We all recall the first case of COVID-19 reported in the US in late January 2020, and the first waves of lockdowns beginning in mid-March of that year; the pandemic’s destruction of our sense of normalcy was so rapid it felt instantaneous. In one moment, COVID-19 was a back-page news story about a new virus in China; in the next, we were hunkered down in our homes venturing out only to search for stores which hadn’t been cleared out of basic cleaning supplies and toilet paper.  With such a monumental public health crisis unfolding in real time, we needed information, and there wasn’t much to be found. Confused leadership and denial in the executive branch of the federal government obstructed the good-faith efforts of the CDC. There was demand from an anxious public for immediate answers to the question of how this could have happened – a demand incompatible with the meticulous, time-intensive endeavor of epidemiological investigation.   

With no explanation readily available, and with scientific denial rampant across the Republican party and Trump administration, scattered pieces of information about the origin of the pandemic were compiled into half-baked theories and shared in public discourse, through the office of the President (injecting bleach, hydroxychloroquine), and through even less-informed people on social media. Real epidemiological investigations continued, but scientific research struggled to compete with alternative facts. The hunt for a negligent, careless, or possibly even malicious actor who singlehandedly set off the pandemic had begun. One scientist must have been haphazard with laboratory safety procedure and caused the virus to escape its controlled environment, or someone in China must have eaten a meal of exotic animal meat procured from a Wuhan wet market. There must have been a Patient Zero. These theories, regardless of their sensationalism, led to real consequences - for Asian Americans in particular. The racialization of the virus by the Trump administration and their GOP counterparts accompanied a significant rise in anti-Asian hate crimes from 2020-2021, and Asian people (regardless of whether they were Chinese or not) were stigmatized as vectors of disease and death (Associated Press, 2021). 

This rapid descent to fear-induced stigmatization of an outgroup in the immediate aftermath of a crisis, particularly a public health crisis, is not unfamiliar to those who witnessed the origins of the HIV/AIDS epidemic in the 1980s. In the case of COVID-19, there was no identified individual who has been universally branded as the cause of the pandemic, though some tried to blame the Chinese government. For HIV/AIDS, narratives coalesced to assign blame to a single person: a Canadian flight attendant named Gaetan Dugas – the person for which the now-common term Patient Zero was invented. 

The Flight Attendant: Initial Reports of AIDS in the US 

Gaetan Dugas was born in Quebec City, Canada in 1952. Described as outrageously flamboyant and unapologetically charismatic in his identity as a gay man by his friends and coworkers, Dugas joined Air Canada’s flight attendant crew in his early 20s. In the backdrop of the 1970s where “sex was kind of the gay man’s obligation…because this was gay liberation” (Killing Patient Zero, 2019, 21:50), Gaetan utilized the benefit of frequent travel to enjoy casual sex with partners in several cities across the US and Canada. Gaetan particularly frequented New York City and San Francisco, a key detail which would eventually lead to his branding as Patient Zero due to the earliest known cases of “Gay Cancer” (later identified as Kaposi’s Sarcoma, a rare skin cancer that can present as a symptom of AIDS) being reported from these cities in 1981. Gaetan himself was diagnosed with Kaposi’s Sarcoma in 1980 and eventually traveled to New York City to seek treatment for his condition (McKay, 2014).  

With rising cases of young, otherwise healthy gay men presenting to hospitals with an aggressive form of a rare skin cancer and dying relatively quickly after admission from unexplained immunodeficiency and pneumocystis pneumonia, investigations were undertaken by the CDC to solve the rapidly emerging phenomenon in 1981. At this time, the way the condition was transmitted was unknown, which caused a frenzy of paranoia and fear. Hypotheses of how the condition spread ranged from the use of alkyl nitrate aka “poppers” (a popular recreational drug within the gay community) to a CIA bioterror plot to repeal the progress made by the gay liberation movement in the previous decades. In the summer of 1981, the CDC task force assigned to investigate the emerging AIDS epidemic received a report of three young men in Los Angeles who were in the same hospital with the same condition and had all been sexual partners. This prompted the CDC to “pursue the possibility of a cluster of cases connected by sexual contact within the last 5 years” (Killing Patient Zero, 2019, 35:53).  

