A “Creation of the Media”: AIDS, Sensationalism, and Media Portrayals of Epidemic Risk

Understanding the bitterness of AIDS-related media controversies requires situating them within two key upheavals underway in the 1980s: one in public trust in scientific expertise, the other about journalistic standards. As medicine and science became more central to American life in the years following the second world war, reporting on infectious diseases became part of the recognized subspecialty of science journalism. Journalists assigned to the science beat were expected to develop technical knowledge of the subject as well as exhibit the values that scientists were assumed to possess: objectivity, neutrality and, above all else, fealty to the scientific process. As David Perlman, longtime science editor for the San Francisco Chronicle, noted, “The science writer is above all a reporter, and as such is not entitled to bias or conflicts of interest.”¹³

In theory, journalists highly knowledgeable about scientific complexities were supposed to explain them in ways that would prevent popular misunderstanding. In practice, controversies about what constituted good science and good government consistently complicated the work of science reporting. As the medical and health care industries expanded in the years after World War II, new bonds among universities, the pharmaceutical industry, and the government complicated what constituted “objective” reporting about medical controversies; important examples include Morton Mintz’s work on thalidomide in the early 1960s, Barbara Seaman’s on the birth control pill in the late 1960s, and Jean Heller’s on the Tuskegee Syphilis Study in 1972. This journalism reflected growing concerns about the tendency of an almost exclusively white male scientific “establishment” to ignore the needs of women and people of color. In covering such stories, both scientists and journalists had to contend with laypeople who felt it was their right and obligation to read the science and evaluate risks for themselves.¹⁴

The growing dependence in medicine and public health on risk assessment became a key battleground for these debates. Reliant on what political scientist Herbert A. Simon termed in 1968 “the sciences of the artificial,” risk assessment relied on huge data sets collected and analyzed by computers in ways that seemingly promised greater precision in gauging the probabilities of specific threats. Although women contributed to this work, the largely white male professions of computer science, epidemiology, and medicine dominated the creation of this allegedly more scientific, rational approach to disease avoidance and management.¹⁵ Being able to mitigate disasters depended on alerting members of the public to danger and getting them to modify their behavior as needed. In theory, expert analysts would run the numbers, develop the models, and then issue informed guidance about what people needed to do. Newspapers and television stations would then report that message clearly and calmly, and the public would act rationally to minimize the threat. In this model, “affect and emotions were seen as interfering with reason,” as one risk communicator noted, and thus to be avoided. It was an appealing model of how expertise should work and—despite decades of evidence disputing any singular or pure rationality—constitutes a common approach to risk communication even today.¹⁶

By the time AIDS appeared in the early 1980s, these methods of risk analysis and risk communication about health threats had become formalized and rationalized. But as the controversies described in Science in the Streets made clear, the way that risk assessment universalized and objectified bodies at risk had already generated serious criticism. In responding to the environmental crises of the 1970s, activists and journalists had begun to question what constituted “pure” science and “rational” science communication, calling attention to their minimization of the risks faced by specific groups, such as women, low-income homeowners, and communities of color.

These critiques of scientific objectivity and universality collided with a parallel crisis underway within journalism. Younger reporters shaped by political controversies and upheavals, especially regarding the Vietnam War, questioned the values of the older generation now in charge of editorial policy and business strategy in both print and electronic journalism. As Michael Schudson wrote in 1978, “to the increasingly numerous and vocal critics, the rhetoric of objectivity seemed hypocritical or deceitful, or in Vietnam, criminal.” This new generation of journalists called out what they saw as “an ideology of technique and neutrality” that concealed the underlying biases inherent in so-called objective reporting and editorial policy.¹⁷

Initially focused on politics and foreign relations, this journalistic debate expanded over the course of the 1970s to include reporting on scientific issues. As the 1984 Task Force report noted, standards of science reporting had been tested and found wanting during a string of environmental and public health controversies, including the 1978 Love Canal controversy about industrial wastes in the groundwater and the 1979 Three Mile Island nuclear power plant incident near Pittsburgh. As the report observed, “Scientists claim that they act responsibly by insisting on having all the facts before making information public,” and “public officials believe that they are acting responsibly when they withhold information that might cause unnecessary panic.” In contrast, “journalists believe—as we do—that their responsibility is to disclose the risks (real or perceived) at hand—whatever the costs.” So deep were the Task Force members’ own divisions about these issues that they could not come to consensus about a single set of recommendations.¹⁸

The report’s discussion of the Ford administration’s swine flu vaccination program warrants a closer look in light of the influence it later had on public health responses to AIDs. In January 1976, public health officials reported a flu outbreak among new recruits at Fort Dix, New Jersey; in total, about two hundred men fell ill and one died. Genetic analysis of the cases showed that four men, including the dead soldier, were infected with a variant known as “swine flu.” Based on new modeling of viral evolution, experts worried that enough mutations might have occurred for a potentially deadly return of the strain responsible for the 1918–19 influenza pandemic, still the deadliest outbreak of the twentieth century. CDC director David Sencer thought even the slight probability that the Fort Dix outbreak represented a return of that variant required aggressive action, and he convinced President Gerald Ford to launch a mass vaccination campaign in March 1976.¹⁹

