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

Attempts to Reduce the Risk of AIDS Transmission

Patient Counseling

Hughes

Did you counsel patients along the lines--I mean early--"Maybe you'd better cut down on your sexual activity"?

Campbell

I think starting in 1981 or 1982, definitely. When they showed the charts about the T cells in the gay community, it didn't seem like it was just a few isolated cases of KS. It seemed

---

like there must be something that many, many people in the gay community, maybe more than half, were suffering from. Since it was most likely contagious, sexual contact had to be modified, regardless of who the partner was, since one really did not know who out there might have it.

Hughes

So you talked along those lines with patients?

Campbell

Oh, yes, I started talking about sexual risk-reduction guidelines in 1982.

Hughes

How was such advice received?

Campbell

Variably. Some people thought it was very good advice, and there were a few that would say, "Well, we don't really know that that's the case, and so I am going to do what I want to do." Some people rejected it. And some people felt very angry that they were given such advice. But I don't think most people.

When we started formulating risk-reduction guidelines, about certain things like monogamy and safe sex, it seemed to me that the only answer at that point was safe sex with everybody. There were a number of people that said, "Well, monogamy is okay," implying that monogamy would protect you from whatever this was. However, I thought many seemingly healthy persons carried the virus. The problem was that if you were out there trying to meet somebody to become monogamous with, you had a 50 percent chance of meeting the wrong person. If you were a gay man in San Francisco, and even if you met somebody two years ago and you were monogamous all of that time, you still might not be safe.

The Position of the Centers for Disease Control

Hughes

But was that way of thinking common in the population at large? Maybe it wasn't used to the concept of a latent infection. You had sex with somebody who for all intents and purposes looked perfectly healthy. Wasn't it unusual to expect people to question a partner who looked as fit as could be about whether they were a danger?

Campbell

Yes. Dr. Curran talked to BAPHR in 1983 at our conference, and he presented his detective work on AIDS in the USA. We had just put out our first set of safe-sex guidelines, and I was so anxious that this topic be discussed at a conference like that,

---

that I raised my hand and I said, "Have you come up with any particular sex practice which is likely to transmit this virus?" And he said, "No. There isn't anything in our studies that seems to have been more associated than other things." CDC had done a study, but somehow, it didn't seem to factor out that one thing [sex practice] was any worse than another thing.

However, he said, "I think if you're monogamous that this disease might not be such a worry." I had a couple of friends that were in BAPHR that had been monogamous since 1981; they met in 1981. They were doing everything together, but they were monogamous. They didn't have nearly the anxiety that I had. A lot of people like that felt relatively safe. And those people both have AIDS. Because early in 1981, I think, one of them had contracted it. But this was very typical.

Hughes

So you objected to Curran saying that if you were monogamous, you were safe? That wasn't necessarily the case.

Campbell

Yes. Monogamy would be nice, but I think it would be very difficult for many people in the gay community to suddenly become monogamous, and [it was] not a realistic expectation. The realistic thing was safe sex with everybody. Even if you were in a monogamous relationship, safe sex should be the rule. Several years later, when many started getting tested, if you looked at gay couples in San Francisco, maybe a third were testing positive-positive, and another third were testing negative-negative, and a third were testing negative-positive. Those latter third were really the ones who had to be on the guidelines.

Hughes

So Curran at that stage as spokesperson for the CDC wasn't advocating safe-sex procedures for every encounter?

Campbell

Well, he never came out and said, "If you are in a monogamous relationship, you should be on safe-sex guidelines." Many people who were in monogamous situations then--regardless of how long they'd been monogamous--seemed not to be worried. And people who were really worried were people who were having multiple partners.

Hughes

A study published by the CDC in 1983 found the factor putting people most at risk for AIDS was number of partners.

---

Campbell

That is correct. What that study showed was the number of partners [as the main risk factor]. I think this led to saying, "Monogamy is like one partner, and celibacy is zero, and this is the best way to avoid getting AIDS."

Hughes

Also, because some of the early publications had associated promiscuity and AIDS, it predisposed certain people to say, "Well, I'm not promiscuous; I only have a few partners; I don't have a problem." You didn't even have to try to be monogamous.

Campbell

Yes, and I know that our [BAPHR's] first set of risk-reduction guidelines advised general things like, "Get to know your partner first." It sounded very good, but it didn't make a lot of sense to me, considering that what you really want to know is what nobody could know, unless you had eyes that had DNA probes in them. [laughter]

Hughes

You couldn't know at that point, because there was no antibody test.

