The AIDS Epidemic in San Francisco: The Response of Community Physicians, 1981-1984, Vol. I
II The AIDS Epidemic
Bay Area Physicians for Human Rights
Kaposi's Sarcoma Brochure
HughesWas the June '81 symposium the first time that BAPHR had gotten the word about AIDS?
Andrews
I think it was.
Hughes
BAPHR later agreed to distribute a brochure on KS. Do you remember that?
Andrews
Vaguely, yes.
Hughes
Marcus Conant saw one of the early cases of KS in San Francisco.
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AndrewsAll of us were mystified: why is Kaposi's sarcoma, which normally happens in older Mediterranean men, appearing in young gay men? That's why Marc's foundation was first called the KS [Research and Education] Foundation, and only later became the San Francisco AIDS Foundation.
The KS brochure was the first AIDS-related thing we did, even thought it was a still unnamed disease at that point. We met with Marc, and produced this brochure with photos of KS lesions that went out to doctors' offices, it was all over the city--all over the country, really, because we started distributing it at the symposium.
Hughes
BAPHR and the KS Foundation were both funded by gay men and both concerned about AIDS. Was there any interaction, any idea,
Andrews
There was a lot of communication back and forth. Marc Conant was a BAPHR member and came to some of our meetings, and many of our members would go to his early discussions about what they were finding. There was a lot of interchange.
Hughes
Was the main way you got your information by talking?
Andrews
I think so. Someone would hear something from someone in L.A. or New York, and then it would get in the news or it would go through the medical grapevine. There were a lot of personal calls.
BAPHR Focus on AIDS
HughesYou've said that BAPHR had other concerns. I'm wondering when AIDS began to dominate.
Andrews
I think it began to take over the whole focus of the organization when it became clear, not only to the physicians in the country and in the Bay Area but to the population, including politicians and homophobic people, that something--GRID [gay-related immune deficiency]--was going on that was very, very serious. And because of that, there were two things happening. The gay community was in an enormous state of anger and denial. The nongay community was in an enormous state of unrest and fear.
Hughes
Was it also something that you as a gay physician felt particularly responsible for addressing? You had two reasons to be concerned: you were not only physicians but you were gay men.
Andrews
That's right.
Hughes
And it was your community that was being hit.
Andrews
That's right. We had done the health fair and had been trying to reduce the incidence of sexually transmitted diseases, and suddenly most people were saying, "There's something infectious here. We don't know what the hell it is." It began to greatly alarm us. So it was very, very relevant to each one of us, personally and professionally.
Handling a Health Crisis in the Gay Community
HughesWhich BAPHR committees dealt with AIDS?
Andrews
We had several standing committees, including Scientific Affairs and Social Concerns. Scientific Affairs took on the safe sex guidelines. They quickly became the committee that tried to put together the information that we were going to distribute. I don't think we ever called it the AIDS Task Force.
9. The October 1, 1982, issue of The BAPHRON refers to "BAPHRs AIDS subcommittee (formerly the KS Task Force)..." (p. 167)
Hughes
What did BAPHR set out to do?
Andrews
First it was information collection and trying to get the best information about what was going on to try to understand it. And then there was this challenge of how to respond as a gay medical organization. Suddenly there was a health crisis that seemed to be affecting mostly gay men. We wanted to respond to the community about what to do.
And the gay community was, as I said, suspicious. It is important to understand what had been happening in the gay male community leading up to the AIDS epidemic. I don't think it's an understatement to say that there has been little or no acceptance of homosexuality throughout history, or at least in Western civilization. Certainly in America, there has never been a period when homosexuality was acceptable; quite the contrary. Some of the most severe punishments have always been reserved for those who were found guilty of this "crime." With that in mind, imagine what it was like in San Francisco, and a few other cities that had large urban gay populations, for gay men, for the first time, to feel free to be who they were: to seek out other men without significant fear of being physically harmed. Finally there was a freedom to explore and express yourself, socially and sexually.
So what happened? Male sexuality, not gay sexuality, began to flourish with few inhibitions. I think it is important to realize that lesbians generally have fewer sexual partners than straight women. Why? Because female sexuality, in most species of the animal kingdom, is expressed differently than male sexuality. Take the bathhouses: they should not really be called gay bathhouses, but male bathhouses. It is a rare female,
Okay, so this man-man thing starts getting into high gear. Bathhouses and sex clubs flourish. The rate of STDs skyrockets as "bugs" get passed around between more and more men. So everyone just goes to the city clinic and gets a shot of penicillin and is back in action in a week or less. Even hepatitis, a much more serious illness, is looked at as only a minor inconvenience that can put someone "out of action" for a few weeks or months. And then something changes: people start getting much sicker and dropping like flies from some mysterious cause that no one knows about.
So very early in the epidemic, when little is known, and nothing is proven, we still have a good hunch this is a new sexually transmitted disease of some kind. But when I, as president of BAPHR, meet with members of the community and bathhouse owners, and tell them that it does look like a sexually transmitted disease, it is not really surprising that people are upset and angry to hear this possibility. People suggested this was a plot by the CIA to eradicate homosexuals and they were putting something poisonous in air vents at the bathhouses. The local gay papers would also repost this as a possibility. It was wild!
Hughes
Can you say something about your general approach when you were confronted with a person who was close to hysterical? Or was it that far along?
Andrews
It was that far along pretty early. The hardest thing initially was to try to keep my composure, because it was upsetting to hear some people that I even knew and had considered friends addressing their anger as if I were responsible for the problem. I mean, I'm the messenger and the messenger has a bad message, like, "We need to think about the fact that it might be something sexually transmitted, you guys." The response would be, "Boo! Go away! You're a liar, you're a turncoat, you're an Uncle Tom, you're working for the government."
All that kind of stuff leaves you a little baffled. You feel like you've been working for several years, to be an advocate for gay health, coming out, et cetera, and then to be looked at as a traitor and as an enemy was very disconcerting. It was very--well, it was very difficult, is what it was. Frankly, a lot of our [BAPHR] members didn't want to go to these
Hughes
Did denial play a role? "This can't happen to me, and it particularly can't happen to me if it means that I'm going to have to change my sexual practices."
Andrews
Absolutely, absolutely.
Hughes
Also, the epidemic came on the heels of the gay liberation movement, and here were these people trying to regulate or even close the bathhouses.
Andrews
Yes, that's right.
Hughes
Which were symbolic of--
Andrews
Freedom, absolutely. I think that is the main thing. We had come from a time in the late seventies where sexual expression and freedom were tested to the limit, and there were people who would boast of their casual sexual experiences anywhere--in a department store, in the park--just about anywhere.
As I said, I was never in that group, partly because I just felt uncomfortable going to bathhouses. I always wanted to know who I was having sex with, and I wanted to have sex with someone that I was attracted to. I didn't like anonymous sex, so the bathhouses just didn't appeal to me, or I would have been there myself.
To hear, "Wait a minute, things may be worse than hepatitis. They may be worse than gonorrhea. They may be going to kill us," was the worst thing you could say to someone. It was like saying, "You're bad." It was like the Bible saying, "You shall reap the vengeance of the Lord." There was just enormous anger and anxiety and fear when there began to be the awareness that there was some deadly disease that was affecting large numbers of gay men in our town and L.A. and New York and causing quick deterioration.
Hughes
How was the BAPHR membership reacting? Was there a consensus of, We're physicians, we should take such-and-such a stand, or was there a lot of division within BAPHR itself?
Andrews
I must say that there were very few physicians that I heard from who would come to the conclusion that this was a plot by the CIA. Most medical folks were saying, "Damn it, there's got to be something transmissible." There were a few people who would say,
But as for what to do about it, there was enormous controversy. Should we take a stance on limiting sexual activity? There was a major, major resistance to imposing restrictions on civil rights that had been fought for for so long. So that was divisive in the organization.
Antibody Testing
AndrewsAnd a little bit later when antibody testing came along, that almost ripped our organization apart. I was strongly in favor of the organization recommending confidential, anonymous testing, and our organization would not take a stand on that. They said, "You shouldn't be antibody tested. There's no reason to be antibody tested, because there's nothing to do about it anyway. It upsets people too much; don't tell them." Which frankly just bewildered me.
Hughes
What was your argument for testing?
Andrews
That if people knew that they were positive, two things: they at least could be more aware of possible medical problems that might arise and treat them, whether it was just thrush or something else; and two, people might be more willing to take responsibility for not transmitting it further. If you just don't know and no one wants to know, you just keep having unprotected sex and the disease keeps spreading. It gets worse and worse.
Hughes
And you were in the minority with that opinion in BAPHR?
Andrews
Yes. I was in the minority, and I was the strongest voice on that side. The organization did not want to come out with recommendations for antibody testing. In fact, they initially recommended that people should not be tested. That's what we recommended.
Hughes
Yes, the minutes of a July '85 board meeting record a recommendation
10. Sam Thal, M.D., Secretary, Minutes of the [BAPHR] Executive Board Meeting, July 7, 1985 (BAPHR office documents, folder: Executive board minutes).
Yes, and I'm not quite clear what that could mean.
Hughes
It didn't explain.
Andrews
That was when we started getting really divided about the issue of testing. Oh, people were very upset about the whole idea of that.
Hughes
The arguments against testing were: one, what good is it going to do, we don't have a treatment, and two, this is an infringement on civil rights?
Andrews
And if this information ever does get out, you could lose your job, health care. It was all of those things. My argument was always, "Well, but if you do it anonymously, you won't have those problems." We went through long arguments about, "You can't promise that it's anonymous." I went over to Health Center 1 where they were doing testing and I learned the whole procedure. I knew it was impossible for it not to be anonymous when you had to make up any two letters and numbers and that was the only code they had for you. People were worried that they might be taking your picture or something and I would say, "Really, you guys. Now, come on. Look who's doing the testing: it's another gay man." You had to sort of beg for some faith in some system, but it was very hard to get that idea through.
Hughes
Was there ever a time when BAPHR changed that policy?
Andrews
I don't know exactly when, but I know we changed it, and it was a slow process. I don't remember all the gradients we went through. It wasn't, "Everyone should be tested." That's where we are now, I would say. But way back then, it was, "If you're thinking maybe about donating sperm"--I'm just pulling this out of the air, "if you're ready to have a baby with someone, it might be good to get tested." The blood donation issue we'd already sort of dealt with by then, just encouraging people not to donate if they were sexually active. But I can't really recall. Maybe if I looked through the BAPHRONs I could see the progression.
Speculation on the Cause of AIDS
HughesWell, before it became obvious that this causal agent must be a virus, did you have any idea or speculation about what it was?
Andrews
There was a strong hunch that this was a sexually transmitted disease. We didn't know how, didn't know exactly what, but
Hughes
Yes, because that was in essence what you were seeing, wasn't it? Physicians were taking sexual histories, were they not?
Andrews
Yes, and they were having fifteen cases of GC and two cases of hepatitis and chlamydia--I mean, they were just having everything. And if you took a history, the ones that had the huge number of sexual partners seemed to be the primary ones coming down with it at first. So it was like, Come on, who are we fooling here? Something's going on sexually here.
Hughes
Except that early on, the CDC and others looked at poppers as a possibility.
Andrews
Poppers, I knew you were going to ask me that. Yes, that's right.
