The AIDS Epidemic in San Francisco: The Response of Community Physicians, 1981-1984, Vol. I

Bay Area Physicians for Human Rights

Kaposi's Sarcoma Brochure

Hughes

Was 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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Andrews

All 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,

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"We're confronting a common problem here; we should coordinate," or were these two ships passing in the night?

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

Hughes

You'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.

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Handling a Health Crisis in the Gay Community

Hughes

Which 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.

There was an AIDS Task Force at the San Francisco Medical Society, and we participated in that.

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,

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straight or gay, who seeks out multiple anonymous sexual partners. If straight women were interested in this kind of activity, there would be plenty of straight men prostituting on city corners, and straight bathhouses would be very busy indeed. So what we've got are two men, both highly sexual, as most men are, left to "go at it" with abandon.

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

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meetings. They knew what was going to happen when you went into this roomful of people. You're not getting friendly people in there; you're getting very angry, upset, fearful people. They didn't want to hear what we had to tell them.

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,

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"I think it's a plot; someone's introduced something," but that was very rare.

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

Andrews

And 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

against antibody testing except for "special circumstances."

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Andrews

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.

About this text
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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