Dr. Peter Drotman

MILLER: This is Dr. Bess Miller, and I'm here with Dr. Peter Drotman. Today's date is August 2, 2017, and we are in Atlanta, Georgia, at the Centers for Disease Control and Prevention [CDC]. I am interviewing Dr. Drotman as part of the oral history project The Early Years of AIDS: CDC's Response to a Historic Epidemic. We are here to discuss your experience during the early years of CDC's work on what would become known as AIDS. Dr. Drotman, do I have your permission to interview you and to record this interview?

DROTMAN: Yes, of course.

MILLER: For this oral history on the early years of AIDS [acquired immunodeficiency syndrome] and CDC, we will be focusing on the first several years, beginning in June 1981 with the publication of the first MMWR [Morbidity and Mortality Weekly Report] on the five cases of Pneumocystis carinii pneumonia among homosexual men. Peter, you were one of the first epidemiologists at CDC to work on what would become known as AIDS. You were involved in nearly 00:01:00all of the critical aspects of CDC's work on AIDS during those early years and actually throughout your career, including epidemiologic research, education--including education of the public--and clinical care of AIDS patients. For over 15 years, you have been the Editor in Chief of Emerging Infectious Diseases [EID], a monthly peer-reviewed journal published by CDC.

But let's begin with your background. Tell me about where you grew up and your early family life, and then where you ended up going to college.

DROTMAN: I was born in Bronx Lebanon Hospital in New York City, which much later became the hospital with the largest number of AIDS patients in New York City. By that time it was a public hospital. When I was born there, and my mother went 00:02:00to their nursing school there, it was not a public hospital-- semi-private, I guess. I never actually lived in New York City. My parents lived 20 miles north of New York in a town called Scarsdale, New York, in the crummiest part of that town, which was otherwise a rather prosperous town. They moved there so my little brother and I could go to the school system, which was quite good. It was one of those Lake Wobegon-like school systems, where all the children are above average and 80% are in the top 10% of the class and stuff like that. It was just assumed everybody is going to college. It's not a question of, do you get a job, join the military or do something else with your life. That was the career track. No other future was even contemplated. It was just a question of which 00:03:00college and what do you want to study.

I knew from an early age I was interested in medicine as a career path. It may have been because I admired my pediatrician, who I thought was a great guy, Dr. [Roderick C.] Richards, practicing in Scarsdale, or because my mother was a nurse or some other reason for altruism, and interest in the work of the United Nations and Dr. Albert Schweitzer-- a Nobel Prize-winning medical missionary whose autobiography I read, and others, but that was my goal-- to get into the best college I could that would lead me to that end. It turned out that college 00:04:00was in upstate New York and perhaps [had] some of the worst weather in the country, in a town called Schenectady. It was called Union College, and it was both a liberal arts and engineering school that had a very high track record of getting its students accepted into medical schools, and I said, "sign me up."

Getting there, I found that the other premedical students were extraordinarily competitive. The word cutthroat was often used. I didn't want to be in those guys' classes all the time, [and I decided] I was going to go a different route to get to my goal. I became a psychology major, which was interesting, but I didn't actually love psychology. The assumption for many of the professors was, this guy is going to be a psychiatrist, which I really did not want to be. When 00:05:00I tried to sign up for the advanced chemistry classes that I knew I would need to succeed in medical school, I went to some classes that really only chemistry majors were in. The chemistry professors needed to give permission for non-majors to join. They were convinced a psychology major only wanted in here so he could learn how to manufacture LSD [lysergic acid diethylamide], which I never learned how to do, and it was not my goal. I was just trying to get good grades and show a good record and present a reasonable record to a medical school admission board, which I ultimately did and actually got admitted to several. Of the ones where I was accepted, I picked the one that had the weather most opposite to that in Schenectady, which was the University of Hawaii.

So I relocated to a warmer climate. The University of Hawaii at that time was just starting its medical school and only offered the first two preclinical years, which was okay with me. I figured it's much easier to transfer after two years than it is to get in originally, and that turned out to be true. I transferred after two years there to another warm place, the University of Southern California [USC] in Los Angeles, now called the Keck School of Medicine. It was mainly affiliated with the largest public hospital in the United States, Los Angeles County USC Medical Center, [which is] bigger than Cook County or Bellevue, with the most active emergency room of pretty much any 00:07:00place-- more births, more babies than any other hospital in the country. It was a very intense experience. It involved very little sleep and a great deal of work. I developed an interest in adolescent medicine, and I was trying to decide whether to become a pediatric resident or an internal medicine resident as a way to get to adolescent medicine. I opted for the pediatric route, because there's more learning about growth and development than at least in the big public hospitals, the geriatric orientation of the internal medicine track.

It was during my pediatric residency-- and I had every intention of becoming a 00:08:00practicing pediatrician [in] adolescent medicine, a student health service physician with a clinical bent--but it was during that internship working in this immensely busy pediatric emergency room that I had my epiphany. A family of probably undocumented immigrants brought in a number of their children, but they could only afford to register one of them as a patient. Their hope was we would give this young boy enough medicine to treat his-- he actually had erysipelas, a skin infection, that really could be prevented with soap and water, but it had progressed and was becoming clinically a problem for them. They were hoping we'd give them enough medicine to treat all their other kids, who were not officially registered as patients. I gained the assistance of a sympathetic nurse who was 00:09:00able to give the family all the medicine to treat all the kids, even though they weren't patients.

My thought was this family didn't need to come to the busiest emergency room at the biggest university hospital in the country to get a problem taken care of that could have been prevented with soap and water. Is there nobody in the community who tells people this? I took that question to heart and looked into it and discovered the field of preventive medicine. I said, that's where I need to be. At the time USC did not have a preventive medicine residency, so I went across town to UCLA [University of California at Los Angeles], which did have one. I interviewed there and applied for their preventive medicine residency, 00:10:00and that changed my life. I met Professor Paul Torrens, who I said, this guy is great. I want to work on his projects and get out into the community and prevent bad stuff from happening. The dean was [Dr.] Lester Breslow, who had been the health officer of Alameda County, California, where he developed the seven health habits: if you adopt a good diet and good exercise and good sleep and a few other things, you will influence your health for the rest of your life.

That was my goal when I eventually applied to work at the CDC after my training at UCLA: to bring Dr. Breslow's seven health habits to the community, and the place where you could do that at CDC was not in infectious diseases. It was in 00:11:00what was then called the Chronic Diseases Division, which was an easier thing to match to when you join the Epidemic Intelligence Service [EIS] than the highly competitive infectious disease positions that were so well coveted by generations of trainees at the CDC. I was matched to the Chronic Disease Division and something called the Special Studies Branch, which had basically everything that CDC could possibly do other than infectious diseases. There was a Birth Defects Branch, a Reproductive Health Branch, and a Cancer Branch. Everything else was in Special Studies. A lot of it related to exposure to toxic 00:12:00waste, lead, polluted water, a variety of things. Many of them were cancer clusters among neighborhoods or residents near toxic waste areas, and we investigated quite a few.