Over the course of the investigation, similar descriptions of sexual relationships with a tall, handsome, French-Canadian flight attendant were reported among several of the interviewed subjects.  William Darrow, the lead investigator for the Los Angeles cluster study, was eventually able to secure a name and contact information for Gaetan. The two met in New York in 1982. According to Darrow, Gaetan was very intelligent and well-read on what little information was available about AIDS. Darrow also describes Gaetan as very concerned about his condition and the health and wellbeing of others. Many of his friends in the US and Canada had been exhibiting similar symptoms to his, and some had even died by the time of his initial interview with Darrow. Darrow cites Gaetan’s sympathy as a catalyst for his cooperation in the investigation, particularly regarding questions involving his sex life. Gaetan was able to provide the names of 72 past sexual partners connected to the cluster study. Darrow followed up with the 72 contacts provided by Gaetan in an attempt to link cases in New York and San Francisco. Gaetan would meet with CDC researchers several more times before his death from AIDS-related complications in March 1984. Because of Dugas’ diligent cooperation with the CDC and abnormally extensive memory of past sexual partners, Dugas was vital to the confirmation of the hypothesis that AIDS was spread through sexual transmission, which led to the eventual discovery of the HIV virus in April 1984, only a month after Gaetan’s death. Due to Gaetan’s exceptional documentation of past sexual partners and invaluable contributions to CDC researchers, he became a central figure to early CDC reports of the AIDS crisis. Unfortunately, this act of compassion and selflessness led to his eventual demonization. 

The week of Gaetan’s death, the CDC made their Los Angeles/New York cluster study available to the press. The initial drafts of the study did not directly name Gaetan Dugas. He was referred to as Patient O, the letter O standing for ‘Out of California’. This was misread by Darrow’s fellow researchers as Patient 0, the number zero, and by the time it was released to the public, Patient Zero became known as the origin point of a web of successive AIDS cases connected through sexual contact. This was the birth of the term Patient Zero, and its misguided personification of the origins of disease. 

And the Band Played On 

After the death of Gaetan Dugas the person, Gaetan Dugas the character was being formed in the mind of author Randy Shilts. Shilts was a journalist for the San Francisco Chronicle who had dedicated himself to being a constant voice of concern about AIDS. He operated in a media environment largely silent about the epidemic due to systemic homophobia and the lack of a coordinated public health response by the conservative federal government. To counter this silence, Shilts was relentless in his coverage and investigation of AIDS, and published the bestselling history of the early AIDS epidemic And the Band Played On in 1987. He was a constant presence in AIDS-related meetings and press events across the country from the epidemic’s earliest days until his passing. Shilts was determined to uncover the identity of Patient O from the 1984 cluster study, which Shilts and his peers had misinterpreted as Patient Zero. In his mind, and to many others, Patient Zero represented the epicenter of the epidemic, a missing piece crucial to the narrative he was crafting for his book. After numerous interviews with CDC researchers, medical officials, and others on the frontlines of the AIDS crisis, Shilts’ journalistic pursuit had led him to the missing piece of his puzzle. Patient Zero was Gaetan Dugas.  

And The Band Played On drew from the detailed research for articles Shilts had written in the San Francisco Chronicle about the AIDS crisis, held together with highly dramatized narrative elements. Lead CDC Researcher William Darrow, whom Shilts had interviewed dozens of times throughout his investigation, begged him not to publish the identities of patients from the cluster study that included Patient O. Feeling it was his duty to do so, Shilts published the book naming every name he had. At the time of Band’s drafting, what little reporting was circulating about the AIDS epidemic was largely presented in a medicalized frame.  Numbers, figures, data, and the opinions of medical officials took priority over personal experiences of those living with AIDS. With coverage divorced from lived experience, people living with and dying from AIDS were dehumanized in the media, and as a result, people experiencing AIDS were subject to dehumanization in their lives. Shilts, who received an AIDS diagnosis in 1987 eight months prior to the publication of Band, felt that naming names was necessary to get the government and the country to finally take the epidemic seriously and “bring home the reality of the epidemic and make it far less frightening” (McKay, 2014). 

And The Band Played On did in many ways humanize those experiencing AIDS, and more importantly, helped to shift the public’s perception of those experiencing AIDS from degenerate vectors of disease to people with a medical condition. However, Shilts dramatized lived experience, crafting his own narratives instead of sharing directly from primary sources. He framed people living with AIDS as victims, and as such, he needed a villain, whom he found in Gaetan Dugas. Shilts portrayed Gaetan Dugas not as a product of systemic failure to address AIDS fueled by prejudice, homophobia, and government negligence, but as a careless, sociopathic Typhoid Mary-like character who knowingly infected others with disregard for anything except satisfying his endless sexual appetites. Shilts made this decision knowing that Gaetan was dead and could not object to his name being used in such a sensationalized profile nor provide any defense for himself. The success of the book sparked a wave of media coverage, which was highlighted by a 1987 front page article in the notoriously homophobic New York Post titled "The Man Who Gave Us AIDS."