The Bathhouses

Campbell

My feeling about this, which gets to the bathhouses, is that so many people then were of the thinking that if you met somebody decent, who was seemingly healthy and agreed to a mutually monogamous relationship, there was no risk of AIDS virus transmission.

##

Hughes

Was there an unstated assumption, then, that there were good gay men and there were bad gay men? That some, just the way they presented themselves, as you were saying, must be okay?

Campbell

Yes.

Hughes

Maybe those bathhouse people were the bad guys? Did it ever get to that?

Campbell

My feeling was that if you went to the bathhouses, you just assumed that you were in a place where many people were infected. Therefore, any contact needed to be very, very safe. You would instinctively put up your armor, because you were in a real high-risk population.

Hughes

You mean you make it safe by taking safe-sex precautions?

---

Campbell

Yes, if you were in a bathhouse, it would seem reasonable to take the maximum precautions.

Hughes

But did that happen?

Campbell

I don't know if that was happening, but to me, it seemed like the reasonable thing. I thought, rather than having the bathhouses closed down, safe-sex instruction should start there, with monitors and behavior codes. The bathhouse could still be an erotic place to meet people, but with the understanding that high-risk activities were definitely verboten. Some people who met their partners in more proper places would often think that they were really meeting a much safer person and might feel more comfortable doing more.

Hughes

Do more that was potentially dangerous.

Campbell

Do more dangerous things; it's sort of a paradox.

Hughes

Yes, I can see that.

Campbell

People said, "Well, if we close down the bathhouses, the epidemic will go away," or, "We won't have as much transmission." To me, it seemed a bathhouse really could be an arena where you post lots of signs on walls. Bathhouses have to be set up in a way that people realize that there's a code of behavior, that there's only so much you do. It could be compared to rules of safety and etiquette which are found in sports.

Hughes

Which would be enforced by social pressure, not by outside force?

Campbell

Yes. And I know that some time around then, they did start having these, quote, "safe-sex clubs," in which people were touching, hands-only contact. There was a lot of peer pressure: you do only this and that's it. And people felt very safe, but yet it was erotic and many people enjoyed it.

Hughes

And that happened in the bathhouses?

Campbell

Those were other organizations that started to crop up.

Hughes

A problem with this argument would seem to me to be that some people were in denial. Regardless of guidelines, they continued their lifestyle. And because the bathhouses were built on the idea of anonymous sex, wouldn't they attract people willing to take sexual risks?

---

Campbell

Some people, yes. I don't know if you read about Patient Zero in Randy Shilts's And the Band Played On?

Hughes

Yes. Gaetan Dugas wasn't Patient Zero, as we know.

Campbell

He went into the bathhouses and infected all these people. My feeling is that if you go to a bathhouse, you had better suspect that there are sick people there. You put so much blame on this particular person, who was already ill, but then there were so many people who were very well and really enjoying their sex lives who could potentially be carrying the virus. The message that I thought had to go out in 1982 is that everybody, including you yourself, may be carrying this virus. And it's your responsibility, no matter where you are, in the baths or at home, to operate on that assumption. You don't operate on the assumption that you don't have the virus and other people do.

BAPHR's Safe-Sex Guidelines

Hughes

You were on BAPHR's scientific affairs committee from the start?

Campbell

Pretty much from the start, yes.

Hughes

Is that where these safe-sex guidelines were being discussed?

Campbell

Yes.

Hughes

Can you remember when you might have begun to talk about them?

Campbell

Yes. We started talking about them in late 1982. We put out a draft of guidelines for blood donation in January 1983.

Then for the health fair that came up in April 1983, we had our first set of guidelines. Bob Bolan and I did those together with the scientific affairs committee.

Hughes

Can you recreate some of the discussion that went into those guidelines?

---

Campbell

We didn't talk so much about bathhouses and whether they should be opened or not. I wanted to make sure that we had it in black and white that the most dangerous thing that one could do was rectal intercourse without a condom.

Hughes

Now, how did you know that?

Campbell

Because of things that Dr. Larry Drew had been talking about the previous summer. I had just gone to a symposium in March 1983 at NYU at which Michael Marmor gave some pretty good data on it. We published those guidelines just a few days after, April 1983. I wanted to make absolutely sure that that warning was in them.