Hughes
Bob Bolan waged a campaign against poppers.
Andrews
Well, he wasn't the only one, but there was concern, and it was because so many of the people who were so sexually active used poppers to enhance having all this sex, that it seemed like that was a common ingredient. So it seemed reasonable to wonder if that was a contributing thing. But I think even Bob never really thought it was just the poppers. It just seemed too unlikely. I don't remember what it was like before the spread of poppers, but I do remember that every dance I went to everyone was always doing poppers--to dance, to have sex. Poppers were ubiquitous for quite a while.
Hughes
As soon as you came to the city?
Andrews
Well, see, I didn't really get out and become more active until 1975, and even then, going to the discos in 1976, people were frequently sniffing poppers.
Hughes
So, long preceding AIDS.
Andrews
Yes.
Duration of the Epidemic
HughesDo you remember thinking about the duration of the epidemic in the early days? Did you imagine that it would be something like toxic shock syndrome, something where science rushed in and solved the problem, and it would be gone?
Andrews
Like Legionnaire's disease. Yes. I think there was a hope that this was some weird, idiosyncratic, bizarre, remote disease. Legionnaire's and toxic shock both preceded this. We hoped we could contain this, and it would go away. I don't think anyone had a clue it was going to be as enormous as it is. How could anyone know that?
Hughes
Right. And there was a long latency period, which you couldn't have known of in those early days.
Andrews
Yes.
Hughes
Another turning point was the 1983-1984 period when the virus was isolated. Did that prompt the idea, Well, here we've got the virus. Just around the corner will be drugs and vaccines?
Andrews
That's right. There was a real sense that, we know what it is, and we'll push for the government to do this research and get this thing nipped in the bud. I think there was a real hope initially that things weren't going to get out of hand, like they certainly have.
Hughes
Do you remember when it hit home that this problem was a long, overwhelming problem?
Andrews
Well, as the time went by, and as the BAR, the Bay Area Reporter, the gay newspaper, would report the number of cases, as did the CDC, you'd see this huge increase. It almost seemed like a geometric increase. It wasn't any longer just in three or four major urban cities; it was beginning to show up more and more and more. The hope that it was going to be something we'd snuff out quickly evaporated.
Personal Impact of the Epidemic
HughesWhat about the impact on your personal life? What about friends and associates who were getting sick, and then eventually dying?
Well, that was tough. I remember one of my best friends--let's see, when did he die? I think 1988. But he had been sick for a number of years before that, really sick. I remember having long conversations with him about whether he should get tested or not. He was a very, very intelligent guy, and he just felt like that there was no point in doing that, because we didn't have all the treatments then; we didn't know exactly what to do. After he got some symptoms, he got tested, and he was positive. He said, "God, I wish I would have been tested much earlier, because I would have been more careful about what I did in this last year and a half when I probably have been infectious." And he died, like a number of physician friends did too.
The early deaths were so quick, too. That was what was sort of astounding, because someone would come in with advanced stages of PCP and they'd die three days later or a week later. A conversation might be: "My god, did you hear he--" "Yes, he's in the hospital." "No, he died yesterday." It seemed like the disease initially just ate people up.
Hughes
Was that because people did not recognize symptoms of AIDS and didn't come in until the later stages?
Andrews
I think so.
Hughes
There wasn't much you could do for Pneumocystis, was there?
Andrews
I don't think there was initially. I'm sure they gave them all sorts of antibiotics, but I just remember, you got Pneumocystis and you just expected you would have six months to live. You were not going to have more than a year to live at the most if you came down with Pneumocystis, if you even survived the initial bout, which most people didn't.
Hughes
Were you getting a lot of sick people in your practice?
Andrews
I had some. I've never had more than ten to fifteen men that I've seen here as outpatients, because I was so busy with the kids and with the administrative things that I didn't have a huge practice. In the eighteen years I was in practice, I probably had twenty or twenty-five men that have been positive or have died and so on. So I certainly had that in my practice.
Hughes
Did your training stand you in good stead? Because most psychiatrists don't really expect to be dealing with death and dying, at least on an ongoing basis, do they?
Andrews
No, this was a culture shock for everyone. All of us were dealing with young people, our contemporaries, being gay and dying right in front of our eyes. It was like the Vietnam War.
Hughes
What personal resources did you use? I would think you'd have to protect yourself from the emotion in order to function.
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Andrews
Well, most physicians are used to dealing with crises. Even though this was one that hit us in an unexpected way, and hit us personally, that's what we are trained for. Psychiatrists are used to people crying and being psychotic or trying to kill themselves, and they are used to being calm when that is happening. And certainly, surgeons are used to people dying on the table. We're used to death and dying in medicine, because it just comes with human territory.
The difference was changing gear when you felt personally so attached to the people that were dying. But the training still worked, and because we had such a good support group, there were so many of us here to talk about it. Most of my best friends were primarily gay doctors. So talking about this and sharing the angst and the concern and the anger and all that really helped a lot of us work with it.
Hughes
You mentioned a support group, and I think you probably meant that in an informal way, but wasn't there also a formal physicians' support group at BAPHR?
Andrews
Yes, there was. Originally, there were several that started out to help people that were either personally involved or were just affected by the epidemic, the mushrooming epidemic. I never was involved in any of those because interestingly enough, at Social Security where I worked, at one point the president, vice president, secretary, and treasurer of BAPHR all worked there, all of us. There were twenty-five physicians who worked in this regional office, and about twelve of us were gay, and of that twelve, about six of us were intimately involved in BAPHR and the politics. So unlike a doc who's in isolation, there were a couple of days a week where I'd be spending a few hours going over charts, and we'd sit down and talk about this stuff. We weren't in as much isolation as other practitioners.
The other thing was, BAPHR was still very much functioning at the time, so we still had social functions and many scientific meetings and cocktail parties, and there was a great deal of contact among ourselves.
Mervyn Silverman's Medical Advisory Group
HughesDid you have any particular connection with what was going on at the university, either UCSF [University of California, San Francisco] or San Francisco General?
Andrews
My primary connection was through Merv Silverman's meetings, which were around the bathhouse issue. At those meetings were people from all over the city: from S.F. General, from UCSF, from Marc Conant's office, the Veteran's Hospital system, the blood bank, the president of the medical society, me as president of BAPHR, researchers--that sort of colloquium was where I had a connection. The medical society also had an AIDS task force that many of us went to. So there was considerable cross-pollination. Hughes: Was there any territoriality in terms of orientation towards the problem? By that I mean, did you as a community physician tend to take a different stance than, say, Paul Volberding and Donald Abrams and the people associated with the university?
Andrews
Well, in the context of Silverman's meetings, there was a different stance, and that was, although there were several other gay physicians in that group, I was the representative of BAPHR, and I was, I think, the only psychiatrist in the group. Everyone else was either an epidemiologist or a surgeon or oncologist; they were more academically inclined, perhaps.
I think there must have been a different orientation between the academic-affiliated physicians and the rest of us, but I really experienced a wonderful team effort of people struggling so hard to try to come up with some answers. Whether it was about safe sex guidelines, or whether it was about the bathhouse issue, people were so committed to trying to figure out what to do with this complicated medical-social-civil rights issue. One of the surgeons from S.F. General, Merle Sande, I believe, might be worried about contamination if a gay doctor was performing surgery that might infect the patient, and that would get us off into, "Well, we've got to do universal precautions for everyone anyway, so it doesn't really matter." Those kind of issues.
But I was probably the most focused on the [gay] community response--not to say that Dr. Silverman wasn't; he certainly was very, very concerned. But being the gay medical representative from the community, I think it fell on me maybe a bit more.
Hughes
And you were reflecting that opinion as you saw it expressed through BAPHR?
Andrews
Right.
And through your life, as a member of the gay community.
Andrews
Yes, that's right.
BAPHR's Safe Sex Guidelines
Formulation
HughesLet's talk about the safe sex guidelines. I've read an article by Daniel C. William, "The changing lifestyles of homosexual men in the last fifteen years," which appeared in a book edited by Alvin Friedman-Kien and Linda Laubenstein called AIDS: The Epidemic of KS and Opportunistic Infections. William said that physicians caring for gay patients--and this is before the epidemic--reinforced the concept that "judicious promiscuity held acceptable health risks." I guess he's saying, "If you're reasonably careful, medicine can take care of any consequences." Which I suppose is what you were saying before.
Andrews
That's right: you'd go to the City Clinic, get your shot of penicillin, and then that takes care of it. So go out, and don't put a light bulb up your rectum or something like that, but otherwise, it was just like carte blanche, do what you want.
Hughes
So that was the backdrop against which you were having to formulate these guidelines. How was the process organized?
Andrews
I can't remember exactly. It seems that we decided early on that one of the contributions we [BAPHR] could make is to come up with some kind of response to the community that we could publish to say, "These are the things that, based on what we know, we're going to say as an organization you should watch out about." So how do you make that list, and how do you categorize certain things?
We had endless meetings which evolved into our first safe sex guidelines, which involved issues like closed-mouth kissing, and fondling, and body frottage or body rubbing. All those kind of things were definitely safe. Originally, I think we had three categories: things that were safe, things that were unsafe, and things that were questionably safe.
Hughes
And where were you getting that information?
We were using the basic guidelines for sexually transmitted disease and what we knew about hepatitis B; that semen carried hepatitis B and a lot of other things, so that you want to avoid semen. So blood contamination, you probably want to avoid that. But when you think of sex guidelines, it was mainly avoid semen. Then it was maybe urine too, maybe feces, sweat and tears and all those things were major things we discussed. It just didn't quite make sense to say they are high-risk. Then you'd get everyone totally hysterical.
So part of this was coming up with guidelines that you could recommend to the gay community, but that also didn't throw people into absolute panic.
Hughes
And also were do-able.
Andrews
Yes. Guidelines that would not only not throw the gay community into panic, but throw the larger community into panic, where they would want to isolate all gay people. There was this quarantine thing going on too, that all people that were positive should be quarantined away. That was a real discussion topic, not by us but by other people saying that's what we should do. So there was a real worry that if we came out saying anything that's too constricted as far as you'd better not do anything, that people would use that to round us up. So that was scary.
Hughes
When did you come out with the first set of guidelines?
Andrews
I believe that I was president and Bob Bolan was chair of the scientific affairs committee which wrote them, because I remember so many meetings where we discussed the wording of "might" and "should" and "could" and all those kind of things. I don't remember when exactly that was, but it would be there somewhere. I know we could recover that.
11. See the oral history with Robert Bolan for BAPHR's role in formulating guidelines for sexual activity.
Andrews
We put together a brochure at the request, I believe, of a group called the Sisters for Perpetual Indulgence, the nun drag group that got together to be politically active. They were very pro-sex but they wanted to protect the gay community. They came to us, as I recall, asking for some guidelines, and we came up with something that they then put together in a brochure that was very interesting. We also came up with the same thing for the AIDS Foundation. It may have still been the KS Foundation then. I'll bet you in the BAPHR office somewhere we've got these earliest brochures that we came up with.
We spent so much time just working on the wording so that it would be as amenable as possible to someone reading it, that it would be believable and nonoffensive and pro-gay. It was amazing, is what it was. It was an amazing effort to try to be taking care of all the different sides, so whatever you came up with could work and would be honest, too.