MILLER: Before you even got to CDC, I just wanted to hear a little bit about your experience with the smallpox eradication campaign in Bangladesh. How did that happen?

DROTMAN: While I was a preventive medicine resident at UCLA, we were required to do rotations at all levels of public health work, from local community, state, to international. In 1975, the World Health Organization [WHO] was recruiting for international epidemiologists to assist in what they considered to be the 00:13:00final push to eradicate smallpox from Asia. The last countries in Asia with smallpox were India and Bangladesh. At the time, the Cold War was going on, so they wouldn't send Americans or British doctors to India, which was aligned with the Soviet Bloc. We went to Bangladesh, then recently transitioning from a country called East Pakistan to that country which actually had the worst variola major [smallpox] epidemic. A group of us was recruited. We volunteered and were flown to Southeast Asia Regional Office of the World Health Organization, which is actually located in New Delhi. They gave us a one-week crash course in smallpox, its diagnosis and its control, and the use of the 00:14:00vaccine and the surveillance system, and then flew us through a monsoon to Dhaka, Bangladesh. They gave me a Land Rover, a case of vaccine, a motorcycle and a motorboat to get around. I was responsible for a three-county area that had outbreaks, with a population of several million people.

Amazingly, we did it through the traditional use of a surveillance and containment strategy that had been devised by former CDC Director, [Dr. William H.] Bill Foege and others. You find the cases and start vaccinating rings around them. I had the last three outbreaks in the northernmost part of Bangladesh. Smallpox was eradicated first in India by July 4, 1975. I remember getting that 00:15:00news sitting on a sandbar in the middle of the border river between India and Bangladesh. The person who told that to me was a woman who was a medical officer colonel in the Red Army, who had been assigned to that side of the border. Of course, I didn't believe her. But she was right. They had eradicated smallpox from India. Then we eradicated it and it went south, the eradication pattern went south. The last case of smallpox in Asia was a little girl on an island called Matlab in the Bay of Bengal off the southern coast of Bangladesh. After that, [there were] no more cases in Asia. Two years later it was eradicated from Africa.

MILLER: That sounds like a life-changing event. Was it?

DROTMAN: It very definitely was. It was there that I met-- actually there were CDC assignees, some of them EIS officers and Public Health Advisors, and I 00:16:00developed immense respect for them. The Director was actually Dr. [Stanley O.] Stan Foster, an EIS alum and career CDC person and others there.

MILLER: Do you think that's what got you to CDC?

DROTMAN: I had heard of CDC and the EIS, but I had not worked on the ground with people except for the EIS officers assigned to Los Angeles County, where I was based. That was Dr. [Walter A.] Walt Orenstein, who went on to become a major immunization expert, and my professor of pediatrics at USC, Dr. Paul [F.] Wehrle, who was actually in the EIS class of 1951. He was one of Dr. [Alexander D.] Langmuir's original EIS officers, and he eventually served on the global 00:17:00certification panel that certified the eradication of smallpox. He and I actually gave grand rounds at our hospital after I returned, about the eradication of smallpox. Yes, it was certainly a great achievement of mankind to which I contributed a modest amount. It just seemed like a lot of hard work, living under adverse circumstances in a lot of mud and rice paddies at the time. It just shows if you work together and you have the right resources, people in public health can accomplish a lot.

MILLER: So you came to CDC as an EIS officer, and you were in the Special Studies Section. What were you doing initially?

DROTMAN: Actually, I did more epidemic aids than anybody else in my EIS class or 00:18:00any Epidemic Intelligence Service officer does today. In my two-year term I did ten "epi aids," as they're called. They were all over the United States, and some of them were natural disasters. For instance, Mount St. Helens blew up during the time I was an EIS officer, spreading ash all over the Pacific Northwest. We assessed the health effects of inhaling that ash or living among it as it spewed inches of it all over the place. I did aluminum mine slag that had been dumped illegally in Kansas City, Kansas. Kids were playing King of the Mountain on these great mounds of dirt that actually were loaded with arsenic and beryllium and cadmium and lead. Actually, in one of my last epi aids, the 00:19:00index case was a baby whose parents were professors of medicine at Harvard Medical School, and the baby was diagnosed with arsenic poisoning. The family lived in Southern New Hampshire, the Granite State, where people who lived apart from the municipal water system had to drill wells into the granite, and some arsenic leached into the water that the family then drank. We did surveys of the children and diagnosed them and got the people off of the wells. They had to get hooked up to the municipal water-- the surface water was perfectly okay. It was the deep wells that were the problem. There were many others. I became an expert in polychlorinated biphenyl, a banned chemical form of chlorinated hydrocarbon 00:20:00and dioxins, which contaminate them. That's part of my history that I remember, but I'm not in that field anymore, happy to say.

MILLER: When did you first get involved in CDC and working on AIDS, or at that time it was called Kaposi's sarcoma?

DROTMAN: I was finishing EIS in 1981 and looking for my next job, and it was in 1981 when the first cases of AIDS were being reported. Some of them, of course, were the Pneumocystis pneumonia, which was at UCLA, my old hospital. They were diagnosed in the hospital where I had recently worked, so I was interested in those cases, but it was not my area. There were also some potential linkages 00:21:00between the people at risk for the Pneumocystis pneumonia and those developing a rare form of cancer called Kaposi's sarcoma. In the Special Studies Branch where I was, cancer clusters was something we investigated. I was working with another EIS officer, [Dr. Alexander] Alex Kelter, who was devoted full time to investigating that cancer cluster. Alex and I were in the same office. I wouldn't call it a suite. It was more of a dump where we both had desks. I was close to him and following it with considerable interest.

MILLER: Speaking of dumps, where was that located? Was that located in Chamblee in the Quonset huts that were CDC's quarters in those day?

DROTMAN: Yes. The environmental health center and the chemical toxicology laboratory on the Chamblee campus which [the CDC] had converted World War II-era hospitals wards and laundry buildings to CDC offices. We were in building 28, although we affectionately called it Stalag 28. It was a long hospital ward that was two beds wide and probably 30 beds long, but the beds were removed and desks were put in. It was cold in the winter and hot in the summer and miserable all year around.