Some of the things that we said were general, like "reduce the number of your sex partners"--things that seemed to make sense, but they were subject to a broad interpretation. [laughter] There was certainly not a message to stop having sex.

Hughes

But did some people interpret it that way? Did you get attacked?

Campbell

No.

Hughes

The guidelines were accepted pretty well?

Campbell

Yes, and obviously, people did start reducing the numbers of sexual partners, and I think the majority of people can do that only very, very gradually. But there are a few that cut it off completely and haven't had sex since. I've talked to many patients like that.

Hughes

There was a statement: "As health care professionals we recognize the importance of physical and emotional intimacy for overall health."

You said something along those lines in the very first guidelines?

Campbell

Yes: don't give up sex. Then there was a message to reduce the number of your sexual partners, get to know your sexual partner first, lean toward having one sex partner.

---

Hughes

Even though you didn't think that that was adequate, right?

Campbell

No, I definitely didn't think that that was adequate. I thought that it should be stated clearly that certain types of sex were dangerous no matter who it was with.

Hughes

So why didn't the guidelines say that?

Campbell

I think I did get that into the first guidelines. That would be a very interesting document to read. I guess I just eventually threw it away, because it didn't seem to have much meaning.

Later Iterations of BAPHR Guidelines

Hughes

By 1984, the guidelines appeared in several guises. For example, there was a wallet-sized one that was passed out at Gay Pride Day.

Campbell

Yes, that's right.

Hughes

And then there was a version that was in street language.

Campbell

That's right.

Hughes

There was another version that was academically oriented. I suppose that's different than the medical evaluation?

Campbell

Well, we did three [editions of guides for use by physicians for] medical evaluations of persons at risk for AIDS. I think I probably sent you the most recent one, which was 1989 or '88, but I think we did one in 1984 and maybe 1986.

They always had the safe-sex guidelines in them. We did them in conjunction with the Department of Public Health and the San Francisco AIDS Foundation to get their seal of approval. But the first ones we did in early 1983 were just our BAPHR committee, and we just got them out for the health fair, and that's all.

Hughes

That was why you were hurrying it?

---

Campbell

Yes. We worked on that for about a month or two.

Hughes

It seems to me there would be three categories of people in your potential audience: the people who knew that they had this disease, the people who didn't know but maybe later learned they were infected, and then the people that were just worried about it. Right?

Campbell

Yes.

Hughes

Was it in your consciousness that the guidelines had to be broad enough to draw in all these people?

Campbell

In those days, it was just a small number of people that knew that they had it, because they'd had Pneumocystis or KS. And then there was a huge number of people out there that were worried, worried and a little bit sick, and worried and mostly well. And then there were a number of people who were well and not worried.

Assessing Risk

Hughes

You had to decide what sexual practices were safe, what wasn't safe, and what were possibly safe. BAPHR tried to categorize what was high risk, what was low risk, and what seemed to be safe. How did you reach those decisions?

Campbell

That category that said "possibly safe": those were my words. I think a lot of people on the committee, and of course, most of the gay community, wanted something that said "safe" and "unsafe."

Hughes

No gray area.

Campbell

I just thought we had to have that gray area. Otherwise, it would be misleading. It's just how much risk does one want to take?

Hughes

Where did you get information to categorize risk?

Campbell

A lot of it was based on knowledge of anatomy, of certain tissues, and concentration of viruses in certain tissues, and common sense. We put mouth-to-mouth kissing in "possibly safe." One could assume that if the virus was in very high concentrations in saliva that the virus would be in the community at large. So it didn't seem very likely that kissing

---

was a common way of transmission. Most of this [categorization] was by inference.

Hughes

It's inference based on the little medical and scientific information that was available and on your knowledge of the gay community. Did you become authorities, in a way? Were there people at the CDC, for example, who would be able to combine these different sources of knowledge and come up with some reasonable safe-sex guidelines?

Campbell

When we were doing that, the CDC was not saying anything, except something to do with risk for AIDS associated with numbers of partners. Therefore anything that they said just did not seem to be particularly relevant. There were a few people who were talking about transmission of other diseases. Larry Drew was talking about the transmission of CMV, and how that correlated with receptive anal intercourse and seropositivity for CMV. Michael Marmor was talking about instances of KS correlated with sexual practices, and was able to get statistically meaningful data.

