June 9, 2023 • 56 mins
The Clinton administration promises a new approach to the AIDS epidemic — but gets bogged down in the politics of sex, drugs, and morality.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hey, this is Leon Napok. I'm the host of Fiasco,
but you may also know me from the podcasts Slowburn,
Think Twice, Michael Jackson, and Backfired the Vaping Wars. I'm
excited to be sharing with you the next season of Backfired,
titled Attention Deficit, which is now available exclusively on Audible.
Backfired is a podcast about the business of unintended consequences.
(00:20):
In the first season, my co host Ril Pardess and
I dove deep into the world of vaping and how
the well intentioned quest for a safer cigarette went awry.
Now we're tackling ADHD and how the push to destigmatize
this hard to define childhood diagnosis has led to an
explosion of stimulant use in kids as well as adults.
It's a story about the promise of psychiatry to fix
(00:41):
our brains and the power of the pharmaceutical industry to
shape how we and our doctors think about what's wrong
with us. To hear both seasons of Backfired, go to
audible dot com slash Backfired and start a free trial
that's audible dot com slash backfired. Fiasco is intended for
mature audiences. For a list of books, articles and documentaries
(01:03):
we used in our research. Follow the link in the
show notes. Previously on Fiasco, AIDS is infecting more and
more heterosexuals, men and women, teens and babies.
Speaker 2 (01:18):
The Surgeon General today prescribed education children he feels need
to be yarned in school about the danger of AIN.
Speaker 3 (01:25):
Now many people are not receiving information that is vital
to their future health and well being.
Speaker 4 (01:30):
Researchers say, a new class of drugs are working.
Speaker 2 (01:33):
A cure for AIDS may soon be a possibility.
Speaker 1 (01:35):
Felt like some grand act of mercy made manifest when
we decided to make a season of Fiasco about the
AIDS epidemic. The arrival of the Triple Cocktail in nineteen
ninety six seemed like a natural place to end our story.
Speaker 2 (01:55):
The most optimistic note since the terrible disease was first recognized.
Speaker 1 (01:59):
These new so called to wonder drugs, the Triple Cocktail
represented a monumental turning point, a bookend to the era
when HIV meant certain death.
Speaker 2 (02:09):
A new combination of drugs, including a new class called
proteation inhibitors.
Speaker 1 (02:13):
From the discovery of the earliest cases of AIDS, people
had been imagining, dreaming of something like the Triple Cocktail,
a medicine that could overpower the disease. It was easy
to assume that the war on AIDS would be one
with the development of a successful treatment.
Speaker 5 (02:30):
I've really had about as close to a miraculous recovery,
certainly more so than I ever imagined I would see.
Speaker 1 (02:38):
But the Triple Cocktail did not end the epidemic. While
it helped people who were already sick, new people kept
getting infected, about fifty thousand the year after the Triple
Cocktail became available, in fifty thousand more the year after that.
In the decades since the treatment was introduced, nearly one
million people in the United States have been diagnosed with HIV.
(03:01):
And So, in this final episode of Fiasco, season five,
I want to get into some of the reasons why
the epidemic is still with us. What needed to happen
that didn't, and what could have been done that wasn't.
Speaker 6 (03:17):
I want you to believe that we can make America
work again.
Speaker 1 (03:22):
To tell this part of the story, I want to
go back to the early nineties, when a Democrat from
Arkansas was running for president and promising a new approach
to the AIDS crisis.
Speaker 7 (03:32):
I think most Americans still don't know how many people
are out there who are HIV positives.
Speaker 1 (03:36):
If nothing else, Bill Clinton was willing to talk about HIV.
Unlike his Republican predecessors, Clinton seemed less inclined to minimize
or ignore the problem.
Speaker 7 (03:47):
The president should type responsibility or the problems of the
country and be honest enough to say, we might not
solve them in a year or two, we may not
solve them all in four years, but at least we're
going to roll off our sleeves.
Speaker 8 (03:57):
And go to work.
Speaker 1 (03:58):
Let's get to work, Clinton for people for a change.
At this point, scientists were still years away from developing
what became the triple cocktail, but that didn't mean there
was no progress to be made. After all, treating people
who already had HIV was only one front in the
(04:19):
war on AIDS. The other was preventing people from getting
it in the first place, and that was hard for
reasons that had nothing to do with science or medical research.
By the time Clinton took office, public health experts already
had a bunch of good ideas for how to prevent
more people from getting infected. Those ideas all had one
(04:43):
thing in common. They required talking openly, explicitly and pragmatically
about how HIV was spread, and because that meant talking
about sex and drugs, it ensured that AIDS would continue
haunting the country and threatening people's lives long after the
medical mystery was effectively solved. I'm Leon Nafok from Audible
(05:09):
Originals and Prologue Projects. This is fiasco.
Speaker 9 (05:14):
Anytime you're talking about sex and drugs.
Speaker 8 (05:17):
It's a moral issue.
Speaker 10 (05:18):
We need to crack down on drug abuse, not promote
more drug addiction.
Speaker 11 (05:23):
But we don't want people to use drugs. Well, that's great,
there's no easy way to do that.
Speaker 5 (05:27):
We had a strategy that would save people from getting infected.
Speaker 10 (05:30):
And the question is why aren't they acting.
Speaker 1 (05:35):
On this week's season finale, a new administration promises to
turn the page on the HIV AIDS epidemic and instead
gets wrapped up in old arguments about sex, drugs, and morality.
Ricky Blutenthal was living in Oakland, California, studying sociology at Berkeley,
(06:00):
and he came face to face with HIV. The year
was nineteen ninety.
Speaker 11 (06:05):
I was getting a PhD because I was interested in
the problems of what we were then calling interstiti black people.
Speaker 1 (06:12):
Blutenthal had started his research with a focus on gangs
and drug distribution. Now he was part of a team
that was studying the prevalence of HIV in people who
used drugs in the Bay Area. Their data collection effort
was centered on a neighborhood about twelve miles outside Oakland
called the Iron Triangle.
Speaker 11 (06:31):
And it's called Iron Triangle because it's there's a triangle
formed by rail lines that cut through the community. It's
like a very common thing that happens to historic African
American neighborhoods, where they get split up and divided by
undesirable infrastructure.
Speaker 1 (06:45):
Blutenthal knew that racial disparities and health outcomes were structural
and that if properly understood, they could be undone. By
studying drug use and HIV and the Iron Triangle, he
saw an opportunity to use social science to actually help people.
Speaker 11 (07:01):
I had an advantage in that, you know, I'm African American,
so I felt comfortable working in the community and being
respectful engaged with people. So I didn't come in with
a lot of hard attitudes about any of it, about
drug use, about HIV, and so that gave me a
chance to learn and then try to be responsive to
(07:24):
the problems people were confronting.
Speaker 1 (07:26):
As part of the study, the researchers administered HIV tests
to lots and lots of people who used injecting drugs.
At one point, it fell to Blutenthal to give a
group of study participants the results.
Speaker 11 (07:39):
You know, I had like a series of seven or
eight counseling results that I had to share, and everyone
was positive, and I just started crying. Remember, you know,
this was a context of you know, it was five
years before we had effective treatments for HIV, so essentially
(08:01):
we were handing what felt like death sentences. I mean
it chacks me up now, you know. And it was
one of those moments where you you know, your rubber
meets the road, right, you know, you have to decide
are you going to do something about it.
Speaker 1 (08:22):
What Blutenthal decided to do about it was help start
a program in Oakland where people who used injecting drugs
like heroin could obtain clean syringes for free instead of
sharing contaminated ones with other people. It was a model
that first gained traction in the Netherlands and crossed over
into the United States in the mid eighties.
Speaker 4 (08:42):
There are some cities where groups of individuals have set
up privately run exchanges.
Speaker 8 (08:47):
Me a heroin addict is a bad nothing.
Speaker 4 (08:49):
I don't really feel I want to get AIDS to say,
the clean needles work for me.
Speaker 1 (08:55):
The premise of needle exchange was straightforward. When people who
are using drugs together syringes, they end up sharing blood
and if one of those people has HIV, the rest
are at extreme risk for getting it to The reason
so many people were sharing syringes was that they were
hard to get, and the reason for that goes back
(09:17):
to the War on drugs, which began under Richard Nixon
in nineteen seventy one.
Speaker 2 (09:22):
America's public enemy Number one in the United States is
drug abuse. In order to fight and defeat this enemy,
it is necessary to wage a new, all out offensive.
Speaker 1 (09:35):
Nixon's offensive led to a host of new laws around
the country aimed at making it harder for people to
use drugs.
Speaker 11 (09:42):
There was a bit of a cannabis or marijuana panic
in the late seventies, so the Department of Justice developed
a model drug paraphernalia law that was really focused on cannabis.
Speaker 10 (09:53):
Marijuana has become so widespread that virtually anyone is likely
to be a user upon its site.
Speaker 3 (09:59):
There was no such thing a safe.
Speaker 11 (10:00):
Marijuana, So they wanted to get rid of roach clips
and shut down the smoke shops. But in the course
of doing that they added other things, right, and one
of those other things they added was syringes.
Speaker 1 (10:12):
Selling syringes became illegal in most states, and some states
even banned possession before long. Syringes were extremely hard to
come by, and those who needed access to them multiple
times a day started sharing them with each other. Unsurprisingly,
that had some major health consequences, and as heroin use
(10:33):
rose over the course of the seventies, some injecting drug
users in New York City started coming down with a
respiratory disease nicknamed junkie pneumonia. Others developed a condition that
was referred to as the dwindles because the people getting
sick looked like they were wasting away. More recent research
has revealed that these conditions were most likely caused by aids,
(10:56):
which circulated among drug users in New York for years
before crossing over into other populations. As you heard in
our first episode, researchers only identified it as a new
disease in nineteen eighty one, after it started showing up
in gay men.
Speaker 11 (11:11):
In the United States, the focus was on sexual minority men,
and for good reason. The problem we had then we
still have a problem now, which is that people who
inject drugs aren't a particularly sympathetic group, and unlike sexual
minority men, they're not able to mobilize politically at the
same level.
Speaker 1 (11:32):
The earliest needle exchange activists in the US knew that
what they were doing was illegal. They were distributing drug paraphernalia.
Their hope was that local governments would see the good
in it and potentially even take over the exchanges themselves,
but that wasn't going to happen without a struggle.
Speaker 12 (11:50):
Handing out needles is illegal throughout most of the country.
Speaker 1 (11:53):
Many people believe that keeps attics addicted. To many politicians
and government officials, change sounded a lot like enabling drug use.
Speaker 13 (12:02):
It sends a terrible message that we are encouraging people,
or we are at least accepting the fact that these
people are are drug users and not doing very much
to get them offer.
Speaker 11 (12:12):
It's almost like throwing in the town.
Speaker 1 (12:14):
In nineteen eighty eight, President Reagan signed a law that
banned federal agencies from providing funding for needle exchange programs.
Here is Reagan's Surgeon General see Everett Coop explaining the
politics around the decision.
Speaker 3 (12:28):
It's very difficult even with people who are quite reasonable
about the problems associated with AIDS, they can bring themselves
to countenance a program that seems to aid and a
bet an illegal and an mral practice, namely IVY drug abuse.
Speaker 1 (12:46):
The funding ban put a very low ceiling on how
widespread needle exchange could become. According to the text of
the law, the ban could be overturned, but not until
there was definitive evidence that needle exchange reduced the bread
of HIV without simultaneously increasing drug use. As public health
(13:06):
experts set about conducting that research, small locally funded exchanges
continued to pop up around the country. The program, co
founded by Ricky Bluthenthal, was among them. In nineteen ninety two,
he and his team set up shop in West Oakland,
near an area where drugs were sold. They were supported
(13:27):
by tiny grants from community organizations and sourced their supplies
from another more established exchange in the Bay Area.
Speaker 11 (13:34):
So we just set up a table. We have educational
information condoms, clean cotton, and then there'd be a big
red bucket to collect the use syringes in, and then
we'd have our cases of clean syringes.
