His Death Focused Attention on Disease : Hudson Brought AIDS Coverage Out of the Closet

When Rock Hudson died in October, 1985, USA Today published an editorial that said, “With Hudson’s death, many of us are realizing that AIDS is not a ‘gay plague’ but everybody’s problem.”

Given Hudson’s own homosexuality, that statement seemed ironic. But it also proved to be strikingly accurate. AIDS coverage in the American media can clearly be divided into two eras, two eras so strikingly different that it’s almost as if it were two different diseases--pre-Hudson AIDS and post-Hudson AIDS.

“Prior to Rock Hudson’s death . . . U.S. policy-makers and the public could have concluded from mass media coverage (in general) that AIDS was perversely fascinating but, overall, not very important as a national issue,” said James Dearing and Everett Rogers of USC’s Annenberg School of Communications in their unpublished study, “The Agenda-Setting Process for the Issue of AIDS.”

But after Hudson’s death--beginning, really, with his diagnosis for AIDS--AIDS was suddenly Page 1 news, cover story news, network news. Everywhere.

More than 12,000 people were suffering from AIDS and more than 6,000 had died of the disease before Hudson, but a Times investigation has shown that:

--No one in the press asked President Reagan a single question about AIDS at a presidential news conference until after Hudson was stricken with the disease.

--Not once in the first three years of the AIDS epidemic did the annual Associated Press poll of editors and broadcasters on the year’s most important stories include AIDS in the top 10; AIDS finally made the list in 1985--after Hudson’s death was judged to have “illuminated the insidious powers of the disease.”

--AIDS stories in the major print media more than tripled in the first six months after the announcement of Hudson’s diagnosis.

Just five days before Hudson’s diagnosis, Marlene Cimons--a reporter in the Washington bureau of the Los Angeles Times--said one of her editors in Washington questioned her use of the word epidemic in a story on AIDS funding.

“Couldn’t we call it an outbreak , he asked. “I don’t know anyone who has this disease. Do you?”

‘A Different Dimension’

George Cotliar, managing editor of the Los Angeles Times, echoed the comments of many editors in saying, “Clearly, when you get a celebrity, you do have a different dimension to a story.” But Cotliar, like many other editors, insisted, “We didn’t rush into battle because of Rock Hudson. . . . I don’t think that anyone stopped and said, ‘Hey, Rock Hudson has AIDS; let’s turn loose twice as many reporters (on the AIDS story).’ ”

True enough. After all, The Times had published more than 200 stories on AIDS before Hudson’s diagnosis. But like most papers, The Times greatly increased the space and the prominence it accorded AIDS post-Hudson.

In the six months before Hudson was diagnosed with AIDS in July 1985, The Times published three Page 1 stories on AIDS; in the six months after Hudson’s diagnosis, The Times published 29 Page 1 stories on AIDS--several of them comparable to earlier stories that did not run on Page 1. Analyses at other papers yield similar findings.

Interestingly, although Hudson’s case triggered the largest and most enduring wave of press attention to AIDS, the first such wave actually came in the spring of 1983 after the Journal of the American Medical Assn. published an article (and an editorial) suggesting that “children living in high-risk households are susceptible to AIDS . . . (without) sexual contact, drug abuse or exposure to blood products.”

When Lawrence Altman, the New York Times medical writer, saw the brief wire service story his paper was planning to run on the study, he was “horrified” by it and wanted to write a story challenging it. But it was already past deadline for the first edition, and Altman said his editors didn’t want him to write a story for the next edition.

Then Altman saw the headline on the first-edition story--”Mere Contact May Spread AIDS.” He protested. In the next edition, the story carried a far less alarming headline--”Family Contact Studied in Transmitting AIDS.”

But when Altman tried to interest his editors in a follow-up story the next day, they weren’t interested; many other papers throughout the country followed the tone of the Journal study and the original New York Times headline.

“Once a seemingly authoritative source such as the Journal raised the specter that AIDS was not necessarily limited to a few specific groups, many in the media felt they had important backing to speculate and to scare,” said a 1984 report by the Twentieth Century Fund.

Red-Flag Words

Words like panic , terror , nightmare and fear began showing up in the nation’s news media, and even though the vast majority of medical authorities denied that contracting AIDS through casual contact was possible, the press leaped on the story more vigorously than on any other AIDS development to that time.

Collectively, the major news organs in the country published five times more stories on AIDS in the immediate aftermath of that Journal study than they had in the entire first two years of the epidemic.

Once this initial hysteria died down, media coverage dropped precipitously, though, and through the second half of 1983 and, especially, most of 1984 (an election year and an Olympics year) the media focused on other stories.