MILLER: After EIS were you--

DROTMAN: In looking for my next job, I actually just blindly put my CV into the 00:23:00hopper at the American Public Health Association's annual meeting that year, which was in Detroit. The person who picked out my CV and said, we ought to hire this guy, was Dr. [James W.] Jim Curran, who was Chief of the Clinical Research Branch in the VD Control Division at CDC. I interviewed with him, along with Dr. Richard [M.] Selik, and we both got jobs in the Venereal Disease Control Division. Dr. Selik was in Dr. Curran's branch, and I was in the other branch, the Training, Education and Consultation Branch. The chief was Mr. [William C.] Bill Parra, who later became one of the chief Public Health Advisors of the AIDS Program.

My initial task was to rewrite STD [sexually transmitted disease] treatment 00:24:00guidelines. I was working on that, and it was at that same time that others in that division, namely [Dr.] Mary Guinan and [Dr. William] Bill Darrow and [Dr.] Harold Jaffe and Jim Curran, were investigating these new AIDS cases. Weekly we would get briefings about how they were doing and what their findings were, and we had the opportunity to comment and give advice. It was quite interesting and exciting to learn what was going on with those cases, but it quickly became apparent that they were being overwhelmed with the amount of work and the amount of inquiries and the demand for information and results. One of the heroes of the outbreak was Dr. [Paul] Wiesner, the Director of VD [Venereal Disease] Control. He told Jim Curran, "you cannot be spending all your time looking for help. I'm going to offer you five medical officers for 90 days, and they serve 00:25:00at your command." He said, "good, I'll take them all now." I was one of those five, along with Rich Selik and [Dr. James] Jim Goodrich and [Dr. Robert] Bob Johnson and [Dr.] Dorine Kramer. We all went there for 90 days. I ended up staying 14 years, but that's not an unusual story at CDC. You get assigned a 90-day detail, and it changes your career and everything about it. Dr. Selik stayed also for decades, but the other three didn't stay. After 90 days they went back to Venereal Disease Control.

MILLER: Can you describe the atmosphere a little bit as you were being detailed for 90 days? What was the state of things? What was the atmosphere like among the colleagues?

DROTMAN: Intellectually it was very exciting, because we were learning something 00:26:00new. We were learning new manifestations of immune deficiency. We all had different tasks. Dr. Selik's goal was to develop a definition of, how do we decide who's a case and who isn't a case, and what a case is. I was working with EIS Officer [Dr.] Harry Haverkos, and we had the twin task of investigating all of the cases that were not in the original hotspots of New York, San Francisco and Los Angeles. At the time in 1982, AIDS was still a rare disease, and there were only a few patients. The original case-control study, where we were fishing for etiologic hypotheses, involved immensely intense interviews, where we 00:27:00dissected the patients' entire lives, looking for any clue that could explain an immune deficiency. That included environmental things that I'd been working on for the previous years, radioactivity, toxic drugs or chemicals, medical treatments that might result in immune deficiency, and any other hypothesis: occupational, sexual, anything, travel history, exposure to pets or animals. Harry and I flew around the country to wherever a physician reported to us that they had a suspect case. I interviewed the first AIDS patients to be diagnosed 00:28:00in Chicago and in Durham, North Carolina, and in Tampa and Sarasota, Florida, and other places, and Port-au-Prince, Haiti, for that matter.

MILLER: What was that like? Just who were these patients, and what was it like going in and interviewing them?

DROTMAN: It was a very arduous, difficult experience. That was certainly a life-changing and in a sense inspiring experience. The main thing is that all the patients were dying, and they knew it. At the same time, many of them, or nearly all of them, were gay men who had been in the closet all of their lives. It's only because they became sick and weren't able to care for themselves any 00:29:00longer that they would be disclosing to their families that they were gay. At that time, being a gay man was a very different world than it is in 21st century America. Being gay was equivalent to being a pariah and an outcast. Discrimination was perfectly legal and acceptable in American society back in those days. The patients had lived all their lives frankly lying to the people who in some sense were closest to them about their orientation and their lifestyle and their friends and their social milieu and their employers. Every aspect of their life was they had to live two lives. This illness was bringing 00:30:00it out in a way that they didn't want. But they felt a kinship to other gay men, and when the doctor from the CDC showed up to ask them questions, I explained to them that it's unlikely to help you but it will help others to find the answers to questions that need to be answered-- will you go through this? The interviews took literally hours. We went through every year of their life with every exposure, including all the sexual exposures, and calculated up any medicines, STDs, numbers of sexual partners and travel history and occupation history, all of these things. The questionnaire was immensely long, and many of these 00:31:00patients were quite sick, many with Pneumocystis pneumonia, which inhibited their breathing. Some of them had oxygen, and they would take some breaths and then answer a few questions and take--

MILLER: Were you interviewing them in the hospital?

DROTMAN: Yes, most of the interviews took place in intensive care units. Some of them, there were family members there. Some of them, we tried to excuse the family. Some of them wanted either their partners or their family members to be there. I call them the heroes of the epidemic, because they were giving their all to help others.

MILLER: How did you personally respond to that? It sounds emotionally draining.

DROTMAN: All of us who did this came out with the same experience. We admired the patients, and we all said, there for the grace of God go we, because the 00:32:00patients were basically the same age as we were, in our 30's, roughly. But they were dying and we weren't. Many of them grew up in middle-class homes and had for the most part good educations. Quite a few of these people were performing artists, and some were in business. A few were intravenous drug users. The first case that I interviewed in Chicago was a Haitian man who was a taxi driver. While I was there, I learned of a case at Northwestern University Hospital of a highly educated guy, and then I learned of one out in the suburbs west of Chicago. I interviewed all of them.

MILLER: How were these case reports coming in? Was there an active pursuit of 00:33:00cases on the part of CDC?

DROTMAN: Since it was a new disease, it was not a reportable disease. Sometimes it was clinicians who had read that initial MMWR article that said, I think I might have a case. Another way was the patients themselves reported. They would call the CDC and say, I think I'm sick, doc. It was a variety of things, but it was not the usual way CDC gets cases reported, which is from state and county health departments. It was more directly from either the public or the clinical medical care system. We, of course, informed the state health departments whenever we were going into their state to interview patients, but frankly so 00:34:00many people, including clinicians, wanted to have nothing whatever to do with this outbreak. There was a great deal of prejudice against gay men. There were people in responsible government positions and in clinical medical positions who were more inclined to condemn the patients, saying, you got what you deserve for being a gay guy, than there were people saying, gee, we need to investigate and take care of this in the traditional public health medical response.

MILLER: As you were investigating these cases and the so-called case-control study was going on, what was the thinking about the cause of this illness? Again, it was still being defined as you were going out and seeing the cases.

