Anti-Gay Bias? : Coverage of AIDS Story: A Slow Start

Last year, when David McCallum and Stephen Klaidman of the Institute for Health Policy Studies in Washington were preparing a program on media coverage of AIDS, they titled it “AIDS: A Moving Story.”

“Moving” indeed--”moving” as in emotional . . . and “moving” as in changing. AIDS is a human tragedy of staggering proportions. But AIDS is also a story that has everything a journalist could ask for: Mystery. Death. Sex. Drugs. Rivalry. Controversy. Politics. Money. And change. Constant change.

How does the press cover such a story--a story about a disease that didn’t even have an official name until it had already killed more than 200 people, a disease that has now killed more than 27,000 Americans and may have infected as many as 5 million to 10 million people worldwide, a disease with no known cure, a disease with--in the beginning--no known cause and with, even now, conflicting and contradictory information being released, leaked, trumpeted, denied and challenged almost daily?

Three months ago, USA Today assured its readers, based on generally accepted medical evidence, that antibodies to the AIDS virus “take (only) six to 12 weeks to appear (in a blood test).”

But three weeks later, the British magazine Lancet reported a new study that showed some people carry the AIDS antibody for up to 14 months before tests can detect it.

On Oct. 6, the Washington Post reported on a study at a Baltimore clinic for sexually transmitted diseases showing AIDS infections spreading through heterosexual contact at “a rate much higher than previous studies have reported.”

Different Conclusion

But five days later, the New York Times reported on a study at a New York clinic for sexually transmitted diseases showing “nothing has changed. . . . The AIDS virus is not spreading widely beyond members of known risk groups and their partners” to the general heterosexual population.

Is acquired immune deficiency syndrome a serious threat to the general heterosexual community? How accurate are tests for the AIDS antibody? What are the privacy and civil liberties questions implicit in AIDS testing? Will an AIDS vaccine ever be discovered? Where did AIDS come from? What percentage of the people who are infected with the AIDS virus will ultimately get AIDS? What percentage of those who get AIDS will ultimately die?

Medical experts have been wrestling with these questions for several years now, and editors and reporters have been wrestling with the often contradictory answers to these questions--and with resultant questions of their own--for almost as long.

Last August, two days before the Los Angeles Times published a 16-page special section, “AIDS: A Global Assessment,” William F. Thomas, editor of The Times, said he was pleased with the section, “but even after you read it, you’ve got your hands full of smoke. . . . Everything is still so inconclusive. It’s hard to decide what to do (with AIDS) in the paper. All you can do is chase the bouncing ball.”

In the beginning--from 1981 until, at many papers, mid-1985--the press did not chase the bouncing ball very aggressively. Indeed, the press, like most other institutions in American society, reacted very slowly to AIDS.

No AIDS story appeared on the front page of the New York Times until May 25, 1983, for example--by which time there had already been 1,450 cases of AIDS and 558 AIDS deaths in the United States.

‘Blood, Sex and Politics’

“We couldn’t . . . get the press interested (at first),” said Walter Dowdle, deputy director of the Centers for Disease Control in Atlanta. “Then, when the press finally did pick up on it, it was a sort of blood, sex and politics approach.”

“The American people rely on the press” to hold the other institutions accountable on “issues of great public concern,” said Dr. Marcus Conant, chairman of a statewide task force on AIDS. On AIDS, Conant said, the press “focused on some of the superficial . . . attention-getting issues and did not look at the greater sociological questions that this epidemic is raising.”

Virtually all the earliest AIDS stories were simply rewrites of medical journal articles. With a few noteworthy exceptions, there was almost no enterprise or investigative reporting and little effort to question local or federal authorities about what they were doing to combat the growing epidemic.

But in 1987, several papers have full-time AIDS reporters, medical writers at many major papers spend 65% to 90% of their time covering AIDS and most major papers now routinely assign other reporters to write about the personal, social, political and economic aspects of AIDS as well. Many newspapers were publishing so many AIDS stories earlier this year--sometimes four or five in a single day--that some editors (and some readers) began asking if the press was paying too much attention to the disease.