The San Francisco Chronicle, which had covered AIDS more thoroughly than any other paper from the beginning, was largely alone in remaining attentive to AIDS during this period. Through the first 10 months of 1984, the Chronicle published 163 stories on AIDS--60% more than the New York Times, Los Angles Times and Washington Post combined.

Then came Rock Hudson--and this time the media attention was not short-lived.

There were, of course, other developments in the AIDS story than Hudson’s death to provide new impetus for journalists in the second half of 1985. The Defense Department announced it would begin testing prospective military recruits for exposure to the AIDS virus. A test was developed to screen AIDS-tainted blood from the nation’s supply of blood for transfusions. Controversies about children with AIDS erupted in several communities--most notably in Kokomo, Ind., where 13-year-old Ryan White was barred from returning to school after contracting AIDS while being treated for hemophilia.

But in interview after interview for this story, journalists and public health service authorities alike agreed that it was Hudson who finally--belatedly, tragically--propelled AIDS into the public consciousness and onto the front page.

“Rock Hudson moved AIDS (awareness) ahead further in three months than it had (moved) in the preceding three years,” said Bruce Decker, president of the Health Policy and Research Foundation.

Concerns for ‘Good Taste’

Hudson’s death did more than make AIDS legitimate Page 1 material. It also helped persuade many editors that their concerns about “good taste in a family newspaper” might occasionally have to “give way to explicit, potentially life-saving information involving blunt language,” in the words of Stephen Klaidman and Tom Beauchamp in their “Case Study in AIDS Reporting.”

“Editors ask themselves questions like, ‘Would our subscribers like to read that at the breakfast table?’ ” Klaidman and Beauchamp said. Early on, most editors’ answer to that question was a resounding “NO!” Early media coverage of AIDS was often burdened by what what Newsweek later called “a squeamish lack of specificity.” AIDS is, among things, a sexually transmitted disease, and the words necessary to describe that transmission are not the sort of words one customarily finds in a daily newspaper.

At first, some reporters used only such euphemisms as intimate contact and an exchange of bodily fluids, but most soon realized that was misleading--misleading to readers who were not at risk for the disease but might be unnecessarily alarmed and misleading to readers who might be at risk for the disease and wanted to know what practices to avoid.

Given the absence of specific government education programs until very recently, reporters and public health authorities alike thought it especially important for the press to convey precise information in this area. Reporters wanted to be specific--to write semen and blood, not bodily fluids , for example--but many editors were worried that they might offend readers with such language.

Steve Findlay, now a reporter at U.S. News & World Report, remembered initially having to “make the reader guess what the hell was going on, rather than use the term anal intercourse “ when he was at USA Today.

Many major newspapers refused to use that phrase until after Hudson’s death.

Naming the Risky Practices

The Los Angeles Times was among the first papers to publish the words anal intercourse in an AIDS story--in April, 1983,--but when the paper’s medical writer subsequently tried to mention such risky sex practices as rimming (anal/oral sex) and fisting (inserting the fist and, sometimes, part of the forearm into the anus), his editors excised the phrases, even when he tried to use them without their definitions.

The Chicago Tribune, Boston Globe, Philadelphia Inquirer and San Francisco Chronicle have used these words in AIDS stories, though, and editors there insist they are not only relevant but essential.

The Globe “kind of sneaked up on” specific language, said Managing Editor Tom Mulvoy. The paper first used some specific sexual terms only in direct quotations and not on Page 1. But when the Globe published a special section on AIDS six months ago, editors decided, “We shouldn’t beat around the bush.”

Mulvoy said he didn’t receive a single angry letter from Globe readers about those words.

Like the Globe, most other papers have become far more specific in their use of sexual terms in AIDS stories since Hudson’s death. But vague phrases still creep into print occasionally. In October, a Los Angeles Times story said, “Health authorities say that the AIDS virus is transmitted only by bodily fluids during physical contact”--which could mislead readers into thinking they could contract the virus by brushing up against a sweaty person.

Public health service authorities said reporters who have been covering AIDS for a long time generally avoid this kind of dangerous journalistic shorthand; they try to spell out precisely how AIDS is transmitted and they often point out that medical authorities say AIDS cannot be transmitted through casual contact. But reporters new to a story often fail to include such essential qualifiers.

Because AIDS is such a powerful and sensitive story, with so many immediate, personal ramifications, newspaper editors said they have become increasingly aware that they must exercise special care in all aspects of the story, not just on potentially offensive words.