Unlike most medical stories, which appeared only on the science pages, the swine flu campaign was covered as national news. Initially, that coverage simply conveyed the government’s talking points. As then USA Today reporter Abigail Trafford recalled, “in the beginning, the story was wrapped in fanfare,” complete with “staged hoopla events that must be covered and thus build momentum for the government’s program.” But this publicity meant that once the program began to encounter problems, they too would be reported as news. Initial criticisms came not from the press corps but from public health experts who questioned the need for the program: there were as yet no signs of a mass outbreak, they noted, so why not wait to vaccinate until there was? Vaccines could never be 100 percent safe, so should not be used unless absolutely necessary.²⁰

An array of influential mainstream media outlets picked up those concerns. Harry Schwartz, then on the New York Times’s editorial board, wrote an editorial in June 1976, suggesting the requisite vaccination was a “swine flu false alarm.” Network news also covered the dissent; for example, Martin Goldfield, a public health official from New Jersey, shared his concerns in a televised interview. The network coverage, in classic journalistic form, reported both Goldfield’s perspective and expert opinion arguing the contrary. As the mass vaccination program encountered more obstacles, including pharmaceutical companies’ demands for protection against potential lawsuits, the journalistic style of reporting perspectives from “both sides” proliferated. Then in early August 1976, attendees at an American Legion convention in Philadelphia fell ill of a mysterious respiratory disease, raising fears that it was swine flu. Although that claim was quickly disproven, the outbreak of Legionnaire’s disease helped the Ford administration win passage of the needed tort relief legislation.²¹

The mass vaccination campaign finally began in early October 1976, followed almost immediately by widely reported news: three elderly people in Pittsburgh died after receiving their shots. Assistant Secretary of Health Theodore Cooper held a news conference denying that the vaccine caused the deaths and decrying the press’s “body count mentality”; that same evening, Walter Cronkite chided his fellow journalists for their overly dramatic reportage of the Pittsburgh deaths. Then in early November came reports of people developing Guillain-Barré syndrome after being vaccinated; the “body count” reportage switched to those cases, and more experts expressed concern. The polio vaccine pioneer Albert Sabin, who had initially supported the campaign, wrote a New York Times editorial lamenting “the use of 1918 ‘scare tactics’” to justify it. In mid-December, the program was halted. After Jimmy Carter was inaugurated as the 39th US president in January 1979, his new secretary of health Joseph Califano reviewed the program, decided not to restart it, and asked Sencer for his resignation.²²

In its aftermath, the swine flu episode became an object lesson in how not to make public health policy and how not to communicate to the public about a possible pandemic threat. Overall, policy makers read the swine flu “debacle” as a case of government failure rather than press irresponsibility. It was the Ford administration that had “cried wolf” and responded foolishly and unscientifically, producing an “overemotionalized situation,” as critic Martin Goldfield told Martin Waldron of the New York Times. To be sure, the press bore some responsibility in the debacle; as Goldfield noted, “talk and newspaper stories about a new ‘killer flu’ have created unnecessary alarm.” But overall, analysts agreed that the main fault lay with the Ford team’s inappropriate politicization of public health policy. In reporting on that debacle, the press was arguably just doing its job.²³

In retrospect, media coverage of the swine flu debacle seems remarkably restrained, given the issues raised about government overreach, expert dissension, and the risks of vaccination. This controversy played out at a time when the media elite, including the most influential newspapers and the three major network news outlets—ABC, CBS, and NBC still dominated the news industry. But their dominance was already weakening, and the changing media milieu of the 1980s complicated the scientific and governmental responses to HIV/AIDS.

By the 1980s, science reporting by mainstream newsmakers no longer had the power to frame the agenda that other media outlets would follow. Newspaper readership was steadily declining, creating increasing pressure on papers to compete for attention. With the founding of CNN in 1980, the cable television channels mounted a serious challenge to the old broadcast system, creating a 24/7 news cycle that required quick turnover and a high volume of stories. Cable also opened up the possibility for national talk show formats that brought in dramatic “vox populi” segments, for example, Phil Donohue in 1982, Oprah Winfrey in 1986, and Geraldo Rivera in 1987. The cable revolution accelerated the shift from programming aimed at a “mass” audience to more diverse media niches. Similar trends reshaped radio; the proliferation of FM music-oriented stations led to the rise of all news stations and talk shows on the AM band. So-called shock jocks attracted a largely blue collar male audience. Conservative Rush Limbaugh started a nationally syndicated talk show in 1988 that gained a huge following.²⁴

This competitive environment reactivated old and fierce debates about journalistic standards and ethics that dated back to the heyday of “yellow journalism.”²⁵ These debates perpetuated a division of news into “hard” and “soft,” information versus entertainment, reason- versus emotion-driven. “Hard” news supposedly appealed to the higher order needs for objective, rational information: what informed citizens (imagined as affluent white men) needed to make wise political and economic choices. In contrast, “soft” news appealed to the lower order needs for distraction and entertainment: what the “masses” (imagined as emotional women and uneducated men) needed to find pleasure or relief in their everyday lives. Defenders of the old news traditions of “objective” or evidence-based investigative journalism decried the growing tendency to report on dramatic, usually “bad,” news to lure in bigger audiences.²⁶