DROTMAN: It became apparent that it had something to do with sex, because the cases had immensely more sex partners and sexually transmitted diseases and 00:35:00treatments for sexually transmitted diseases and started sexual activity at younger ages than the controls did. That was off the charts statistically significant. We were looking at either a bad STD drug, some faulty antibiotic -- we quickly discarded that, because there was too much variety of exposures there to explain it -- or was there a particular sexually transmitted disease, either a new one or an old one? The old one that came closest to a suspicious one was hepatitis B, which turns out to have the same epidemiology as HIV [human immunodeficiency virus], transmitted in very similar ways. We weren't far off with that hypothesis, but it turned out it was a virus that had not been seen in 00:36:00humans before. We paved the way for the laboratory about where to look to get proper specimens to find a new virus, and several research teams did, both in Paris and at the NIH [National Institutes of Health] in the United States and also in San Francisco. But the one in Paris came in first, and they got the Nobel Prize.

MILLER: You worked with the cases in Haitian patients. Can you tell us about the early reports of Haitians? Who were reporting those, and why was it thought to be even related to this disease in gay men?

DROTMAN: In the early 1980's, there was a migration of Haitians to the United 00:37:00States. It was something called the Mariel boatlift. Actually that was Cubans, but Haitians came at about the same time. There were actually refugee camps set up in the Miami area to house a great many Haitians. Some of the early AIDS patients were Haitians, and they didn't appear to be gay men, and some of them were not drug users. What was going on there? Why would Haitians be-- because they were such a small part of the population of the U.S., but a significant fraction of the early cases of AIDS.

MILLER: How did you meet the case definition? Do you recall some of the diseases they were presenting with? Was that similar to those in previous groups that 00:38:00Richard Selik was developing [in] this case definition?

DROTMAN: Yes. In the case definition, the number one qualifying opportunistic infection was Pneumocystis pneumonia, but there were others. I believe several of the Haitians had toxoplasmosis of the brain. I don't know that it was part of the original case definition, but disseminated tuberculosis was certainly a problem. Cytomegalovirus pneumonia and retinitis, there were a number of other opportunistic diseases that were written into the case definition. Some of the Haitians also had disseminated herpes infections. That took the longest to get 00:39:00written into the case definition, but they certainly had it early on in the Haitian community. We weren't sure that this was connected, but we were suspicious. Then we got calls from two doctors in Haiti who requested assistance, and they were requesting assistance from anybody who would be willing to help. Their closest connection in the U.S. was to the University of Miami, so there were a few doctors there who went to Haiti. They also contacted the CDC, and I got volunteered to travel to Haiti and meet with those doctors.

MILLER: Tell us about that first meeting when you went to Haiti.

DROTMAN: It was an eye-opening experience. Haiti is the poorest nation in the 00:40:00Western Hemisphere. At the time it was run by President "Baby Doc" [Jean-Claude] Duvalier, the son of "Papa Doc." It was a complete and total autocracy, where one person ran the whole country. When you go to Haiti and land at Duvalier International Airport, the first thing you see in the town is the presidential palace, which is enormous and looks very much like the White House does in Washington, D.C., except it's surrounded by disheveled buildings that are crumbling. It's an island of white marble in a sea of garbage. The contrast is what strikes you immediately.

Being a CDC representative, the first thing I did was go to the Minister of Health to explain my mission. I was ushered in with great fanfare to a modest office, but it was in fact the only office that I entered in Haiti that had air conditioning; everything else was stiflingly hot. The Minister of Health was gushingly gracious and welcoming, and he said the words, "all the facilities of the Ministry of Health are at your disposal, and here is the address where all of our offices are." I said, this is great. I'll be able to do something here. I went to that Ministry of Health building, not all that far from the minister's 00:42:00office or the presidential palace. I entered a two- or three-story walk-up wooden building and entered into the hallway, and there was literally nothing there. There were no people. There were doorways with signs, and the signs would say Immunization Department, Malaria Control, Tuberculosis, Venereal Disease, and you walked in the door and there was literally nothing-- not even walls. You just see the other doors with the other signs. The Ministry of Health was literally a shell with nothing in it. I said, this is odd.

I eventually came to the end of the hall, and I found a person. It was actually a Belgian physician, [Dr. Alain J.] Ali Roisin, who had been an EIS officer and 00:43:00was working for the World Health Organization assigned to Haiti. He was the only person at work in the Ministry of Health. I met him, and he was a French-speaking person. I enlisted his help, and he became my coworker. He and I went around and visited the clinicians who had reported AIDS patients. One was a dermatologist, Dr. Bernard Liautand, and he introduced us to his patients. We drew their blood and sent it back--

MILLER: Those were Kaposi's sarcoma patients?

DROTMAN: I don't remember the diagnosis of his patients. It may have been actually herpes zoster, but I don't remember that exactly. The other physician was actually a guy who didn't get along with Dr. Liautand, the dermatologist. He 00:44:00was a guy who ran a clinical laboratory in Haiti, Dr. Robert Elieand. It's sad that those two guys didn't get along, but they both were smart enough to know that they had patients that might meet our case definition. The other fellow had Pneumocystis pneumonia, and he was suffering in the hospital.

MILLER: It's 1982-83, but there was not an antibody test. You were drawing blood to look at the lymphocyte counts?

DROTMAN: Yes, we were measuring CD [cluster of differentiation] cells. We were shipping the samples back to Dr. [Thomas] Tom Spira in the immunology lab at CDC Atlanta, and looking at the profiles of the lymphocytes and the CD-4 cells and the hepatitis B serologies and other things to see if it matched up, and they 00:45:00did. One thing about drawing blood is-- because I also went to other hospitals to find the patients. This was before universal precautions were promulgated, before we knew the routes of transmission. I was in hospitals that were hospitals in the sense that they were buildings with sick people in them, but they had essentially no other asset that you would associate with a hospital, including running water. They did have a lot of alcohol because sugarcane grows there. They distilled their own alcohol and it smelled like rum, which is basically what it was. One of the vacutainer tubes was leaking when I was 00:46:00drawing blood, so I got patient's blood on my hands. I couldn't wash them, so I basically was washing my hands with raw ethyl alcohol. I said to myself, "if I ever get AIDS, I know who I got it from." But luckily I didn't. Those patients all had immunologic profiles that matched the U.S.-borne patients, and the epidemiology appeared to be the same. There may have been a heterosexual transmission component there. There probably was a homosexual transmission component, but it was much more difficult to get the kind of history questionnaire response from the Haitian patients in Haiti than I had become used 00:47:00to in traveling around the United States. The cultures were different, the languages were different, and the degree of confidentiality--

MILLER: Was homosexuality intensely stigmatized in the Haitian population?