After all, there are half a dozen other diseases, each of which kills far more people in a given year than AIDS has killed since it was discovered. Heart disease killed 765,000 Americans in 1984 alone, almost 30 times the total number of AIDS deaths in the last 6 1/2 years.

“Obsessive coverage . . . creates panic,” Charles Krauthammer wrote in the New Republic in September. “It is not more stories about the terrors of AIDS . . . that the public needs, but fewer.”

What constitutes too much coverage, though--or too little? By writing as much about AIDS as it has in the last two years, has the press--as Krauthammer argues--helped create a climate of panic that resulted in the burning down of a home in Arcadia, Fla., in August because three children who lived there carried the AIDS virus? Or have panic and hysteria grown in the general public because the press, for too long, either neglected AIDS or resorted to euphemisms, oversimplifications, sensationalism and journalistic shorthand that inevitably led to public misunderstanding?

Complex Subjects

Science and medicine stories have always been difficult for the press to cover; they’re complex subjects in which most journalists have little or no training. Moreover, many scientists are reluctant to speak to the lay press before their work is published in peer review journals (many of which won’t publish a scientific study if it’s already been reported elsewhere).

But most critics say the biggest shortcoming of the press on the AIDS story, especially in the first few years, was not medical/scientific coverage but political coverage; the press didn’t aggressively pursue the public policy and funding aspects of the story.

The press reported, largely without question or investigation, various Reagan Administration statements, ranging from one that the nation’s blood supply was “100% safe” (at a time when it wasn’t) to one that an AIDS vaccine would be ready for testing within two years (it took more than three years to begin the first clinical tests, and government health authorities now say no vaccine is likely to be available before the mid-1990s).

Worse, no reporter asked President Reagan about AIDS at any press conference until more than four years into the epidemic. Nor, according to a search of newspaper data bases, did any paper other than the San Francisco Chronicle report that the President did not include in his 1987 State of the Union address a statement on AIDS that Dr. Gary Noble, AIDS coordinator for the Public Health Service, said he was asked to draft specifically for that speech.

(Many subjects are proposed for but ultimately dropped from the State of the Union address, but since this would have been the President’s first significant comment on AIDS, his decision not to make that comment at a time when more than 20,000 Americans had died from the disease would seem to have been newsworthy.)

The Chronicle was one of the very few papers to report on federal AIDS policy in the early years. Chronicle reporter Randy Shilts reported in 1983, for example, that at the same time Reagan Administration officials--among them, Edward Brandt, assistant secretary of the Department of Health and Human Services--were telling Congress no emergency funds were necessary for AIDS, they were writing memos to other Administration officials saying (in Brandt’s words), “AIDS work cannot be undertaken because of the lack of available resources.”

Shilts learned of these memos--and much other revealing material on Administration behavior--by filing Freedom of Information Act requests, something other reporters could also have done.

‘Went to Sleep’

The media “went to sleep on the story,” Shilts said. “I’m not God’s gift to journalism. I’m a good reporter, but I didn’t get this because I’m a brilliant reporter. I just did . . . the work that any reporter could have done.”

B. D. Colen, science editor at Newsday, agrees. “We all slipped up,” he said. “I kick myself now. . . . “

The failure of the press to do these stories made it possible, Shilts and others say, for the White House to get away with making no line recommendations for AIDS research funding until 1984--and for the President of the United States to avoid giving his first speech devoted entirely to AIDS until this year, when the epidemic was 6 years old and 36,058 people had been diagnosed with the disease and 20,849 had died.

In her study, “AIDS in the Media,” sociologist Andrea Baker of Ohio University argues that press coverage and official action on AIDS show journalists “can influence the course of the emergence and outcome of a social problem,” and many who agree with her point to San Francisco to support their thesis.

San Francisco is widely regarded as having the earliest and best public health service programs for AIDS in the United States, and although there are several explanations for that, the extensive, early coverage of AIDS in the San Francisco press clearly “put AIDS on the public agenda,” say James Dearing and Everett Rogers of USC’s Annenberg School of Communications in their unpublished study, “The Agenda-Setting Process for the Issue of AIDS.” The Chronicle “played a special role of encouraging aggressive action against the disease,” Dearing and Rogers say.