Many people involved in the AIDS battle resent the media’s use of the phrase AIDS victims for example; they prefer people with AIDS as less likely to intensify the sense of helplessness such individuals already feel. Most longtime AIDS reporters try to comply. But most papers are less cooperative in acceding to another request--that lovers of gays who die from AIDS be identified as survivors in obituaries; editors prefer to reserve that designation for legal spouses--although some occasionally identify surviving lovers as companions.

(Obituaries are a whole sub-species of AIDS journalism, presenting editors with several dilemmas--most notably, deciding whether to identify someone as having died of AIDS if neither his doctor nor his family is willing to say so. The San Francisco Chronicle has been most consistent in identifying AIDS as a cause of death and the Washington Post has often done so, too, but most papers have declined to specify AIDS as a cause of death without official confirmation. Editors said they don’t want to invade the privacy of the deceased or his family--and they don’t want to risk legal action if they turn out to be wrong. But critics say this practice further stigmatizes AIDS patients and initially made it possible for the government to underestimate the scope of the epidemic and to delay AIDS research, funding and education.)

Newspaper headline writers--who must try to summarize an entire story in a very few words--have special problems with a story like AIDS. Even the most responsible newspapers have published headlines about “AIDS Tests,” for example; but there are no tests for AIDS, only for the presence of the AIDS antibody. A mere technicality? No. Many have tested positive for the virus and have not developed the disease.

Dr. Neil Schram, former head of the Los Angeles City/County AIDS Task Force, said he once heard about a man who tried to kill himself after testing positive, mistakenly thinking he had the disease itself and was doomed to die when, in fact, he didn’t have (and may never get) the disease.

“Guiding an AIDS story through the reporting and editing process can be nearly as precarious as escorting tankers in the Persian Gulf,” said Thomas Heinen, reader-contact editor at the Milwaukee Journal.

Two-Page Policy

The Journal has tried to minimize these problems by formulating a two-page policy for “editing in the age of AIDS.” A few other papers have a policy of asking reporters knowledgeable about AIDS to vet all AIDS stories. The Boston Globe asks editors to check headlines on AIDS stories with the reporters who wrote them.

The New York Times and Washington Post, each of which has more than a dozen reporters and editors covering science and medicine, now provide the most thorough coverage of that aspect of the story in the American press, but as the AIDS story has continued to develop, different papers have come to cover it in different ways.

“I thought this was the biggest story I’ve ever seen or heard of in my life, and so I . . . put the best reporter I got on it (full time),” said James D. Squires, editor of the Chicago Tribune.

Thus, for most of 1987, the Tribune’s John Crewdson has been writing exclusively about AIDS, specializing in controversial stories that run contrary to the prevailing view on everything from the threat of heterosexual spread to the discovery of the AIDS virus to official projections on the numbers of AIDS cases expected in the United States.

Before one Crewdson story, it was widely accepted that a Danish surgeon named Grethe Rask, who died in December, 1977, was the first Westerner documented to have contracted AIDS and that the first cases of what came to be known as AIDS weren’t discovered in the United States until June, 1981. But in late October, Crewdson wrote a story saying, “AIDS may have been responsible for (the) otherwise inexplicable deaths (of as many as half a dozen Westerners) going back 30 years or more;” in one such case, the frozen blood of a 15-year-old St. Louis boy who died in 1969 tested positive for AIDS antibodies this year.

The Philadelphia Inquirer also has a reporter writing full time about the social and political impact of AIDS--Loretta Tofani, hired away from the Washington Post specifically for that job. (In October, Tofani helped Donald Drake, the Inquirer’s medical writer, put together a report on the global impact of AIDS on a single day--a report based on the work of 23 reporters and 16 photographers dispatched to 15 cities in the United States and seven cities abroad.)

The Post, the San Francisco Chronicle and Newsday have full-time AIDS reporters, too, and all these papers continue to cover AIDS with other reporters as well. In addition, Newsday has a special “AIDS page” in its weekly science section.

Praise for Coverage

USA Today has also won praise for some of its recent AIDS coverage--and for its longstanding editorial stance on the civil liberties issues involved in AIDS.

The Wall Street Journal, not surprisingly, has emphasized the economic aspects of the AIDS epidemic, but Marilyn Chase has written almost 100 stories on various AIDS issues since mid-1984, and her work is highly regarded in the field.

Indeed, several reporters have become especially well-known and well-respected among their peers and in the public health service field specifically for their work on AIDS in recent years--and many of them have become so emotionally involved in the stories that their work has become something of a personal crusade.

Several of these journalists work for the major daily newspapers, of course, but others are well outside that circle.