DROTMAN: Yes, it was. But clearly it was there, it was, because Haiti was a highly repressed and totalitarian government. Duvalier was very much in charge, and his government enforced the laws with a group called the Tonton Macoute, which was the secret police, some of which were not so secret. They wore a kind of blue jumpsuit and carried big guns, and people readily identified who they 00:48:00were and they kept out of their way. I met a few of them, and I went into places looking for patients, including what's called a slum but would barely pass as a refugee camp, called Cité Simone and Cité Soleil. These are slums named after the wives of the Duvalier family. No municipal sewer system basically. They were smelly hovels that you would not be surprised if there was any kind of outbreak there. I was not supposed to go to these places, and I encountered some Tonton Macoute. They could have done anything they wanted, including kill me, without answering to anyone, so I just tried to keep out of their way.

MILLER: It sounds like it could have been a fairly lonely, scary pursuit. Do you 00:49:00recall how you felt doing this investigation? Were you getting a lot of support back from Atlanta?

DROTMAN: Of course, we didn't have very much in the way of a communication system. This was well before email was invented or satellite telephones. You could occasionally get a phone call from the-- I was staying in something called the Holiday Inn, but it didn't resemble any Holiday Inn anybody has ever been in. The toilets were backed up, and there was no air conditioning, just barely hallways, no screens and no windows. Yes, so it was kind of lonely.

MILLER: It sounds glamorous in the telling, but I can imagine at the time it was grueling.

DROTMAN: Yes, it was. It wasn't easy, and I learned a lot about Haiti that I 00:50:00didn't know. It had been, at one time, a pretty lush, forested mountainous scenic place, but nearly all the forests were cut down for the people to make charcoal, which is their basic fuel that they use for cooking. Now the hillsides were all bare and eroded. It was quite sad. It would get hit with hurricanes every once in a while. There had been one not too long before I got there. There were a lot of people sleeping on the streets. There were beggars everywhere, and all the flights out were-- in fact, I got bumped out of my flight out, and it was a question of, how do I get out of here?

MILLER: How long were you there?

DROTMAN: A couple of weeks. Actually there were people there from the University of Miami, too. They were interested in pathology, so they were interested in 00:51:00talking to the doctors and examining their specimens. They didn't go and visit patients so much.

MILLER: When you came back and debriefed the Atlanta headquarters, what was your thinking? Do you remember what you were reporting?

DROTMAN: Yes. There was AIDS in Haiti, and the patients that are diagnosed in the United States may be connected to that, or it may be being transmitted in some way both in the United States and in Haiti. There were hypotheses that AIDS had come to the United States from Haiti, and there were many people--

MILLER: Why would that be? Can you tell us--

DROTMAN: There were early cases there, and nobody knew how it came to the United 00:52:00States. There were cases also being reported from French-speaking nations in Africa, Central Africa, so black French-speaking people were lumped together. Some were saying, "what do they have in common?" There were hypotheses, none of them proven, that Haiti had a French educational system that they inherited from their former colonists and with a surplus of educated people who would do anything to get out of that country, because the quality of life there was not so good. They would take jobs in bureaucracies of other French-speaking former colonies, and that became a hypothesis of how AIDS might have spread. There was this old-- I guess you would call it a myth-- of syphilis having originated in 00:53:00Haiti or the island Hispaniola, a poem written 500 years ago by [Girolamo] Fracastoro, that describes how syphilis became epidemic, first in the Americas and then from Columbus being brought back to Europe and spreading rapidly. Here was yet another STD that Haiti is giving to the world. So this was a hypothesis [that was] not proven, but one that in today's era of fake news, you can understand how these kinds of things could gain some traction.

MILLER: With regard to stigma, it looks like so many of these so-called quote-unquote risk groups were suffering from stigma. The Haitians, gay men, 00:54:00hemophiliacs. Can you talk a little bit about stigma and what it was like?

DROTMAN: In the early '80s, before we knew the cause of AIDS, and even after the cause was discovered, there was basically full-scale panic. People who were at risk for HIV, and that included gay men, injection drug users, people with hemophilia or others who had to get a lot of blood products, and Haitians, were all severely socially isolated. Many of them lost their jobs, lost their housing, lost their place in school, were kicked off athletic teams, and it became a social crisis as well as a biomedical problem. It fell to CDC and some 00:55:00other government agencies to deal with that.

Now, at CDC we had developed a case definition that was intended to be highly specific. We wanted the cases we investigated to be cases with a great deal of certainty. We recognized that there would be some people who were likely not meeting our case definition, but were sick. The agencies that were charged with enforcing disability criteria or fair housing practices or access to school opportunities all adopted the CDC case definition as that's AIDS. We were going to prevent discrimination against people with AIDS, but it didn't prevent discrimination against much larger populations that didn't have AIDS but yet were at risk or had some mild manifestation that wasn't meeting our case 00:56:00definition. It didn't take a long time for some of those communities to organize and become angered with the CDC for trying to cover up the problem by identifying or defining AIDS as a severe debilitating immune deficiency and not counting all of the others. We were accused of being part of the discrimination, and so CDC became the subject of a letter-writing campaign, and our campus was picketed. There were windows that were broken whenever we would give talks in the communities or at scientific or other meetings. There would be groups that would boo us or demonstrate in some way.

We had immense sympathy for the communities we were trying to help and we were trying to accomplish a scientific mission here, but we all recognized it was probably doing some indirect harm to a large number of people. The group Act Up [AIDS Coalition to Unleash Power] was one of the major community organizations that was actually highly effective. Their slogan was "Silence Equals Death," and they had that printed up as a logo. They wore that on banners and tee shirts and wore them and displayed that at all the conferences we attended.

MILLER: Do you remember the atmosphere at CDC in terms of the Office of the 00:58:00Director, and were you given support to work on this?

DROTMAN: The homophobia that predominated in society was also present in the halls of government and in the halls of the CDC. It's probably one of the reasons that AIDS was originally assigned to the Venereal Disease Control Division, now the Division of STD Prevention, because doctors and others who worked in that area had some degree of comfort in talking and taking medical histories from gay men and also to a certain extent drug users. A lot of the traditional infectious disease division was saying, we deal with children or we 00:59:00deal with cooks or we deal with people with TB. We don't deal with gay men. We don't want to talk to them. Others that dealt with sexual issues, even the Division of Reproductive Health, were not too comfortable talking with gay men. It was by default, and it was actually serendipitous default, that the people that were assigned to work on this problem originally came from the division that was most well equipped to investigate it properly.

MILLER: In 1986, then Surgeon General [Charles Everett] Koop was allowed to issue the first Surgeon General's report on AIDS, and then in 1988 this report 01:00:00was sent to every household in the U.S.. This was after the cause of AIDS has been identified and there was a test.

