I Background, Education, and the San Francisco Gay Community

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Upbringing, Education and Early Career

Hughes

Dr. Andrews, please give me a thumbnail sketch of where you were born and educated.

Andrews

I was born in Union, Mississippi, July 20, 1947, and at age three I moved to El Reno, Oklahoma with my family. At age seven we moved to Oklahoma City, where my parents remained. I went to Trinity University in San Antonio, Texas, got my B.A. there in 1969. I went back to Oklahoma City, to the University of Oklahoma, School of Medicine, for medical school, where I graduated in 1973. Then I began my psychiatric residency at McAuley Neuropsychiatric Institute at St. Mary's Hospital here in the city, where I remained from 1973-1977.

Hughes

Why did you choose St. Mary's?

Andrews

When I came out to do my West Coast interviews, I wasn't "out" as a gay man at the time, and I really had no idea that San Francisco was the "gay mecca." But I was immediately struck with the beauty and the magic of the city. During my interview at McAuley's I was offered a residency position, and when I returned to Oklahoma I cancelled all my East Coast interviews. One of my best friends from college was also coming here, so I just sort of settled on San Francisco, and have been grateful ever since.

Hughes

And then what happened?

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Andrews

I finished my residency in 1977 and began a private practice, which included working with children who were hospitalized or in group homes, and outpatient adults. I also became a medical consultant for the Social Security Administration Disability Program. I worked in the regional office, which involved training physicians and medical examiners in California and three other states, and reviewing disability claims for quality insurance.

Hughes

In the area of psychiatry.

Andrews

Yes. It's a multispecialty review, and I was reviewing in the specialty of psychiatry for Social Security.

Hughes

I see. And had you pretty much always intended to focus on child psychiatry in your private work?

Andrews

Not exclusively, but my residency was a combined adult-child psychiatric residency, and I enjoyed working with the kids a great deal. I had some connections with several psychiatric group homes and I just pursued them. Until I retired last April, I continued to do a combination of the private practice, mostly with adults, group homes with kids from eight to eighteen, and this administrative work with Social Security.

Becoming Active in the Gay Community

Hughes

What happened between 1973 and 1981?

Andrews

Things were relatively undramatic for me until probably about 1975, when I began to explore the gay culture in the city. Actually, once I had my first sexual experience here, I felt "liberated." All the guilt I'd had all my life about these feelings completely disappeared, and from that point on, I was 100 percent totally and comfortably gay, as far as my sexual orientation.

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Joining Bay Area Physicians for Human Rights [BAPHR]

2. Dr. Andrews, in the editing process, substantially rewrote the sections, joining BAPHR and the Assassination of Milk and Moscone.

Andrews

In the fall of 1977, seventeen gay doctors got together and formed the Bay Area Physicians for Human Rights, or BAPHR, the first gay doctors' group in the country, actually the world. I had just finished my residency that summer and although I wasn't at the first meeting, word spread quickly and I joined within the next few months.

In my opinion it was no coincidence that BAPHR was formed at the same time that San Francisco had its first district elections for supervisors. Harvey Milk, the owner of Castro Camera, had run for office three times and lost, but this time he won and made history as the highest openly gay elected official in the country.

Harvey's election served as a catalyst to activate the growing gay community here. The Gay Freedom Parade in June 1978 was historic, not only because Harvey was the Grand Marshall, but because, for the first time in this country, there were marching contingents of openly gay doctors (BAPHR), businesspeople, church groups, and even a gay marching band and twirling corps.

Nationally, we were also experiencing a backlash against gay civil liberties as one state after another repealed ordinances that had prohibited discrimination against gay men and women. And right here in California State Senator John Briggs had succeeded in getting Proposition 6 on the state ballot. The 'Briggs Initiative' would have prohibited homosexuals or lesbians from teaching in public schools; furthermore, any heterosexual who even supported the idea of gay teachers was to be excluded. Harvey quickly became the primary spokesperson in the state to address and debate Briggs and his supporters. He came to a BAPHR meeting, and met with BAPHR officers on several occasions to get medical and psychiatric support for his arguments against this legislation. It was a very tense time because it looked like we might lose even up to the day before the election. And when we won, Harvey joined a thunderous crowd of supporters at the "No on 6" headquarters on Market Street. Listening to Harvey speak, asking everyone to "come out of the closet," was probably my most intense personal experience with Harvey.

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The Assassination of Milk and Moscone

Andrews

When Harvey and Mayor George Moscone were assassinated I was just three blocks from City Hall, working at Social Security. I walked over to the Polk Street side of City Hall and just stood there, silently, with several hundred others who were in a state of shock. That evening the candlelight march, from Castro to City Hall, was a tremendously moving event. As the thousands and thousands of us gathered at City Hall, Joan Baez sang "Amazing Grace", and the newly formed Gay Men's Chorus sang for the first time. I still cry every time I see the film, "The Life and Times of Harvey Milk." But nothing was more powerful for me than the memorial service at the Opera House a few days later. The building was packed to overflowing and hundreds who couldn't get in listened to speakers outside. My friends and I were crammed high in the balcony, but we could still see Governor Jerry Brown, the State Supreme Court justices, and all the VIPs in the front rows. Dave Kessler, the president of BAPHR, was one of five speakers. I don't remember the specific words spoken but I will never, never forget jumping to my feet, again and again, clapping, with tears streaming, as different people talked about Harvey, what he stood for, about "coming out," et cetera. It was as intense an experience, whether religious or spiritual, as I have ever had and I imagine it being similar to what Pentecostal groups would call "being filled with the spirit"; and for me it was the spirit of the gay movement.

