a kind of catharsis for the heterosexual population. One reporter described this feeling of relief, writing that "one only wonders whether Mr. Shilts hasn't inadvertently provided fuel for those unsympathetic to the fight against AIDS, by reassuring them of their exemption from the epidemic," (Lehmann-Haupt C20). For those who comfortably moved AIDS back into the realm of a homosexual problem, the detailed descriptions of AIDS victims in Shilts's book only served to further alienate the horror of AIDS from the consciousness of heterosexuals. For example, Shilts directly blamed Dugas for the death of Wall Street businessman Paul Popham, saying, "I realized I was looking at somebody who was effectively dying of the virus, and that was courtesy of Gaetan… That was when the entire scope of the AIDS tragedy hit me like a bullet between the eyes. Gaetan had slept with somebody on Oct. 31 of 1980 and now I was looking at somebody in 1986 who was dying'" (qtd. in Sipchen 5). Regardless of the terrifying story being told and the feelings of sadness or helplessness it created, all three individuals involved in the story—Shilts, Dugas, and Popham—were gay men dealing with a virus that was brought to the United States by a gay man, affected mostly gay men, and killed mostly gay men. In the wake of recent reporting that highlighted the threat to heterosexuals, this focus allowed consumers of various media to relocate the threat of AIDS back toward the gay community and feel a sense of relief at no longer needing to worry about the "gay disease."

If, as I argue, Shilts's motive in writing And the Band Played On was to resist the scapegoating of the homosexual community, media coverage related to the book produced the opposite result. His choice to include the story of Gaetan Dugas—a choice that seems contrary to his overall argument—dominated public perception of AIDS and gave society a Patient Zero to blame. Dugas became the face of homosexuality—the gay man to be feared and hated. The media attention on Dugas effectively allowed the Reagan administration and the scientific community to escape any consequences for their lack of action.

Even as Shilts's portrayal of Dugas as Patient Zero alienated the gay community, it also gave homosexuals someone to blame for AIDS. Shilts himself recognized Dugas as a scapegoat in his statement about Popham's death being "courtesy of Gaetan" (qtd. in Sipchen 5), and in the way he told Dugas's story. In one narrative Shilts detailed Dugas's visit to a former lover in the hospital dying from AIDS, writing that "For the first time, his friend thought, he's seeing how serious this really is" (And the Band 79), then in the next mention of Dugas, Shilts described him bragging about his sexual exploits and casually mentioning that "one of his old tricks was in a New York hospital with something strange now" (83). Regardless of his stated goals in writing the book, Shilts consistently portrayed Dugas as the villain of the story, the one man who filled the role of agent in his narrative of AIDS. The other men and women in Shilts's book were trapped in a scene dominated largely by forces they could not control. Dugas, however, chose to take agency and to intentionally cause harm. Shilts's depiction of Dugas created the ultimate evil that homosexuals and heterosexuals alike could hate and blame. Even 30 years later, activist Larry Kramer relayed his frustration with Dugas: "You know, the fact Gaetan was labeled 'Patient Zero' does not deny the fact that he was, I think, an irresponsible gay man" (qtd. in Neese). For Kramer and other gay men, then, Dugas became a symbol of what they were not—the man who spread death instead of trying to stop it; the man who was responsible, if not for all AIDS victims, for many, many deaths from AIDS. The story of Patient Zero, narrated by Shilts and perpetuated by the media, served both to further stigmatize the homosexual community and to provide a purification function for gay men—a scapegoat for the scapegoats.


When Randy Shilts published And the Band Played On, he wrote in the prologue that his story was "a tale that bears telling, so that it will never happen again, to any people, anywhere" (xxiii). This stated motive, then, explains his careful research and retelling of the trials faced by AIDS patients and researchers alike. He believed that if the federal government, the scientific community, the media, local leaders, etc., could be held accountable for their actions in the AIDS epidemic, future generations would learn from their failures and work to address health crises in a timelier manner. When applied to the story of Patient Zero, however, Shilts's stated motive falls short. Although Shilts admitted that whether or not Dugas actually brought AIDS to the United States "remains a question of debate," he attributed the first AIDS cases in New York and Los Angeles to Dugas and referred to his ubiquitous travel as an airline steward, facts that "give weight to that theory" (439). In his attempt to portray Dugas as the one man who could take away the AIDS guilt homosexuals faced, Shilts brought more societal stigma toward the gay community. The drama and sensationalism of the Patient Zero story attracted the media and gave reporters and book reviewers a juicy, succinct narrative to recount for their readers.

In Burke's terms, Shilts's Patient Zero narrative served a clarification function (Philosophy 219). Gaetan Dugas was Patient Zero and he was the ideal of gay life, which meant that both Dugas and those like him (homosexuals) were guilty and deserved to be punished. Moreover, if AIDS was their fault, perhaps it only affected homosexuals and the heterosexual community could escape their fear of AIDS. By creating a scapegoat in Dugas and the homosexual community, media coverage of Shilts's book allowed heterosexuals to feel safe in their separation from the threat, potentially opening up this community to increased risk of unsafe sexual practices and other risky behaviors because they believed themselves to be unreachable by AIDS. The rhetorical result of Shilts's book and the surrounding media coverage was a seeming sense of relief and catharsis by the heterosexual community, a stronger stigma related to homosexuality, and a single man that both the homosexual and heterosexual communities could blame for AIDS. In a rhetorical sense, these two communities experienced a "curative unification" (Philosophy 218) as they shared a common enemy (see Grey). Each group placed a different load of guilt on Dugas's metaphorical shoulders—heterosexuals their determination to ignore the AIDS virus; homosexuals the guilt placed on them for the lifestyle choices and connection to AIDS—and each experienced a different brand of catharsis. For heterosexuals the scapegoating of Dugas signaled a return to the original hierarchy, while for homosexuals Dugas took on responsibility for the stigma they faced and gave them a person to blame for their suffering. As Burke noted, it is difficult to "get people together except when they have a goat in common" (Cowley 499).

For both groups, the creation of Dugas as a rhetorical scapegoat changed nothing about the reality of the AIDS epidemic. People continued to contract AIDS and die from the disease. However, as Shilts and other journalists continued to write about AIDS, the medical community and the federal government took notice and slowly increased AIDS funding and research (Neuharth 13A). The story of Patient Zero, however, resulted in the further alienation of the gay community and has continued to impact homosexuals in the United States. One of many lasting effects is the standing ban on homosexuals and bisexuals donating blood. The U.S. Food and Drug Administration (FDA) created the ban in 1985 in an effort to stop HIV-infected blood from contaminating the national blood supply. Blood banks have been conducting HIV tests on donated blood for years and screening has continued to improve since 1985, but the ban remains. In 2015 it was modified to allow gay and bisexual men to donate blood as long as it had been 12 months since their last male sexual encounter. However, in the wake of the Orlando shooting in the summer of 2016, thousands of gay and bisexual men wishing to donate blood were turned away. In the age of the Internet, these men took to Twitter, tweeting their frustration about the ban and asking others to donate in their stead (McKenzie, 2016). Even as Americans celebrated the Supreme Court ruling in favor of gay marriage and other advances forward for the gay community, constraints such as the blood donation ban exist as a legacy of AIDs, Patient Zero, and the longstanding effects of the heterosexual society's desire for moral superiority.

* An earlier version of this essay was presented at the 102nd National Communication Association Conference in Philadelphia, Pennsylvania, in November 2016. The author wishes to thank Clarke Rountree and Chris Darr for their helpful feedback, and Kambren Stanley for assistance in an early draft of this essay.

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