Gaetan was lambasted throughout the media with the same vitriol his character was written to evoke. The concept of a Patient Zero has since become a standard framing device for the origin of communicable disease, continuing to fuel a misplaced desire to manufacture a single villain for the cause of disease spread.  

Gaetan Dugas was vindicated of his “Man Who Gave Us AIDS” label in 2015 when his viral DNA was genetically sequenced and compared to other samples. There was nothing significant about his HIV sample compared to others at the time – genetic analysis showed that HIV was present in the country at least a decade before Gaetan contracted it (Doucleff, 2016). These discoveries decades later do not erase the damage done to Dugas' legacy and to those living with HIV/AIDS through the stigmatizing concept of Patient Zero. And The Band Played On and other media at the time failed to cause the government to take accountability for public health, as Shilts had hoped. Rather than emphasizing authentic lived experience to foster empathy and understanding, the sensational framing of Gaetan Dugas as a villian and the Patient Zero narrative enabled the simmering stigma of dehumanization and moral condemnation to metastasize in the public's conception of people living with HIV and AIDS. The Patient Zero narrative, combined with widespread prejudice, placed gay men in the role of scapegoat, allowing the public health system to wash its hands of its systemic failure to address the epidemic at all three levels of government. 

Reagan’s Failure 

It cannot be overstated how pervasive stigma was in this environment. Most AIDS diagnoses were among young gay men, who would have grown up anywhere between the 1940s and 1960s. In that time, existing as a gay person was illegal in most of the country. Police routinely raided gay bars and brutalized attendants. There were no legal protections for discrimination based on sexual orientation. LGBTQ+ people could be fired from their jobs, evicted from their homes by either their parents or landlords, and arrested for exhibiting anything deemed homosexual behavior by their arresting officer. The Health Insurance Portability and Accountability Act (or HIPAA) with its medical privacy and anti-discrimination policies didn’t exist yet, so the security of a person’s medical history and patient confidentiality was without any protection. Homosexuality was listed in the Diagnostic and Statistical Manual of Mental Disorders as a mental disorder less than 10 years before the onset of the AIDS crisis. Homosexuality was simply unspeakable without risking life-threatening consequences. While there was great progress in the post-Stonewall gay liberation movement, and progress continues, the stigma that both precipitated and perpetuated anti-LGBTQ+ stigma and practices persists to this day.  

Deeply conservative, hostile to public services, and promoting sanctity of the heterosexual nuclear family as the cornerstone of American life, the Reagan administration was infamously neglectful toward the rapidly escalating AIDS crisis in the early 1980s due to entrenched homophobia and an aversion to federal oversight. When asked a question about the growing crisis in a 1982 White House Press Conference, Reagan’s Press Secretary Larry Speaks dismissed the question with sarcastic laughter and irreverence (Lopez, 2016). This malicious disregard for any kind of appreciation for the gravity of the AIDS crisis continued throughout the mid-1980s as death tolls multiplied on a yearly basis. President Reagan did not so much as say the word “AIDS” in public until his second term during a press conference in 1985 and did not address the nation regarding the existence of the epidemic until 1987, when deaths numbered in the tens of thousands. The Reagan administration’s dereliction of duty to address AIDS, to invest in research and treatment, to develop clear messaging to the public, to so much as discuss causes and risk factors publicly, created a vacuum of public health leadership that was inevitably filled with conspiracy theories, conjecture, and prejudiced misinformation - like the Patient Zero narrative.  Reagan’s prejudice, borne of ignorance, bred further ignorance and prejudice that cost us thousands of lives. 

The Enduring Harms of Stigma 

The tragic irony of Gaetan Dugas is that it was precisely his curiosity and investment in public health – his repeated interviews with epidemiologists, his attendance at conferences, his regular medical visits – that exposed his identity and allowed him to be assigned blame by those less interested in understanding the AIDS epidemic. In the absence of strong public health leadership, stigma, misinformation, and blame flourished. This pattern repeated itself with the recent COVID-19 pandemic. The scapegoats created to bear the brunt of blame for these crises say more about our society’s fears and anxieties than they do about disease. With HIV/AIDS, societal fears of homosexuality and of wider sexual liberation and civil rights movements were projected onto the public understanding of the epidemic. With COVID-19, the fear of Chinese ascendancy on the global stage manifested as a demonization of the Chinese government and people in response to the global pandemic. With both COVID and HIV, it was easier to assign stigma and blame to already marginalized groups than it was to mount a comprehensive public health response. We have not yet learned our lesson, that microbes cause disease, not people – and that the way to respond is through open inquiry and robust public health services. Stigma heals no one.