From that point on, I became much more of an activist and became much more involved in BAPHR, and was the treasurer [1980] and then the vice president [1981, 1988, 1989] and then the president [1982, 1990, 1991]. I became involved with BAPHR at a time when there was no office, no staff, and there was only an answering machine at someone's home. When I was president, I established the first office and the first staff person. So we really began to have some stability for the organization.

BAPHR's Medical Symposia

Andrews

Someone at one of our symposia, I think it was Dr. Bob Bolan

, mentioned some cases of immune deficiency, something going on with some gay men. That was the first little inkling that something was happening.

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Hughes

Do you remember when that was exactly?

Andrews

You know, I really don't. If I could trace back to when that symposium was--because one of the things that BAPHR also did was we began to have medical symposia. Every year, we sponsored a symposium, and I was one of the coordinators. We had gay doctors coming from all over the United States to talk about gay health care.

Hughes

Are you talking about the symposium where Alvin Friedman-Kien spoke?

Andrews

Yes.

Hughes

That was June of 1981.

Andrews

Okay, yes, that must have been it. It was June of '81--yes, that would be right. That's when we got the first reports.

Hughes

So there had been nothing official yet on KS [Kaposi's sarcoma]. Now, there had been the article on PCP [Pneumocystis carinii pneumonia], which [Michael] Gottlieb wrote.

Andrews

That's right, that's right. Now I remember.

Hughes

Do you know what people were seeing? Were they seeing PCP at that early date up here, or was it all KS?

Andrews

I think it was mostly KS. Now, Bill Owen

or Bob Bolan or one of the other internists would have more specifics about that, I think. Everyone was just becoming aware there was something going on, and no one knew what exactly.

Hughes

Did you think much about it?

Andrews

At first, we were all bewildered. I just remember everyone thinking, What is this? Even early on I think many of us had this fear that whatever was happening might be related to sexual practices.

Hughes

Was your practice largely gay men?

Andrews

Yes, it was predominantly gay men.

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Hughes

And did you notice that there was a lot of sexually transmitted disease?

Andrews

Oh, yes; it was fairly common for many gay men. We had been doing STD [sexually transmitted disease] screenings at our health fairs.

Hughes

The first health fair was in 1978.

Andrews

Gosh, was it that early?

Hughes

Yes.

Andrews

Golly. Okay, yes, so we were doing routine STD screening, vision and blood pressure screening, health awareness, et cetera. I think that by '81 we had moved away from the health fair situation, so we weren't dealing with that when the epidemic began.

Hughes

Oh, really? Why did BAPHR move away?

Andrews

I think it was mostly an issue of lack of organizers. There weren't people available to organize it; that's my guess.

Hughes

Why did BAPHR choose to organize that segment of the health fair?

Andrews

Well, at that time KRON TV and several different organizations were having these community health fairs, and for the first one, we as an organization were asked to participate. I met the director of Health Center Number 1, Dr. Hope Corey, and we explored the possibility. They were a bit apprehensive initially about having so many gay people in their facility, but Dr. Corey and I became good friends.

Out of the health fair experience came this liaison of gay and lesbian health care workers, not only physicians but other people that began to come and help us do all sorts of screening

--blood pressure and vision and GC screening, et cetera. Sexually transmitted disease screening was one of our biggest focuses.

Hughes

And was it a good thing for BAPHR in terms of community visibility?

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Andrews

Oh, it was wonderful, yes. Those first couple of years, we really got great exposure and a lot of appreciation. I think we were looked at in the community as the equivalent of the Golden Gate Business Association, the gay business organization, the San Francisco Band Foundation with the gay band, et cetera. Now we had a gay doctors' group, we had a referral service, we had people calling us all the time trying to find gay-sensitive docs. And the health fair increased our visibility in the community.

American Association of Physicians for Human Rights

Hughes

What was the state of gay and lesbian health care, beginning, say, with the late 1970s and moving to the time of the epidemic?

Andrews

Well, as I recall, as BAPHR became more visible, we would get calls from all over the country from people just desperate to talk to a gay or a gay-sensitive physician about whatever was going on where they lived. It could have been something that was psych-related, e.g., that a man had a therapist who told him that he needed to "recover" from homosexuality, or a lesbian being uncomfortable talking about the fact that she didn't need birth control and being fearful of her health care provider. Initially, we were just swamped by this.