Speaker 1 (13:49):
That was the system. Bring used syringes, toss them in
the big red bucket, and leave with one clean syringe
for each one you brought with you. Bluthenthal and his
team distributed thousands of syringes during the first few months
of the Oakland program. Through it all, they got no
support from any government agency. In fact, they did their
work knowing they could be arrested at any time. Until
(14:11):
government officials at the local, state, and federal levels embraced
need to exchange, that would be the status quo. Then
Bill Clinton became president, and suddenly there was reason to
hope that needle exchange could come out from the shadows.
Speaker 7 (14:26):
I was born in a little town called Hope, Arkansas.
Speaker 1 (14:29):
After twelve years of Reagan and Bush, many AIDS activists
thought there was at least a chance that the Clinton
presidency could be different, to.
Speaker 7 (14:37):
Change all our people's lives for the better and bring
hope back to the American dream.
Speaker 1 (14:45):
After he was elected, Clinton took steps to signal his
commitment to public health one was to task his wife
Hillary with shaping his administration's approach to healthcare. Another was
to nominate an unapologetically progressive doctor named Joycelyn Elders as
surgeon General.
Speaker 9 (15:02):
I was a sophomore in colleague when I realized that
I wanted to be a doctor.
Speaker 1 (15:08):
Growing up in rural Shawl, Arkansas, population ninety.
Speaker 8 (15:12):
Nine ninety eight, when I'm in little Rock.
Speaker 1 (15:14):
Elders didn't know anyone who was a doctor, and she
got very little health education at school, you know.
Speaker 9 (15:20):
For I learned the most about sex education of really
more about menstruation and now was from the leaflet that
co Texts put in the cotext box.
Speaker 1 (15:32):
Elders went to medical school and became a pediatric endochronologist.
In nineteen eighty seven, while Clinton was governor of Arkansas,
he put her in charge of the state's Department of Health.
By that point, AIDS was affecting people of color at
twice the rate of white people. Black women, in particular,
were twelve times as likely to contract HIV as white women.
(15:55):
From her position in the state government, Elders tried to
do something about the disparities by pushing for comprehensive sex
ad and free condoms.
Speaker 9 (16:03):
I began called the condom Queen, and in fact I
had condom tree on my desk.
Speaker 1 (16:09):
Wait, what's a condom tree?
Speaker 9 (16:11):
Well, it was a rubber tree, a tree that the
nurses made for me, the public health nurses condoms of
all different colors, Christmas tree, and sat in the middle
of my conference table.
Speaker 1 (16:25):
And so you could take what if you wanted to one.
Speaker 8 (16:27):
No, they couldn't take them off my tree.
Speaker 9 (16:29):
But then there was plenty of them sitting out in
the condom bow out in the office that you could
just reach in and grab them.
Speaker 1 (16:39):
Elders made it a point to try to reach people
who had been overlooked in a lot of HIV prevention messaging.
She found that most of her ideas, particularly on sex
ad and the distribution of condoms, were wildly unpopular in Arkansas.
Speaker 9 (16:53):
Anytime you're talking about sex and drugs, it's a moral
issue rather than a public health issue.
Speaker 6 (17:01):
And that has made doctor Joycelne Elders Arkansas's most controversial woman.
Speaker 9 (17:06):
That wanted to tell me how God was going to
strike me dead and stuff like that.
Speaker 11 (17:13):
This nation, not just our exult.
Speaker 1 (17:14):
Sex education is chronography, and.
Speaker 9 (17:17):
I felt that they were concerned about what they were
concerned about. What I was concerned about, the young black
girls that I was seeing lost in the Delta, that
was being abused because of lack of education. Nothing could
keep me from worrying about it and doing everything I
(17:38):
could to make a difference. I had trouble sleeping at night,
but I was determined that we were going to do
something to make a difference.
Speaker 1 (17:49):
Governor Clinton at least seemed to appreciate Elder's willingness to
dive headfirst into controversial issues, and when he became president,
he once again called on her to serve in his administration.
Speaker 14 (18:00):
Doctor Joycelyn Elders, the former health commissioner of Arkansas now
President Clinton's choyce for Surgeon General of the United States.
Speaker 1 (18:09):
Almost immediately, Elders became a lightning rod for scandal. A
few months into her tenure, she caused a media frenzy
by suggesting that the legalization of drugs could be good
for society.
Speaker 9 (18:20):
And I do feel that we would marketly reduce our
crime rate if drugs were legalized.
Speaker 1 (18:27):
And conservatives immediately jumped on Elders' comments. A right wing
lobbying group circulated petitions to request her dismissal. Eighty seven
House members signed a letter calling on Elders to resign.
Rush Limbaugh mocked her on his show.
Speaker 15 (18:41):
Your Time Off for a Little Comic Relief, America's number
one national embarrassment speaks for herself. Here's Joycelynd Elders and
her theories on legalizing drugs.
Speaker 1 (18:53):
Here's Elders responding to the criticism at the time.
Speaker 16 (18:56):
Despite many of the comments and editory and reports that's
been about me, I'm still grateful because you see, if
I was walking around not saying anything that was at
all controversial and that was all neutral, first of all,
you wouldn't write about me. Secondly, if it was something
that was right and simple and easy and everybody accepted
(19:20):
it as a matter of fact, it would already be done.
Speaker 1 (19:26):
Legalization may have been a pipe dream, but need to
exchange was at least a somewhat more realistic policy idea.
To Elders, It's potential for slowing the spread of HIV
was obvious.
Speaker 9 (19:38):
If somebody who has HIV uses the needle and then
you use the same needle because she does say you
can't afford to buy them, well, then you were injecting
the virus into your body and you may not know
that for a year, two or ten.
Speaker 8 (19:57):
So that was why Baby.
Speaker 9 (19:58):
Bolt needle exchange program, and then that reduced a lot
of the HIV spread in a community.
Speaker 1 (20:07):
As Surgeon General Elders says, she always supported needle exchange
and understood what it meant for programs to have to
operate without support from the federal government.
Speaker 9 (20:17):
Some communities had really gotten tiny little grants, like from
churches and other places, and they were passing out train
needles from the trunk ofbec car.
Speaker 1 (20:29):
During the campaign, Bill Clinton had indicated that he was
open to lifting the Reagan era funding ban on needle
exchange programs, but if the model was going to win
the administration's blessing, activists would need other players in Clinton's
orbit to push him on it. That included Donna Shalela,
Clinton's Secretary of Health and Human Services.
Speaker 5 (20:50):
We saw needle exchange as a mitigation strategy to reduce
the incidents of AIDS and to save lives. Excuse me
if I could interrupt for one moment. I've got to
let him in here. He is you should know. My
dog is named Fauci. Really yeah, he's a rescue dog.
Speaker 1 (21:15):
Hi Fauchi.
Speaker 5 (21:15):
When I went to pick him up, they said he
had run into an Italian restaurant and he needed an
Italian name, and I said, I'll call him Fauci. Tony
said he'd been called worse.
Speaker 1 (21:28):
Before she joined the administration, Donna Shalala had been the
chancellor of the University of Wisconsin. She says the job
prepared her for the pressure she faced from AIDS activists
as HHS secretary.
Speaker 5 (21:40):
I knew that we were going to be pushed by
act UP and all of the groups who were in
a desperate state, So that was expected as part of
the job.
Speaker 8 (21:51):
I was a political scientist.
Speaker 5 (21:53):
I have been leading major research universities, so people getting
into my face was something that was expected.
Speaker 1 (22:03):
During Clinton's first term, Salela enraged AIDS activists by suggesting
that more research was needed to determine whether the Needle
Exchange Funding Band should stay in place. The administration's stance
on the issue became a kind of litmus test for
a lot of activists, a sign that Clinton was willing
to slow walk certain policies that posed a political risk.
(22:28):
Here is a protester confronting Clinton about it at an
AIDS event.
Speaker 17 (22:32):
There's been steps taken here advocated to be taken, like
legalizing needles have been talked about for three years?
Speaker 7 (22:39):
Where have you been? Didn't you listen to what we
said before about what we've done?
Speaker 18 (22:44):
Last night?
Speaker 1 (22:46):
Skeptics of needle exchange continued to insist there wasn't enough
empirical evidence that the model worked and that it didn't
result in more people using drugs, But the opposition was
often about more than just data. For many, was rooted
in a fundamental concern at the core of American drug policy.
Agreeing to provide people with drug paraphernalia would mean acknowledging
(23:09):
that the zero tolerance, just say no approach to drugs
didn't work. It would basically mean throwing out the philosophical
underpinnings of the whole drug war.
Speaker 14 (23:19):
There's no question that the right signal for the government
of the United States to send is to say to somebody,
if you're a drug addict and you need to use
intravenos drugs, come into a center and let us help
you get off drugs.
Speaker 1 (23:31):
This is former House Speaker Knut Gingrich weighing in on
the needle exchange debate at a press conference.
Speaker 14 (23:36):
That is the only message, we should give drug addicts,
but the government's job is to help you get off drugs.
It is not the government's job to try to make
killing yourself marginally safer as you do it.
Speaker 1 (23:50):
It wasn't only Republicans who opposed the idea of undoing
the ban. Members of Clinton's own party were apprehensive too.
Speaker 5 (23:57):
There was a debate within the Democratic Party. I mean,
you cannot say that this was just the Republicans. The
party itself was torn on the issue because of drug
addiction and because of crime related to drugs.
Speaker 1 (24:13):
Not all prevention measures were so fraught, as HHS Secretary
Donna Shalala focused a lot on public health messaging through
popular culture.
Speaker 19 (24:22):
Thank you all for coming AIDS is often thought of
as a hopeless problem. Today we are here to talk
about solutions.
Speaker 1 (24:32):
In early nineteen ninety four, Shalala announced a prevention initiative
at the Clinton administration had developed with the CDC. It
would include a series of PSAs starring celebrities like Jason
Alexander and Martin Lawrence.
Speaker 19 (24:45):
This campaign is focused on young adults because studies tell
us that young Americans are more sexually active than ever before,
and they are not taking proper precautions.
Speaker 5 (24:59):
So it was very important for us to approach young people.
So we went to the entertainment industry, but mostly to
the raps and to the music industry. We literally needed
everybody the communicated with young people to educate the entire
society about AIDS.
Speaker 17 (25:21):
I'm Anthony Ketis of the Red Hot Chili Peppers, and
I've been naked on stage. I've been naked on magazine covers.
In fact, I was born naked, And of course I'm
naked whenever I have six. And what I have here
is a condom, a latex condom. I wear one whenever
I have six, not whenever it's.
Speaker 1 (25:40):
The Clinton administration's media push coincided with another leap in
the growing public awareness of HIV and AIDS. Much like
Rock Hudson years earlier, several famous people disclosing their diagnoses
changed the public understanding of what HIV was and whom
it could affect. The most famous of these was NBA
legend Magic Johnson, who had revealed his diagnosis back in
(26:04):
nineteen ninety one.
Speaker 6 (26:06):
I think sometimes we think, well, only gay people can
get it, only is not going to happen to me.
Speaker 1 (26:12):
And here I am saying that it can happen to anybody.
Even later, there was easy E from NWA, just.
Speaker 11 (26:18):
Like Magic Josson when he thought it. You know well,
stuff like this happened.
Speaker 20 (26:22):
Agency to come out speak and let other people wherever.
So you know what I'm saying, we can try to
contain this stuff that was getting bad, you know what.
Speaker 1 (26:29):
There was also Pedro Zamora, the activist who appeared as
a housemaid on MTV is the Real World in nineteen
ninety four.
Speaker 8 (26:35):
I will probably not see the AH thirty.
Speaker 10 (26:37):
I will probably die.
Speaker 1 (26:38):
As Elay dying. Even the President called, I just want
to tell you.
Speaker 11 (26:43):
I was thinking about you, and tryan for He might
not be able to answer, but he understands everything.
Speaker 17 (26:47):
Okay.
Speaker 1 (26:49):
All these disclosures went a long way towards educating the
public about HIV risk and prevention, but activists were frustrated
that the policy changes Clinton had seemed to support as
a ended it weren't materializing faster in his presidency, and
after the nineteen ninety four midterm swept in a new
conservative Congress, the political possibilities seemed even more limited. As
(27:13):
the activist Sean Strube wrote at the time in his
magazine for people with HIV. This administration's priority is all
about image and media. As I write this, they are
cynically trying to have a press flurry of pseudo action
prior to World Aid's Day. As it turned out, World
Aid's Day in nineteen ninety four would end up generating
(27:34):
a lot of press for the Quinton administration, just not
in the way they had hoped.