In contrast, many in the AIDS battle say Los Angeles has the poorest public health service programs of any of the three metropolitan areas with the largest AIDS caseloads, and they attribute that, in part, to the failure of the Los Angeles Times to write aggressively about those shortcomings in its news pages during the early years of the epidemic.

As in San Francisco, there are other factors involved, of course. Just as San Francisco is relatively small and cohesive, with coterminous city and county jurisdictions that simplify government action and coordination, so Los Angeles is large and sprawling, with many different and often conflicting jurisdictions that often complicate and delay government action and coordination.

Moreover, the Los Angeles Times has written strong editorials on the need for local action on AIDS, and--despite some flaws and oversights, especially in the early years of the epidemic--The Times has generally covered AIDS well in recent years in its news columns and on its editorial page, according to interviews with more than 100 journalists, doctors, public health service professionals, drug-abuse experts and gay activists.

The Times has also published two special sections on AIDS--one of them, the entire U.S. surgeon general’s report--and the paper’s View section has been writing about the personal impact of AIDS periodically since 1983. Moreover, Marlene Cimons of The Times’ Washington bureau is widely acclaimed for her reporting since 1985 on federal AIDS policy and, in particular, for an ongoing series of articles on a Boston AIDS patient and his doctor as they try to cope with his problems of daily life and confronting death.

First Story on AIDS

The Times published the first story on AIDS to appear in any mainstream American paper--a 17-paragraph story that ran June 5, 1981, under the headline, “Outbreaks of Pneumonia Among Gay Males Studied.” The story was based on a Centers for Disease Control report of five cases involving Los Angeles men and on “another half-dozen cases . . . under investigation in San Francisco, along with an undetermined number in New York, Toronto and Florida.”

The San Francisco Chronicle published a similar story the next day, but it wasn’t until almost a month later, when a second Centers for Disease Control report linked an unusual form of skin cancer (Kaposi’s sarcoma) to male homosexuals, that the New York Times, Washington Post and a few other major daily papers published their first AIDS stories. It was another year before AIDS was first mentioned on a network evening news program.

“A rapidly spreading disease that has an extremely high mortality rate might be expected to have attracted swift attention by the mass media . . . , “ Dearing and Rogers of USC say in their study. But AIDS did not receive much early press attention, Dearing and Rogers say, because “key media gatekeepers did not consider the epidemic newsworthy or appropriate.” These “gatekeepers”--editors--essentially decided that AIDS didn’t affect or interest enough of their readers to be given thorough, prominent display in the early stages of the epidemic.

Generally speaking, when AIDS was covered in those first two or three years, it was covered purely as a science/medicine story; only later did it also become a human interest story, a political story and an economics story. Thus, those very few newspapers that did a relatively good job covering the early stages of the AIDS epidemic were generally those papers with good medical writers--especially those whose judgment was highly respected and trusted by their editors.

In fact, while many see the press as a monolithic institution, AIDS coverage was, in some ways, a classic instance of the individualized, even idiosyncratic, nature of the press.

The San Francisco Chronicle is perhaps the best example of this. The gay community in San Francisco is activist, relatively large and politically influential--casting about 25% of the total ballots in any given election--so perhaps it is not surprising that the Chronicle has covered the AIDS story in the most detail from the early days of the epidemic.

In fact, the Chronicle hired Shilts, an experienced reporter who is gay, specifically to cover the city’s gay community in August, 1981, before AIDS was perceived as an epidemic. But by May, 1982, Shilts was covering AIDS full time, something he has continued to do ever since, except when on leave to write his current best-seller, “And the Band Played On: Politics, People and the AIDS Epidemic.”

In the Public Eye

Shilts offended many gay activists, public officials and traditional journalists with his brand of advocacy journalism on some AIDS stories, but through the first 3 1/2 years of the epidemic, the Chronicle published more stories on AIDS than the New York Times and Los Angeles Times combined. Although many of these stories were relatively short, they served to keep AIDS in the public eye--and many longer Chronicle stories described AIDS funding controversies, problems in the nation’s blood supply, fears in the gay community, AIDS education programs, AIDS research, the politics of AIDS and the impact of AIDS on individual lives.