The flavor of this “journalism is going to the tabloid dogs” argument was brilliantly captured in Eric Pooley’s 1987 article “Grins, Gore, and Videotape” in New York Magazine, which is credited with introducing two phrases that would be often repeated: “body bag journalism” and “if it bleeds, it leads.” Pooley’s article focused on the declining quality of local news coverage in New York City. The major networks that owned local news outlets (WABC, WCBS, and WNBC) had learned that they could slash news-division budgets without diminishing their overall profits because the strength of their prime-time entertainment lineups kept viewers on to watch the late news on their channel. Without funds to hire their own reporters, local news became a form of entertainment. Overworked staff had to “put on a newscast that will grab viewers with lurid ‘teases,’ compete in the ratings game, cover the next day’s tabloid headlines, and—every so often, almost by miracle—break real news or offer real insight.”²⁷

It was in this context, Pooley explained, that “crime and tragedy” stories had come to dominate the local news; “it if bleeds, it leads.” He linked the tilt toward sensationalist news coverage to the growing class divide in news consumption. Late night news watchers were blue collar types; as Pooley put it, “Joe Beercan wants blood.” Better educated, more affluent viewers—the ones advertisers most valued—did not. As an advertising professional observed, those upscale viewers shunned the local news as “the same awful stuff every night” and instead turned the channel to CNN, Nightline, or Cheers.²⁸

Significantly, Pooley’s article did not mention AIDS, which by 1987 had become a major issue in New York City politics. But the trends he described deeply affected decisions about how to report information about AIDS: whether it should appear on the front page, above or below the fold, or on the science pages, and whether it should be configured as “hard” or “soft” news. Those decisions exposed the lack of consensus in key circles, including scientists, government leaders, and journalists, about AIDS’ seriousness as a public health crisis: was it a “mini-menace” or a national emergency? In the absence of consistent messages from scientists and public health officials, deadly silences and distortions flourished in the mainstream press, creating voids that nonelite players (alternative newspapers, tabloids, and talk shows) would step in to fill.

To start with, covering the AIDS story exposed the inability of elite news outlets—the newspapers of record and the national broadcast news—to live up to public health experts’ expectations for covering a developing disease crisis in a “rational,” unbiased fashion. In theory, the more elite media outlets, which had science reporters with connections to experts in different fields, were supposed to take the lead in deciding which science and technology issues merited attention. When a new risk appeared, those journalists would relay and disseminate what scientific experts knew about the problem and thought “the public” needed to know. This “agenda setting” model failed to work with AIDS because of problems with the scientific “feed”; expert consensus about what the disease was, how it was spreading, and who was at risk took several years to solidify. Problems also emerged in the journalistic framing of that uncertainty. The mainstream press coverage of AIDS was marked by “variability and volatility,” as one 1991 study concluded: short peaks of attention followed by long periods of silence.²⁹

Like the Swine flu “incident,” awareness about AIDS began with reports of unusual clusters of disease; in this instance, in the CDC’s Morbidity and Mortality Weekly Report. Journalists assigned to the “health beat” routinely monitored this CDC periodical for potentially newsworthy trends. In June 1981, the MMWR carried a short article titled “Pneumocystis pneumonia—Los Angeles,” documenting the appearance of an unusual form of pneumonia in five previously healthy young gay men. Prominent newspapers in the two cities mentioned in the article, the New York Times and the Los Angeles Times, ran pieces on the report. Calm and reassuring in tone, those stories were picked up by the wire services and quickly made their way into most other major newspapers. As journalist Randy Shilts later observed, “The writing was crafted so as not to offend and not to panic.” After “this day in the limelight,” AIDs received little mention in the mainstream news media until 1983.³⁰ Note here that this generalization did not apply to the alternative gay newspapers, which covered AIDS in depth from 1981 onward; their reporting played an important role in shaping mainstream media coverage.

From late 1981 to late 1982, scientific concern intensified as more clusters of Pneumocystis pneumonia (PCP) and Kaposi sarcoma (KS) showed up among not only gay men but also other groups previously not at high risk for those diseases: IV drug users, hemophiliacs, and Haitian immigrants. In part because of how they collected their epidemiological data, experts thought in terms of “at risk groups” rather than the behaviors they might have in common. Gradually, researchers came to understand that the new agent of disease targeted the immune system and spread through the intimate exchange of bodily fluids, in particular blood and semen. In September 1982, the Centers for Disease Control’s MMWR first used the term Acquired Immune Deficiency Syndrome to refer to the epidemic, chosen to replace the early, informal designation of Gay Related Immune Deficiency. Researchers also realized that there was a very long incubation period between infection and the development of symptoms; originally estimated as a year and a half, the dormant phase would soon be determined to be much longer, up to ten years.³¹

By the spring of 1983, experts affiliated with the CDC, NIH, and NIAID felt confident in these findings but hesitated to communicate them widely or aggressively both to at-risk groups and the broader public. In part, that caution reflected the limited perspective of experts who were largely straight white men. As James Curran observed in 1984, in general, “scientists avoid issues that relate to sex and there is not much understanding of homosexuality.” That included a lack of knowledge about anal sex. Also, the memory of the swine flu “debacle” was still fresh; having allegedly overreacted in 1976, the national scientific leadership did not want to do so again.³²