Speaker 4 (27:49):
This is World Age Day. There were ceremonies and observances
around the world, but very little in the way I've encouragement.
Speaker 1 (27:57):
The seventh annual World Aid's Day took place on December one,
nineteen ninety four. As part of the event, Surgeon General
Joycelyn Elders was invited to speak and answer questions from
the press at a United Nations forum.
Speaker 8 (28:10):
Yeah.
Speaker 9 (28:10):
I don't think the speech I gave was necessarily that earthshaking.
But a psychiatrist asked me about masturbation.
Speaker 21 (28:21):
I think that that is something that it's a part
of human sexuality that perhaps should be taught, and I
feel that we have tried ignorance for a very long time,
and it's time we try education reguard to masturbation.
Speaker 1 (28:40):
Elders didn't think anything of it. It was the kind
of thing she said all the time to all kinds
of audiences.
Speaker 4 (28:48):
Doctor Joycelyn Elders proved once too often that speaking your mind,
especially on issues as sensitive a sex, education and sexuality,
could be very bad politics, especially with the Republicans breathing
down the President's neck as they are.
Speaker 1 (29:02):
Within days, Elders was being pummeled in right wing media.
Speaker 8 (29:06):
Why does the president keeper? I assume he shares our values.
Speaker 14 (29:08):
I assume he thinks it's okay.
Speaker 1 (29:10):
For Clinton and his political advisors. It was the last straw.
A little more than a week after she made the
comments about masturbation, Elders was forced to resign.
Speaker 4 (29:20):
Doctor Elders was fired today by President Clinton. In a
letter to the Health Secretary Donachileela late this afternoon, doctor
Elders writes, President Clinton and I maintain our strong mutual
respect for each other. She also says that as a
private citizen, she intends to continue speaking out on the
public health causes that are as she puts it, dear
to her.
Speaker 1 (29:39):
Here's Elders talking about her firing the week it happened
on this day show.
Speaker 18 (29:43):
Yeah, I really thought that all of the comments I
made were true and you know, I think that the
country needs to approach many of these issues. And the
longer we wait, I feel, the more children we are
going to lose. And I don't feel that, you know,
I should start second guess in my life self today.
Speaker 1 (30:01):
After she left Washington, Elders returned to her home state.
She became a professor at the University of Arkansas and
toured the country as a speaker and educator.
Speaker 8 (30:11):
You know how I was.
Speaker 9 (30:12):
I never tiptoed around very much. I just said what
I thought and believed. I was sorry, you know, to
have lost the position. Now I'm not saying that, but
the next five years so I was all over this country,
talks it all over the time.
Speaker 8 (30:30):
Yeah.
Speaker 9 (30:31):
In fact, that was all I did, was running around
running my mouth.
Speaker 1 (30:36):
On one occasion, Elders told an audience that she regretted
not advocating more firmly for needle exchange while she was
in government. Politicians, she said, should drop all this crap
about not using federal money for needle exchange programs because
they don't want to support IVY drug use. Is it
all right? She asked to support death.
Speaker 3 (31:02):
Good morning, and welcome.
Speaker 1 (31:05):
In nineteen ninety five, the year, after Joycelyn Elders was fired,
Clinton appointed a brand new, twenty three member Advisory Council
on HIV and AIDS.
Speaker 6 (31:15):
I'd like to begin by thanking all of you for
your service on this advisory council. We need your advice,
your wisdom, your enthusiasm. You're urging an American najor service,
and I thank you for it very much.
Speaker 1 (31:31):
As you know, both the Reagan and Bush administrations had
appointed their own advisory councils to make recommendations about the epidemic,
and both times members had resigned publicly because so little
of their advice was taken. Clinton's new council was meant
to signal that he was going to do things right
this time, and that, unlike his predecessors, he would actually
(31:51):
listen to the experts. One of the members of the
new AIDS council was a lawyer from Chicago who had
been a fundraiser for Clinton's ninety two campaign. His name
was Bob Fogel.
Speaker 10 (32:02):
I was just a regular person. I've loved politics all
my life, and I had met Clinton and.
Speaker 11 (32:10):
Really thought he was terrific.
Speaker 1 (32:12):
After Clinton won, Fogel thought about trying to become an
ambassador but his wife nixed the idea of a family move.
Speaker 10 (32:19):
So I looked at boards and commissions, and AIDS was
a big issue, and I thought, you know, I can
pivot away from being the trial lawyer guy. I can do,
hopefully something that would be useful and contributory to the
well being of our country. So I figured I would
ask if I could be appointed to the President's Advisory
(32:39):
Council and HIV AIDS.
Speaker 1 (32:41):
When Fogel showed up to a hotel in Washington for
the council's first meeting, he realized right away that he
was the odd man out.
Speaker 10 (32:49):
The night before our first official meeting and swearing in,
we made a circle in the little meeting room in
the basement area and introduced ourselves. I was almost a
little embarrassed at how little I really knew compared to
everybody else.
Speaker 1 (33:07):
The other council members were medical professionals or had long
personal histories with AIDS activism. The person who introduced himself
right before Fogel was an activist with HIV who had
spoken at the Democratic National Convention.
Speaker 10 (33:21):
One of the things he said was, you know what,
you know, we've been pushing Clinton to do stuff related
to AIDS make it a focus of his administration, and frankly,
he figured, he'll give the straight white guys in the
suits one more opportunity to get it, and if they don't,
then he would be done with them.
Speaker 1 (33:41):
Then it was Fogel's turn to speak.
Speaker 10 (33:44):
And I said, well, I'm one of those people, and
I'm here to learn, and if I end up getting it,
then there's really no reason why the straight white guys
in the suits in the White House shouldn't get it either.
Speaker 1 (33:59):
As part of his work on the Advisory Council, Fogel
was briefed on the connection between intravenous drug use and HIV.
It was clearly a huge problem. By that point, ivy
drug use accounted for about a third of new HIV
cases in the US, But when Fogel learned about needle exchange,
he was extremely skeptical.
Speaker 10 (34:19):
When I first heard about needle exchange, it was like,
are you kidding me? You want to give needles to
drug addicts. Aren't you promoting the use of drugs? There
must be a different or better way to deal with
this issue.
Speaker 1 (34:34):
But as Fogel learned more, he started to take a
different view. Back home in Chicago, he met with an
activist and drug user who ran in exchange.
Speaker 10 (34:44):
You know, I asked my I would say, straight white
guy in the suit sort of questions, you know, gosh,
you know, why are you doing this? And why does
this work? And what are the benefits? And aren't you
afraid of you know, those sorts of things, and so,
you know, it began to make sense. It wasn't just
giving needles to drug addicts. It was perhaps getting some
(35:05):
of them into drug treatment, and it was certainly counseling
them on the dangers and risk of age and if
they had aids, perhaps into some treatment programs for that
as well.
Speaker 1 (35:17):
Back in Oakland, Ricky Bluthenthal continued to run his needle exchange.
Over time, he had become an expert on harm reduction,
the idea that drug policy should be focused on reducing
the negative consequences of drug use as much as possible,
rather than trying to punish or restrict people out of addiction.
Bluthenthal felt that the scientific evidence and the moral imperative
(35:40):
were aligned, and if other people couldn't see that, then
it wasn't necessarily worth trying to engage with them.
Speaker 11 (35:47):
The people arguing against these programs aren't even in the
same universe as far as I'm concerned. They're dealing with
a set of problems that have nothing to do with
the individual that I'm talking to. Cross the way. They're
living in a world that's full of moral fictions and
fear that misunderstand the harm that's done by substances and communities.
Speaker 1 (36:12):
From Bluthenthal's perspective, those who opposed needle exchange on moral
grounds were simply not interested in HIV prevention.
Speaker 11 (36:21):
The people arguing against us were fine with people dying
from HIV AIDS. There's no a solution, right, so they're like, oh,
we don't want people to use drugs. Well that's great,
you know, there's no easy way to do that. And
the things that you've been doing at that point for
twenty years we now know definitively don't help.
Speaker 1 (36:43):
But as long as the laws didn't change, need to
exchange volunteers continued to risk arrest. In nineteen ninety five,
Bluthenthal and several of his colleagues went on trial for
distributing drug paraphernalia. Blutenthal says he was confident the jurors
would find him to be a sympathetic defender.
Speaker 11 (37:00):
I was a young African American man getting a PhD
at UC Berkeley, and I had a bunch of evidence
on my side, So you know, I think there were
a lot of people in the jury box you're reading
for me.
Speaker 1 (37:11):
After deliberating for four hours, the jury found Luthenthal and
his colleagues not guilty on the basis that their work
was a benefit to society. It was the third time
the County DA had tried and failed to prosecute needle
exchange activists. For all the worry that needle exchange was
politically deadly, it seemed to have grassroots support within the
communities that actually had programs, but reversing the ban on
(37:36):
federal funds still didn't seem to be a priority.
Speaker 6 (37:39):
Never again, should Washington put politics and party above law
and order.
Speaker 1 (37:45):
From the start of his presidency, Clinton had always gone
to great lengths to position himself as a proponent of
law and order, not some hippie, as he was often portrayed,
but someone who took the drug war seriously, just like
Reagan and Nick and had. After Republicans took control of
the House and Senate, Clinton felt he had even less
(38:06):
room to take chances on progressive policies. As he prepared
to run for a second term, he decided to appoint
a new DRUGSAR, a retired general named Barry McCaffrey, who
was a hardliner on drug policy. For now, at least,
Reagan's ban on funding for needle exchange would remain firmly
in place.
Speaker 5 (38:34):
Are scientists on the verge of making AIDS a manageable disease.
Speaker 1 (38:38):
There was positive news on that issue, but some caution too.
When the Triple Cocktail was announced in nineteen ninety six,
the whole outlook of the AIDS epidemic shifted. Over the
following year, the mortality rate for people with AIDS in
the US dropped by almost fifty percent.
Speaker 6 (38:55):
We have a lot to celebrate. For the first time
since the epidemic began, deaths due to AIDS in the
United States have declined for the first time. Therefore, there
is hope that we can actually defeat AIDS.
Speaker 1 (39:10):
And yet, there were still more than fifty thousand new
cases diagnosed that year, and the racial disparities were only
getting more stark. In nineteen ninety six, forty one percent
of infections were diagnosed in Black Americans, even though they
only made up about thirteen percent of the country's population.
Speaker 14 (39:28):
More and more African American women are being infected through
heterosexual contact.
Speaker 1 (39:33):
Their children are also at risk. In nineteen ninety seven,
the CDC released a major study concluding that IV drug
use was the primary driver of new HIV infections. Expanding
needle exchange and reversing the ban on federal money had
never seemed more urgent. Here again is Bob Fogel, the
(39:55):
trial lawyer who served on Clinton's Council on HIV and AIDS.
Speaker 10 (40:00):
The benefits of federal funding is that bypasses the states,
the governors or the legislatures, and programs could be set
up where needed in cities and states where it otherwise
wouldn't occur. And the federal government has the deepest pockets
you know. For the federal government to put five hundred
million dollars or one hundred and fifty million dollars into
(40:22):
natal exchange programs would have been huge. I mean, they
could have started programs and a lot of major cities
across the country.
Speaker 1 (40:31):
The President's Advisory Council on HIV AIDS was in complete
agreement that the federal government should fund needle exchange. They
had said as much in a formal recommendation, but the
White House made no moves to follow through. Fogel was
losing his patients, and.
Speaker 10 (40:47):
The question is, why aren't they doing something so important?
Why aren't they acting? Why aren't they responding? I mean,
are we just you know, in my head, are we
just a phony front? And you know, at that point,
it's like, are we wasting our time?
Speaker 12 (41:02):
You know?
Speaker 10 (41:02):
And if they're not going to follow our recommendations, let
alone this one in particular, then let's just quit wasting
you know, time and money. So yeah, I was pissed.