Then you look at the anatomy of various bodily organs, like the rectum, the vagina, the penis, the mouth, the skin, the hands, as to how many cell layers does something [a pathogen] have to go through until it gets to the blood. Much of that was based on histology, and tissues with only one cell layer such as the rectum would facilitate transmission more readily than tissue like skin which has many cell layers.

Hughes

This was the kind of conversation that was going on in BAPHR?

Campbell

This was the postulate, yes. We felt that we had to give some guidelines, and it seemed, and I guess still does seem at this point, irresponsible to say, "Well, this is safe and this is unsafe." You have to have a middle ground. You have to have a very high-risk category to make sure that everybody avoids the high risk, and that nobody is afraid to go for the safe. The middle ground is where you tread with caution as to how much risk you take. Some people are willing to take a lot more risk than others. Some people will do only things that are totally safe. But the object was to keep as many people as possible out of the high-risk category.

Hughes

Did you find that your medical colleagues that were not gay, and perhaps representatives of the CDC, whom I understand came to San Francisco with some frequency, were consulting you because you had knowledge that they didn't have?

---

Campbell

Yes, there were some symposiums. I remember one that I think Marcus Conant gave in 1983 or 1984, to which a lot of authorities, like Roger Detels, came. Roger Detels runs the Los Angeles Men's Study of Multicenter AIDS Cohort Study and is a good epidemiologist. He had written on various sexual practices and risk of T-cell abnormalities. Representatives from the CDC were also in attendance. Some BAPHR physicians attended. We had a dialogue about what we thought was safe, possibly safe, and unsafe. We tried to stratify everything. This happened as a prelude to the re-publication of the guidelines that came out in the spring of 1984.

Guidelines for Blood Donation

Hughes

What were the guidelines for donating blood to the Irwin Memorial Blood Bank?

Campbell

There was a statement from BAPHR that came out very early in 1983 that went to Irwin Memorial. It said that gay people should refrain from donating blood.

Hughes

Was there controversy over that?

Campbell

Yes. I think almost everybody in BAPHR thought that that was a reasonable thing to do, but I think a few people thought it was not right to target the gay community and say that they were tainted or anything like this.

Hughes

Were you thinking about hepatitis when you were formulating these guidelines? Did that model play any role?

Campbell

I think I remember Paul Volberding or Don Abrams say, "The new virus seems to follow the hepatitis B model for transmission." Which means, it seems to be something that gets introduced straight into the bloodstream. That was why it seemed reasonable to use hepatitis B core antibody as a surrogate marker for AIDS exposure; the risk groups were similar.

##

---

Campbell

The thinking was, if you somehow subjected yourself to hepatitis B, you might have also subjected yourself to HIV.

Hughes

Was this a way of getting around asking potential donors if they were gay?

Campbell

Starting January 1983, blood banks requested that anyone having had homosexual contact with a man since 1977 not donate blood. The same applied to intravenous drug users. Once you donated blood, it was then checked for the surrogate marker, hepatitis B core antibody.

Hughes

Surrogate markers threw the net wider than just the gay community, didn't they?

Campbell

Oh, yes.

Hughes

So that was the point of having the screen for gay donors, plus the surrogate markers?

Campbell

The surrogate markers would include a large number of people that may not have admitted to being in a risk group, such as gay or IV drug user, plus a few people that weren't in those risk groups who had really had hepatitis B, and they might have gotten it without being in those risk groups. That blood was not used either. If you've ever had hepatitis, you're not supposed to donate blood. I don't know if they're still checking for hepatitis B core antibody or not. I'm sure they check for hepatitis C antibody, which they couldn't [test for] until 1989. They must certainly be checking for hepatitis B surface antigen.

Guideline Distribution

Campbell

The first set of guidelines was done for the health fair that took place in the Castro District, Health Center Number 1, April 1983. Every spring, there was a health fair--there were health fairs at several health centers in San Francisco. That particular one, Health Center Number 1, had many gay people at it, because it was in the Castro District. But it also had some straight people and some elderly people who attended. The guidelines went out at that particular event, and were probably passed out at the Gay Pride Day parade that occurred in June. They might have even been in bathhouses. I don't know just how wide the distribution of that one was.

---

Hughes

What about distribution outside the city, outside the state?