Perhaps even more important to federal policy was the conservative politics of the US president elected in 1980. Republican Ronald Reagan had won in large part due to the support of the “moral majority,” in particular its evangelical Christian wing, who viewed disease as a direct corollary of sins such as homosexuality, sexual promiscuity, and drug use. The Reagan administration’s commitment to conservative values and spending cuts led it to ignore AIDS as long as it could. Not until 1985, after his friend and fellow actor Rock Hudson was diagnosed with the disease, did President Reagan say the word AIDS in public. The advisors he put in place generally followed his lead by ignoring or downplaying the epidemic.³³

Unlike the 1976 swine flu epidemic, the mainstream press did not aggressively critique the scientific confusion or policy failings. A field dominated by white, straight men, the media industry was known for its homophobia; like scientists, reporters approached the “gay lifestyle” with a mixture of repulsion and fascination. From the early days of the epidemic, gay and lesbian journalists who had experienced the industry’s homophobia themselves, as well as straight journalists who had a family member contract AIDS, tried to push back against these patterns. But at a time of intense competition for audience, editorial sensibilities about offending readers with blunt discussions of anal sex or IV drug use prevailed. Liberal urbanites, conservative evangelicals, and blue-collar men: none of them allegedly wanted to hear about AIDS—unless it threatened them directly. Coverage of the AIDS epidemic alternated between low key, calming stories that repeated government officials’ reassurances with occasional bursts of more intense, attention-getting coverage (1983, 1985, and 1987), usually prompted by fears that the virus might spread beyond the groups initially flagged as at risk, and reinforcing its associations with sexual promiscuity, sexual “deviance,” and illegal drug use.³⁴

There were exceptions to the general avoidance strategy among mainstream news outlets. An early and influential outlier was San Francisco, a city where gay voters had become a large and well-organized political force in the 1970s. Among leading national newspapers, the San Francisco Chronicle was the first and most consistent in its attention to the AIDS epidemic. In 1981, the paper had hired its first openly gay journalist, Randy Shilts, to cover the “gay beat,” and he quickly realized the importance of the “gay plague.” Likewise, the Chronicle’s longtime science editor David Perlman believed AIDS to be a story of national importance. A local television station, KPIX, early began to cover the epidemic and run extensive public service announcements about HIV prevention. This media coverage pressured the city’s mayor and city commissioners (all of whom were Democrats), to respond to the gay community’s calls for swift action against the outbreak.³⁵

The response in New York City, not only an influential metropolitan area but also the media capital of the United States, was dramatically different. Despite being recognized as an epicenter of the virus’s initial spread, media coverage and political action around AIDS were both slow in coming. In contrast to its leadership during the 1976 swine flu episode, the influential “gray lady” New York Times did little reporting on AIDS between 1981 and 1983. In journalist circles, its executive editor A. M. “Abe” Rosenthal had the reputation of being deeply homophobic. In the summer of 1983, as both scientific alarm about and public awareness of the virus spread, Larry Kramer and other gay activists lobbied Rosenthal for more coverage, with little immediate success.³⁶ These meetings were very likely the “special interest” lobbying that Harry Schwartz found so objectionable in his 1984 analysis in Science in the Streets.

Other New York City media outlets remained silent as well. For example, in 1982, Jerry Bishop, a well-respected science reporter at the Wall Street Journal, could not get it to carry a piece he wrote on AIDS.³⁷ Local politics reinforced the media silences about AIDS. Mayor Ed Koch was a conservative aligned with Reagan’s agenda. He deferred questions to his Commissioner of Health, who was none other than David Sencer, the architect of the swine flu program, who took that position in early 1982. As Shilts suggested, Sencer was “not about to repeat the mistake that had cost him his job at the CDC,” so he erred on the side of inaction, “comforting himself with the notion that at least he was not feeding panic.”³⁸

The same silence characterized the national network news outlets, all of them headquartered in New York City. It was not that the leaders and staff determining the content of the nightly news did not know about AIDS; in fact, they were very aware of it but treated it primarily as a joke. For instance, in November 1983, Bill Kurtis, the coanchor of the CBS Morning News, started his keynote at the San Francisco Press Club’s annual awards ceremony with the joke, “What’s the hardest part about having AIDS? It’s trying to convince your wife you’re a Haitian.” The NBC News crew sent to cover the Democratic Convention in the summer of 1984 asked for reassurances that their caterer did not use gay workers. So, despite their professional commitments to objectivity and accuracy, elite news makers perpetuated the homophobic, dismissive perception of AIDS as “toxic cock syndrome,” widespread at this time.³⁹

During the short bursts of attention that national news programs devoted to AIDS, only very occasionally did that coverage acknowledge the emotions of fear and prejudice surrounding it. A case in point was the August 1983 segment for ABC’s 20/20, in which Geraldo Rivera, a journalist known for his dramatic flair, interviewed Ken Ramsauer, a twenty-seven-year-old freelance lighting designer who was in the last stages of AIDS. “It is the most frightening medical mystery of our time,” Rivera told his viewers. The juxtaposition of Ramsauer’s photograph with the very sick man on the screen conveyed the frightening power of the new disease. In response to Rivera’s questioning, Ramsauer recalled overhearing the hospital nursing staff laughing outside his door, saying, “I wonder how long the faggot in 208 is going to last.” Ramsauer died a few days after the show aired.⁴⁰