Hughes
Do you think the brochures were published as early as 1982?
Andrews
Yes, I know that we came up with the first group of safe sex guidelines when I was president. So that must have been before the end of '82.
Hughes
Were those the first safe sex guidelines for AIDS in the city?
Andrews
I think they were. In fact--and this could be wrong--it seems like they were the first ones anywhere. I remember we sent them out to New York and all over the place. I remember someone, and I forget who it was, who had some connections with the Public Health Department, and the Public Health Department adopted almost in toto what our safe sex guidelines were, to go through public health clinics.
Hughes
Were you in touch with the Gay Men's Health Crisis?
Andrews
Yes. I went to some meetings in New York in that period where those kind of things were discussed, but my recollection is that they may have discussed and maybe fine-tuned ours. But the first [set of guidelines] came from us, I think.
Distribution
HughesWhat was the community response?
Andrews
Well, mixed. Some people were just scared to death and just didn't want to have sex, didn't want to touch anyone. Other people just thought it was all a bunch of baloney and that we didn't know what we were talking about. This was before the virus was even identified, so you couldn't really stand on scientific proof. It was just based on what we knew, which people would just dismiss as a flimsy argument if we couldn't prove it. So some people took it seriously, some people took it too seriously, some people completely dismissed it. A real mixture.
How well do you think the brochures were distributed in the gay community? Would it have been difficult not to have come across the guidelines?
Andrews
Yes. I don't know when the health fairs stopped, but at the Gay Pride day, we had a booth. Gay Pride day: 200,000, 300,000 people. During those times when we would staff the booth there, we were always handing out every kind of brochure. We had two or three brochures we were handing out, not only from us [BAPHR], but also from other organizations, and people were just flooding there. The Castro Street Fair, the Folsom Street Fair--at all the street fairs, we had booths. And we would mail the brochures out in batches of 100 to different places all over the country. It was printed up in the gay newspapers. It was widely distributed.
Now, someone that wasn't in the gay community at all, someone who didn't have any connection to this community, then they might not have gotten it. But anyone that was "out" in the community, and I mean "out" as far as going to community events, would have run across it. It was in the bars; all the bars passed them out at the door. It was just everywhere for a while.
Hughes
Was it a problem that you had a mixed audience? You talked about classifying sexual activities, but you also had at least three different categories of audience. You had the people who were well, you had the people who were sick, and you had some sort of intermediate group. These guidelines had to apply to everybody, even though the circumstances were different.
Andrews
Well, we quickly came to the conclusion that the only workable solution was universal precautions for everyone, that everyone had to assume that anyone might be positive. The message was to try to get everyone to look at the possibility they might be positive, and if they were, we thought they could transmit this. So here's what you need to do. And that was a very difficult message to give to a community that had been as liberated as it had just been.
Hughes
Right, and still a large percentage of them feeling fine.
Andrews
Yes, that's right. "This isn't going to happen to me." People could carry it for ten years and feel perfectly fine. It was really weird.
Struggle for Acceptance
HughesDid you do some research on how to get people to change behavior?
Andrews
I don't remember any. Well, we did try to spend a lot of time on how to get people to change behavior. The principles were, don't condemn people; we had to be sex-positive. We knew that if we said sex was bad, who would listen to us? So the message had to be that something "bad" is going on that we don't know much about, and that "bad" thing that's going on we've just got to be careful about. We wanted to try to dissociate that from us being bad.
The other thing that was very important in the discussions that I had was to explain to people why this was so upsetting to them. I don't think a lot of people thought this through. I remember many, many times saying, "You know, we have been so persecuted, and we finally came to a time where positive things were happening like Harvey's election, community organizations, et cetera--where finally we can be okay with who we are sexually. And then something comes along that makes us much sicker than GC or hepatitis. But this "thing", this organism, isn't "evil", and gay sex and loving aren't "evil." It's just that these organisms can jump back and forth between our bodies when we have unprotected sex. So the more bodies you have sex with, the more chance this organism can be spread. This isn't God's wrath; it's just basic biology."
And who wants to hear this? So my sense was, you had to explain to everyone why it is that this is so upsetting to them so they could begin to listen to what you were trying to say. Otherwise, they were so upset hearing the news that they just wanted to throw eggs at you.
Hughes
So you felt that was your job to get people to a place where they could hear?
Andrews
I felt that was one of my most important jobs, to get people to understand what's going on here instead of just reacting, and being angry or afraid.
Hughes
And did you have pretty good luck?
Andrews
Well, [laughs] not enough.
The Bathhouse Issue
Background
AndrewsEven around the issue of the bathhouses, the struggle had been contentious, and in BAPHR there were a lot of people that were very upset with me when Merv Silverman closed the bathhouses. In that front page picture
12. San Francisco Examiner, 4/9/84.
13. Andrews was a member of the committee from May 1983 to October 1984.
But I had been the main voice, I believe, at Merv Silverman's meetings, saying, "We've got to help people understand this, and then get the gay community to stop going to the baths, get the community upset about the bathhouse owners who are making money on us, and by the way, we're getting sick from this, and somehow we should be the ones addressing the issue." And I just couldn't get people mobilized around doing that. There were times I thought, Let's get a group of us together and go down and picket in front of the gay bathhouse. But it just never happened.
I will always remember a week or two before we had the final discussion about what was going to happen with the bathhouses. It was very much on the front pages of the newspaper, and we had a big meeting at the Pride Foundation, which was over on Hayes Street at the time--ultimately Shanti had their headquarters there--and I don't think there's ever been a time in my life that I've been more intensely striving to try to figure out a solution, that I can recall.
I remember talking to the owner of the BAR [Bay Area Report], Bob Ross, and the editor, Paul Lorch. Because previous to that, I had been listed in the BAR along with ten other people as the enemies of the community. I remember going to them and
And at that Pride meeting, which was all about civil rights and spreading disease and all this polarity, I remember talking about, "Why can't we be promoting bathhouses as the way out?" A strange thing: to turn this bad thing that's ours into something that can help us get out of this, by expecting, demanding--we do this for our own selves, not because of government; because we're the fucking ones dying! Many people came up to me afterwards and said, "You know, that makes sense."
But Silverman was under pressure from the mayor, Dianne Feinstein.
14. For Silverman's position on the bathhouse issue, see the oral history with Mervyn Silverman, M.D. San Francisco AIDS Oral History Project: The Medical Response, 1981-1984. Regional Oral History Office, The Bancroft Library, University of California, Berkeley. Hereafter, AIDS physicians series.
Actually, it's very interesting to realize that the decision of Merv's medical advisory group, and his ultimate decision as reported in the press, was not to close the bathhouses, but to prohibit any sexual activity that would promote the spread of AIDS. This was actually what I had been recommending. In that seven-hour meeting of his medical advisory group, which included a special trip by Jim Curran of the CDC, the majority opinion was that the baths should just be closed. But I argued strongly for the same idea I had expressed at the Pride Center community meeting, i.e., let the baths stay open, and give them a chance to become educational, safe-sex facilities, so long as they were not conducive to spreading AIDS, which primarily meant no anal intercourse.
We finally reached consensus on this idea and on Sunday, the day before the decision was to be made public, Merv convened a large group of gay community and political leaders to discuss his decision and seek support. I was the main proponent of this plan, and the vast majority of the people attending were in
Hughes
Your idea was, in a nutshell, that the bathhouses themselves could be places of instruction.
Andrews
That's right. That was the only way I could see out of the polarity between civil rights and [the attitude of], "We can fuck and no one's going to tell us what to do; we don't care," and "All you people should be quarantined because there's this serious disease going on, and this place is obviously promoting it." So that didn't work.
Hughes
In the report by psychologists Leon McKusick, Tom Coates, and William Horstman which came out in late 1983, one of the points made was that, "men who frequented bathhouses were the most likely of the groups surveyed to be engaged in high-risk behavior and to have contracted other STDs."
15. Randy Shilts, And the Band Played On: Politics, People, and the AIDS Epidemic, New York: Penguin Books, 1988, pp. 260-261, 414.
Andrews
That's right. And so your question is, how could we come to that?
Hughes
Yes.
Andrews
The assumption is true: if you went to a bathhouse and you only kissed someone, and you masturbated, you were not going to get anything. You might get a sore throat from a cold or something. But the premise is: it's not where you do it but what you do. That was one of our little mottos. It can happen in the park. There were all the arguments about the bathhouses; the counterarguments were, "Now, you can't tell me that someone going
And the answer was always, "No one ever said you can't do it other places. We're simply saying that places that are designed solely for as much anonymous sex as people can have, and with the amyl nitrate, the drugs that go on there, and the orgy rooms, it just makes it 100 times easier for this [disease] to get transmitted than it does in a public place. People don't have 100 people over to their houses."
Hughes
There was a dissociation: it's what you do; it's not where you do it. But on the other hand, when you go into a bathhouse--
Andrews
That's what you're there for!
Hughes
Exactly.
Andrews
It's promoted! You see, that is where politics and civil rights and all that entered into this medical-physical epidemic. The gay establishment had grown more powerful and become more visible in the United States, particularly in metropolitan cities, and we had made, as I said, liaisons with medical societies and with the CDC, the blood bank, the Public Health Service, et cetera.
##
Andrews
All those people were out here, and I was in groups that met with them probably ten times. The meetings were here and L.A. and Washington and New York, but mainly they came out here, and New York, because the community was so huge here, and because the gay community itself was more organized here than anyplace else in the world, at that time--still is.
So there was this awareness of how to get the community involved in solving the problem, and the community was so sensitive around civil rights violations after these struggles of so many decades or centuries that the message would be, Well, any idiot can see it's not where you do it but what you do, but if you go to the bathhouses that's what you go there to do. But then when you go out to talk to people, you say just what we were saying: "So it's not the place you do it, it's what you do; but guess what: what do you do at a bathhouse? You all have been there. Are you all playing cards, or are you having multiple sexual encounters? Now, come on!" Those were the discussions I was having with people.
"So we're going to say this so that they won't come down and boycott all the gay people in the country, but you all use your heads now. We're saying stuff in two ways so that we don't get
Hughes
There were really two messages that you were trying to give.
Andrews
There really were: a political message and a medical message.
BAPHR's Involvement
HughesNow, do you think that in the eyes of the gay community, BAPHR, because it was gay and because it was medical, had more force, so that if a statement came out from BAPHR, the community would tend to pay more attention to it than even from Silverman or the health department?
Andrews
Yes, exactly. Because of the early work we had done, coming out, hosting these health fairs, Harvey mentioning during the Briggs Initiative that he'd gotten information from BAPHR about how to address the issue of homosexuality--we were a known and relatively trusted force, especially early on. We were gay docs, we were part of "us," we were looking out for ourselves, so that many gay people thought we could be trusted. And we were the most powerful gay physicians' group in the country. We were the best organized.
People had to work with us, because they knew that we had the inside route to where most of the infection was happening. They couldn't just say, "Screw them." They knew that if we got angry, whoever it was, it was going to turn the whole community off. That was a time when we were looked to as the good guys.
Hughes
Was the CDC involved in actually observing bathhouse behavior?