Speaker 1 (41:17):
Frustrations reached a boiling point at a council meeting in
July of nineteen ninety seven. Members of Act UP interrupted
the meeting, demanding faster movement on a wide variety of issues.
After the protest subsided, Fogel spoke up in solidarity.
Speaker 10 (41:33):
And I raised my hand and I said, look, we've
made multiple recommendations on this that appear to be ignored.
No action is being taken. There's no good reason for
not taking action, and perhaps maybe what we ought to
do is just resign on mass in protest, and somebody
across the room yelled, I second the motion. The press
(41:58):
people that covered our meetings, you know, jumped up like
holy shit. You know, Fogel has just moved that the
council resign and protest over their failure to certify needle
exchange programs.
Speaker 1 (42:14):
After the meeting ended, the council chairman pulled Fogel aside.
Speaker 10 (42:18):
And said, great job. This is terrific. You know, the
press is going to run with this. This is really
going to put pressure on them.
Speaker 5 (42:25):
Some harsh criticism today for the President and it comes
from his own advisors on AIDS.
Speaker 2 (42:30):
Especially critical of the administration's failure to fund programs for
drug addicts to exchange dirty syringes for clean ones to help.
Speaker 10 (42:39):
I remember my mother called me a few days later.
She told me she read about me in the Springfield
Union and which is in Springfield, Massachusetts, and she was
so proud of me. I said, Mom, I want to
give needles to drug addicts. She said, well, if you
think it's the right thing to do, I'm for it.
Speaker 1 (43:04):
In the spring of nineteen ninety eight, the year's long
pressure campaign on Clinton to reverse the funding ban appeared
to finally be working. It had been almost a decade
since the ban was put in place and it was
set to expire soon. If the administration wanted to make
a change, it seemed like the perfect moment. HHS Secretary
(43:24):
Donna Shalela was ready to certify the research required to
change the policy to confirm that needle exchange programs did
reduce the spread of HIV and that they didn't increase
drug use. In private, Shalalela tried to convince the President
that the scientific basis for the policy was unimpeachable.
Speaker 5 (43:43):
I made every argument I possibly could. He knew what
the arguments were. He had a letter in his hand
from all the scientific leaders and public health leaders of
the department.
Speaker 1 (43:54):
Still Clinton wouldn't commit. At one point, Shilela says the
White House urged her to hold off on certifying the research. Instead,
they wanted her to suggest that the efficacy of needle
exchange was still up for debate.
Speaker 5 (44:07):
Someone from the White House called over and said, tell
Schalela to announce that we needed more research. And I said,
I will not repeat on this program what I said,
but basically I said, no, that was ridiculous. I was
not going to say the researchers we needed more research.
When they said the research was clear. This was a
(44:29):
matter of integrity for the apartment and for me personally.
Speaker 1 (44:34):
Shalela was confident that the President understood the science just
as clearly as she did. If anything was preventing him
from embracing needle exchange, it wasn't the quality of the research.
It was politics.
Speaker 8 (44:47):
Delay.
Speaker 5 (44:47):
Delay meant to me they we were making a political calculation.
It wasn't substantive, and the call that maybe Shililah should
say we need more research was the tip off.
Speaker 1 (44:58):
Shaleala was resolved to publicly validate the idea of needle exchange,
regardless of what Clinton decided to do, so her office
scheduled the press conference from Monday, April twentieth. Schalela's hope
was that by the time she took the podium, Clinton
would have made up his mind to undo the ban.
Speaker 4 (45:17):
The President could lift that ban if he could certify
with scientific evidence that such programs reduced the rate of
HIV infection without encouraging drug use.
Speaker 1 (45:26):
Scientists and activists who had been advocating for needle exchange
were told to expect good news, but Shilala says she
wasn't sure what the president's decision would ultimately be.
Speaker 5 (45:36):
The press conference was one or the other. I warned
everybody before the press conference that it was possible the
President would say no.
Speaker 1 (45:48):
It turned out that Shilala was right to temper expectations.
Less than an hour before the press conference, HHS was
contacted by the White House to say that the President
would be keeping the ban in place. The department scrambled
to adjust its plans, delaying its announcement by three hours.
That day, Bob Vogel was with his brother at a
(46:10):
Red Sox game in Fenway Park when he received a
page to join a conference call. He took it in
the parking lot.
Speaker 10 (46:17):
We got on the call and the news was broken
that the final decision had been made that there would
not be a formal certification. And I would say I
was shocked. I mean, it just seemed like, and I
hate to use this word so but like a flip flop.
(46:37):
We were heading down this road and suddenly they chickened out.
I guess is how I would describe it. It was
very disappointing.
Speaker 1 (46:49):
At the press conference, Secretary Shalala did what she had
come to do and certified the research findings required to
overturn the ban, but as she explained to reporters, the
ban itself was staying put.
Speaker 4 (47:01):
In Washington to day, the Clint administration has decided to
maintain the ban on using federal funds to pay for
needle exchange programs. Those are the ones designed to prevent
the spread of AIDS.
Speaker 5 (47:12):
It was painful. It was painful because the evidence was
so clear. It was heartbreaking for me to face the
scientist and say. The President said, no, I didn't like it.
I didn't like transmitting it, but he made the decision.
Speaker 4 (47:27):
The Secretary of Health and Human Services, Dona Chalela, said
there is evidence that the programs do reduce the transmission
of HIV without significantly increasing drug use, but she said
that state and local governments have to pay for the programs.
Speaker 10 (47:43):
I suppose it was a compromise, you know. I was shocked.
I wished they had bigger balls than that, but that
was better than silence.
Speaker 1 (47:57):
Journalists reported that scientists seated next to Shalala looked visibly uncomfortable.
I wish I could play you some audio from the
event itself, but it was limited to print reporters only.
Here's Chilela explaining the compromise A few days later.
Speaker 5 (48:11):
Federal money doesn't pay for everything that's important in this country,
and in this case, the administration made the decision not
to make this ineligible activity under prevention funds. The most
important message today is that the science is now there
so that local communities ought to look at their strategies
and they can then consider using a needle exchange program
(48:33):
as part of that overall strategy. It was the worst
moment in my HHS leadership in terms of a policy decision.
I thought it was the most dangerous thing that Congress
and the President could do. I mean, we had a
strategy that would save lives, save people from getting infected,
(48:55):
and we ought.
Speaker 10 (48:55):
To use it.
Speaker 1 (49:02):
There are a few different theories about why Clinton came
out against needo exchange at the last minute. One blames
his drugs are Barry McCaffrey, who cornered the President on
Air Force one just before the press conference and made
the case that changing the rule would condone drug use.
Clinton would later say he believed Congress would simply pass
a new funding ban if he lifted the old one,
(49:25):
but according to Donna Shalela, his decision had more to
do with pressure from Senate Democrats than anything else.
Speaker 5 (49:31):
Bill Clinton did it under political pressure because Democrats thought
they were going to have trouble getting re elected. There
were Democrats that bought the argument that it would enable
drug use.
Speaker 1 (49:47):
Clinton's waffling led to a significant increase in national media
coverage of needle exchange miss America. In nineteen ninety eight,
Kate Shindle spoke publicly about her personal evolution on the issue.
Speaker 8 (49:58):
I was very much against these pro when I first
became Miss America.
Speaker 1 (50:01):
It's a really had issue as far as.
Speaker 19 (50:04):
Government is concerned right now, because there is that catchphrase
needle exchange, and unfortunately there are a lot of people
that don't read past the headlines.
Speaker 1 (50:10):
And I was sort of guilty of that. But then
I was enlightened.
Speaker 20 (50:13):
I guess.
Speaker 1 (50:15):
Four years later Quinton said he had been wrong not
to lift the ban, and about fourteen years after that,
in twenty sixteen, Congress quietly got rid of it. The
new policy made it possible for federal funds to be
used for anything a needle exchange program needed, except the
syringes themselves. As we finish our work on this podcast,
(50:51):
there's still no vaccine for HIV, and there's still no
cure for AIDS. More recent medical innovations like PREP made
it much easier for people to have sex safely, and
treatments for people with HIV and AIDS have allowed many
to live with undetectable viral levels. And yet the UN
estimates that of the nearly forty million people worldwide who
(51:14):
were living with HIV in twenty twenty, a quarter did
not have access to effective treatment. The trends that emerged
in the nineties have also deepened the racial disparities and
the disproportionate impact on drug users. Meanwhile, most of us
move through the world not thinking very much at all
about AIDS. It's kind of like the Ozone layer or
(51:36):
Save the Whales, an issue people used to think it
was important to care about. One thing that's become obvious
to me during the COVID pandemic is how big a
difference visibility makes if someone you know gets sick. If
you can hear the ambulances in the street, you pay
more attention, You're more willing to take precautions. Then as
(51:58):
soon as the disease is out of sight, it becomes
incredibly easy to pretend it's not happening at all. The
people we spoke to for this podcast the ones who
witnessed the beginning of AIDS from up close don't need
to be reminded that the story does not yet have
(52:19):
an ending. Many of them told us they hoped to
live long enough to see the next big breakthrough. You know,
the work is essentially interminable until we have a cure
in a vaccine.
Speaker 8 (52:31):
So we're still working on those same things.
Speaker 10 (52:33):
Forty years later.
Speaker 7 (52:34):
I'm still here and got the treatments, waiting for that cure,
waiting for that vaccine, but still hopeful and still curious.
Speaker 8 (52:43):
We've come a long way.
Speaker 9 (52:44):
We've made a lot of progress on this disease, so
we can eradicate the spars. So back to me is
what I would really that would be my dream. That's
what I've like happened.
Speaker 20 (52:59):
We've lost so many people, We've lost so many lives.
We have to remember this. We have to remember the struggle,
because it's only in remembering the struggle that you understand
that you can fight, that you must fight.
Speaker 13 (53:15):
What patients are asked on and asked me because I
start having a lot of gray hair, white hair, whatever.
They're getting nervous that I may have a retirement in
my future, and so what I try to do to
assuage their concerns and fear is that You've got me
from the very first case in New York. You've got
(53:35):
me until hopefully the very last case, after a cure
has developed and I get to administer it to all
of my patients, and then I'll be happy to step down.
Speaker 10 (53:47):
And that's the way I leave it.
Speaker 13 (53:49):
It's a I guess it's a fantasy.
Speaker 1 (53:53):
For all the people who survived those years. There are
so many who didn't. I want to leave you with
a c from the funeral of Bobby Campbell. He was
the first person with AIDS you heard in the series,
the nurse from San Francisco who turned himself into a
poster boy for the disease. When Campbell died in nineteen
eighty four, he was remembered with a memorial service attended
(54:16):
by a thousand friends, family members, and neighbors. One of
the people who spoke was Campbell's partner, Bobby Hilliard.
Speaker 12 (54:26):
When Bobby was an intensive care I left my backpack
out in the waiting room and I was in the
room with him. After he died, I went back to
the waiting room and sitting on top of the backpack
was a little bell that I had never seen before,
and someone left there and I've been carrying it around
(54:46):
in my pocket since then, and I'd like to say
one more thing before ringing it. Love after Death for Bobby.
Speaker 1 (55:22):
Fiasco is presented by Audible Originals and Prologue Projects. The
show is produced by Andrew Parsons, Sam Graham Felsen, Madeline
kaplan Ulla Culpa and me Leon Nafock. Our researcher is
Francis Carr. Editorial support from Jessica Miller and Norah waswas
archival research by Michelle Sullivan. This season's music is composed
(55:45):
by Edith Mudge. Additional music by Nick Silvester of God Mode,
Joel Saint, Julian and Dan English, Noah Hect and Joe Valley.
Our theme song is by Spatial Relations, Music licensing courtesy
of Anthony Roman. Audio mixed by Erica Wong with additional
support from Selina Urabe. Our artwork is designed by Teddy
(56:06):
Blanks at Chips and Y. David Blum is the editor
in chief of Audible Originals. Mike Charzik is the Vice
president of Audible Studios. Zach Ross is Head of Acquisition
and Development for Audible. Thanks to Peter Yassi, Percy Everlin,
Arlene Arevelo, Michael Helquist, Carrie Baker, Alice Gregory, Jannis Kolpa,
(56:27):
Chris Robi, Stephen Fisher, and everyone at Audible
Hey, this is Leon Napok. I'm the host of Fiasco,
but you may also know me from the podcasts Slowburn,
Think Twice, Michael Jackson, and Backfired the Vaping Wars. I'm
excited to be sharing with you the next season of Backfired,
titled Attention Deficit, which is now available exclusively on Audible.