The scientific community often cited this kind of dramatic coverage as evidence that the media’s fearmongering was creating unnecessary anxiety about AIDS. But uncertainties and inconsistencies in scientific messaging also contributed to the breakdown of the traditional model of “rational” risk communication. In reporting on medical issues, journalists were particularly dependent on scientific experts and scientific publications as sources. Both science publishers and journalists assumed that the former’s emphasis on good data and analysis and high standards for peer review would screen out questionable facts and conclusions. Yet in the early years of the AIDS crisis, the expert community and the scientific press stumbled in providing consistent, reliable reporting on HIV, compounding the sense that media standards were not working as they should.⁴¹

A case in point arose in May 1983, when the American Medical Association issued a press release about James Oleske’s article forthcoming in JAMA, its flagship publication, suggesting that “routine household contact” could spread AIDS. The press release included a statement from National Institutes of Health (NIH) expert Anthony Fauci that “if routine close contact can spread the disease, AIDS takes on an entirely new dimension.” As soon became evident, the JAMA editors had chosen to feature Oleske’s study while ignoring another article in the same issue, documenting a different scenario: eight babies under the age of one who contracted HIV through mother-to-child transmission in utero. The editors had also failed to send Oleske’s article to Fauci, ensuring that his comment amplified the questionable findings and interpretations of a single study.⁴²

As Shilts noted, Fauci blamed the uproar on a “hysterical media” that took his comments “out of context” and the public’s inability to “understand the language of science.” But Fauci did recognize the “chief villain” of the incident as “the press office of the American Medical Association, which had so shamefully sensationalized the medical journal articles in an effort to draw attention to a journal that always found itself playing second fiddle to Science and the New England Journal of Medicine.” Unfortunately, Shilts concluded, the JAMA release “set in motion a wave of hysteria that no disclaimer would prevent.” The incident “lent scientific credibility to ungrounded fears; the social damage would linger for years.” In his account of the controversy, Harry Schwartz, a retired editor of the New York Times, maintained a more neutral tone but nonetheless agreed, “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.”⁴³

Similar confusions continued to arise as individual researchers came up with evidence suggesting nonsexual modes of transmission. For example, in 1985, two physician-researchers noted a concentration of AIDS cases in a rural area of South Florida and speculated they might be the result of mosquito transmission. Both local and national newspapers, as well as Newsweek, picked up their findings. Although the CDC quickly moved to dispute the mosquito hypothesis, it continued to circulate for years afterward. Scientists’ reluctance to make categorical statements about AIDS causality also contributed to the media confusion. In her 1987 article about AIDS, Treichler parsed the ambivalent words of an immunologist interviewed for a 1985 television documentary. While describing public fears of “casual contact” as misconceptions produced by “strong emotions,” the immunologist went on to state “there’s the problem that we cannot give any 100 percent assurances one way or the other about these factors,” stressing “there may always be some exception to the rule.” As Treichler concluded, “Would you buy a scientific fact from this man?”⁴⁴

So, in the epidemic’s early years, the role of scientific publications and scientists in muddling public messaging about AIDS became a focal point of critique. Their scientific “feed,” so to speak, was contradictory and required frequent revision. These incidents called into question the supposedly higher standards of external review and objectivity that the scientific press claimed to practice, standards that they felt made them “better” than their mass media counterparts. Medical journalism no less than the high-end press could be swayed by editorial biases that reflected their own moral, financial, and reputational goals.⁴⁵ Individual researchers might be prejudiced and fail to present balanced, evidence-based opinions. This sense of disillusionment was compounded by widespread news coverage of the infighting among French and American scientists over who first isolated the HIV virus, conflicts seemingly driven by personal ego and potential financial gain rather than pure scientific goals.⁴⁶

In the swine flu debate, leading medical organizations and publications had largely stayed out of the controversy, leaving the government health officials to bear the brunt of criticism. In the early AIDS pandemic, experts did not escape so easily. Objective scientific standards and professionalism seemed to fail as guides to a rational rollout of public information. These failures reinforced doubts about medical authority that had been growing since the 1970s. With standards of peer review and expert judgment in disarray, the very notion of scientific objectivity seemed in question, making rational planning for and response to emerging public health threats virtually impossible.