Shilts does not deserve sole credit for that, of course. Others have written about AIDS for the Chronicle--most notably David Perlman, the paper’s longtime science editor, who is both a skilled, insightful journalist and the respected friend and confidant of the paper’s executive editor, dating back to their college days together. Perlman had enormous influence on Chronicle coverage.

Similarly, when B. D. Colen took an early interest in AIDS, Newsday published perhaps the first in-depth series on the subject in any American newspaper, in September, 1982. Harry Nelson, medical writer for the Los Angeles Times, not only wrote the first story on AIDS in the mainstream press, he also wrote the first Page 1 AIDS story in the mainstream press--on May 31, 1982, more than two months before the Chronicle (and almost a year before the New York Times) put AIDS on Page 1.

One might have expected relatively early interest in AIDS among medical writers in New York, San Francisco and Los Angeles, where the three largest concentrations of AIDS cases were (and still are) to be found. But medical writers in a few other cities with far smaller AIDS caseloads also recognized the importance of the story early--among them Donald Drake of the Philadelphia Inquirer and Loretta McLaughlin of the Boston Globe.

‘Very, Very Obsessed’

Drake began working on AIDS full time in August, 1982, and produced a comprehensive series that began in January, 1983, and ran periodically for more than a year. Public health authorities and other journalists still cite that series as the best early work on the subject. McLaughlin, meanwhile, became so “very, very obsessed” with the AIDS story that, in the first 3 1/2 years of the epidemic, the Globe published as many stories on AIDS as the New York Times and Los Angeles Times combined. McLaughlin traveled to Africa twice and to Haiti to report on AIDS, and she also wrote comprehensive stories on the search for the cause of the disease, among other subjects.

The Charlotte Observer also published an impressive series on AIDS--more than a dozen stories spread over four days in June, 1983--and, far more recently, the New York Times, Wall Street Journal, Chicago Tribune, Washington Post and a few other papers have received widespread praise for various aspects of their AIDS coverage.

But none of these papers covered AIDS continuously and comprehensively during the first years of the epidemic, and none gave AIDS the kind of early attention they gave Legionnaire’s disease.

Legionnaire’s disease, which left 29 people dead and 182 ill, received far more press coverage in a few weeks in 1976 than did AIDS in the three years from mid-1981 to mid-1984--during which time several thousand people died of AIDS.

The New York Times, for example, published 62 stories on Legionnaire’s disease in August and September, 1976, 11 of them on Page 1. But the New York Times published only seven stories on AIDS in the first 19 months of the AIDS epidemic, and AIDS didn’t make Page 1 of the New York Times for the 11th time until the epidemic was more than four years old--by which time there were more than 12,000 cases and more than 6,000 deaths.

Studies at other newspapers (including the Los Angeles Times) yield similar statistics. But these are not just statistics--not just an embarrassing journalistic box score. Lawrence Altman, medical writer for the New York Times, has argued that press coverage of Legionnaire’s disease “forced scientists to work harder to find the cause of the . . . disease . . . than they had worked on similar outbreaks in the past,” as the Journal of the American Medical Assn. put it in October.

More Manageable Story

Might similar press coverage have triggered quicker scientific progress--and quicker government action--on AIDS? Perhaps not. After all, no two diseases--and no two stories--are alike. Besides, in purely journalistic terms, Legionnaire’s disease was a more manageable story than AIDS: All the victims contracted Legionnaire’s disease in the same place at the same time (during a convention in Philadelphia), whereas early AIDS reports involved cases scattered throughout the United States and, soon, the world, dating back months and years.

Nevertheless, Joel Howell and Mary Mancewicz of the University of Michigan Medical Center say in their “work in progress” on media coverage of AIDS that the “biggest demonstrable difference” in press coverage of AIDS and Legionnaire’s disease was that AIDS began, at least in the public consciousness, as a disease of homosexuals--”the gay plague,” “gay cancer,” “gay pneumonia.”

This characterization of the disease had “a direct impact” on the way the press initially covered AIDS, as opposed to Legionnaire’s disease, Howell and Mancewicz say.