Andrews
I don't know if the CDC was. Either Silverman or the mayor definitely sent people into bathhouses to observe sexual behavior, anonymous, multiple sexual behavior. It was described in some detail, because we discussed the results of this report in one of Silverman's meetings. Again, I don't know if it was through Silverman's health department or the mayor through her own operatives--that word sounds sort of like spies--but spies, yes. I think they were health department people, actually, that had gone out and observed.
Silverman's Struggle
HughesWell, flipping back to the year before bathhouse closure, in December of 1983, you reported to the executive board of BAPHR that, "Dr. Silverman said that he would never agree to bathhouse closings unless a large number of gay/lesbian physicians and other health care providers gave complete support to do so."
16. Minutes, Executive Committee Meeting, December 4, 1983 (BAPHR Office Records, folder: Board Minutes).
Andrews
As I've said, before Silverman made his formal announcement, he had a meeting with probably forty or fifty gay community leaders, and all of the gay people that had been part of his task force were there: me, Don Abrams, and some other people too. In that meeting, Silverman tried his best to say that he wasn't really going to close them; he was going to prohibit anything besides masturbation. He was going to say, "You can go there, but you can't do more than masturbate." My sense is that the general consensus of the people at that meeting was, We can stomach this; we can handle this.
And then the next day, he made this statement that, "They'll be closed if they don't stop other than masturbatory activity." Some of the gay community leaders that had been at that Sunday meeting felt like they'd been used. But he needed to have support from the gay community to say this was a combined consensus to go to the full community.
Hughes
Did you have second thoughts about being in that newspaper photograph?
Andrews
Yes, sure. I had still such strong, agonizing, ambivalence, I wished it didn't have to be this way. Because my sense was, If we get people built up into being resistant and radically opposing this, we're going to have even more problems. We're going to lose our credibility, and the epidemic is going to keep going on unabated. But how do you get through to people? And there was just no clear way to get through to people at that time.
Bathhouse Owners
HughesIn July of 1984, W. L. Warner of BAPHR--
He was a later president. That's when I left the organization, pretty much.
Hughes
Writing confidentially to Silverman he said, "BAPHR stands ready to assist the health department in transferring the main issue of safe sex and role of the bathhouses back to the gay community if that is indeed possible. We can reactivate our dormant program that was being developed several months ago for working with bathhouse owners. We also have some ideas for setting up a monitoring system for the assistance of other nonmedical gay organizations." What is the dormant program that he was talking about?
Andrews
Well, we did have meetings with bathhouse owners. We had had ongoing meetings with members of BAPHR, and I was at many of them, because we knew that the more communication we had, maybe we could make some inroads into something that would be useful. And what I think Will was saying is, "You don't do it; let us [BAPHR] do it." The problem is, we weren't able to do it.
Hughes
What were those meetings with the bathhouse owners like?
Andrews
Well, from what I recall, they were an evolution of education from initially the idea of the CIA putting something into the vents to some of them coming to the conclusion that, okay, this [disease] sounds like it is transmissible in some way. There was still that group that remained rabidly, "You can't prove anything; you're full of shit; we're not going to listen to you; and these are my civil rights." Just furious.
Hughes
Also, "This is my livelihood that's going down the drain."
Andrews
That's right--their business. There were other bathhouse owners that weren't in as much denial and they were willing to put up signs around the bathhouse, "Wash your hands; use a condom," that kind of stuff. But none of them wanted to close the bathhouses. A few of them did have safe sex information sessions at the bathhouses. So there was a movement to try to do something. Maybe if we hadn't had the political pressure, which is hard to imagine in the climate of AIDS, and more people weren't dying, we might have been able to do something. But it had gone on so long--
Hughes
What was your take on Silverman himself?
Andrews
I have the greatest respect for him. I thought he struggled valiantly to ensure the health of the people of San Francisco, and that was his charge as the health director. I felt he was not homophobic. He was at many BAPHR meetings before all this happened. He was honored. I knew his wife. I felt that he was
The Bathhouses Close and Reopen, October 1984
HughesThe baths were closed in October of 1984, and they immediately reopened. There was a press statement which included Dennis McShane--
Andrews
Oh, Denny McShane. He was the president [of BAPHR] then, I guess.
Hughes
Yes, he was. Anyway, the day after the baths were closed, a group which was not exclusively gay--there were some civil rights groups in it as well--issued a statement saying that bathhouse closure sent the wrong message. It was not location but risky sexual behavior that was the problem. Well, I guess that's the same--
Andrews
It's the same old song.
Hughes
The Committee to Preserve Our Sexual and Civil Liberties arose. Do you remember that group?
Andrews
Vaguely. I don't remember a lot about it.
Hughes
Which probably answers my question, because I was wondering if that group worked closely with BAPHR, and if they did, you probably would have known it.
Andrews
A lot of BAPHR people were very unhappy with the fact that I had even been a part of this. It was like I was a traitor, blah blah blah. So they were saying things like, "We're going to look at it in a different way." It really was the same way. In my opinion, it was just trying to get back on the good side of the community by saying, "We're going to oppose this now," and that was a politically popular thing to do. The people that were saying this hadn't sat through the hours and hours of meetings that we had sat through, earnestly trying to come up with some resolution. It's easy when you're on one side just to say the other side did it wrong. That was my opinion of it.
In November of '84, you wrote what I assume was a personal letter, because it was on your stationary rather than on BAPHR's, addressed to "Colleagues and Friends."
Andrews
Ah, it was printed in the BAPHRON, I bet.
17. Ric Andrews to Colleagues and Friends, November 15, 1984 (BAPHR office documents; also published in November 1984 issue of The BAPHRON).
[tape interruption to view the letter]
HughesYou said that you'd been through a tough time. You also said that you had "difficulty supporting the 'radical rhetoric' in recent statements by BAPHR's leaders," although you did share many of their concerns. I'm assuming this is all in the context of bathhouse closure.
Andrews
Yes.
Hughes
Your letter supports your statement at the beginning of the interview that there was a period in which you philosophically were not in tune with BAPHR leaders.
Andrews
Right, it was this time. By the time bathhouse [closure] had happened, I was the past president; I wasn't the formal BAPHR representative. BAPHR was swinging into a reaction against civil rights stuff. They were making fun of the mayor and Silverman, making them all out to be the enemy. It just seemed [that they were saying], "You're the problem," instead of saying, "Wait, this [issue] is much more complicated than that." [My letter] was an attempt to say, "Come on, you all, look at the whole picture."
Hughes
You were the voice of reason.
More on Bathhouse Owners
How did the bathhouse owners feel about the threat of closure?
Andrews
Well, threatened, angry, resentful, suspicious. I think that describes what their mood was. They were very upset about it.
Hughes
How did they feel about BAPHR's role in the episode?
I think they were very ambivalent, because as I said, [BAPHR] had had this health fair; we had gotten exposure; we had a name in the community, along with the other budding gay organizations. Then for us to be the messenger of what sounded like possibly catastrophic news made us very unpopular.
Hughes
With the owners as well?
Andrews
Right, yes. There were a few owners that would talk to me and say, "I know that you're not an enemy and I know you're trying to help, and this is just so confusing." But the rhetoric of the mass of them was very suspicious and angry, as if we were betraying them by giving them the message that there was this disease that was going on that was probably sexually transmitted. That sounded like a betrayal, just hearing that.
Hughes
Can you sort out how much of their emotion was due to the fact that their business was threatened, and how much was for other causes, namely, that they too were gay men, and this disease obviously had a personal impact on them?
Andrews
Exactly. I would hesitate to proportion out what percentage for what, but I think that you can't underestimate the importance of their livelihood. For some of these people, this was their main source of income. I understand one of the bathhouse owners may have even been a doctor. I don't know if he was a straight or a gay doctor. But they were businessmen that dabbled in lots of things, and the bathhouses were making a lot of money. So to cut off that revenue faucet was alarming.
We heard that some of the baths were run by Mafia. I don't know. I didn't go to enough of them, and I didn't see any characters that looked like Mafia people to me, whatever they're supposed to look like. [laughter] But I think that it was that double whammy of money and economics, and, free expression is what the liberation movement had been all about, and now we're saying it's dangerous.
Hughes
In some of the really bitter encounters, there were some very damning things said. One of them, repeated by Paul Volberding, was something to the effect, "We bathhouse owners and you physicians are both profiting by this epidemic." Did you as BAPHR physicians also get that line from them?
Andrews
Not early on, because it was so early in the epidemic that there wasn't any profit to be had. That was before all the drug companies were into this, at least that we knew about. In the early years the outrage didn't seem to be, "You're going to profit from this." It was, "You're not telling the truth. You
At the same time that organized groups were so vehement, there were plenty of my friends that were saying, "Well, this [closing the baths] makes total sense." Even lay people were saying, "This makes sense." Looking at gonorrhea and hepatitis and all the other things we talked about, this doesn't sound surprising, and what did we expect? A lot of people were very supportive. The organized civil rights groups had a hard time being supportive of any kind of news like this.
Hughes
There were essentially two arguments for closure--I got this from one of the BAPHRONS. First, obviously, closure as a means of reducing the rate of infection. But closure also as a symbolic gesture.
Andrews
As a message to the nation.
Hughes
Yes, exactly. Is that the way that BAPHR saw it?
Andrews
Well it wasn't really the message that we wanted to give: "You should close the bathhouses." As I said, it really was, "We need to make a drastic change in the way we're behaving sexually with each other, and possibly the bathhouses could be the conduit for that. But certainly right now they're the conduit for disease instead of for health."
I don't think BAPHR as an organization liked the idea that we were sending a message, because it looked like here in San Francisco, the pinnacle of gay progress, we were the ones folding to worries about health and giving up our civil liberties. That was what the majority of people looked at, I think. The vocal ones, at least.
Bathhouses Outside San Francisco
HughesWhen the bathhouses were indeed closed, did it have a symbolic, ripple effect in other communities?
Andrews
I don't think it did, because the bathhouses never closed in L.A.
Hughes
Or in New York.
Andrews
Not in New York, not in Berkeley, not in San Jose. The one in Berkeley is certainly operating now and has been for at least
It must have had some impact on both straight and gay perception of what's going on with this disease to have this controversy going on in the "gay mecca" of San Francisco.
Larry Littlejohn's Initiative
AndrewsThere was a guy named Larry Littlejohn who was about to file a suit against the city, I believe, to close the bathhouses.
Hughes
It was actually an initiative measure.
Andrews
An initiative, that's exactly it. He was going to get an initiative on the ballot. This was way before the bathhouses closed. I wasn't president [of BAPHR] then; Dave Kessler was the president. He asked for a group of about fifteen leaders to come very secretly to his house and talk about this. And they included Carole Migden, who was the head of the Harvey Milk Gay and Lesbian Democratic Club; Sal Rosselli, the head of the Alice B. Toklas Gay Democratic Club; Bill Kraus, who was Congressman [Philip] Burton's aide. I think he might have been Supervisor Harry Britt's aide at the time. Gay doctors, gay lawyers. We were asked to come and very quietly talk about this initiative, and what would happen if, even in this liberal town, there was an initiative on the ballot. Everyone was concerned. Clearly it would pass; the voters were going to say, "We shouldn't have bathhouses open." We didn't want all this stuff in the paper. It was our dirty laundry.
In that meeting the politicians were pushing very, very hard that we had, as a group of gay leaders, to preempt this initiative thing. They wanted us to say the bathhouses should close, so that it didn't become a public policy issue. But specifically, all the politicians wanted to put it on the doctors to say, "The reason is medical, not political; it's strictly medical." And of course, that was long before the virus was identified. Everything was in a state of supposition.