DROTMAN: I have a copy of it right here: Dr. Koop's original Surgeon General report. It's actually very short. I'll confess, I had great doubts about Surgeon General Koop. He became the Surgeon General of the United States at the appointment of President Ronald Reagan. He was a very conservative pediatric surgeon from the Children's Hospital of Philadelphia, where he pioneered a great many surgical techniques to save newborn babies with congenital malformations. 01:01:00His anti-abortion credentials were impeccable, which was one of the qualities that President Reagan specifically looked for in a Surgeon General. When Dr. Koop said, "I'm the Surgeon General for all of the people, and there's a problem that's afflicting a certain fraction of the people, I need to put the medical facts out there and say what the population needs to do to prevent itself from getting HIV." It's deceptively simple-- you need to either not have sex with people who have it or use condoms all the time, and not use intravenous drugs, and a few other things.

That caused a firestorm of controversy. He was viewed as a traitor to the people that had appointed him Surgeon General, but he won the undying affection and the 01:02:00trust of the American people. They said, this is a Surgeon General who can talk to us in a way that we understand. If you've ever seen a Surgeon General's report, they're big thick things with a lot of data and statistical tests and advice and long medical words. Dr. Koop's thing is 85, or fewer than 85, 36 short pages of plain language with pictures, and anybody could read it and understand it. A few members of Congress requested copies of it to send to all the residents of their district, and the district was several hundred thousand people. We got some requests like that, and we got other requests that said, this shouldn't be sent to anybody. It was a very controversial thing-- but by 01:03:00the time he won the respect of the people, they couldn't fire him. He had too much credibility. He was left alone by his political bosses, including Secretary Otis [R.] Bowen, the first physician to be Secretary of Health and Human Services in the history of that department. He had been governor of Indiana, but he did essentially nothing about HIV and AIDS. Surgeon General Koop was a guy with great stature. I met him personally when he visited CDC. He told us, I have told Secretary Bowen that you will not be remembered for any other accomplishment in your tenure as the Secretary of this department if you don't 01:04:00do anything about AIDS. And he didn't do anything about AIDS.

MILLER: You were in CDC's now Division of HIV/AIDS, and then you were heading up the Technical Information Activity. What was CDC's response after Surgeon General Koop's report came out, and what were some of the approaches that CDC was taking then in terms of educating the public?

DROTMAN: That's true. That was my first title, as branch chief of the Technical Information Branch in HIV AIDS. Shortly after I got that appointment is when Dr. Koop's report came out, and we were immediately overwhelmed with requests for information. The Surgeon General's office in Washington has very little 01:05:00resources. It's mainly a figurehead kind of job, although the Surgeon General is technically the head of the Public Health Service. The office has no budget or very little budget and very little staff, so the firestorm of response that Dr. Koop got was all referred to my little branch, and I didn't have much of a budget or much of a staff either. We had, I would say, an inadequate response to the immense, basically tsunami of requests for information and explanations and action about preventing AIDS and diagnosing it and doing something about it. After inadequately responding to the great many congressional inquiries and controlled correspondence that we got, it's not an exaggeration to say that we 01:06:00got-- back in those days CDC put congressional and controlled correspondence in orange folders. CDC ran out of orange folders. We got more than a hundred a day.

MILLER: And the controlled correspondence means?

DROTMAN: Means it's high-level correspondence. Although my branch was tasked with drafting the response, often the response would go out under the signature of the Director of CDC or even the Surgeon General if it warranted. We were getting inquiries from senators and congressmen, presidents of universities, deans of medical schools. Everybody needed immediate access to information to deal with, because they were getting questions from their constituencies and patients and students and colleagues.

MILLER: How long did it take before you were able to mount a significant response? I remember America Responds to AIDS, Business Responds to AIDS.

DROTMAN: It took months to years. I don't remember the exact timeline, but a whole unit was developed to make a national campaign. I was peripherally involved in that, because the whole unit of [Charles Frederick] Fred Kroger and others were brought in who were PR [public relations] experts, not biomedical people, more from the advertising world, to deal with that kind of problem. They eventually developed a brochure that was a Reader's Digest version of the 01:08:00Surgeon General's report. It was delivered to every mailing address in America. At that time we were saying, it's the only thing the government sends to everybody in America that's not a tax form. And it was true.

MILLER: Before we move on to some of your other work, are there other things around this time that you'd like to discuss at all?

DROTMAN: Part of the response to the request for information was we developed a set of technical teaching slides. People may not know what teaching slides are anymore, because everything is electronic. It used to be that if you had a lecture for teaching, you'd have a Kodak carousel projector and a bunch of little 2x2 Kodachrome or other brand of slides, and you would arrange your deck of slides in boxes. We shipped them out to anybody who requested them, and they 01:09:00were immensely popular, so much so that I was invited to write chapters in medical textbooks that depicted those slides. Here's one in the first Atlas of Infectious Diseases. Some of the most popular slides we ever did were the maps of the United States with the dots depicting where AIDS was occurring. It showed over a period of years where the first cases in big cities on the coast had been, and then spreading out to light up the whole country. That kind of spot map has been depicted on Hollywood films and disaster movies involving biologic terrorism in the decades since.

One of our strategies was that if we put out good information, it would suppress 01:10:00some of the bad information that others were seeking to put out. Being in that arena, part of my job was to react to some of the bad information and wacky hypotheses that were being promulgated. One of these a prominent professor in California named Dr. Peter [H.] Duesberg, who was a legitimate Ph.D. tenured professor at the University of California. He came up with a hypothesis that HIV is not the cause of AIDS, but rather it's a toxic reaction to medicines, including some of the early medicines used to treat HIV, which were indeed derived from anti-cancer drugs, so they were kind of toxic. Dr. Duesburg became a popular guy, and he convinced some people that HIV was not the cause of AIDS. 01:11:00I was one of the people who had to put out the correct scientifically justifiable information to contrast with some of his ideas. Some of his ideas were being promulgated by fake news outlets, including the Soviet Bloc, which planted fake stories in some of their newspapers around the world. [For example,] the Communist newspaper of India was the source of the rumor that the AIDS virus was concocted in a CIA [Central Intelligence Agency] laboratory and deliberately introduced into Africa and Haiti to kill people deliberately. There 01:12:00were a great many people who believed that, and once it was in one of those newspapers, it was picked up and spread to others.

Another one was that HIV was an inadvertent contaminant of the oral polio vaccine, because it is true that the oral polio vaccine is grown in monkey kidney cells that are laboratory-derived strains, but some of those strains are taken from monkeys that may have had some viruses, [simian virus] SV-40 or others. The hypothesis was that HIV was contaminating early stocks of oral polio vaccine, and there were books written promulgating that hypothesis. They all gained notoriety for a brief period of time but have all of course since been debunked. It was harder to do it 30 years ago, when we didn't know for sure all 01:13:00the manifestations of AIDS, all the routes of transmission, and any known effective way to treat it.