Campbell

I don't know if the first set of guidelines was widely distributed outside of the city. I do know that the next one (1984) must have been, because I saw them at the New Zealand booth at the international AIDS meeting. I'd say, "Oh, these are the ones that we wrote." [laughs]

Hughes

They were almost verbatim?

Campbell

Yes, or BAPHR had been acknowledged.

Hughes

What other guidelines were out there when yours came out in 1983?

Campbell

The Gay Men's Health Crisis in New York had guidelines.

Hughes

How did they compare?

Campbell

I think that they were even stricter.

Hughes

Did theirs come out before yours?

Campbell

Probably about the same time.

National Lesbian and Gay Health Conference, Denver, 1983

Hughes

BAPHR's position that, "secretions and excretions are the most likely vehicles for AIDS virus transmission,"

apparently met with an adverse reaction at the National Lesbian and Gay Health Conference in Denver in 1983. Do you remember that?

Campbell

There was an earlier meeting where they coined the phrase "AIDS," and I think that was in '82. I didn't attend that meeting.

Hughes

The one in 1982 was in Houston. The 1983 meeting was held in Denver.

Campbell

There was an AAPHR, American Association of Physicians for Human Rights. I know there was a meeting that February 1983 in Hawaii. I didn't go to that one either. I wasn't even in AAPHR. But it seemed like starting in late '82, most people in

---

BAPHR thought that the body fluids were what transmitted "AIDS virus." It was really a minority in 1983 that thought it could be poppers, steam from the bathhouses, or "immune overload."

I talked to groups as late as early '84 that thought it was something else: the CIA is doing it; something was planted somewhere. But it didn't have to do with sex.

Hughes

I believe it was the 1983 Denver conference where the People with AIDS movement got off the ground. So some of the people there had an activist orientation.

Campbell

We had said early on in the guidelines that it's the body fluids that transmit it. I know that that was a big thing on that first set of guidelines: "This [disease] is transmitted by body fluids."

Hughes

Did you say what those body fluids were?

Campbell

That was one of the problems. I thought that "body fluids" was a really vague term about which most people don't have a good concept. I mean, it could be saliva or sweat.

Hughes

Yes. And is semen a body fluid?

Campbell

I think the term body fluid just seemed to be an eponym for semen. I wasn't pleased with those guidelines, because I thought there was so much vagueness. You really should talk to Bob Bolan,

because he was the chair of the committee that formulated the guidelines. I just kept needling him, because I wanted them to be more specific. I was not totally happy with those guidelines, because they were just too vague. They gave mixed messages about meeting people, numbers of partners, and other warnings that people could interpret too broadly.

Hughes

Was leaving the guidelines open to individual interpretation somehow tied in with the idea of not saying "NO" to sexual expression?

Encouraging Sexual Expression

Campbell

That was part of it. We were saying, "Yes, you can still have sex, but try for monogamy." [laughter] If that doesn't work,

---

practice safe sex, and be careful of body fluids. I think people were afraid to go out on a limb to say, "Well, semen has it in it, but saliva doesn't," or, "sweat doesn't." Some people were very, very worried about saying specific things about things that were still theoretical. We were so vague about our theories that we just couldn't say these things with conviction, other than it just did seem reasonable that the virus was in some body fluids, as opposed to, let's say, the atmosphere or skin. You could touch people and breathe with them, but beware of body fluids.

Hughes

In a report in The BAPHRON in August, 1983, you wrote, "Heretofore we have never had any written rules as to what constitutes a "moral" or "safe" sex life, as is prescribed in heterosexual marriage." Then you go on: "We must bear in mind that sexual habits do not change overnight. Furthermore, new data on transmission of AIDS may be forthcoming. Consequently it may be several years before the gay community can establish its "sex code" which is both emotionally fulfilling and medically safe."

Campbell

That sounds like something I could have written. It doesn't sound very specific.

Hughes

My interpretation of what you're saying, and please comment, is: we're doing the best we can to give you some guidelines, but we frankly don't have all the information that we need to make these guidelines very explicit. Therefore, the ultimate sex code for the gay community is off in the future.

Campbell

Yes.

Hughes

But for your own safety, you've got to take these interim steps. Is that more or less what you were saying?

Campbell

Yes. And I suspect that, if that was August 1983, it was probably the report on the symposium that we had at the end of June.