That was an incredibly intense meeting that night. The politicians actually had convinced me and most of the BAPHR members that we did need to sign some kind of petition, and that's where my name and all these other people's names came from and got on the enemy list of the community in the BAR.
I forget all the details, but we came up with the text of the petition that night. We all signed our names to it. By the
I clearly remember that there was a community meeting shortly after that petition and after the BAR named us enemies of the community.
Hughes
Was that the Valencia Rose meeting?
Andrews
Yes, that was at the Valencia Rose. I was there; Bob Scott was there, another BAPHR member; Carole Migden was there; but no one spoke but me. Not one person that was at that meeting addressed the crowd but me, because no one wanted to. Because the people were extremely angry that we were traitors.
I remember in that meeting saying that we had jumped the gun. I backed down. No one else was up there. It was like we made a mistake; this was premature. We still thought there was clear evidence that there was something dangerous going on, but we backed down. We pulled back from that. The crowd [reaction] was mixed. Some people applauded because I said, "Hey, I made a mistake. I made an error in judgment. It's not conclusive, but we still think there's something going on." I wish I knew when Merv Silverman started his task force.
Merv Silverman's Press Conference, March 30, 1984
HughesI think that meeting came very close to a press conference that was scheduled by Silverman--
Andrews
To close the bathhouses, yes.
Hughes
--when he was expected to close the bathhouses.
18. See the oral history in the AIDS physicians series with Merv Silverman.
Andrews
You're right. He called a press conference. At that press conference, there were gay men in nothing but towels. The room was full of reporters and angry gay people. Merv at the health department pulled many of the same leaders that had been at that meeting into an office. We delayed the press conference for at
In that debate, I was the most vocal person saying that we didn't have clear evidence to close the bathhouses. I remember debating mainly with Bill Kraus, who ended up being a major political person back in Washington as Philip Burton's aide. He was saying, "You know that we [politicians] can't do this, but we should come down on the side of closure." Everyone else was being quiet, and I just kept debating about, "We have to try to work with the community to see if we can help them come to the same conclusion, instead of trying to impose something on them."
From that [stance], Merv could not feel comfortable closing the baths. So he went out and said, "The whole thing's canceled," and just shocked everyone. It was because we'd had this debate in the inner office that he didn't [close them].
Hughes
Had he called that press conference on the basis of that first meeting?
Andrews
I believe so.
Hughes
When he thought he had consensus of gay leaders?
Andrews
Because he had heard from the political leaders. We [BAPHR] weren't the ones contacting him, but Migden and the political people were the ones that said, "Look, we've got a way to bypass this initiative. We've got gay leaders calling for closure." And then overwhelming condemnation came out in the gay press, no one was there to back up the decision; I was the only one that spoke at that meeting.
So then there was a reversal. We were intimidated. I mean, I was tremendously intimidated being the sole person up there to talk to this angry crowd. And all of us had been invited, and no one came except me. I saw Carole Migden in the corner; she left before I got up there to speak. I knew she was there and then she was gone. No one wanted to get up in front of that group of people.
Hughes
It shows the tenor of the times, the intensity of it.
Andrews
It really does. People were just being ripped apart.
Hughes
What happened to you after that? Were you still the bad guy?
Andrews
I was still sort of wimp guy, I think. I was looked at as indecisive. The ones that wanted closure felt we were cowards.
And I don't remember the details of the initiative, to tell you the truth, because after all this happened that initiative never happened. Littlejohn withdrew the initiative, I believe. He was at Dave Kessler's house. He was in one of the discussions that we had with this group of people. I believe because we said we were working so strongly on trying to educate the community, I think that's why he withdrew it. He was a gay person too, and he didn't want to cause all this down stuff. He just wanted to stop people from getting sick.
Hughes
Was the initiative solely his idea?
Andrews
From the best I knew, he had come up with this thing and just sort of surprised everybody. It was like out of the blue. Now, he probably talked about it with people, but I certainly didn't know who had planned that.
An important piece that we didn't mention last week was this big "go ahead" and then a "pull back." Then there were these ongoing meetings that Merv had with all these different people, medical people primarily, to try to grapple with [the bathhouse issue], and then finally there was the formal closure.
The Final Months Before Closure
HughesSilverman's press conference occurred in the spring of 1984, and the baths were finally closed in October. What shifted Silverman to a position in which he felt he could close the baths?
Andrews
I think it was partly the political pressure. Gay politicians like Bill Kraus were saying, "You've got to close these bathhouses." Bill ultimately died of AIDS. He had been there. He knew what was going on. He knew the rampant unprotected sex that was happening at the baths. Certainly Mayor Feinstein was putting a lot of pressure on Silverman. The picture was just becoming clearer and clearer: This is a sexually transmitted disease, even if we don't have the virus identified. So there was ongoing political and health pressure to educate the gay community and get them to change voluntarily, which wasn't successful, until finally Silverman just said, "I've got to do it."
We talked about the evidence coming out of the CDC showing that bathhouse attendance and the disease don't necessarily go hand in hand. There was an article in the BAPHRON accusing Silverman of having repressed that information, which implies that he himself was moving towards closure, right? Otherwise, why would he suppress it?
Andrews
I don't know that he really suppressed it. My sense of Merv from the beginning was, he knew--I think every one of us in that room knew it was in the best interest of the health of the people of San Francisco to curtail these businesses where it was so easy to facilitate the spread of the disease. He wanted closure, but he was very conscious of trying not to divide the gay community. He did not want to make it be a "strong arm" confrontation with police and then riot squads--and that could have happened. Even when he closed the bathhouses it was this convoluted thing where Merv was trying to reach a compromise by saying, "We'll just say that there can't be any rooms where the doors are shut, and so we will prevent disease transmission."
Without saying it, he was saying off the record, "There can be as much masturbation as people want. I'm not going to say that in this ordinance; I'm just going to say that we can't have closed rooms." So it was this ambivalent sort of thing of not wanting to close the baths entirely, but to say that if they had closed rooms, we were going to close them.
Hughes
And there were agents that were sent in to observe.
Andrews
Right.
Hughes
Did people as a result stay away from the baths?
Andrews
I don't think so. I believe the agents were probably gay. They put their towels on and walked around, and they didn't have badges, and they went through and just observed.
Hughes
Oh, so that wouldn't be disruptive.
Andrews
Yes, there was no disruption, that's right. The music was still going strong, the porno movies were going, and I think a lot of people actually got into this thing of, "They can't do this to us; I'm gonna go to the bathhouses." Just sort of a normal human reaction to a restriction: "Okay, I'm going to push the limit. You can't prove this to me. I'm going to go to the baths even more." I think some people had that reaction.
Will Warner
HughesThere was an article in the BAPHRON by Will Warner, who seems to have been very active in the bathhouse episode.
Andrews
He was on the other side. He was a leather person, and he was apparently into the S&M [sadism & masochism] scene. He was strongly opposed early on to the antibody testing. He was just totally focused on civil rights. His position was, "We can't prove anything, and we've got to protect our hard-won freedoms."
Hughes
Yes, that's the gist of the articles that I saw in BAPHRON.
Hughes
Warner's article appeared in the November '84 BAPHRON, so just the month after Silverman had finally closed the baths. Warner wrote, "Open war has now been declared between BAPHR and Dr. Silverman, our presumed 'friend' for many months." Is that his perception, or indeed was there now a war between BAPHR and Silverman? How general was that feeling in BAPHR?
Andrews
I don't think that Warner had even the majority. The majority of BAPHR didn't like the whole issue. How could you like anything that disruptive and antagonistic. It was unpopular. But Will clearly represented the polar opposite of where I was. So I wrote that letter we talked about last week.
Hughes
It appeared in that same issue.
Andrews
It was because I knew Will's letter would be published, and I wanted to counter with something that wasn't so radical.
Hughes
Ah, that's interesting. So that was a deliberate move on your part to counter his argument?
Andrews
Yes.
Hughes
What kind of reaction did you get?
Andrews
Well, I think some people thought Will was a total idiot, and some people thought I was a total idiot. So I got mixed reactions. I think a lot of people thought he was too extreme, and probably people thought I was too extreme.
Dichotomy in the Gay Community
What about perceptions within the gay community? To put it very extremely, was there a segment of the gay community that said, "If we just didn't have these bathhouse gays, we wouldn't have this AIDS problem"? In other words, was there a social hierarchy that existed before the epidemic that maybe was intensified by the tensions of the epidemic?
Andrews
Yes, I think there was. I think there was a group of people, primarily the people who didn't go to the baths, people that might be in monogamous relationships, or people that either felt intimidated or scared about going [to the bathhouses], or just didn't care for anonymous sex. They formed a little core group of people that said, "It's those idiots that are causing all this. We should close the baths, and we shouldn't be having sex in the parks, and it's disgusting." There was a revulsion with all this preoccupation with sex. There was that segment, and I know that these events polarized that group more.
But they didn't speak up very strongly, because if you got to a big gathering of people, the vocal ones were against bathhouse closure, and so it was more "traditional," what we would probably call establishment gays, not the radical ones.
Hughes
The more radical viewpoint is probably more easily heard than the establishment one.
Andrews
Definitely I think so. It's like ACT UP [AIDS Coalition to Unleash Power]. The most vocal, dramatic segment gets the most attention, and in some ways comes to represent what the whole community feels, which is often not really the case.
Hughes
Well, I err, too. I realize when I say "the gay community," it really should be "the gay communities." There isn't--
Andrews
A monolith. That's right.
Hughes
There wasn't then and isn't now.
Andrews
During those couple of years when people were expressing fairly radical views, fairly polar views, I wasn't very active in what went on in BAPHR. I went to some meetings and events, but I just felt like there wasn't a place for me. Maybe I just didn't want to make a place. Maybe I was just worn out having gone through these ordeals.
In February, 1985, BAPHR held a forum which was called "Community in Crisis: What is BAPHR's Role?"
19. The BAPHRON, March/April 1985, p.302.
##
Andrews
Yes, along with Denny McShane, or it might have been Will Warner, or it might have been Bill Kemp, I can't remember. I believe the forum was a clear response to the stuff that had gone on, two things primarily: the bathhouse closure issue, and that meeting at Dave Kessler's house around the petition. All of BAPHR's officers were there, and we were trying to do something that we did not consult the membership about. We knew this initiative was not public yet, and we were really trying to do some--undercover is the wrong word--damage control. We knew that if we brought this up, it would get misinterpreted. We were trying not to publicize this and see if we could short-circuit it, i.e., stop the initiative before it got started.
So when we signed this petition, and it had some BAPHR members on there, including some officers, the membership felt like BAPHR had represented itself. We said, "Our signing this petition does not represent our organization." But when you have the president of the gay Democratic clubs and other community leaders, it looks like it's involving the membership of those groups. So there was a lot of anger and concern [within BAPHR] over that, that we were even involved. And it was understandable.
I have no apology about it--our intentions were noble and appropriate. We were trying to handle a community crisis. But the membership that wasn't involved in those meetings looked at it like, "You're taking the name of our organization and representing us," even though we really weren't. You get the movers and shakers together, and if they represent organizations, the organizations feel like they should be acknowledged. So that's the reason there was that forum.