The medical reporters for the three television networks--Robert Bazell of NBC, Susan Spencer of CBS and George Strait of ABC--are all highly regarded for their AIDS coverage, for example, but in the course of more than 100 interviews for this story, Laurie Garrett of National Public Radio and Jim Bunn, now on leave from television station KPIX in San Francisco, were praised far more often than any other electronic journalists (and more often than virtually all other print journalists) for their coverage of AIDS.

Although some gay journalists--and some gay leaders--initially tried to downplay AIDS, for fear that it would further stigmatize gays, Larry Mass, a gay physician and writer, wrote the first AIDS story to be published in any American newspaper (the New York Native, May, 1981), and he has become “the exemplar for continuous, accurate, informative coverage” of AIDS, in the words of Dr. William Check, co-author of “The Truth About Aids: Evolution of an Epidemic.”

Lisa Keen, editor of another gay newspaper, the Washington Blade, wrote a moving, 11-part series in 1985 following an AIDS patient from diagnosis to death, and Susan Okie, a Washington Post medical writer, said that series (along with a later AIDS series in the New Yorker) “got the attention of the Post editors” and helped increase the paper’s commitment to AIDS coverage.

Journalistic Goats

But if there are journalistic “heroes” in the AIDS epidemic, there are also journalistic goats--more institutional than individual, especially among the national magazines. Although journalists and public health service professionals alike praise Newsweek for its AIDS coverage, for example, most also say the worst examples of “scare journalism” came in Life and Atlantic Monthly.

Life’s July, 1985, cover story “Now No One Is Safe From AIDS”--with its huge, red type and its cover photos of a family, a young woman and a saluting soldier--was the single most widely criticized story presentation during interviews for this article.

Not far behind: The Atlantic’s stories on the threat of AIDS to the heterosexual community and on the potential dangers of insect transmission of AIDS.

In fact, several newspapers--most prominently, the Atlanta Constitution--have also written about the latter subject, especially the alleged involvement of mosquitoes, even though medical authorities insist this means of transmission is highly unlikely.

The question of heterosexual transmission of AIDS in the general, non-IV-drug user population is a more open question, though.

From late 1985 through early 1987, the press was filled with such headlines as “Heterosexual AIDS Spread Causes Growing Concern” (Washington Post), “AIDS Linked to Heterosexual Contact” (Philadelphia Inquirer) and “AIDS Readily Transmitted from Women to Men, Study Shows” (Boston Globe).

Many initial stories on this threat derived from a 1985 study of military personnel, and the New York Times and Washington Post were among the few papers to point out immediately that the study was questionable because its sample was so small (41 patients) and, as the New York Times reported, “covert homosexuals or drug-abusers in the military may well lie about how they picked up the disease” to avoid punishment or ostracism.

It wasn’t until 1987 that a few papers--among them, the New York Times on its editorial page and (several months later) the Chicago Tribune on its front page--reported that there is very little evidence so far that AIDS has entered the general heterosexual population.

Editorial Criticized

It is symbolic of the disagreement in the press on this issue that the New York Times editorial specifically criticized an earlier Los Angeles Times editorial that had said, “Unless society can loosen the grip that the AIDS virus has taken on heterosexuals, it will not be long before the pattern the disease has followed among gays repeats itself among straights.”

Six months later, the Los Angeles Times published a Page 1 story that seemed to echo the New York Times editorial and to contradict its own editorial. “There is a growing consensus among leading medical scientists that the threat of AIDS to the wider population, while serious, has been exaggerated,” that story said.

But disagreement in the press on how to report the threat of AIDS to the general heterosexual population is not surprising. AIDS experts disagree on the threat, too.

Of the 48,574 AIDS cases reported so far to the Centers for Disease Control in Atlanta, 93% involve gays, bisexuals, intravenous drug-users, hemophiliacs and those who received blood transfusions before AIDS-tainted blood was screened from the nation’s blood supply. Of the remainder, 3% are classified by the Centers for Disease Control as being of “undetermined” origin and 4% are classified as heterosexual.

But almost half those heterosexual cases involve patients born in countries in which, the Centers for Disease Control said, “heterosexual transmission is believed to play a major role” (primarily in Haiti and some African nations), and the other half are patients who have had “heterosexual contact with a person with AIDS or at risk for AIDS.”

Many medical authorities say it’s just too soon to know about secondary and tertiary transmission of the disease--i.e., what will happen if the large numbers of gays, bisexuals and IV drug-users suffering from AIDS have sex with a large number of heterosexual non-drug-users--and then those heterosexual non-users have sex with other heterosexual non-users . . . and so on.