While mainstream media outlets waffled over whether AIDS was a “mini-menace” or a “real” threat, media actors outside that mainstream played a critical role in drawing attention to AIDS in 1983 and 1984. As the supposedly more objective, unbiased standards of science and journalism proved wanting, different kinds of reporting from nonelite players—alternative gay newspapers, tabloid newspapers, and talk shows—covered the emerging epidemic. These organizations not only filled the voids left by the mainstream media’s inattention but also broke important stories on their own. Their coverage derived its power by openly addressing the fear and prejudice AIDS evoked and by calling out the failures of their more elite counterparts. At the same time, these news stories attracted intense criticism for their alleged resort to “sensationalism” and “fearmongering.”⁴⁷

The most important of these nonelite media outlets were the alternative newspapers aimed at gay and lesbian readers, a niche that had grown significantly in sophistication and audience during the 1960s and 1970s. The generalization that “the media did not cover AIDS” in the early 1980s needs to be qualified, given that the alternative gay press was on the story early and often. In particular, gay papers in the metropolitan areas initially most affected, Los Angeles, New York City, and San Francisco, played a critical role in drawing attention to the epidemic and framing the agenda for how the mainstream media covered AIDS. Journalists who once worked for those newspapers, including Randy Shilts and Cindy Patton, played an important role in bringing AIDS into the media mainstream.⁴⁸

Unlike the mainstream press, the alternative gay press realized the fundamental threat that HIV posed to their readers: in the relatively tight-knit gay community that they wrote for, friends and neighbors afflicted with KS or PCP were impossible to ignore. Their reporting helped get the word out that a deadly new virus was in circulation that seemed to target gay men. Surveys conducted at the time show that by 1984, gay men in the most affected cities knew of the existence of AIDS and its possible links with oral and anal sex. At the same time, the alternative press’s messaging about where the virus came from and what should be done to halt its spread reflected deep divisions within gay communities. Having only recently claimed space for same sex pleasure, many in those communities resisted public health measures aimed to reduce the virus’s spread. As Cindy Patton, one-time features editor of Boston’s Gay Community News, wrote in 1985, “this perplexing disease only exacerbated the traditional splits between sex and politics.”⁴⁹

Those divisions were evident in how gay newspapers reported on the cautious and contradictory messaging coming from the public health community. Depending on the editor or the reporter involved, papers took very different positions on what preventive measures should be adopted. Within the same paper, opinions could differ between one page and the next; they also evolved over time. But the gay press was the first to begin addressing the distinction between “healthy” and “unhealthy” fear. Simply put, they understood that for gay men, fearing HIV infection was not irrational, and that acting on that fear by adopting safe sex practices was essential to stopping its spread.

Tabloid newspapers also played an important but problematic role in the dissemination of AIDS related information. For example, the New York Post carried early AIDS coverage largely because its medicine and science editor, Joseph Nicholson, was gay. In June 1983, at a time when blood banking services still refused to admit the possibility of HIV transmission, the New York Post’s front page carried the headline, “L.I. Grandma Died of AIDS.” The story reported the death of Lorraine DeSantis from an AIDS-related infection; her only known risk factor was having had a blood transfusion during heart surgery in 1980. To attract readers, the New York Post continued to dramatize the threat AIDS posed to the general public. Other tabloid newspapers followed suit. That coverage helped boost awareness of AIDS outside the gay community at the same time it overplayed the threat of casual contact as a source of infection. In the absence of strong counternarratives from the mainstream press, those stories likely contributed to the discrimination and harassment directed toward people with AIDS.⁵⁰

Elite media circles dismissed such stories by the New York Native and the New York Post as “sensationalism” and “fearmongering,” as mentioned, but recognized the power of AIDS stories to capture readers’ attention. In a competitive, rapidly evolving media landscape, that potential could not be ignored. As Geraldo Rivera’s 1983 segment for ABC’s 20/20 indicated, AIDS had “soft news” pull as an attention-getting, emotion-inducing story. In the spring of 1985, when the United Press International wire service first broke the story that actor Rock Hudson had contracted AIDS, the mainstream media began to adopt techniques associated with their nonelite counterparts. In this competitive, chaotic media landscape, both hard news and soft news about AIDS carried more fear-based messaging, which in turn intensified the political and moral polarization around the epidemic.⁵¹

The journalistic tradition of giving both sides of a controversy equal time played a role in that confusion and polarization. Not only did gay activists’ efforts to break the mass media silence lead to complaints like Schwartz’s about “special interests” and their influence; it also sparked a countereffort on the part of conservative activists to oppose what they perceived as too sympathetic a treatment of the “gay plague.” Anita Bryant, Jerry Falwell, and other leaders of the moral majority ramped up story lines about AIDS as God’s punishment of the wicked. For example, in July 1983, Falwell’s Moral Majority Report carried a front page story with the headline, “AIDs: Homosexual Diseases Threaten American Families,” accompanied by an illustration of a white heterosexual couple and their two small children wearing masks. As the AIDS story developed, the conservative press continued to hammer away at the same theme: this deadly disease was God’s judgment on the wicked. Due to the established both-sides convention, their opinions were dutifully repeated in the mainstream press; in terms of quantity and placement, the conservative message competed with that of AIDS activists.⁵²

“Both sides-ism” also reinforced the dynamic of amplifying any evidence that HIV might be moving beyond the “4H’s” to menace the rest of the American population. In the minibursts of mass media attention in 1985 and 1987, that issue predominated, especially in the national news magazines. For example, the January 12, 1987, issue of U.S. News carried the cover story “AIDS: What You Need to Know, What You Should Do,” replete with a graphic showing the rising rates of AIDS-related deaths superimposed over the faces of a white heterosexual couple. Polls conducted in the mid-1980s revealed that those most worried about HIV risk were straight white women, a group that the epidemiological data showed was least at risk.⁵³