Hughes
There were four people on the panel. Jim Campbell
20. See the oral history with James Campbell in this series.
Andrews
Jim Krajeski is a psychiatrist, and he had major connections with the American Psychiatric Association and was involved in forming
Bill Lipil was an internist. I can't remember why he was chosen. Jim Campbell was, of course, an internist who had been on the [BAPHR] Scientific Affairs Committee and had helped with safe sex guidelines and eventually became the chair of the Scientific Affairs Committee. The reason that I was on there was because I had been involved in all this stuff and I was targeted as the radical. [laughter]
Hughes
Antibody testing was another thing that was in the offing. The forum was in February '85 and the commercial tests were to become available the next month. So you were looking forward--
Andrews
You're right. "What are we going to do about that?" I was for trying to get people to take the test if it was confidential, and the organization didn't agree and clearly said people should not take the test. That was the official stance of the organization.
Hughes
Did you work out that stance at this particular forum?
Andrews
No, I don't think it was worked out. I think there was some discussion, and then the executive board continued to mull it over and came up with their recommendation. That was when I was out of the leadership and there were people that disagreed with me.
Hughes
Do you remember coming to some sort of conclusion about whether BAPHR should look upon itself as a medical organization or a political organization?
Andrews
I think there was general consensus, we're definitely a medical organization. There's no way around it. But it's impossible to be just a medical organization with something as political as AIDS, disease, homophobia, and all that. So you can't have one without the other. Yet we were a 501(c)(3) organization, which meant we couldn't use more than, I think, 20 percent of our funds toward any kind of political action. So under the restrictions of the nonprofit setup of our organization, we couldn't be primarily political. And we always knew that. At the same time, we wrote lots of letters, and always had, about medical issues that had major political implications.
Hughes
That was one of BAPHR's purposes, was it not?
Andrews
That's right.
BAPHR's Connections with Other Agencies
HughesDid you have a set of contacts at various levels of government?
Andrews
Yes. As I said, we knew Harold Jaffe, Jim Curran, Dr. [Herbert] Perkins, who was the head of the blood bank here, of course Silverman, Conant, Volberding.
21. See the oral histories in the AIDS physicians series with Drs. Perkins, Silverman, Conant and Volberding.
Hughes
You could have gone as members of BAPHR directly to the federal government, but I'm gathering it was a little bit more indirect: BAPHR used these San Francisco spokespeople to represent its viewpoint.
Andrews
Right. Our input to the federal government was often through the CDC, with Jaffe or Curran or someone like that, with us saying, "Here's what we think and here's what we know." They listened to us, because there was this huge population of infected people [in the gay community]; the numbers were going up. The same thing locally with the medical society and their stance. At least half of the composition of the San Francisco Medical Society AIDS Task Force was BAPHR members. So yes, we had a lot of input that was fairly direct to these different groups and individuals.
Hughes
But BAPHR has never had its own lobbyist or anything like that?
Andrews
No. We never did. Actually, what happened was as the national organization began to take off, BAPHR scaled down and the national organization scaled up, so we became less important. And another major thing is, as the AIDS epidemic continued, we began to see a multitude of institutions handling this. The AIDS Foundation took care of education; there were physician referral lists from Shanti; there were lots of other things. In the very beginning, there was no organization, so people looked to us for a lot. Afterwards, we weren't the central organization any longer, and we didn't have the staff or the resources to handle the intensity of what was going on. Other groups were doing it.
Hughes
Did you willingly cede those functions to the other organizations, or was there a little bit of competition there?
I don't think there was competition. Often BAPHR leaders and members were represented in those other organizations. The AIDS Foundation, Shanti, different task forces were very interested in our input. So we had a voice there. And as time went on, what happened was these organizations began to be composed of their own members, perhaps with their own doctors, maybe BAPHR members, maybe not. And then there just wasn't the kind of interconnection, because everyone had their own agenda.
BAPHR and the AIDS Foundation
HughesI saw a reference to BAPHR providing medical advice to the KS Foundation at about the time it became the San Francisco AIDS Foundation [March, 1984]. Amongst the leadership of the KS Foundation, there were a few medical people, but apparently it was felt not enough. Do you remember that particular relationship?
Andrews
Yes. A couple of our members were either advisory members to the AIDS Foundation board or maybe even board members.
Hughes
Bob Bolan is one.
22. See oral history with Robert K. Bolan in this series.
Andrews
Right. Jim Campbell, I think, did something with the AIDS Foundation. I don't know if he was an advisor or what. So we had these networking activities. But again, we became less and less the command post, because other organizations had the resources, the federal funding, the staff. We didn't have any of that, and we didn't really want any of that. Because we were an organization primarily of docs, our main work wasn't to do this; it was to practice medicine.
Hughes
Did it suit BAPHR members to have these functions taken on by other organizations?
Andrews
Certainly it was fine with me. Maybe some people felt like we gave up center stage, but I think most of us realized there was just too much to be done; we couldn't even begin to do it. We were happy to have other organizations forming to take over.
More on BAPHR's Safe Sex Guidelines
HughesDid you go to the National Lesbian/Gay Health Conference in Denver in 1983?
Andrews
Yes, I did.
Hughes
Apparently, that was a very hot meeting. I guess BAPHR's safe sex guidelines had just come out, because there was a reference to secretions and excretions, and that precipitated a lot of fireworks. Do you remember any of this?
Andrews
Sorry, I don't remember too much. I know I was there; I remember it being very intense. My recollection is that our safe sex guidelines were, as I said earlier, the first ones really formulated anywhere in the country. And when we brought them there to talk about them, the people that had not been a part of the ongoing discussion about what is safe and safer were very worried about saying things like "secretions and excretions," secretions--sweat, saliva. I remember things like, "Totally safe is dry kissing. Wet kissing, questionably safe." Who knew how much virus was in saliva and how infective it was? And people responded, "What do you mean, we're going to say people can't kiss? Come on!" It was: "Well, we don't know. Are we going to reassure people about something that may get them infected? We don't know if this is like hepatitis or what." Of course we realized that if the virus could be easily transmitted by kissing, then everyone would have been infected, and this clearly wasn't the case. So that was a very, very hot thing, and it was the breaking in of our safe sex guidelines to a national audience.
I remember a lot of people thought they were very good and were using them. There was just controversy about them. There was support, and there was wariness about them. And of course there would be, because no one had any definitive answers.
Hughes
Would it also have been the first opportunity for many of the attendees to learn in detail about the epidemic?
Andrews
I think so. I think not only learn about the epidemic, but [also about] the bathhouse stuff.
There was discussion about what to do even then, and most of these people who were coming in from all over the country really hadn't had the intense prolonged discussions that we had been having here in San Francisco. So I think [the conference] was a first exposure for a lot of people to upsetting stuff.
Then in May of 1984, Marcus Conant and others at UCSF organized a symposium to develop guidelines on AIDS risk factors. In other words, doing what BAPHR had already done. And there must have been some ruffled feathers, because apparently nobody from the community was invited to participate, and in fact, BAPHR was explicitly not invited.
Andrews
I don't remember that. I certainly knew Marc Conant and all those [UC] people; we talked to each other on the phone quite a bit during those times. [tape interruption]
Hughes
What I'm showing Dr. Andrews is a comparison of the UCSF-generated safe sex guidelines and the ones that BAPHR had come up with. The safe and the definitely not safe categories are not that far apart, but it's the middle ground that's very different.
Andrews
The middle ground has always been the point of contention. Massage, cuddling--we all knew that was safe. It was the possibly safer--they call it the suspected high risk--where all the controversy was, because no one knew at that time [whether it was safe or not].
UCSF said that documented high risk was fisting and anal intercourse, and we said unsafe was fisting, anal intercourse without a condom, rimming, blood contact, sharing sex toys, semen or urine in the mouth. What's interesting is that all the activities that we said were documented high risk, we know now are high risk, very high risk, with the exception of urine. I think we were right on.
The months that we spent on those guidelines, and we revised them several times, really reflected pretty accurately [our] epidemiological knowledge of how disease is transmitted and what we knew of sexual practices. We were pretty frank about sex toys: if you insert one toy and then insert it in the other partner, you could have disease transmission. It was so frank that it was sort of distasteful, even to some gay men. I mean, you had to look at all these sexual practices and say, "Sex toys and rimming--oh, my god." That had hardly even been talked about in the gay community, and now we were starting to have to talk about oral-anal contact. That was not a popular thing to be talking about. [laughter]
Hughes
Still isn't.
Andrews
That's right, absolutely.
Hughes
Has the federal government come out with guidelines that use that terminology?
My understanding is that some of the safe sex guidelines that came out--now, this would have been some years ago--did have this kind of terminology, because they were written in the language the community could understand. This was when [Dr. C. Everett] Koop was surgeon general. But at the same time, there was primarily Republican conservative backlash to try to stop all funding, and they did pull back all funding to anyone that said anything that was offensive, so we had to use only scientific terminology. So you had to educate people with words they didn't know what the hell they meant. It was a typical American puritanical response to how you handled social problems. Pathetic. [laughter]
Hughes
As of August of '84, BAPHR offered safe sex guidelines in a variety of formats. I'll just refresh your memory?
Andrews
Yes, please.
Hughes
One was a wallet-sized card which was passed out in many places, including the Gay Pride Day parade, and was also available at the baths.
Andrews
That's right.
Hughes
Then there was a short brochure in the form of a letter in street language--just what you were talking about--written by one gay man to another. And then there was a longer brochure which had a scientific bent.
Andrews
That's right.
Hughes
And then there was an update of the original brochure. So there were four different formats. It seems to me that the attempt here was to draw in as many different segments of the population under as many different circumstances as you possibly could.
Andrews
That is exactly right. For several years when we marched in the parade, we had those little cards. Every one of us passed out hundreds of cards as we were marching, in addition to being at the booth. The brochure [produced] with the Sisters of Perpetual Indulgence was written in street language, and they helped support it. We came up with the wording, and then the Sisters of Perpetual Indulgence helped do some of the publishing. They did lots of distributing, even though it was from us. They took what we had. And then ultimately, the AIDS Foundation.
Hughes
The AIDS Foundation came out with guidelines. Are they yours?
Yes. I think if we were to look at them, they are almost identical, because we had major input into what their guidelines were.
Hughes
So the AIDS Foundation was a mechanism for getting them out in the community.
Andrews
Right.
Hughes
What was the handkerchief code?
Andrews
I have a hunch that that might have been started under the direction of Will Warner. I don't know if he was president then, but Will, as I said, had been very active in the leather community, and I think this was a personal interest of his to help people identify what people were into sexually so they could link up better. That's what it really was. The handkerchief was all the guides to what people were into sexually. Passive, active, oral sex, rectal sex, toys, rimming, golden showers--a lot of sort of fringe-y stuff that only the cult knew about. It was like shorthand. "Now I know what you and I can do because you're wearing that handkerchief, so I don't have to ask you; I know what I'm getting."
Hughes
The code didn't really have anything to do with safe sex, did it?
Andrews
I don't think it did. I don't know if part of that card had safe sex guidelines or if it was strictly just a hanky identification. It may have been just that.
Hughes
In the write-ups, I didn't see any juxtaposition of those two things. I thought that the handkerchief code had something to do with safe sex, but it doesn't sound that way.