In their new book “The Virtuous Journalist,” Stephen Klaidman and Tom Beauchamp agree. When AIDS was “perceived as an epidemic almost exclusively affecting homosexuals, it was not given coverage comparable to that received by other recent, epidemic-like health scares perceived as affecting the heterosexual population, such as Legionnaire’s disease and toxic shock syndrome,” they say.

Editors deny they underplayed or neglected AIDS stories in the early stages of the epidemic because it seemed to affect only gays. But in a survey of science and medicine writers nationally “the No. 1 complaint was editors’ demands for heterosexual angles (on the AIDS story),” often to the exclusion of human and public policy angles, said Laurie Garrett, science reporter for National Public Radio

This doesn’t mean editors were all homophobic. Many just exercised the same kind of news judgment on early AIDS stories that they use every day on other stories: Does this subject affect or interest enough of our readers to warrant a story and, if so, how long a story, how prominently should we display it and when should we run another story on it?

Most editors decided their readers weren’t very interested in AIDS early on. After all, gays are “only” about 10% of the total population--and, to many editors, an aberrant 10% at that.

‘Essentially Ignored’

Regardless of their reasoning, “it was a goddamn disgrace . . . outrageous” that most newspapers “essentially ignored” the AIDS story in 1981 and 1982, said Donald Drake of the Philadelphia Inquirer.

At first, Drake said, when gay activists complained that the press wasn’t covering AIDS aggressively because it affected only gays, he thought they were being “paranoid.” But he “came to realize they were right,” he said. “There is a homophobia on the part of the American press. . . . If it (AIDS) had involved any other group of people, they (the media) would have been all over it.”

Jerry Bishop, medical writer for the Wall Street Journal since 1958, echoed many reporters when he spoke of his problems trying to interest editors in AIDS stories back in 1981 and 1982.

“As long as it seemed to be a disease affecting only homosexual males, neither the editors nor the readers felt like it was a threat . . . to the general population . . . which made it of not much concern,” Bishop said.

Bishop said his first two AIDS stories were cut considerably, and neither was prominently displayed; the second was published, he said, only after he rewrote it to emphasize a possible AIDS threat to the heterosexual community. Bishop said that when he wrote a third story, Journal editors rejected it.

Bishop rewrote the story, and it was published in Discover magazine.

The Journal finally ran an AIDS story on Page 1 in December, 1982--a year after Bishop’s first AIDS story--but in time, Bishop said, he gave up trying to interest his editors in AIDS stories and wrote about other subjects instead.

Laurence O’Donnell, managing editor of the Journal at that time, insisted that the paper initially paid insufficient attention to the AIDS story only because “it dealt with a small group of people,” not because that small group was primarily gay. But O’Donnell conceded that, in retrospect, Bishop was right about the importance of the AIDS story and about the Journal’s having underplayed it.

Might Journal editors have been more interested in AIDS had the New York Times been covering AIDS thoroughly in those early days?

Bishop thinks so. He figures that his editors wondered, “If it’s such a big thing, why isn’t the New York Times covering it?”

Editors’ Skepticism

Although O’Donnell denied that, reporters at other papers say they encountered precisely that kind of skepticism from their editors, and given the agenda-setting influence of the New York Times on the rest of the media--and on governmental policy-makers as well--many critics blame the New York Times, in part, for the relatively slow development of AIDS into a top national priority.

Critics say the Washington Post must share that blame.

“The real story (in the early years) was in their own backyard; it was a question of budget allocations and the fight within the Administration over the approach to be taken,” said Larry Bush, administrative assistant to Assemblyman Art Agnos (D-San Francisco). “The Post (was) . . . one of the worst papers in the country (covering it).”

But it was the absence of prominent display for AIDS stories in the New York Times that is most often lamented by critics; as a character in Larry Kramer’s AIDS play, “The Normal Heart,” says, “The front page of the Times has a way of inspiring action.”