Backfired is a podcast about the business of unintended consequences.
(00:20):
In the first season, my co host Ril Pardess and
I dove deep into the world of vaping and how
the well intentioned quest for a safer cigarette went awry.
Now we're tackling ADHD and how the push to destigmatize
this hard to define childhood diagnosis has led to an
explosion of stimulant use in kids as well as adults.
It's a story about the promise of psychiatry to fix
(00:41):
our brains and the power of the pharmaceutical industry to
shape how we and our doctors think about what's wrong
with us. To hear both seasons of Backfired, go to
audible dot com slash Backfired and start a free trial
that's audible dot com slash backfired. Fiasco is intended for
mature audiences. For a list of books, articles and documentaries
(01:03):
we used in our research. Follow the link in the
show notes. Previously on Fiasco, AIDS is infecting more and
more heterosexuals, men and women, teens and babies.
Speaker 2 (01:18):
The Surgeon General today prescribed education children he feels need
to be yarned in school about the danger of AIN.
Speaker 3 (01:25):
Now many people are not receiving information that is vital
to their future health and well being.
Speaker 4 (01:30):
Researchers say, a new class of drugs are working.
Speaker 2 (01:33):
A cure for AIDS may soon be a possibility.
Speaker 1 (01:35):
Felt like some grand act of mercy made manifest when
we decided to make a season of Fiasco about the
AIDS epidemic. The arrival of the Triple Cocktail in nineteen
ninety six seemed like a natural place to end our story.
Speaker 2 (01:55):
The most optimistic note since the terrible disease was first recognized.
Speaker 1 (01:59):
These new so called to wonder drugs, the Triple Cocktail
represented a monumental turning point, a bookend to the era
when HIV meant certain death.
Speaker 2 (02:09):
A new combination of drugs, including a new class called
proteation inhibitors.
Speaker 1 (02:13):
From the discovery of the earliest cases of AIDS, people
had been imagining, dreaming of something like the Triple Cocktail,
a medicine that could overpower the disease. It was easy
to assume that the war on AIDS would be one
with the development of a successful treatment.
Speaker 5 (02:30):
I've really had about as close to a miraculous recovery,
certainly more so than I ever imagined I would see.
Speaker 1 (02:38):
But the Triple Cocktail did not end the epidemic. While
it helped people who were already sick, new people kept
getting infected, about fifty thousand the year after the Triple
Cocktail became available, in fifty thousand more the year after that.
In the decades since the treatment was introduced, nearly one
million people in the United States have been diagnosed with HIV.
(03:01):
And So, in this final episode of Fiasco, season five,
I want to get into some of the reasons why
the epidemic is still with us. What needed to happen
that didn't, and what could have been done that wasn't.
Speaker 6 (03:17):
I want you to believe that we can make America
work again.
Speaker 1 (03:22):
To tell this part of the story, I want to
go back to the early nineties, when a Democrat from
Arkansas was running for president and promising a new approach
to the AIDS crisis.
Speaker 7 (03:32):
I think most Americans still don't know how many people
are out there who are HIV positives.
Speaker 1 (03:36):
If nothing else, Bill Clinton was willing to talk about HIV.
Unlike his Republican predecessors, Clinton seemed less inclined to minimize
or ignore the problem.
Speaker 7 (03:47):
The president should type responsibility or the problems of the
country and be honest enough to say, we might not
solve them in a year or two, we may not
solve them all in four years, but at least we're
going to roll off our sleeves.
Speaker 8 (03:57):
And go to work.
Speaker 1 (03:58):
Let's get to work, Clinton for people for a change.
At this point, scientists were still years away from developing
what became the triple cocktail, but that didn't mean there
was no progress to be made. After all, treating people
who already had HIV was only one front in the
(04:19):
war on AIDS. The other was preventing people from getting
it in the first place, and that was hard for
reasons that had nothing to do with science or medical research.
By the time Clinton took office, public health experts already
had a bunch of good ideas for how to prevent
more people from getting infected. Those ideas all had one
(04:43):
thing in common. They required talking openly, explicitly and pragmatically
about how HIV was spread, and because that meant talking
about sex and drugs, it ensured that AIDS would continue
haunting the country and threatening people's lives long after the
medical mystery was effectively solved. I'm Leon Nafok from Audible
(05:09):
Originals and Prologue Projects. This is fiasco.
Speaker 9 (05:14):
Anytime you're talking about sex and drugs.
Speaker 8 (05:17):
It's a moral issue.
Speaker 10 (05:18):
We need to crack down on drug abuse, not promote
more drug addiction.
Speaker 11 (05:23):
But we don't want people to use drugs. Well, that's great,
there's no easy way to do that.
Speaker 5 (05:27):
We had a strategy that would save people from getting infected.
Speaker 10 (05:30):
And the question is why aren't they acting.
Speaker 1 (05:35):
On this week's season finale, a new administration promises to
turn the page on the HIV AIDS epidemic and instead
gets wrapped up in old arguments about sex, drugs, and morality.
Ricky Blutenthal was living in Oakland, California, studying sociology at Berkeley,
(06:00):
and he came face to face with HIV. The year
was nineteen ninety.
Speaker 11 (06:05):
I was getting a PhD because I was interested in
the problems of what we were then calling interstiti black people.
Speaker 1 (06:12):
Blutenthal had started his research with a focus on gangs
and drug distribution. Now he was part of a team
that was studying the prevalence of HIV in people who
used drugs in the Bay Area. Their data collection effort
was centered on a neighborhood about twelve miles outside Oakland
called the Iron Triangle.
Speaker 11 (06:31):
And it's called Iron Triangle because it's there's a triangle
formed by rail lines that cut through the community. It's
like a very common thing that happens to historic African
American neighborhoods, where they get split up and divided by
undesirable infrastructure.
Speaker 1 (06:45):
Blutenthal knew that racial disparities and health outcomes were structural
and that if properly understood, they could be undone. By
studying drug use and HIV and the Iron Triangle, he
saw an opportunity to use social science to actually help people.
Speaker 11 (07:01):
I had an advantage in that, you know, I'm African American,
so I felt comfortable working in the community and being
respectful engaged with people. So I didn't come in with
a lot of hard attitudes about any of it, about
drug use, about HIV, and so that gave me a
chance to learn and then try to be responsive to
(07:24):
the problems people were confronting.
Speaker 1 (07:26):
As part of the study, the researchers administered HIV tests
to lots and lots of people who used injecting drugs.
At one point, it fell to Blutenthal to give a
group of study participants the results.
Speaker 11 (07:39):
You know, I had like a series of seven or
eight counseling results that I had to share, and everyone
was positive, and I just started crying. Remember, you know,
this was a context of you know, it was five
years before we had effective treatments for HIV, so essentially
(08:01):
we were handing what felt like death sentences. I mean
it chacks me up now, you know. And it was
one of those moments where you you know, your rubber
meets the road, right, you know, you have to decide
are you going to do something about it.
Speaker 1 (08:22):
What Blutenthal decided to do about it was help start
a program in Oakland where people who used injecting drugs
like heroin could obtain clean syringes for free instead of
sharing contaminated ones with other people. It was a model
that first gained traction in the Netherlands and crossed over
into the United States in the mid eighties.
Speaker 4 (08:42):
There are some cities where groups of individuals have set
up privately run exchanges.
Speaker 8 (08:47):
Me a heroin addict is a bad nothing.
Speaker 4 (08:49):
I don't really feel I want to get AIDS to say,
the clean needles work for me.
Speaker 1 (08:55):
The premise of needle exchange was straightforward. When people who
are using drugs together syringes, they end up sharing blood
and if one of those people has HIV, the rest
are at extreme risk for getting it to The reason
so many people were sharing syringes was that they were
hard to get, and the reason for that goes back
(09:17):
to the War on drugs, which began under Richard Nixon
in nineteen seventy one.
Speaker 2 (09:22):
America's public enemy Number one in the United States is
drug abuse. In order to fight and defeat this enemy,
it is necessary to wage a new, all out offensive.
Speaker 1 (09:35):
Nixon's offensive led to a host of new laws around
the country aimed at making it harder for people to
use drugs.
Speaker 11 (09:42):
There was a bit of a cannabis or marijuana panic
in the late seventies, so the Department of Justice developed
a model drug paraphernalia law that was really focused on cannabis.
Speaker 10 (09:53):
Marijuana has become so widespread that virtually anyone is likely
to be a user upon its site.
Speaker 3 (09:59):
There was no such thing a safe.
Speaker 11 (10:00):
Marijuana, So they wanted to get rid of roach clips
and shut down the smoke shops. But in the course
of doing that they added other things, right, and one
of those other things they added was syringes.
Speaker 1 (10:12):
Selling syringes became illegal in most states, and some states
even banned possession before long. Syringes were extremely hard to
come by, and those who needed access to them multiple
times a day started sharing them with each other. Unsurprisingly,
that had some major health consequences, and as heroin use
(10:33):
rose over the course of the seventies, some injecting drug
users in New York City started coming down with a
respiratory disease nicknamed junkie pneumonia. Others developed a condition that
was referred to as the dwindles because the people getting
sick looked like they were wasting away. More recent research
has revealed that these conditions were most likely caused by aids,
(10:56):
which circulated among drug users in New York for years
before crossing over into other populations. As you heard in
our first episode, researchers only identified it as a new
disease in nineteen eighty one, after it started showing up
in gay men.
Speaker 11 (11:11):
In the United States, the focus was on sexual minority men,
and for good reason. The problem we had then we
still have a problem now, which is that people who
inject drugs aren't a particularly sympathetic group, and unlike sexual
minority men, they're not able to mobilize politically at the
same level.
Speaker 1 (11:32):
The earliest needle exchange activists in the US knew that
what they were doing was illegal. They were distributing drug paraphernalia.
Their hope was that local governments would see the good
in it and potentially even take over the exchanges themselves,
but that wasn't going to happen without a struggle.
Speaker 12 (11:50):
Handing out needles is illegal throughout most of the country.
Speaker 1 (11:53):
Many people believe that keeps attics addicted. To many politicians
and government officials, change sounded a lot like enabling drug use.
Speaker 13 (12:02):
It sends a terrible message that we are encouraging people,
or we are at least accepting the fact that these
people are are drug users and not doing very much
to get them offer.
Speaker 11 (12:12):
It's almost like throwing in the town.
Speaker 1 (12:14):
In nineteen eighty eight, President Reagan signed a law that
banned federal agencies from providing funding for needle exchange programs.
Here is Reagan's Surgeon General see Everett Coop explaining the
politics around the decision.
Speaker 3 (12:28):
It's very difficult even with people who are quite reasonable
about the problems associated with AIDS, they can bring themselves
to countenance a program that seems to aid and a
bet an illegal and an mral practice, namely IVY drug abuse.
Speaker 1 (12:46):
The funding ban put a very low ceiling on how
widespread needle exchange could become. According to the text of
the law, the ban could be overturned, but not until
there was definitive evidence that needle exchange reduced the bread
of HIV without simultaneously increasing drug use. As public health
(13:06):
experts set about conducting that research, small locally funded exchanges
continued to pop up around the country. The program, co
founded by Ricky Bluthenthal, was among them. In nineteen ninety two,
he and his team set up shop in West Oakland,
near an area where drugs were sold. They were supported
(13:27):
by tiny grants from community organizations and sourced their supplies
from another more established exchange in the Bay Area.
Speaker 11 (13:34):
So we just set up a table. We have educational
information condoms, clean cotton, and then there'd be a big
red bucket to collect the use syringes in, and then
we'd have our cases of clean syringes.