MILLER: Did you go out and give lectures, you and other colleagues at CDC?

DROTMAN: Yes. Nearly everybody who works at a place like CDC is going to get their 15 minutes of fame, because whatever it is they're working on will come to public attention. My 15 minutes of fame lasted several years. I got more invitations to give lectures and grand rounds that I would ever have imagined. I went just about everywhere giving lectures. I was almost like a rock star. That is what it felt like, because there was such great demand to show these slides 01:14:00and give the latest updates.

MILLER: What kind of places? Academic centers, hospitals, other types of places?

DROTMAN: It was everything. I was invited to Rotary Clubs and lunches and churches, to international congresses with literally tens of thousands of attendees. Perhaps the biggest one was the World Congress of Dermatology at New York City, where the opening ceremony was Liza Minelli singing 'New York, New York.' It was at the invitation of Dr. Alvin [E.] Friedman-Kien, a prominent gay dermatologist who was an expert in Kaposi's sarcoma. He personally invited me and introduced me to the assembled luminaries. Quite interesting.

I was on the Board of Scientific Advisors of the American Foundation for AIDS Research, which was the research foundation founded with money that came from the will of the late Rock Hudson, the prominent movie star who died of AIDS early on in the epidemic. The executor of his will was Elizabeth Taylor, the glamorous movie actress who I got to meet at one of the international congresses on AIDS at a palace in Florence, Italy. It was a rather glamorous session attended by [Dr.] Jonas Salk and Dick Cavett and the President of Merck Vaccines, a bunch of people that I would never otherwise have had any business being in the same room with. Of course, the big attraction was Liz Taylor. She 01:16:00was there to raise money for AIDS research, and she did a heroic job. She was--whatever else you may think of her and all of her marriages and other troubles, she was a great money raiser for AIDS research. She came out with all the klieg lights and the paparazzi in the room pushing me out of the way to get to her and with her sparkling diamonds. She was, "all this for little me?" Then the President of Merck handed her a check for $25,000. Enjoy your 15 minutes of fame, because now I don't get invited to that stuff.

MILLER: In doing all of this, it sounds like CDC did a lot of great things. When 01:17:00you look back at that period, are there some things you think CDC could have done better or differently?

DROTMAN: The main thing that we probably should have done is find the AIDS virus. Our lab didn't do it. It was the Pasteur Institute in Paris and Dr. [Robert] Gallo's lab in Bethesda at the NIH and Dr. Jay Levy's lab in University of California San Francisco. We had the specimens; we had the patients. I personally met-- you may have heard this story of the so-called Patient Zero, the Canadian Airline steward who was depicted in the book [by Randy Shilts] And The Band Played On and in the film. He was not the first person with AIDS, but he was certainly one of the most prolific. He was sexually linked to 200 other AIDS patients by CDC sociologist Bill Darrow. One of the great things that CDC 01:18:00did is prove that it's sexually transmitted. He flew that patient to Atlanta. I met him personally. We drew his blood, but we didn't find his virus.

I personally met the people that won the Nobel Prize. Françoise Barré [-Sinoussi] came to CDC and worked with our laboratory folks. She and colleagues at the Pasteur Institute are the ones that actually isolated the virus, calling it first the LAV, Lymphadenopathy-Associated Virus, because they got it out of people that did not meet the CDC case definition. We were looking for burnt-out AIDS patients, so to speak, because they met our case definition, whereas they were looking at gay guys with lymphadenopathy, so they called it 01:19:00Lymphadenopathy-Associated Virus. They found the virus that turned out to be the same as HIV, but they couldn't call it the AIDS virus because those patients didn't meet our case definition. So we did great epidemiologically. We did not do so well immunopathologically.

MILLER: In 1991 the LA Laker's basketball star, Magic Johnson, announced that he had AIDS, and of course, this shook the world almost as much as when Rock Hudson was found to have had AIDS. You had what some might call an enviable and somewhat unique opportunity to provide advice to many in the world of sports. Can you tell us a little bit about that part of your work at CDC?

DROTMAN: Yes, in the '90s when Magic Johnson surprised America by announcing that he was HIV positive, it just added more to the full-scale panic that was 01:20:00going on. Part of the panic was athletic competition. Here's a premier athlete--by the way, Magic Johnson never played another game in the NBA [National Basketball Association] after he made that announcement--, but he did wish to play on the Dream Team that went to the Barcelona Olympics. So the Olympics committee said, we need to address this problem. What are we going to do? They went to the World Health Organization-- the International Olympic Committee is in Switzerland, as is the World Health Organization, and the International Federation for Medicine and Sports is also nearby Geneva, Switzerland. The Head of AIDS at WHO was Dr. Jonathan Mann, who was killed in an 01:21:00airplane crash some years later, tragically. He assembled a panel to devise sensible guidelines for AIDS prevention in sports. Since I was the guy who was in charge of the--or coordinating the response to wacky theories, I was invited to be on that panel, which was very interesting. We spent a few days at the WHO headquarters with physicians from around the world and representing a great many different sports, particularly combative sports and some sports that I had not even thought of. I remember meeting the East German team physician for the weightlifters, who was [in a fake German accent] "And what about the Palmaris 01:22:00manus. They will stretch the tendon, and they will bleed on the bar when they're lifting the weight?"

There were all kind of hypotheses and theories and concerns. Boxing and Judo and wrestling were obvious, but there were a great many other sports and competitions that we needed guidelines for all of it, and so we did [draw up guidelines]. The basic guideline was "don't test and exclude athletes." That's not the way to prevent this. You prevent bleeding, contact with blood. People, contestants, who are bleeding must be brought to the sidelines, and their bleeding must be controlled and whatever, their wounds covered, before they can resume. It was agreed to and the Olympics adopted that as the policy.

Once the Olympics adopted a policy, then every other sports organization said, we need that, too. What was happening was little boys with hemophilia were being kicked off their high school athletic teams, including the late Ryan White, for whom the Ryan White Act is named. He was on a basketball team in his hometown in Indiana. His team didn't kick him off, but the other teams would refuse to play him. It became a controversy no matter where he went, even if he was able to overcome prejudice in his own hometown among the kids who knew him, so they would just forfeit.