Andrews
There may have been a handkerchief that said, "Safe sex only," or "Condoms only." I don't recall that at all.
Hughes
The guidelines were revised in 1986. Did you have any part in that?
Andrews
I don't remember.
Hughes
Is there anything general to be said about the tenor of the guidelines over time? Do they get more definite, for example?
Andrews
I think that over time and with the identification of the virus, they became clearer, but I think there's very little alteration over time from what we thought in the very beginning. There were some little changes, but we were fairly accurate about the fact that if you don't wear a condom, that's the risk. Now, early on,
But the basic guidelines we came up with, although they were refined, I think in general stayed pretty much the same.
Hughes
Around 1983-1984, the rate of new [HIV] infections, and also the rate of other STDs, dropped. Was some of the drop because of the pervasiveness of these guidelines?
Andrews
I think it must have been. Before AIDS, we saw a speeding "train" pushing every frontier toward every kind of sexual expression. And then the train began to derail. As the years went on and there were more and more cases and it became more and more clear that this was a sexually transmitted disease, a larger percentage of people began to be convinced that totally unprotected, frequent sex put you at extreme high risk for death. Some people changed, some people didn't. But I think it had a huge impact on the people that might have had unprotected, frequent sex. It was once perceived as, "Okay to and there's no big deal; you just get a shot [to cure whatever STD you might get]." [And changed] to: "Whoops, now the stakes are, I may die, and die quickly." The whole epidemic had a huge sobering impact on everyone.
Hughes
I would think one of the most sobering impacts would be seeing your friends and lovers die.
Andrews
Absolutely.
Hughes
And not only die quickly, but--
Andrews
Horribly.
Andrews' Video Interview Project on AIDS
HughesIn 1983, you went to the AAPHR meetings in Hawaii. Do you remember?
Andrews
Ah, yes, I do.
You and I think one or two others started a video project.
Andrews
Yes. That was my lover and me, actually. We did that strictly on our own. I have some of those interviews; I haven't looked at them in probably ten years. We decided to take a video camera with us, and go to the gay beach, and go to the conference, and just randomly ask people what they heard about AIDS.
The interview I remember most was being on the beach talking to this very intelligent, very handsome dentist from somewhere on the mainland. I said, "What do you know about AIDS?" He said, "That's that diet candy, isn't it?" In the early stages of AIDS, ADS, that diet candy, was a big joke. I remember him joking about that, and then saying, "Well, I'm just kidding." But that was a normal reaction.
We not only interviewed people in Hawaii, but also in San Francisco, and in New York when we were back there for some meeting. We went to Greenwich Village and interviewed a lot of people on the street and some people from the Gay Men's Health Crisis. At that meeting in Hawaii, we interviewed Bruce Voeller, who was the head of the National Gay Task Force, and a number of other doctors at the meeting. We got their impressions. And it would probably be really interesting to listen to those again.
Hughes
What was the purpose?
Andrews
I thought that this was such a major thing that was happening, sociologically, epidemiologically, and politically, that it would be really interesting and a wonderful opportunity to just capture some impressions without any kind of professional format. It was just me and my lover holding the camera and going up to people and saying, "Can we talk to you for a little bit?"
Hughes
Yes. Good for you.
Andrews
We never did anything with it. We got all the rights to the material; we had the interviewees sign releases, and we never did anything with it. It's still sitting upstairs somewhere.
Some of the stuff is quite amazing. You listen to men in New York on the piers talking very candidly about what they thought was the risk, or who felt the disease was a conspiracy by the government.
Blood Donation and the Gay Community ##
AndrewsThat AAPHR meeting in Hawaii was primarily to talk about the blood banks, and donations, and what to do about contamination of the blood supply. At that meeting was Herb Perkins,
23. See the oral history with Herbert Perkins in the AIDS physicians Series.
The government was wondering what to do, and some of the gay folks were saying, "You better not try to exclude us, because if you do, we'll go donate blood and contaminate the blood supply." It was a threat, which seemed totally crazy to me. My response to this, because we had thought about it and talked about it a long time before we went, was that we should ask and encourage all gay men to not donate blood, to not put a prohibition on it, but to ask us to use our heads, for god's sake. And after a lot of discussion, that was what prevailed, and that was exactly what the blood banks did.
We came back here and we had a press conference with Dr. Perkins and myself and Bob Bolan for the TV cameras. I've got that on tape somewhere, because I taped it myself as well as the TV cameras. And it was really the first response of the blood bank industry about what to do about possible contamination of the blood, that a gay sexually active man should not donate blood. That became the policy of the blood banks initially.
Hughes
One of the concerns of the blood banks was that they were losing good donors, that the gay community had a reputation for really turning out for blood drives. I believe some blood banks were trying to devise a policy that eliminated so-called fast-lane, high-risk gays--
Andrews
Yes, the high risk, that's right.
Hughes
--but encouraged others to donate. AAPHR was saying: No way. It's all or nothing. Is that what you're saying?
Andrews
That's really what BAPHR said, and AAPHR adopted it. Yes, that the only safe thing was to say that if you have been sexually active as a gay man, you should not donate blood. As simple as that.
Hughes
Was there an element that felt this was scapegoating?
Well, that was the worry. That was why it took a lot of debate and discussion around them having this stance, "Don't threaten us." The way we got around this scapegoating [issue] was saying, "We'll be the ones to say that, we'll be the gay doctors saying we recommend to our own community not to donate blood, instead of the government." It was exactly the same model I tried to do with the bathhouse. This one worked. The bathhouse didn't. This was much simpler than the bathhouse.
BAPHR's Social Concerns Committee
HughesThe Social Concerns Committee of BAPHR, I understand, is a mechanism for receiving complaints of discrimination in general, but also in terms of medical care.
Andrews
That was the letter-writing component of BAPHR. That was the group of people--and I was one of them; there were about five of us that met--that would compose letters to anything we saw in the paper. If Strom Thurmond or someone else was coming out with something very homophobic, we would send a letter to our newspaper or to Time or whatever. We just tried to counter the crazy stuff and promote the positive stuff as much as possible, primarily through letter-writing.
Hughes
Was there a problem at Kaiser--I think it was Kaiser San Francisco--in its care of AIDS patients?
Andrews
I have a vague recollection of gay patients that were enrolled in Kaiser feeling like they were either getting bad care or homophobic care. At some point we met with some Kaiser administration people, and through that, Kaiser developed this referral source to physicians that were either gay-sensitive or gay. Probably most of the time they were gay, but they were identified just as being referral sources. So they began, I don't know if it was because of this, to route people to those care givers that would be the most sensitive to them. And that seemed to help the situation.
Hughes
Did you have anything to do with the definition of ARC, AIDS-related complex? Because in 1986, BAPHR published a "workable and medically practical" definition of ARC, implying that there had been confusion around that issue.
Andrews
Well, I remember discussions. I just can't remember it precisely enough to know where I was in position to all of that.
Do you remember the incident when a Florida patient was flown up here and more or less dumped on San Francisco?
Andrews
Yes, I do remember that. I know that we wrote a letter about that.
Hughes
That would be the sort of thing that the Social Concerns Committee would respond to.
Andrews
I'll bet you in the [BAPHR] office, all those letters are on file.
Hughes
I'm afraid that's not the case. [laughter]
Andrews
If they're not, Sam Thal may have them or know where they are. He was our official-unofficial historian. [tape interruption]
More on Antibody Testing
HughesDenny McShane, who was president of BAPHR in '84 during the bathhouse issue, commissioned a task force on the ethical implications in AIDS, which was comprised of BAPHR members, community leaders in law, journalism, religion, and medical ethics, to develop a plan and recommendations for responding to AIDS screening. This was October '84. I suppose by then you knew that the antibody test was on its way?
Andrews
I think we knew.
Hughes
Probably so, because it seems to me the original date when the test was supposed to be commercially available was January 1985, and for whatever reason, it was actually not available until a couple of months later.
Andrews
But we knew it was just right down the pike.
Hughes
Did you have any direct involvement with that task force?
Andrews
You know, I cannot remember.
Hughes
October 1984 was the date that the bathhouses were closed.
Andrews
Oh, well, that was right in the middle of everything. And even during the years I wasn't active, my closest friends were mostly gay doctors, so I had my ear to what was going on.
Hughes
BAPHR produced a brochure called, "Should I Take the Test?"
Aha, yes, I remember that. Gosh, I'd love to see that again.
Hughes
Well, I didn't find a copy.
Andrews
I know that I was a part of the discussion about that pamphlet. I don't remember all the details.
Personal Impact of the Bathhouse Episode
HughesYou said off tape what an emotionally trying experience the bathhouse episode was.
Andrews
Well, when I remember the most trying and emotionally wrenching time of my entire life, it was during the bathhouse episode. It was a time when I, like all of us, was pulled asunder by my own dismay and concern and anger and regret and fear, and more by other people's reactions to what looked like a serious problem that was evolving. [I was] on sort of a tightrope, trying to be a mediator and an educator and a facilitator in a situation in which there didn't seem to be any way to win. The politically popular thing [in the gay community] was to say, "You can't tell us what to do. We're going to mount the barricades. Civil rights now and forever," and all that.
But that didn't make sense to me. I could understand why those people felt so strongly about that, but it didn't make sense to be blind. As I think I've said before, my goal was to try to help people see why it made sense that they were feeling the way they were, but that they were only seeing part of what was going on. They were blinded by their fear and anger [concerning] our liberation and our civil liberties, and they just weren't able to look at the risk and the danger that was involved here. It was understandable why people were upset, but that didn't mean we had to act on our upsetness. If we could just understand why, maybe we could see the bigger picture. But I was unsuccessful in doing what I wanted to do, and even knowing what to do.
I remember going to Merv's meetings, and there were a couple of times that we talked until ten-thirty or eleven at night. We had food brought in, and we had these intense discussions. I was the primary person in that group of maybe twelve to fifteen physicians arguing for trying to educate the community, supporting Merv's stance that if we simply [impose] a government regulation, we're going to have hell to pay and it won't be as successful.
At the same time that I was pushing for us to try to keep the community in mind, the community looked at me as a traitor to the community. So it was almost surreal. And yet it all made sense why they were so angry. I was just racking my brains to try to figure out what to do, and not being able to sleep at night. I remember waking up and writing down little notes on what I could do to communicate successfully. And I obviously never did it to the satisfaction that I wanted, because it didn't turn out the way that anyone really wanted. It was very disappointing.
As I said, the hardest part was that some of my closest friends, other doctors who had supported me in BAPHR, said to me, "You're a traitor; you let us down; you copped out." That just left me with, "Gosh, you guys, at the meetings I was the one saying, 'We've got to consider the community.' I was the lone voice, and now you're saying I'm a traitor." It was a bad LSD dream.
Hughes
Do you have some bitterness?
Andrews
Yes, probably some bitterness, but it's understandable. I think I've come to resolution about why people were so upset. It's just like, Darn it, why couldn't we have turned the corner? And I think I have some regret that I [wasn't] more daring. I should have tried to talk two or three people into doing our own posters and [standing] out in front of the bathhouses. I should have done that by myself if I had to, and I didn't.
Hughes
Well, that would have been pretty scary.