Speaker 1 (13:49):
That was the system. Bring used syringes, toss them in
the big red bucket, and leave with one clean syringe
for each one you brought with you. Bluthenthal and his
team distributed thousands of syringes during the first few months
of the Oakland program. Through it all, they got no
support from any government agency. In fact, they did their
work knowing they could be arrested at any time. Until
(14:11):
government officials at the local, state, and federal levels embraced
need to exchange, that would be the status quo. Then
Bill Clinton became president, and suddenly there was reason to
hope that needle exchange could come out from the shadows.
Speaker 7 (14:26):
I was born in a little town called Hope, Arkansas.
Speaker 1 (14:29):
After twelve years of Reagan and Bush, many AIDS activists
thought there was at least a chance that the Clinton
presidency could be different, to.
Speaker 7 (14:37):
Change all our people's lives for the better and bring
hope back to the American dream.
Speaker 1 (14:45):
After he was elected, Clinton took steps to signal his
commitment to public health one was to task his wife
Hillary with shaping his administration's approach to healthcare. Another was
to nominate an unapologetically progressive doctor named Joycelyn Elders as
surgeon General.
Speaker 9 (15:02):
I was a sophomore in colleague when I realized that
I wanted to be a doctor.
Speaker 1 (15:08):
Growing up in rural Shawl, Arkansas, population ninety.
Speaker 8 (15:12):
Nine ninety eight, when I'm in little Rock.
Speaker 1 (15:14):
Elders didn't know anyone who was a doctor, and she
got very little health education at school, you know.
Speaker 9 (15:20):
For I learned the most about sex education of really
more about menstruation and now was from the leaflet that
co Texts put in the cotext box.
Speaker 1 (15:32):
Elders went to medical school and became a pediatric endochronologist.
In nineteen eighty seven, while Clinton was governor of Arkansas,
he put her in charge of the state's Department of Health.
By that point, AIDS was affecting people of color at
twice the rate of white people. Black women, in particular,
were twelve times as likely to contract HIV as white women.
(15:55):
From her position in the state government, Elders tried to
do something about the disparities by pushing for comprehensive sex
ad and free condoms.
Speaker 9 (16:03):
I began called the condom Queen, and in fact I
had condom tree on my desk.
Speaker 1 (16:09):
Wait, what's a condom tree?
Speaker 9 (16:11):
Well, it was a rubber tree, a tree that the
nurses made for me, the public health nurses condoms of
all different colors, Christmas tree, and sat in the middle
of my conference table.
Speaker 1 (16:25):
And so you could take what if you wanted to one.
Speaker 8 (16:27):
No, they couldn't take them off my tree.
Speaker 9 (16:29):
But then there was plenty of them sitting out in
the condom bow out in the office that you could
just reach in and grab them.
Speaker 1 (16:39):
Elders made it a point to try to reach people
who had been overlooked in a lot of HIV prevention messaging.
She found that most of her ideas, particularly on sex
ad and the distribution of condoms, were wildly unpopular in Arkansas.
Speaker 9 (16:53):
Anytime you're talking about sex and drugs, it's a moral
issue rather than a public health issue.
Speaker 6 (17:01):
And that has made doctor Joycelne Elders Arkansas's most controversial woman.
Speaker 9 (17:06):
That wanted to tell me how God was going to
strike me dead and stuff like that.
Speaker 11 (17:13):
This nation, not just our exult.
Speaker 1 (17:14):
Sex education is chronography, and.
Speaker 9 (17:17):
I felt that they were concerned about what they were
concerned about. What I was concerned about, the young black
girls that I was seeing lost in the Delta, that
was being abused because of lack of education. Nothing could
keep me from worrying about it and doing everything I
(17:38):
could to make a difference. I had trouble sleeping at night,
but I was determined that we were going to do
something to make a difference.
Speaker 1 (17:49):
Governor Clinton at least seemed to appreciate Elder's willingness to
dive headfirst into controversial issues, and when he became president,
he once again called on her to serve in his administration.
Speaker 14 (18:00):
Doctor Joycelyn Elders, the former health commissioner of Arkansas now
President Clinton's choyce for Surgeon General of the United States.
Speaker 1 (18:09):
Almost immediately, Elders became a lightning rod for scandal. A
few months into her tenure, she caused a media frenzy
by suggesting that the legalization of drugs could be good
for society.
Speaker 9 (18:20):
And I do feel that we would marketly reduce our
crime rate if drugs were legalized.
Speaker 1 (18:27):
And conservatives immediately jumped on Elders' comments. A right wing
lobbying group circulated petitions to request her dismissal. Eighty seven
House members signed a letter calling on Elders to resign.
Rush Limbaugh mocked her on his show.
Speaker 15 (18:41):
Your Time Off for a Little Comic Relief, America's number
one national embarrassment speaks for herself. Here's Joycelynd Elders and
her theories on legalizing drugs.
Speaker 1 (18:53):
Here's Elders responding to the criticism at the time.
Speaker 16 (18:56):
Despite many of the comments and editory and reports that's
been about me, I'm still grateful because you see, if
I was walking around not saying anything that was at
all controversial and that was all neutral, first of all,
you wouldn't write about me. Secondly, if it was something
that was right and simple and easy and everybody accepted
(19:20):
it as a matter of fact, it would already be done.
Speaker 1 (19:26):
Legalization may have been a pipe dream, but need to
exchange was at least a somewhat more realistic policy idea.
To Elders, It's potential for slowing the spread of HIV
was obvious.
Speaker 9 (19:38):
If somebody who has HIV uses the needle and then
you use the same needle because she does say you
can't afford to buy them, well, then you were injecting
the virus into your body and you may not know
that for a year, two or ten.
Speaker 8 (19:57):
So that was why Baby.
Speaker 9 (19:58):
Bolt needle exchange program, and then that reduced a lot
of the HIV spread in a community.
Speaker 1 (20:07):
As Surgeon General Elders says, she always supported needle exchange
and understood what it meant for programs to have to
operate without support from the federal government.
Speaker 9 (20:17):
Some communities had really gotten tiny little grants, like from
churches and other places, and they were passing out train
needles from the trunk ofbec car.
Speaker 1 (20:29):
During the campaign, Bill Clinton had indicated that he was
open to lifting the Reagan era funding ban on needle
exchange programs, but if the model was going to win
the administration's blessing, activists would need other players in Clinton's
orbit to push him on it. That included Donna Shalela,
Clinton's Secretary of Health and Human Services.
Speaker 5 (20:50):
We saw needle exchange as a mitigation strategy to reduce
the incidents of AIDS and to save lives. Excuse me
if I could interrupt for one moment. I've got to
let him in here. He is you should know. My
dog is named Fauci. Really yeah, he's a rescue dog.
Speaker 1 (21:15):
Hi Fauchi.
Speaker 5 (21:15):
When I went to pick him up, they said he
had run into an Italian restaurant and he needed an
Italian name, and I said, I'll call him Fauci. Tony
said he'd been called worse.
Speaker 1 (21:28):
Before she joined the administration, Donna Shalala had been the
chancellor of the University of Wisconsin. She says the job
prepared her for the pressure she faced from AIDS activists
as HHS secretary.
Speaker 5 (21:40):
I knew that we were going to be pushed by
act UP and all of the groups who were in
a desperate state, So that was expected as part of
the job.
Speaker 8 (21:51):
I was a political scientist.
Speaker 5 (21:53):
I have been leading major research universities, so people getting
into my face was something that was expected.
Speaker 1 (22:03):
During Clinton's first term, Salela enraged AIDS activists by suggesting
that more research was needed to determine whether the Needle
Exchange Funding Band should stay in place. The administration's stance
on the issue became a kind of litmus test for
a lot of activists, a sign that Clinton was willing
to slow walk certain policies that posed a political risk.
(22:28):
Here is a protester confronting Clinton about it at an
AIDS event.
Speaker 17 (22:32):
There's been steps taken here advocated to be taken, like
legalizing needles have been talked about for three years?
Speaker 7 (22:39):
Where have you been? Didn't you listen to what we
said before about what we've done?
Speaker 18 (22:44):
Last night?
Speaker 1 (22:46):
Skeptics of needle exchange continued to insist there wasn't enough
empirical evidence that the model worked and that it didn't
result in more people using drugs, But the opposition was
often about more than just data. For many, was rooted
in a fundamental concern at the core of American drug policy.
Agreeing to provide people with drug paraphernalia would mean acknowledging
(23:09):
that the zero tolerance, just say no approach to drugs
didn't work. It would basically mean throwing out the philosophical
underpinnings of the whole drug war.
Speaker 14 (23:19):
There's no question that the right signal for the government
of the United States to send is to say to somebody,
if you're a drug addict and you need to use
intravenos drugs, come into a center and let us help
you get off drugs.
Speaker 1 (23:31):
This is former House Speaker Knut Gingrich weighing in on
the needle exchange debate at a press conference.
Speaker 14 (23:36):
That is the only message, we should give drug addicts,
but the government's job is to help you get off drugs.
It is not the government's job to try to make
killing yourself marginally safer as you do it.
Speaker 1 (23:50):
It wasn't only Republicans who opposed the idea of undoing
the ban. Members of Clinton's own party were apprehensive too.
Speaker 5 (23:57):
There was a debate within the Democratic Party. I mean,
you cannot say that this was just the Republicans. The
party itself was torn on the issue because of drug
addiction and because of crime related to drugs.
Speaker 1 (24:13):
Not all prevention measures were so fraught, as HHS Secretary
Donna Shalala focused a lot on public health messaging through
popular culture.
Speaker 19 (24:22):
Thank you all for coming AIDS is often thought of
as a hopeless problem. Today we are here to talk
about solutions.
Speaker 1 (24:32):
In early nineteen ninety four, Shalala announced a prevention initiative
at the Clinton administration had developed with the CDC. It
would include a series of PSAs starring celebrities like Jason
Alexander and Martin Lawrence.
Speaker 19 (24:45):
This campaign is focused on young adults because studies tell
us that young Americans are more sexually active than ever before,
and they are not taking proper precautions.
Speaker 5 (24:59):
So it was very important for us to approach young people.
So we went to the entertainment industry, but mostly to
the raps and to the music industry. We literally needed
everybody the communicated with young people to educate the entire
society about AIDS.
Speaker 17 (25:21):
I'm Anthony Ketis of the Red Hot Chili Peppers, and
I've been naked on stage. I've been naked on magazine covers.
In fact, I was born naked, And of course I'm
naked whenever I have six. And what I have here
is a condom, a latex condom. I wear one whenever
I have six, not whenever it's.
Speaker 1 (25:40):
The Clinton administration's media push coincided with another leap in
the growing public awareness of HIV and AIDS. Much like
Rock Hudson years earlier, several famous people disclosing their diagnoses
changed the public understanding of what HIV was and whom
it could affect. The most famous of these was NBA
legend Magic Johnson, who had revealed his diagnosis back in
(26:04):
nineteen ninety one.
Speaker 6 (26:06):
I think sometimes we think, well, only gay people can
get it, only is not going to happen to me.
Speaker 1 (26:12):
And here I am saying that it can happen to anybody.
Even later, there was easy E from NWA, just.
Speaker 11 (26:18):
Like Magic Josson when he thought it. You know well,
stuff like this happened.
Speaker 20 (26:22):
Agency to come out speak and let other people wherever.
So you know what I'm saying, we can try to
contain this stuff that was getting bad, you know what.
Speaker 1 (26:29):
There was also Pedro Zamora, the activist who appeared as
a housemaid on MTV is the Real World in nineteen
ninety four.
Speaker 8 (26:35):
I will probably not see the AH thirty.
Speaker 10 (26:37):
I will probably die.
Speaker 1 (26:38):
As Elay dying. Even the President called, I just want
to tell you.
Speaker 11 (26:43):
I was thinking about you, and tryan for He might
not be able to answer, but he understands everything.
Speaker 17 (26:47):
Okay.
Speaker 1 (26:49):
All these disclosures went a long way towards educating the
public about HIV risk and prevention, but activists were frustrated
that the policy changes Clinton had seemed to support as
a ended it weren't materializing faster in his presidency, and
after the nineteen ninety four midterm swept in a new
conservative Congress, the political possibilities seemed even more limited. As
(27:13):
the activist Sean Strube wrote at the time in his
magazine for people with HIV. This administration's priority is all
about image and media. As I write this, they are
cynically trying to have a press flurry of pseudo action
prior to World Aid's Day. As it turned out, World
Aid's Day in nineteen ninety four would end up generating
(27:34):
a lot of press for the Quinton administration, just not
in the way they had hoped.