Although some AIDS experts say there would already be far more heterosexual cases than there are now if a major AIDS epidemic were likely in the general heterosexual population, others say that the long incubation period of the AIDS virus means most cases being diagnosed now were probably contracted several years ago when there were far fewer known cases.

Thus, these authorities worry that press accounts that minimize the threat of AIDS to the general heterosexual population could deter many heterosexuals from taking precautions; that, they say, could make the spread of the disease inevitable.

Testing a Difficult Story

Testing has been an equally difficult story for the press to cover, for similar reasons. No one really knows how effective testing will be, or just what it means to say the tests are “accurate.”

Medical authorities say the two tests for AIDS antibodies, combined, are accurate to within a tiny fraction of a percentage point. But when the tests are applied to a low-risk population--say, 100,000 blood donors in Peoria--estimates by the Congressional Office of Technology Assessment say that 80 of the 89 people who would test positive would actually be negative.

The New York Times (in editorials) and the Washington Post and Boston Globe (in news stories) are among the few papers to have made this point about “false positives” strongly.

The AIDS story is a continuing, complex story, though, and few papers have covered everything well. Although the L.A. Times has been widely praised for its AIDS coverage, for example, The Times has yet to report that the death rate among AIDS patients is higher in Los Angeles than in any other city with a large AIDS caseload--63% as compared with, say, 49% in San Francisco.

Nor did The Times (or most other papers) aggressively investigate the controversy three years ago over whether Dr. Robert Gallo of the National Cancer Institute or Dr. Luc Montagnier of the Pasteur Institute in Paris deserved the most credit for discovering the AIDS virus.

“A full year was wasted (by that dispute). . . . Many lives could have been saved,” Cambridge biologist Abraham Karpas told the British magazine New Scientist early this year.

Ironically, given the widespread criticism of the press for having been too slow to recognize the significance of the AIDS story originally--and then too slow to begin writing about the threat of AIDS to IV drug-users--some of the most outspoken criticism of the press now involves its more traditional tendency to move too quickly on a given story.

Sometimes, the press has been too quick to trumpet (or to dismiss) new AIDS drugs without fully understanding the drug-testing process, said Dr. Samuel Broder of the National Cancer Institute. On other occasions, public health authorities say, stories on the infection of health workers with the AIDS virus have been rushed into print based on incomplete and potentially misleading preliminary reports and without putting the incidents in perspective.

Of 5 million health care workers in the United States, only 13 who were not at risk for other reasons have been officially identified as having been infected with the AIDS virus, for example, but few papers mentioned that when they published stories in May, saying three hospital workers, none of whom belong to any known risk groups for AIDS, had tested positive for AIDS “after coming into contact with the blood of an infected person.”

Moreover, it wasn’t until the next day that papers printed a second story, quoting a Centers for Disease Control spokesman as saying the infections were “rare” and wouldn’t have occurred had “the recommendations and guidelines that existed . . . been followed.”

Concern Over Alarm

Public health service authorities worry that misleading press accounts of health worker infections--like misleading stories on the threat of AIDS transmission by casual contact, mosquitoes and heterosexual contact--alarm the public and make their job more difficult.

The press has a responsibility to help educate the public, they insist, and indeed many public health service authorities say that in the absence of a strong government education program on AIDS, the press has actually provided the best education available to the public.

But most journalists say public education is not their responsibility. Their responsibility, they say, is to report the news. Besides, they say, they couldn’t provide the necessary education even if they wanted to.

“If the mass media were an excellent source of public education, nobody in the United States would smoke cigarettes. . . . Nobody would be eating cholesterol-rich foods as a steady part of their diets,” wrote Laurie Garrett in the March, 1987, newsletter of the National Assn. of Science Writers.

She may be right. As recently as October, a Gallup Poll showed that 29% of the public still thought one could catch AIDS by donating blood and 26% thought one could catch it by using the same drinking glass as an AIDS patient, even though the press has long reported that medical authorities vigorously reject the likelihood of either happening.

Actually, most public health service authorities say the press has generally done about as good a job on AIDS as could be expected under the circumstances.

”. . . . If it weren’t for the press, we wouldn’t have any AIDS prevention program in the United States. . . . We wouldn’t have any knowledge. . . . We’d be in real bad shape,” said Dr. Donald Francis, the Centers for Disease Control AIDS adviser to the state of California.

Yes, the press has made mistakes. But so have scientists, public health service professionals and government officials.

“Overall,” said James Curran, director of the AIDS program for the Centers for Disease Control, “I think the press has probably performed as well (on AIDS) as I have . . . and I don’t give myself bad marks.”

Susanna Shuster of The Times editorial library assisted with the research for this story.