Hughes

Yes. [pause as Campbell reads the report]

Campbell

[laughs] Well, there was a heavy component of psychiatry in the meeting that we had in June, 1983. "Morality" and "safety" were discussed at great length. That's probably why I used the words in quotes in my report. That may have been the home-

---

going message from that symposium. Some of that report could have been paraphrased from some of the speakers there. It was run by psychiatrists, asking what can the gay community do about sexual fulfillment?

The 1983 and Later Guidelines

---

Hughes

I have a few more questions on safe-sex guidelines. The BAPHR guidelines first came out in 1983.

Campbell

Yes, our first guidelines were published in the spring of 1983.

Hughes

And then there were several revisions. The revisions that I know about were in 1984, 1985, 1987, 1989, and there have probably been some more recent ones.

Campbell

The revision that we made in 1984 put sexual activities in the safe, possibly safe, and unsafe territories. And I think that since that time, there doesn't seem to have been an essential revision of the guidelines, other than the fact that many of the things that were in the "possibly safe" category, people now may call low risk, but not zero risk. It's more a change in wording and certain precautions.

1985 was the first time we came out with a booklet in which we elaborated on each sexual practice, and precautions to be taken when engaging in any of those practices, and why some of the ones that were possibly safe might not be safe under certain circumstances.

Hughes

I am interested in knowing what the general types of changes were.

Campbell

I think we remained firm on what was definitely safe, and firm on what was definitely unsafe, and we just elaborated on that

---

big middle ground and changed the words a bit. I think that these days most people would still put them in a middle ground.

BAPHR Guidelines as a Model

Hughes

We talked last time about another set of guidelines, which were those of the Gay Men's Health Crisis, which you thought might be a bit more stringent. In the early days of the epidemic, were those the only two sets of guidelines? And did they become models?

Campbell

As far as I know they were, and I have a feeling that they did become a model, because when I went to the AIDS conferences around 1988 or 1989, I was noticing the guidelines for people from New Zealand, and they were just the same as we had written in San Francisco five years before.

Hughes

What about the guidelines that were eventually put out by the federal government? Did those follow the BAPHR model?

Campbell

They weren't in that "safe, possibly safe, unsafe" category, but I think that they said in essence the same thing that we had been saying: unprotected rectal and vaginal intercourse are unsafe, and there is reduction of risk if a condom is used. I'm not sure what it said about oral sex, because those guidelines change from time to time.

Hughes

There is the recent research on monkeys, indicating that oral sex is not as safe as it was originally thought to be.

Campbell

Yes, rectal sex seems to be safer than oral sex for monkeys, from what I heard. However, SIV is a different virus and it's a different species, and epidemiologically that doesn't seem to make sense with the AIDS epidemic.

BAPHR Collaboration with Other City Organizations

Hughes

The AIDS Foundation merely distributed the BAPHR guidelines, or was it more than that?

Campbell

In 1983 at the health fair, when we published our first set of guidelines, they were the BAPHR guidelines. In 1984, I think in preparation probably for Gay Freedom Day, which would have

---

been around May, we had a series of meetings with BAPHR, the Department of Public Health, and the San Francisco AIDS Foundation, in which we rehashed the guidelines and decided on the risk categories. The guidelines that we presented in June 1984 had the seal of approval from the San Francisco AIDS Foundation and the San Francisco Department of Public Health. They were really a tripartite type of guidelines, because nothing got in there that didn't pass muster with those two organizations, and we had several meetings to get all three together.

At that time, I believe, we issued little cards that said, "safe, possibly safe, unsafe," and we published some annotated guidelines that stated why certain sexual practices were safe or unsafe.

Hughes

Last time we discussed the several types of publications that came out. I think the one you're talking about is the wallet-sized version.

Campbell

Yes, and I think that the BAPHR guidelines came out in three versions.

Hughes

Yes, exactly.

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
Copyright Note: Copyright status unknown. Some materials in these collections may be - protected by the U.S. Copyright Law (Title 17, U.S.C.). In addition, the - reproduction, and/or commercial use, of some materials may be restricted - by gift or purchase agreements, donor restrictions, privacy and - publicity rights, licensing agreements, and/or trademark rights. - Distribution or reproduction of materials protected by copyright beyond - that allowed by fair use requires the written permission of the - copyright owners. To the extent that restrictions other than copyright - apply, permission for distribution or reproduction from the applicable - rights holder is also required. Responsibility for obtaining - permissions, and for any use rests exclusively with the user.