Speaker 4 (27:49):
This is World Age Day. There were ceremonies and observances
around the world, but very little in the way I've encouragement.
Speaker 1 (27:57):
The seventh annual World Aid's Day took place on December one,
nineteen ninety four. As part of the event, Surgeon General
Joycelyn Elders was invited to speak and answer questions from
the press at a United Nations forum.
Speaker 8 (28:10):
Yeah.
Speaker 9 (28:10):
I don't think the speech I gave was necessarily that earthshaking.
But a psychiatrist asked me about masturbation.
Speaker 21 (28:21):
I think that that is something that it's a part
of human sexuality that perhaps should be taught, and I
feel that we have tried ignorance for a very long time,
and it's time we try education reguard to masturbation.
Speaker 1 (28:40):
Elders didn't think anything of it. It was the kind
of thing she said all the time to all kinds
of audiences.
Speaker 4 (28:48):
Doctor Joycelyn Elders proved once too often that speaking your mind,
especially on issues as sensitive a sex, education and sexuality,
could be very bad politics, especially with the Republicans breathing
down the President's neck as they are.
Speaker 1 (29:02):
Within days, Elders was being pummeled in right wing media.
Speaker 8 (29:06):
Why does the president keeper? I assume he shares our values.
Speaker 14 (29:08):
I assume he thinks it's okay.
Speaker 1 (29:10):
For Clinton and his political advisors. It was the last straw.
A little more than a week after she made the
comments about masturbation, Elders was forced to resign.
Speaker 4 (29:20):
Doctor Elders was fired today by President Clinton. In a
letter to the Health Secretary Donachileela late this afternoon, doctor
Elders writes, President Clinton and I maintain our strong mutual
respect for each other. She also says that as a
private citizen, she intends to continue speaking out on the
public health causes that are as she puts it, dear
to her.
Speaker 1 (29:39):
Here's Elders talking about her firing the week it happened
on this day show.
Speaker 18 (29:43):
Yeah, I really thought that all of the comments I
made were true and you know, I think that the
country needs to approach many of these issues. And the
longer we wait, I feel, the more children we are
going to lose. And I don't feel that, you know,
I should start second guess in my life self today.
Speaker 1 (30:01):
After she left Washington, Elders returned to her home state.
She became a professor at the University of Arkansas and
toured the country as a speaker and educator.
Speaker 8 (30:11):
You know how I was.
Speaker 9 (30:12):
I never tiptoed around very much. I just said what
I thought and believed. I was sorry, you know, to
have lost the position. Now I'm not saying that, but
the next five years so I was all over this country,
talks it all over the time.
Speaker 8 (30:30):
Yeah.
Speaker 9 (30:31):
In fact, that was all I did, was running around
running my mouth.
Speaker 1 (30:36):
On one occasion, Elders told an audience that she regretted
not advocating more firmly for needle exchange while she was
in government. Politicians, she said, should drop all this crap
about not using federal money for needle exchange programs because
they don't want to support IVY drug use. Is it
all right? She asked to support death.
Speaker 3 (31:02):
Good morning, and welcome.
Speaker 1 (31:05):
In nineteen ninety five, the year, after Joycelyn Elders was fired,
Clinton appointed a brand new, twenty three member Advisory Council
on HIV and AIDS.
Speaker 6 (31:15):
I'd like to begin by thanking all of you for
your service on this advisory council. We need your advice,
your wisdom, your enthusiasm. You're urging an American najor service,
and I thank you for it very much.
Speaker 1 (31:31):
As you know, both the Reagan and Bush administrations had
appointed their own advisory councils to make recommendations about the epidemic,
and both times members had resigned publicly because so little
of their advice was taken. Clinton's new council was meant
to signal that he was going to do things right
this time, and that, unlike his predecessors, he would actually
(31:51):
listen to the experts. One of the members of the
new AIDS council was a lawyer from Chicago who had
been a fundraiser for Clinton's ninety two campaign. His name
was Bob Fogel.
Speaker 10 (32:02):
I was just a regular person. I've loved politics all
my life, and I had met Clinton and.
Speaker 11 (32:10):
Really thought he was terrific.
Speaker 1 (32:12):
After Clinton won, Fogel thought about trying to become an
ambassador but his wife nixed the idea of a family move.
Speaker 10 (32:19):
So I looked at boards and commissions, and AIDS was
a big issue, and I thought, you know, I can
pivot away from being the trial lawyer guy. I can do,
hopefully something that would be useful and contributory to the
well being of our country. So I figured I would
ask if I could be appointed to the President's Advisory
(32:39):
Council and HIV AIDS.
Speaker 1 (32:41):
When Fogel showed up to a hotel in Washington for
the council's first meeting, he realized right away that he
was the odd man out.
Speaker 10 (32:49):
The night before our first official meeting and swearing in,
we made a circle in the little meeting room in
the basement area and introduced ourselves. I was almost a
little embarrassed at how little I really knew compared to
everybody else.
Speaker 1 (33:07):
The other council members were medical professionals or had long
personal histories with AIDS activism. The person who introduced himself
right before Fogel was an activist with HIV who had
spoken at the Democratic National Convention.
Speaker 10 (33:21):
One of the things he said was, you know what,
you know, we've been pushing Clinton to do stuff related
to AIDS make it a focus of his administration, and frankly,
he figured, he'll give the straight white guys in the
suits one more opportunity to get it, and if they don't,
then he would be done with them.
Speaker 1 (33:41):
Then it was Fogel's turn to speak.
Speaker 10 (33:44):
And I said, well, I'm one of those people, and
I'm here to learn, and if I end up getting it,
then there's really no reason why the straight white guys
in the suits in the White House shouldn't get it either.
Speaker 1 (33:59):
As part of his work on the Advisory Council, Fogel
was briefed on the connection between intravenous drug use and HIV.
It was clearly a huge problem. By that point, ivy
drug use accounted for about a third of new HIV
cases in the US, But when Fogel learned about needle exchange,
he was extremely skeptical.
Speaker 10 (34:19):
When I first heard about needle exchange, it was like,
are you kidding me? You want to give needles to
drug addicts. Aren't you promoting the use of drugs? There
must be a different or better way to deal with
this issue.
Speaker 1 (34:34):
But as Fogel learned more, he started to take a
different view. Back home in Chicago, he met with an
activist and drug user who ran in exchange.
Speaker 10 (34:44):
You know, I asked my I would say, straight white
guy in the suit sort of questions, you know, gosh,
you know, why are you doing this? And why does
this work? And what are the benefits? And aren't you
afraid of you know, those sorts of things, and so,
you know, it began to make sense. It wasn't just
giving needles to drug addicts. It was perhaps getting some
(35:05):
of them into drug treatment, and it was certainly counseling
them on the dangers and risk of age and if
they had aids, perhaps into some treatment programs for that
as well.
Speaker 1 (35:17):
Back in Oakland, Ricky Bluthenthal continued to run his needle exchange.
Over time, he had become an expert on harm reduction,
the idea that drug policy should be focused on reducing
the negative consequences of drug use as much as possible,
rather than trying to punish or restrict people out of addiction.
Bluthenthal felt that the scientific evidence and the moral imperative
(35:40):
were aligned, and if other people couldn't see that, then
it wasn't necessarily worth trying to engage with them.
Speaker 11 (35:47):
The people arguing against these programs aren't even in the
same universe as far as I'm concerned. They're dealing with
a set of problems that have nothing to do with
the individual that I'm talking to. Cross the way. They're
living in a world that's full of moral fictions and
fear that misunderstand the harm that's done by substances and communities.
Speaker 1 (36:12):
From Bluthenthal's perspective, those who opposed needle exchange on moral
grounds were simply not interested in HIV prevention.
Speaker 11 (36:21):
The people arguing against us were fine with people dying
from HIV AIDS. There's no a solution, right, so they're like, oh,
we don't want people to use drugs. Well that's great,
you know, there's no easy way to do that. And
the things that you've been doing at that point for
twenty years we now know definitively don't help.
Speaker 1 (36:43):
But as long as the laws didn't change, need to
exchange volunteers continued to risk arrest. In nineteen ninety five,
Bluthenthal and several of his colleagues went on trial for
distributing drug paraphernalia. Blutenthal says he was confident the jurors
would find him to be a sympathetic defender.
Speaker 11 (37:00):
I was a young African American man getting a PhD
at UC Berkeley, and I had a bunch of evidence
on my side, So you know, I think there were
a lot of people in the jury box you're reading
for me.
Speaker 1 (37:11):
After deliberating for four hours, the jury found Luthenthal and
his colleagues not guilty on the basis that their work
was a benefit to society. It was the third time
the County DA had tried and failed to prosecute needle
exchange activists. For all the worry that needle exchange was
politically deadly, it seemed to have grassroots support within the
communities that actually had programs, but reversing the ban on
(37:36):
federal funds still didn't seem to be a priority.
Speaker 6 (37:39):
Never again, should Washington put politics and party above law
and order.
Speaker 1 (37:45):
From the start of his presidency, Clinton had always gone
to great lengths to position himself as a proponent of
law and order, not some hippie, as he was often portrayed,
but someone who took the drug war seriously, just like
Reagan and Nick and had. After Republicans took control of
the House and Senate, Clinton felt he had even less
(38:06):
room to take chances on progressive policies. As he prepared
to run for a second term, he decided to appoint
a new DRUGSAR, a retired general named Barry McCaffrey, who
was a hardliner on drug policy. For now, at least,
Reagan's ban on funding for needle exchange would remain firmly
in place.
Speaker 5 (38:34):
Are scientists on the verge of making AIDS a manageable disease.
Speaker 1 (38:38):
There was positive news on that issue, but some caution too.
When the Triple Cocktail was announced in nineteen ninety six,
the whole outlook of the AIDS epidemic shifted. Over the
following year, the mortality rate for people with AIDS in
the US dropped by almost fifty percent.
Speaker 6 (38:55):
We have a lot to celebrate. For the first time
since the epidemic began, deaths due to AIDS in the
United States have declined for the first time. Therefore, there
is hope that we can actually defeat AIDS.
Speaker 1 (39:10):
And yet, there were still more than fifty thousand new
cases diagnosed that year, and the racial disparities were only
getting more stark. In nineteen ninety six, forty one percent
of infections were diagnosed in Black Americans, even though they
only made up about thirteen percent of the country's population.
Speaker 14 (39:28):
More and more African American women are being infected through
heterosexual contact.
Speaker 1 (39:33):
Their children are also at risk. In nineteen ninety seven,
the CDC released a major study concluding that IV drug
use was the primary driver of new HIV infections. Expanding
needle exchange and reversing the ban on federal money had
never seemed more urgent. Here again is Bob Fogel, the
(39:55):
trial lawyer who served on Clinton's Council on HIV and AIDS.
Speaker 10 (40:00):
The benefits of federal funding is that bypasses the states,
the governors or the legislatures, and programs could be set
up where needed in cities and states where it otherwise
wouldn't occur. And the federal government has the deepest pockets
you know. For the federal government to put five hundred
million dollars or one hundred and fifty million dollars into
(40:22):
natal exchange programs would have been huge. I mean, they
could have started programs and a lot of major cities
across the country.
Speaker 1 (40:31):
The President's Advisory Council on HIV AIDS was in complete
agreement that the federal government should fund needle exchange. They
had said as much in a formal recommendation, but the
White House made no moves to follow through. Fogel was
losing his patients, and.
Speaker 10 (40:47):
The question is, why aren't they doing something so important?
Why aren't they acting? Why aren't they responding? I mean,
are we just you know, in my head, are we
just a phony front? And you know, at that point,
it's like, are we wasting our time?
Speaker 12 (41:02):
You know?
Speaker 10 (41:02):
And if they're not going to follow our recommendations, let
alone this one in particular, then let's just quit wasting
you know, time and money. So yeah, I was pissed.
Speaker 1 (41:17):
Frustrations reached a boiling point at a council meeting in
July of nineteen ninety seven. Members of Act UP interrupted
the meeting, demanding faster movement on a wide variety of issues.