These patterns of media coverage helped to bring into being another key story line of the AIDS epidemic. As gay advocacy groups challenged the prejudice rampant in science and in journalism, they found that actions that evoked emotions served well to attract media attention. Public demonstrations with signs that read “Silence = Death” and public displays of the AIDS quilt commemorating the dead generated newsworthy moments. That realization helped inspire the “direct action” methods adopted by gay male activists in the spring of 1987 that raised AIDS’ profile as a major news story.⁵⁴

The AIDS Coalition to Unleash Power (ACT-UP) was formed in March 1987, with a specific intent to use the 1980s media landscape to its advantage. Much as civil rights protestors had learned to use national news coverage in the 1960s, ACT-UP brought exceptional creativity to the task of giving mass media outlets newsworthy events to cover. While many of their actions focused on the CDC, the FDA, and the Wellcome Burroughs drug company (the maker of AZT), ACT-UP also targeted the financial and media giants located in New York City. ACT-UP staged its first public event on Wall Street on March 24, 1987, the day after the Times carried a blistering op-ed by one of ACT-UP’s founders, Larry Kramer. A few weeks later, ACT-UP chose tax-filing day, April 15, 1987, to hold an event just outside the huge post office across from Penn Station, because, as member Douglas Crimp recalled, news crews “routinely do stories about down-to-the-wire tax-return filers.” In 1988, the group and its allies targeted the Hearst Building in New York City, home of the corporate parent of Cosmopolitan magazine, which had just published a fact-challenged article about women and HIV. Although Cosmo was slow to respond, the Phil Donahue show and Nightline both carried stories about the protest.⁵⁵

From 1987 onward, news coverage of AIDS increased in volume and frequency. To be sure, the missteps and distortions common between 1981 and 1987 by no means disappeared. For years to come, dramatic stories continued to crop up only to be decried and debated: for example, Newsweek’s 1988 cover story of Masters and Johnson’s seriously flawed study of the risks of HIV transmission in heterosexual contact and Rolling Stone’s 1992 story by Tom Curtis on the origins of AIDS. Having reluctantly begun to cover AIDS as a threat to the gay male community, the corporatized mass media showed far less interest in the dangers the virus represented to IV drug users, Black and Latinx communities, and female sex workers, all groups who lacked political clout and did not figure prominently in mainstream media. Instead, media coverage of Ryan White’s bullying in Indiana made a young white male hemophiliac the public face of AIDS in the United States.⁵⁶

As this retrospective view suggests, the media was not the only source of communication failures. There were confusions in the scientific messaging as well; experts did not speak with one voice from the outset, nor could they resist the pull of nonobjective forces such as political bias, publication status, or opportunities for media appearances. In other words, the scientific community did not provide a clear narrative about what to do that the media deliberately ignored; rather, scientific uncertainty and political pressures fed into the uneven quality of scientific news to report. The JAMA incident foreshadowed growing concerns within the scientific community about the incentives for researchers and their home institutions to call press conferences to report on findings before they had been through rigorous peer review.

Finally, noticeably absent from the debates over scientific and media ethics was a clear consensus about what role fear and anxiety should play in official messaging during a public health crisis. From the outset, public health experts worried about issuing warnings directed at the groups most at risk, especially gay men and IV drug users, because they feared causing panic and further avoidance of the experts trying to “help” them. Those experts more knowledgeable and sympathetic to gay men or IV drug users realized that a deep distrust of science and scientists’ intentions formed a serious barrier to effective public health communication. Yet they also knew that unless people understood how deadly the risk was, they would not take protective action, such as practicing safe sex or bleaching needles. Appealing only to “reason” hardly seemed sufficient; the emotions and instincts of self-preservation needed to be mobilized. What was the right way to scare people into protecting themselves? In retrospect, the real accomplishments in AIDS prevention seemed to come not from top-down efforts at risk communication but by grassroots groups whose leaders were trusted by the local community.⁵⁷

A very different problem with “fear” and “panic” presented itself with people outside the main risk groups, the so-called general public. White, affluent Americans were not at risk from casual contact, but they feared HIV infection nonetheless. Their fear-based behavior expressed itself as “irrational” acts of shunning people with HIV AIDS. This audience needed to be calmed down, not hyped up. Unfortunately, in the media environment of the 1980s, public health experts had no control over how their mass messaging was being given emotional valence, nor could they easily tailor specific media messages to specific audiences.

Instead, expert messages were lobbed into a chaotic media environment where no consensus existed on how best to report on them. The message veered tragically from one extreme—AIDS is a “mini-menace”—to another—everyone is at risk. For some reporters (and politicians), it was a story about people whose sexual “promiscuity” and drug use put them at risk; the “facts” and the words used to express them supported that storyline in various degrees of drama. The other story line, which appeared in the same media outlets, portrayed HIV (and by extension the 4 Hs) as a threat to every American; different “facts” and wordings were used to convey that narrative. This kind of discordant media coverage bred what Shilts—a traditional news journalist—described as “panic” and “hysteria,” both among those groups at greatest risk and those who were not, a distinction that has persisted in discussions about AIDS. What Shilts and others judged as “unnecessary” fears increased stigma and discrimination against gay men, IV drug users, and Haitians in ways that compounded the epidemic’s damage to them. But those judgments assumed there was a clear understanding of what constituted a necessary fear, an understanding that did not and still does not exist.⁵⁸