Andrews
Well, so maybe I was too afraid to do that. It was too unpopular for me to do that. I feel like I let myself down on one level. Yet on another level, all I know is that I tried harder than anything I've ever tried in my life to work on something positive, and felt like people were saying I was a traitor, or I was working toward the negative, or I was being short-sighted. I was crying, "I'm trying as hard as I can!" and it wasn't good enough. So that was horrible.
But looking back, it gave me the opportunity to see how fortunate, in a way, I was to be at the very center of a controversy that was affecting a whole community and a whole nation. It was a model for how communities and nations affect anything where there's fear and a stigmatized group and something scary like death and disease. It was so fascinating that I had the opportunity to be at the very heart of this, making all those phone calls, knowing those people. Not exactly "lucky me," but seeing a process of human evolution was fascinating for me.
An amazing experience.
Andrews
In telling you this, it sounds like I was the good guy. [sighs] I wasn't trying to be the good guy; I was just trying to help. Everyone was trying to do what they thought was best. I really think they were. But so many people were so angry and so suspicious that they were blinded by their anger and their suspicion. I saw Bill Owen yesterday for an appointment, and he said, "Gosh, it's so amazing how the things that were going on then, we look back on them now and think, How could we have been so blind? We were just reacting." And I can see why we were so blind. There was so much at stake.
Hughes
Do you think it helped that you were a physician and not only had rigorous training and education but also came from a position of stature in society?
Andrews
I think it had enormous luck for me. It was fortunate that I had an M.D. behind my name, because otherwise, I would just have been another wild-eyed person. I'd worked my way up through a gay organization that had gotten a lot of respect. People listened to me [when] they could have easily dismissed me. And many of them still dismissed me, many of them, but I felt like the times I got to sit down and talk to someone on a one-to-one basis, or in a group like at the Pride Foundation, I think a lot of people heard me.
I remember before that meeting [at the Pride Foundation] that it seemed like there were days and days when I didn't do any work; I was on the phone with one person for an hour and then another person. It took that long to get them to see--no wonder we're upset. I felt at the end of a conversation that people were beginning to open up and understand why they were so upset. And that was really exciting, because it meant to me that I was doing the best I knew how, and that people could learn. It really was a model for me in so many other things in my life. It really showed me that individuals can make a difference.
Let me say a couple more things about all these events. First, it is important to realize that I am relating this to you many years after the actual events happened. There is no doubt in my mind that my memory of these specific events has been influenced by my reaction, and other's reactions, to everything that happened. That is, looking back and trying to remember, I am no doubt influenced by using my hindsight into the whole process. My understanding of all this wasn't clear to me at the time and I know I had my own "blind spots" to contend with. If we had a videotape of everything that happened, I am sure it would look differently than I have presented it. And [telling] my side of the story is naturally going to be influenced by my
Sixth International AIDS Conference, 1990
HughesYou were president of BAPHR [1990-1991] when the Sixth International AIDS Conference met in San Francisco in 1990.
Andrews
Yes. At the same time, I was also on the board of directors of Shanti Project [1988-1993]. I had been an emotional support volunteer for three years [1985-1988], and then I joined the board of directors. So I was intimately involved with people giving care and emotional support to PWAs [people with AIDS], their family and friends.
So when it came on the horizon that we were going to have this meeting here, it was at the same time that the INS [Immigration and Naturalization Service] was saying that no one who was HIV positive would be allowed to come into the country. That set the stage for another major ideological confrontation among gay organizations. Shanti took the strong stance that we would not participate at all, we would actively boycott the conference, because we were serving people with AIDS, and the government was saying they can't come to the conference from other countries.
The AIDS Foundation, on the other hand, was saying, "We think this is reprehensible, but we think it's important to go to the conference because it's an educational experience, and we cannot pass up this opportunity here in San Francisco to disseminate this knowledge."
So there was a great controversy in BAPHR about whether we should or should not attend. A large number of us felt we should boycott, that it made sense to boycott. We had a meeting where I came up with the idea that we should go but protest, and we could combine those two things. I thought that the best way to do it would be to wear an armband of some kind.
I got that idea because a few years earlier the American Psychiatric Association met here in San Francisco, and it was the time that people were wearing a black armband in support of the the ERA [Equal Rights Amendment]. I attended the first caucus meeting of gay and lesbian members of the APA. There was controversy about whether the gay and lesbian caucus should wear armbands in support of the ERA. Many of the men said that they
So that gave me the idea when the AIDS conference came: Let's have a symbol. My first idea was to wear a lavender armband. But then we decided in our discussion that a red armband was more appropriate because it represented blood, and because it was the red badge of courage. I remember that phrase, we thought of that.
So I wrote an article, that I have, that went in the BAPHRON, talking about the AIDS conference. It outlined that there again was this polarization: Don't come or do come. The BAPHR executive board had decided that we would go but we would wear red armbands as an active sign of our protest against the INS policy.
I went to the flower mart and bought rolls of red satin. Then we had 5,000 ribbons cut, and we had some signs made. I know I've got some pictures of it somewhere. I don't think I went to any of the meetings. I stayed outside and pinned about 1,000 armbands on people. Before the very first conference, I had already called Paul Volberding and John Ziegler. They were the two co-chairs of the meeting. I knew them because they had been on Merv Silverman's AIDS Task Force, where we had spent countless hours together. I called them beforehand telling them what our intention was, and I got them to wear these red armbands, and I pinned them on them myself. So as the conference opened they were wearing our ribbon armbands.
That meeting started, and the cameras were on them. By the time people had seen that, the participants, especially the gay ones, were very eager to have these armbands. So it was a very hot commodity. Everywhere I went, I was carrying armbands and safety pins, and pinning them onto their shirts or their suit coat or whatever. As the meeting went on, you could see more and more of these red armbands.
On the last day, Louis Sullivan (the head of Health and Human Services), was coming to the meeting and we knew there was going to be a big protest. On the podium that day--and there are photographs of it--everyone but Sullivan had a red armband on. Every other doctor up there. Many of the people in the hall had red armbands, and there was a massive protest. Whistles and shouting, no one could hear a word he said. We disrupted his speech with nonviolent civil disobedience.
Right after that meeting we led a large group of doctors who were attending the conference to join the Gay Freedom Parade that coincided with the conference. We were there behind the banner with Volberding and Jonathan Mann, who was the head of the World Health Organization at the time. We left the Moscone Center where Sullivan had just spoken and joined the parade. So there was this huge outpouring of protesting people.
24. For John Ziegler's reaction to this experience, see his oral history in the AIDS physicians series.
##
Andrews
Some weeks after this AIDS conference, I got a phone call from a friend who had watched some awards show on TV. He said, "You wouldn't believe what happened. There were people wearing these red ribbons for AIDS awareness. And somebody called and said, "Do you realize that these red ribbons that we started passing out have become a symbol?" We were all amazed. By the end of the conference, one of the things that we had noticed is that a few people, especially women, didn't want this big red armband pinned on their silk blouses, so they were taking a part of it and bending it and attaching it to something else. So it was a smaller fragment, but it was still the red ribbon. And as we know, the red ribbon became the symbol of AIDS awareness, which started as BAPHR's protest against the INS policy at the International AIDS meeting.
Hughes
An amazing story.
Andrews
An amazing story.
Hughes
You don't know who took it from there?
Andrews
We don't know who. Someone saw it, because of course this conference was internationally telecast. I specifically asked Paul Volberding in the opening comments for that conference to mention why he was wearing it and where he got it. He mentioned in the opening statement to that international conference that he was wearing this ribbon because a group called Bay Area Physicians for Human Rights were protesting this [INS] policy. So we knew that people were seeing it as a sign of protest, and then later someone decided to carry it on and wear it again at an awards ceremony, and then it just caught on.
Hughes
It's also a story of activism and acknowledgement by the medical establishment that PWAs and other activists should be part of AIDS activities
That's right.
Hughes
Did you feel that indeed was the attitude of the Sixth International Conference?
Andrews
Very much. Paul Volberding and John Ziegler did an incredible job of organizing a scientific meeting that also included input and participation from AIDS and gay groups. It was, far more than any earlier international meeting, a meeting that addressed the psychosocial and political issues involved with AIDS. It was no coincidence that this happened in San Francisco. What was amazing is that it coincided with this crazy,
Reagan-style government position by the INS. It made no sense to discriminate against HIV-positive individuals, by attempting to prevent them from entering the country to attend the meeting, when we all knew that there was absolutely no way the virus could be passed by casual contact. To the many scientists and doctors attending the meeting, it painted a very clear picture that AIDS wasn't just a disease but had an enormous social impact. Many of the conference attendees told me they had never been politically active before, but they were eager to wear our red ribbons and join the protest. For the first time, they began to understand the implications of this disease, that this was also a social and political situation that had to do with homophobia, AIDS phobia, fear and ignorance.
Hughes
John Ziegler told me that he actually marched in the Gay Pride Day parade.
Andrews
He did.
Children and Family
HughesPlease tell me about your children.
Andrews
My daughter is thirteen. Eighteen years ago at Thanksgiving, two lesbian physicians that I had gotten to know through BAPHR had me over for Thanksgiving, and at the end of the meal they said, "Can we ask you a personal question?" I had no idea what they were about to ask me. What they ultimately asked me was, would I consider donating sperm for Patty, the obstetrician of the couple, to have a baby.
I was completely flabbergasted. I had never thought about having kids. I was quite touched that they would even think to ask me. I was very, very honored, because these two women were the ones that founded that Lyon-Martin Women's [Health Services]
So we talked about this, and for five years we discussed it. They moved to Santa Monica where Leslie did her residency in orthopedics. She was the first female orthopedic resident at UCLA. So we did the artificial insemination, and as Patty became more and more pregnant, we began to talk about how was I going to be identified? Father? Friend? Uncle?
And as we knew each other more and more and got more comfortable, they asked if I wanted my name on the birth certificate, and I said, "Absolutely." I had signed initially a waiver saying I was an anonymous donor; I had no rights to the child; I had given up any claim. But as time went on, we got to know each other, got more comfortable with each other. So I was on the birth certificate as the father. They moved up here when my daughter was, I think, two, so I began to have an active parenting role.
When my daughter was three, Les and Patty split up. About a year after that, Patty, the birth mom, asked if I'd be interested in donating for a second child. And I did, and we did, and my son was born. He's eight now.
My kids are over on Wednesdays and Fridays and live only a few blocks from me, so I see them very frequently and do all the "fatherly" things that any parent would: soccer practice, birthday parties, et cetera. We have always been open with them about the fact that we are gay. Of course, I am totally in love with them both and am so grateful to have this opportunity to share in the parenting experience. Every parent is totally biased about their own kids, but judging from the input we get from their teachers, friends, and friends' parents, they are truly wonderful, intelligent, caring, delightful human beings. I am so proud of both of them.
Hughes
A wonderful place to end.
Andrews
Oh, good.
Transcribed by Shannon Page
Final Typed by Grace Robinson
Courtesy of Regional Oral History Office, University of California, Berkeley
http://content.cdlib.org/view?docId=kt6580067h&brand=oac4
Title: The AIDS Epidemic in San Francisco: The Response of Community Physicians, 1981-1984, Vol. I
By: Sally Smith Hughes
Date: 1996
Contributing Institution: Regional Oral History Office, University of California, Berkeley
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