So why didn’t the New York Times cover AIDS more aggressively earlier--especially given both its longtime commitment to excellent science and medicine coverage and the presence in New York, from the beginning, of by far the largest single concentration of AIDS cases? (The New York metropolitan area has more than 11,000 AIDS cases--about 25% of the national total--almost triple the number in San Francisco and more than triple the number in Los Angeles, the two metropolitan areas with the next highest totals.)

“The biggest problem we had earlier was getting our hands around the story,” said Rick Flaste, science news editor at the New York Times. “There was so much confusion, so many . . . false starts . . . . “

The Times had other problems as well. One was that its highly respected medical writer, Lawrence Altman--a physician--was convinced that the artificial heart might be the medical story of the century, and he devoted much of his time to that story in late 1982 and early 1983.

But Altman covered most of the new developments in AIDS as well, and he even reported several important AIDS stories before anyone else. After a slow start, the New York Times published more AIDS stories than any other paper except the San Francisco Chronicle and perhaps one or two others. But volume does not necessarily connote breadth or prominent display, and--as Drake said--”the paper itself wasn’t making a commitment to . . . reporting the story for what it was--a massive epidemic.”

Altman wrote an excellent series on AIDS in Africa in late 1985, for example, but it wasn’t until March, 1987, that the Times published a series that seriously addressed the problems of AIDS in New York.

The explanation most often offered for this is that A. M. Rosenthal, then executive editor of the New York Times, was “unconvinced that stories on gays were appropriate for his newspaper,” as the Dearing/Rogers USC study says. In fact, the New York Times wouldn’t even use the word “gay” for “homosexual” until six months ago.

Gay Bias Denied

Rosenthal angrily denies having any bias against gays, but many past and present New York Times reporters say that perception was widespread at the paper, and they say it strongly influenced New York Times coverage of gay issues in general and of AIDS in particular.

There is yet another factor that may have inhibited early AIDS coverage, both at the New York Times and in the media in general: Intravenous drug users are the second-largest group of AIDS cases (after gays and bisexuals), and IV drug users with AIDS--most of them blacks and Latinos--are, like gays, not a group traditionally given much attention in the mainstream press.

Robert Bazell, medical reporter for NBC, said he can recall proposing early AIDS stories to his bosses and being told, “Look, it ain’t us. We don’t want to hear stories about homosexuals . . . (and) drug addicts.”

Bazell said he doesn’t know a single reporter on the AIDS beat who didn’t encounter similar reactions from his editors, and--in fairness--it must be noted that he broadcast the first network evening news story on AIDS and has continued to cover the story well, given the limitations of television.

But the prevalence of AIDS among IV drug users is a particular problem in New York, where AIDS kills more drug users than it does gays (in contrast with San Francisco, where 97% of all AIDS cases have involved gays or bisexuals, and Los Angeles, where studies have shown that drug users represent less than 10% of all AIDS cases).

Until the last year or so, New York Times coverage of AIDS and IV drug users was not commensurate with that high level of infection.

When Max Frankel became executive editor after Rosenthal retired late last year, he quickly formed an interdepartmental committee to examine how the paper should cover AIDS. Out of those discussions came the acclaimed four-part series on AIDS in March, and since then, the paper has provided some of the best, most wide-ranging AIDS coverage of any American newspaper, medical authorities and other journalists say.

But it’s misleading to attribute all the improvements in the New York Times’ coverage of AIDS to Frankel. The paper’s AIDS coverage began to improve while Rosenthal was still in charge. These improvements, like similar improvements at virtually every other newspaper, can be largely attributed to a name more recognizable than either Rosenthal or Frankel, though.

Rock Hudson.

COVERING AIDS STORY

First First Page 1 Aids Story Aids Story Los Angeles Times June 5, 1981 May 31, 1982 San Francisco Chronicle June 6, 1981 Aug. 11 1982 New York Times July 3, 1981 May 25, 1983 Washington Post July 4, 1981 July 18, 1982 Philadelphia Inquirer July 4, 1981 June 20, 1982

New York San Francisco Times Chronicle 1982 6 16 1983 126 155 1984 70 189 1985 375 414 1986 356 440

Source: “The Agenda-Setting Process for the Issue of AIDS,” Annenberg School of Comunications, University of Southern California.