AIDS drew attention to a difficult set of problems: How do you get people’s attention to a potentially deadly virus without scaring them? How do you get the “right” people to be afraid of a real threat? The common usage of terms such as “hysterical” and “irrational” to describe those fears points to a central problem of early AIDS coverage: the uncertainty about what the risks were and who should be most worried about them. Ironically, even as those debates heated up in the late 1980s, key aspects of the AIDS pandemic, including its impact on women, IV drug users, and communities of color, remained out of the media spotlight.⁵⁹

In the late 1980s, the scope of AIDS coverage began to change in significant ways. By then, the truly global nature of the pandemic became apparent, diminishing its initial image as a gay American men’s disease. The development of the AIDS cocktail began the disease’s transition from an acute to a chronic infection. Global inequities in health care resources, including access to expensive pharmaceutical drugs, ignited fierce controversies over the colonial legacies of public health. At the same time, AIDS was folded into new narratives about the threat of novel pandemic diseases and the media conventions used to convey them.⁶⁰

In the 1990s, new understandings of the virus, as an actual pathogen and as a social metaphor, entered into existing (and long contentious) discussions about the relationship between “medicine and the media” in which the crisscrossing of scientific, cultural, and media change continued to generate anxiety. The original story lines around AIDS evolved into broader narratives about modernity and disease. On the scientific side, experts came to understand AIDS as one of a new generation of emerging infectious diseases; that story line inspired best-selling books such as Laurie Garrett’s The Coming Plague and Richard Preston’s Hot Zone. On the media side, continued technological and economic transformations multiplied the diversity of media platforms and messages available to spread awareness of “killer microbes.” The expansion of the internet seemed to hold new promise for democratizing the sharing of that knowledge.⁶¹

Press coverage about new and emerging viruses converged with a larger 1990s discussion about the media’s role in creating a sensationalist culture that sought to induce fear and anxiety on a grand scale. Not only did the reality of HIV-AIDS—a virus still sickening and killing people around the world—now compete with concerns about Ebola and other emerging viruses coming from Africa or Asia, concerns about the “coming plague” had to compete with other threats. There were so many risks, how were they to be rank ordered and responded to? As social scientists pointed out, the rational calculus of risk assessment worked for single threats but had more trouble triaging multiple dangers.⁶²

Meanwhile, the “too many risks” problem became an object of media inquiry: why had Americans become such a frightened, anxious people? As the culture wars between conservatives and liberals intensified after the September 11 attacks, accusing one’s enemies of being “hysterical” became an all-purpose weapon. Critics across the political spectrum argued that the media was creating unnecessary fears. As Jane Spencer and Cynthia Crossen wrote in the Wall Street Journal during the 2003 SARS outbreak, “thanks to research labs, tort law and media hype danger seems to lurk in every corner of life, from children’s toys to McDonald’s coffee, anthrax to secondhand smoke, West Nile virus to SARS.” Despite being what they termed “the safest society in recorded history,” Americans had become obsessed with risks. As psychologist Paul Slovic told the reporters, “it’s much easier to scare than unscare.”⁶³

For many scientific experts, the assumption remains that rational thinking must be devoid of emotion: fear, anger, or even positive emotions are enemies of clear thought. The path to safety is evident: get the science right, run the numbers, and do the modeling to determine what level of risk there really is, and communicate that to the public in an affectless way. But even before COVID-19, work in a variety of disciplines, from neuroscience and cognitive psychology to women’s studies, had begun to question that assumption. Now, forty years after the AIDS pandemic, there still exists little agreement about how to promote “healthy” fear in the midst of a public health crisis. That lack makes it all the more important to bring feminist and queer perspectives into the public health mainstream, so we can better understand how fear, self-protection, and community preservation can be linked in more productive ways.⁶⁴

The history of AIDS as a “media creation” also helps provide perspective on the challenge of promoting social distancing (wearing masks, minimizing contact) during the COVID era. Merriam-Webster cites the first use of the term “social distancing” in a public health context as 2003, but in fact it was used much earlier, in a different, negative context. In studies published in the 1990s, researchers began to use the term “social distancing” as a measure of stigma; it was the unwarranted shunning, isolation, and other forms of discrimination directed at people who were HIV positive out of fears of contagion (literal or moral.) In the expert view, such social distancing was unnecessary and “irrational”; it reflected at best a misunderstanding of how HIV-AIDs actually spread, at worst an expression of deep-seated hostility toward gay men, IV-drug users, sex workers, and other vulnerable groups. COVID has required a massive turnaround; public health authorities have had to convert a negative focus on stigma—social distancing as irrational—into a positive social good—social distancing as essential to national survival. Not surprisingly the results have been mixed.⁶⁵

In the past few years, the COVID-19 pandemic has further exposed the “cracked foundations” of modern society and the reliance of public health leaders on media actors to communicate about the nature of disease risks. We can only hope that in the aftermath of this latest pandemic, media makers will develop new forms of messaging that do not depend on a stark opposition between reason and emotion. Feminist theory and history can play an important role in that process by exploring the articulation of necessary and unnecessary fears and the possibilities for integrating “risk as feelings” with “risk as analysis.”⁶⁶