After the protest subsided, Fogel spoke up in solidarity.
Speaker 10 (41:33):
And I raised my hand and I said, look, we've
made multiple recommendations on this that appear to be ignored.
No action is being taken. There's no good reason for
not taking action, and perhaps maybe what we ought to
do is just resign on mass in protest, and somebody
across the room yelled, I second the motion. The press
(41:58):
people that covered our meetings, you know, jumped up like
holy shit. You know, Fogel has just moved that the
council resign and protest over their failure to certify needle
exchange programs.
Speaker 1 (42:14):
After the meeting ended, the council chairman pulled Fogel aside.
Speaker 10 (42:18):
And said, great job. This is terrific. You know, the
press is going to run with this. This is really
going to put pressure on them.
Speaker 5 (42:25):
Some harsh criticism today for the President and it comes
from his own advisors on AIDS.
Speaker 2 (42:30):
Especially critical of the administration's failure to fund programs for
drug addicts to exchange dirty syringes for clean ones to help.
Speaker 10 (42:39):
I remember my mother called me a few days later.
She told me she read about me in the Springfield
Union and which is in Springfield, Massachusetts, and she was
so proud of me. I said, Mom, I want to
give needles to drug addicts. She said, well, if you
think it's the right thing to do, I'm for it.
Speaker 1 (43:04):
In the spring of nineteen ninety eight, the year's long
pressure campaign on Clinton to reverse the funding ban appeared
to finally be working. It had been almost a decade
since the ban was put in place and it was
set to expire soon. If the administration wanted to make
a change, it seemed like the perfect moment. HHS Secretary
(43:24):
Donna Shalela was ready to certify the research required to
change the policy to confirm that needle exchange programs did
reduce the spread of HIV and that they didn't increase
drug use. In private, Shalalela tried to convince the President
that the scientific basis for the policy was unimpeachable.
Speaker 5 (43:43):
I made every argument I possibly could. He knew what
the arguments were. He had a letter in his hand
from all the scientific leaders and public health leaders of
the department.
Speaker 1 (43:54):
Still Clinton wouldn't commit. At one point, Shilela says the
White House urged her to hold off on certifying the research. Instead,
they wanted her to suggest that the efficacy of needle
exchange was still up for debate.
Speaker 5 (44:07):
Someone from the White House called over and said, tell
Schalela to announce that we needed more research. And I said,
I will not repeat on this program what I said,
but basically I said, no, that was ridiculous. I was
not going to say the researchers we needed more research.
When they said the research was clear. This was a
(44:29):
matter of integrity for the apartment and for me personally.
Speaker 1 (44:34):
Shalela was confident that the President understood the science just
as clearly as she did. If anything was preventing him
from embracing needle exchange, it wasn't the quality of the research.
It was politics.
Speaker 8 (44:47):
Delay.
Speaker 5 (44:47):
Delay meant to me they we were making a political calculation.
It wasn't substantive, and the call that maybe Shililah should
say we need more research was the tip off.
Speaker 1 (44:58):
Shaleala was resolved to publicly validate the idea of needle exchange,
regardless of what Clinton decided to do, so her office
scheduled the press conference from Monday, April twentieth. Schalela's hope
was that by the time she took the podium, Clinton
would have made up his mind to undo the ban.
Speaker 4 (45:17):
The President could lift that ban if he could certify
with scientific evidence that such programs reduced the rate of
HIV infection without encouraging drug use.
Speaker 1 (45:26):
Scientists and activists who had been advocating for needle exchange
were told to expect good news, but Shilala says she
wasn't sure what the president's decision would ultimately be.
Speaker 5 (45:36):
The press conference was one or the other. I warned
everybody before the press conference that it was possible the
President would say no.
Speaker 1 (45:48):
It turned out that Shilala was right to temper expectations.
Less than an hour before the press conference, HHS was
contacted by the White House to say that the President
would be keeping the ban in place. The department scrambled
to adjust its plans, delaying its announcement by three hours.
That day, Bob Vogel was with his brother at a
(46:10):
Red Sox game in Fenway Park when he received a
page to join a conference call. He took it in
the parking lot.
Speaker 10 (46:17):
We got on the call and the news was broken
that the final decision had been made that there would
not be a formal certification. And I would say I
was shocked. I mean, it just seemed like, and I
hate to use this word so but like a flip flop.
(46:37):
We were heading down this road and suddenly they chickened out.
I guess is how I would describe it. It was
very disappointing.
Speaker 1 (46:49):
At the press conference, Secretary Shalala did what she had
come to do and certified the research findings required to
overturn the ban, but as she explained to reporters, the
ban itself was staying put.
Speaker 4 (47:01):
In Washington to day, the Clint administration has decided to
maintain the ban on using federal funds to pay for
needle exchange programs. Those are the ones designed to prevent
the spread of AIDS.
Speaker 5 (47:12):
It was painful. It was painful because the evidence was
so clear. It was heartbreaking for me to face the
scientist and say. The President said, no, I didn't like it.
I didn't like transmitting it, but he made the decision.
Speaker 4 (47:27):
The Secretary of Health and Human Services, Dona Chalela, said
there is evidence that the programs do reduce the transmission
of HIV without significantly increasing drug use, but she said
that state and local governments have to pay for the programs.
Speaker 10 (47:43):
I suppose it was a compromise, you know. I was shocked.
I wished they had bigger balls than that, but that
was better than silence.
Speaker 1 (47:57):
Journalists reported that scientists seated next to Shalala looked visibly uncomfortable.
I wish I could play you some audio from the
event itself, but it was limited to print reporters only.
Here's Chilela explaining the compromise A few days later.
Speaker 5 (48:11):
Federal money doesn't pay for everything that's important in this country,
and in this case, the administration made the decision not
to make this ineligible activity under prevention funds. The most
important message today is that the science is now there
so that local communities ought to look at their strategies
and they can then consider using a needle exchange program
(48:33):
as part of that overall strategy. It was the worst
moment in my HHS leadership in terms of a policy decision.
I thought it was the most dangerous thing that Congress
and the President could do. I mean, we had a
strategy that would save lives, save people from getting infected,
(48:55):
and we ought.
Speaker 10 (48:55):
To use it.
Speaker 1 (49:02):
There are a few different theories about why Clinton came
out against needo exchange at the last minute. One blames
his drugs are Barry McCaffrey, who cornered the President on
Air Force one just before the press conference and made
the case that changing the rule would condone drug use.
Clinton would later say he believed Congress would simply pass
a new funding ban if he lifted the old one,
(49:25):
but according to Donna Shalela, his decision had more to
do with pressure from Senate Democrats than anything else.
Speaker 5 (49:31):
Bill Clinton did it under political pressure because Democrats thought
they were going to have trouble getting re elected. There
were Democrats that bought the argument that it would enable
drug use.
Speaker 1 (49:47):
Clinton's waffling led to a significant increase in national media
coverage of needle exchange miss America. In nineteen ninety eight,
Kate Shindle spoke publicly about her personal evolution on the issue.
Speaker 8 (49:58):
I was very much against these pro when I first
became Miss America.
Speaker 1 (50:01):
It's a really had issue as far as.
Speaker 19 (50:04):
Government is concerned right now, because there is that catchphrase
needle exchange, and unfortunately there are a lot of people
that don't read past the headlines.
Speaker 1 (50:10):
And I was sort of guilty of that. But then
I was enlightened.
Speaker 20 (50:13):
I guess.
Speaker 1 (50:15):
Four years later Quinton said he had been wrong not
to lift the ban, and about fourteen years after that,
in twenty sixteen, Congress quietly got rid of it. The
new policy made it possible for federal funds to be
used for anything a needle exchange program needed, except the
syringes themselves. As we finish our work on this podcast,
(50:51):
there's still no vaccine for HIV, and there's still no
cure for AIDS. More recent medical innovations like PREP made
it much easier for people to have sex safely, and
treatments for people with HIV and AIDS have allowed many
to live with undetectable viral levels. And yet the UN
estimates that of the nearly forty million people worldwide who
(51:14):
were living with HIV in twenty twenty, a quarter did
not have access to effective treatment. The trends that emerged
in the nineties have also deepened the racial disparities and
the disproportionate impact on drug users. Meanwhile, most of us
move through the world not thinking very much at all
about AIDS. It's kind of like the Ozone layer or
(51:36):
Save the Whales, an issue people used to think it
was important to care about. One thing that's become obvious
to me during the COVID pandemic is how big a
difference visibility makes if someone you know gets sick. If
you can hear the ambulances in the street, you pay
more attention, You're more willing to take precautions. Then as
(51:58):
soon as the disease is out of sight, it becomes
incredibly easy to pretend it's not happening at all. The
people we spoke to for this podcast the ones who
witnessed the beginning of AIDS from up close don't need
to be reminded that the story does not yet have
(52:19):
an ending. Many of them told us they hoped to
live long enough to see the next big breakthrough. You know,
the work is essentially interminable until we have a cure
in a vaccine.
Speaker 8 (52:31):
So we're still working on those same things.
Speaker 10 (52:33):
Forty years later.
Speaker 7 (52:34):
I'm still here and got the treatments, waiting for that cure,
waiting for that vaccine, but still hopeful and still curious.
Speaker 8 (52:43):
We've come a long way.
Speaker 9 (52:44):
We've made a lot of progress on this disease, so
we can eradicate the spars. So back to me is
what I would really that would be my dream. That's
what I've like happened.
Speaker 20 (52:59):
We've lost so many people, We've lost so many lives.
We have to remember this. We have to remember the struggle,
because it's only in remembering the struggle that you understand
that you can fight, that you must fight.
Speaker 13 (53:15):
What patients are asked on and asked me because I
start having a lot of gray hair, white hair, whatever.
They're getting nervous that I may have a retirement in
my future, and so what I try to do to
assuage their concerns and fear is that You've got me
from the very first case in New York. You've got
(53:35):
me until hopefully the very last case, after a cure
has developed and I get to administer it to all
of my patients, and then I'll be happy to step down.
Speaker 10 (53:47):
And that's the way I leave it.
Speaker 13 (53:49):
It's a I guess it's a fantasy.
Speaker 1 (53:53):
For all the people who survived those years. There are
so many who didn't. I want to leave you with
a c from the funeral of Bobby Campbell. He was
the first person with AIDS you heard in the series,
the nurse from San Francisco who turned himself into a
poster boy for the disease. When Campbell died in nineteen
eighty four, he was remembered with a memorial service attended
(54:16):
by a thousand friends, family members, and neighbors. One of
the people who spoke was Campbell's partner, Bobby Hilliard.
Speaker 12 (54:26):
When Bobby was an intensive care I left my backpack
out in the waiting room and I was in the
room with him. After he died, I went back to
the waiting room and sitting on top of the backpack
was a little bell that I had never seen before,
and someone left there and I've been carrying it around
(54:46):
in my pocket since then, and I'd like to say
one more thing before ringing it. Love after Death for Bobby.
Speaker 1 (55:22):
Fiasco is presented by Audible Originals and Prologue Projects. The
show is produced by Andrew Parsons, Sam Graham Felsen, Madeline
kaplan Ulla Culpa and me Leon Nafock. Our researcher is
Francis Carr. Editorial support from Jessica Miller and Norah waswas
archival research by Michelle Sullivan. This season's music is composed
(55:45):
by Edith Mudge. Additional music by Nick Silvester of God Mode,
Joel Saint, Julian and Dan English, Noah Hect and Joe Valley.
Our theme song is by Spatial Relations, Music licensing courtesy
of Anthony Roman. Audio mixed by Erica Wong with additional
support from Selina Urabe. Our artwork is designed by Teddy
(56:06):
Blanks at Chips and Y. David Blum is the editor
in chief of Audible Originals. Mike Charzik is the Vice
president of Audible Studios. Zach Ross is Head of Acquisition
and Development for Audible. Thanks to Peter Yassi, Percy Everlin,
Arlene Arevelo, Michael Helquist, Carrie Baker, Alice Gregory, Jannis Kolpa,
(56:27):
Chris Robi, Stephen Fisher, and everyone at Audible
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