The NCAA [National Collegiate Athletic Association] and all of the major sports organizations said, we need a policy, too. The one that was most active was the 01:24:00NFL [National Football League]. They were the first most proactive one and they went to their--they didn't know about AIDS or blood-borne pathogens-- they went to their drug advisor. Their drug advisor was then, and I believe he still is, Dr. Lawrence Brown of Brooklyn, New York, who runs an addiction treatment facility in New York City. He is independent of the ownership of the NFL, because the players will not trust anybody who works for the owners. They have agreed he's the independent drug advisor, and the NFL went to him. But he didn't know much about AIDS even though he was a drug expert, so he came to the CDC and eventually found his way to me. He and I devised a study protocol to assess what 01:25:00the risk might be of HIV transmission in contact football.

We devised a study and, of course, we devised a study where Dr. Brown and I would have to be on the sideline of NFL games and observing bleeding injuries firsthand ourselves. He went to the New York Jets and the Giants games, and I went to the Atlanta Falcons home games for the seasons of 1992 and 1993. I went with the players on the sidelines and in the training room, just as he did. This was my little notebook where I wrote down every bleeding injury that I observed, holding everything confidential. I agreed never to disclose the health of any player or anything. I calculated the number of bleeding injuries in a game. It 01:26:00turns out there weren't very many. The bottom line is there were 3-4 per team per game. It just seems like there are more. A lot of it, I believe, is because at least in 1992 was the opening of the Georgia Dome, where the Atlanta Falcons play their home games. It was artificial turf, after playing the previous 25 years outdoors on grass. A great many players skinned their knees or their elbows by sliding or going for a pass or being tackled and scraping this [turf]. When they go back to the huddle and put their bloody elbows on their kneepads, as they're kneeling down to be in the huddle, they stained their pants. Then 01:27:00everybody on TV sees that blood stain for the rest of the game, even though they're not bleeding anymore. It looks like, gee, there's a lot of blood in that game, but really it's only a guy who skinned two elbows, and usually it's the pass-catching guys, the ends, who do that, or running backs.

We calculated the number of contacts, the number of bleeding injuries, the number of games in a career, and calculated the risk to be rather remote from blood exposure. Not zero, but a couple in a million or something, and there have been fewer than a million players in the history of the NFL. We said, if you adopt the policy that we had promulgated for the Olympics, educate players about 01:28:00sex, which is really how they're going to get AIDS, if they're going to get it. Train the medical staff, as every team has to have actually two physicians and a professional trainer and a staff on the sidelines for every game. That's part of the rules of the NFL, and it's not negotiable. You train them to care for bleeding injuries, and this is the way to go.

MILLER: A very satisfying study.

DROTMAN: Yes. We published that in the Annals of Internal Medicine, and it, again, made me a rock star. I got invited to the National College of Sports Medicine meeting. I was on a panel with NFL players and sports writers, a quite interesting group that I would not otherwise have met. The NFL did it one way. We had a meeting where we trained all of their team doctors. They came to their 01:29:00summer meetings, which I attended, and they went back and trained-- each one trained their own team. Professional baseball did the same thing, but they did it centrally at their headquarters at New York City. They have both a national and an American league team in New York City, so as the teams went through New York City. Every team had to go to a required training there, and each sports league did its own. The one group that didn't adopt this set of guidelines was professional boxing. They did testing and excluding, and they actually found some boxers who were HIV positive. The most prominent of them was Tommy Morrison, who was disqualified. He lost his career because of that.

MILLER: In closing, you played a pretty significant role in an epidemic that 01:30:00spanned your career. Any closing thoughts? Can you say how this has affected you?

DROTMAN: It certainly changed my life. If you remember, from the beginning my goal was to come and teach people how to prevent chronic diseases and lengthen their life and to live a healthier lifestyle. I have no training in a bona fide way as an infectious disease specialist or ID [infectious disease] fellowship or any of the traditional infectious disease career paths at CDC. I had worked on immunizations as a pediatrician, and I had worked in smallpox eradication as an international epidemiologist. We've got those problems covered. I don't need to 01:31:00be an ID guy. CDC has tons of them. But I got drafted into HIV/AIDS and became an ID expert, all on-the-job training working in public health. I became a fellow of the Infectious Disease Society of America, and without that training I didn't even think that was possible.

From that, I parlayed that into becoming Editor in Chief of the Emerging Infectious Diseases journal, a job that I would not have ever predicted getting. I replaced the first editor, who was Dr. Joe McDade, the guy who discovered the cause of Legionnaire's Disease, a bona fide microbiology expert, and here I am with none of that training. I couldn't hold a candle to him, but I got enough 01:32:00good judgment in assessing the quality of scientific investigation into infectious diseases that CDC [has] trusted me to do this job for the last 15 years or more.

MILLER: Were you ever worried that you or your family would be infected with the AIDS virus in the early years you were out there?

DROTMAN: I was worried in Haiti when I got blood on my hands from drawing blood from a patient and it spurted out from around the sides of the vacutainer tube, but I wasn't really worried when I was interviewing all those patients. When I was in the ICU [intensive care unit], a lot of times we were required by the hospital protocols to wear masks and gowns when going into the ICU; it was just the protocol for anybody with pneumonia or on a respirator. Typically I took 01:33:00that mask off because I was trying to interview people that I needed to get close to. We were doing it behind curtains, so I wouldn't show the medical staff that I was in violation of their protocols. But I wasn't doing suctioning or doing things that were-- that I would have really wanted to wear that mask.

MILLER: Are there any things that you think CDC could have done better, as you look at the whole picture of the response to HIV?

DROTMAN: We certainly could have tried to do things better. I don't know that we could have. For the '80s we were operating under a presidential administration that really did not want to address the problem. President Reagan never mentioned the word AIDS in his eight years, all of which were when the AIDS 01:34:00epidemic was exploding. His Secretary of Health and Human Services [Margaret Heckler] didn't. The Assistant Secretary for Health barely did anything, and the persons to whom the task fell were the Surgeon General and the Director of CDC, who had to deal with his supervisors. I know we tried to be stealthy about some things. When we would talk about anal intercourse or condom use in the MMWR, which is the CDC newsletter that needs to be cleared at the highest levels of the Public Health Service, it got censored.

There may have been better ways around some of that. It was hard to do. You're 01:35:00part of the U.S. government, and you have to play by the laws of the land. I suppose some people could have been more noble and spoken out and resigned or something. There were a few people who did and said, I can't tolerate this and I'm quitting and going to work in some other outfit. The highest-level guy I think who did resign was Jonathan Mann, the head of WHO's AIDS Program. He quit and went to Harvard [University], where he had a freer hand in what he could say and do. But I think he may have actually been on the CDC payroll assigned to WHO, so I guess there were some noble folks.

MILLER: Any final thoughts?

DROTMAN: This has been great fun. I'm happy to have contributed to the oral 01:36:00history of AIDS at CDC.

MILLER: Thank you so much.