Hughes

Then in 1981, the national organization [American Association of Physicians for Human Rights] was formed.

Andrews

That's right.

Hughes

Were you involved?

Andrews

I was one of the founding members of AAPHR, and I was the first treasurer of the AAPHR [July 1981-June 1982]. AAPHR came about as a result of these medical symposia that we were having every year. Because we had people coming from all over the country, we finally decided that it would be good to have a national organization. Sibling organizations--we called them PHR, Physicians for Human Rights--had already sprung up in San Diego and L.A. and Chicago and New York, so we decided to have a national organization.

Initially, everything was fairly centralized in San Francisco. And now, many years later, AAPHR, now renamed GLMA [Gay and Lesbian Medical Associates], has almost 2000 members, in all fifty states and twelve countries, with a staff of fifteen.

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It has become the premier gay physicians' medical organization, having a national impact.

Hughes

It didn't in the beginning, affect BAPHR? It didn't take some of the activities--

Andrews

I don't know that it did. We were the "father" of all these sibling organizations. We were the only one that had a staff,the only one that had an office, the only one that had a newsletter--we were the only one organized, really.

Hughes

Now, why did it happen in San Francisco, do you think? Why BAPHR?

Andrews

San Francisco has long been known as a tolerant place to live; during World War II many gay men and women in the military passed through and decided to return. By the early seventies there was a mass gay migration to this city from all over the country. The Castro became a neighborhood of more than just bars; people lived, shopped, and worked there. Harvey Milk's election sent out another strong message: San Francisco is a place where you can "come out", where you can be yourself, where you don't always have to be looking over your shoulder to see if someone is going to attack or harass you. As I've mentioned, there was a burst of activity in the late seventies that gave us not only BAPHR, but gay churches, gay business organizations, gay recreational organizations, et cetera. It just seemed to happen here more than any other place.

Hughes

For one thing, if you compare the gay community here to New York's, geographically San Francisco's is more condensed, which facilitates communication and organization and everything else.

Andrews

Yes, absolutely. We really adopted Harvey's message of "come out". Harvey's message was, "Every gay man, every gay woman, should come out." It was a very proud period for us, a very heady time.

Hughes

Was there any pressure within BAPHR to come out?

Andrews

There was. Not initially, but somewhere in the first five years, people were beginning to say we should change our name to contain the word gay. But because we already had a name that was recognized no one wanted to change it. That was our initial reason why. And I think there were also, even in this

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progressive city, still a large number of doctors that were nervous about the word "gay". They could hide under the banner of human rights, conceal it a little bit, although everyone knew what that meant. We would get calls requesting help for human rights problems in Central America and we would say, "Well, frankly, we're really handling gay health issues here." But I think that it was just our own reticence about being open about who we really were initially.

Hughes

Also there was at least an ambiguity, too, for somebody in Des Moines looking at a CV and seeing a membership in BAPHR. They might not know what that meant, and there might have been some deliberateness there.

Andrews

That's right, there was. To make it more comfortable for everyone to join, that they weren't joining a "gay" organization that might "out" them, our membership list was completely confidential.

Hughes

In late '77 or early '78 when you joined, was anybody nervous about being at the meetings?

Andrews

Certainly. The way we started our meetings in those early days was to introduce anyone that hadn't been there before. They would tell us where they were from and what their specialty was and so on. And generally, the people that would stand up would give some little emotional speech about, "You know, I'm really nervous and excited and happy and afraid and proud"--a mixture of both apprehension and pride.

Hughes

And a mixture also of gay concerns and medical concerns? What takes predominance?

Andrews

Definitely gay concerns. Most physicians have numerous opportunities to join professional groups. If you want to get intellectually stimulated about health care, there are plenty of places to go. But there was no place to even say, "I'm gay and a doctor."

Hughes

You became president of BAPHR in 1982. Besides AIDS--because AIDS is going to so dominate the story--what else was going on in 1982?

Andrews

One effort that involved providing referrals for people in the community, to get them health care professionals that were

gay-sensitive or gay. We wanted to gain some credibility in the established medical organizations. San Francisco Medical Society was a good example of that. There was a wonderful liaison between BAPHR and the medical society, because we had our

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symposia there. People that came from Hawaii, New York, Minnesota, were astounded when they would come to San Francisco and we'd go into the San Francisco Medical Society auditorium for our medical meeting. It was like, "Oh, my god, I couldn't even bear to tell somebody in my city that I'm gay, much less walk into the medical society and have the president of the society greet us." It was unheard of, and very liberating.

Another focus was the mushrooming of sexually transmitted diseases. Homophobia was a major concern. We saw it in ourselves and in so many of our patients and friends. So BAPHR was involved in many things.

Psychiatrists in BAPHR

Hughes

There were several lists of the medical specialties represented in BAPHR, and at least as far as through 1983, psychiatry very much dominated by an overwhelming percent. Why is that?

Andrews

Well, I think people that came from a psychiatric background are used to talking about social consciousness and conflict and all that, so it was perhaps easier for psychiatrists as physicians to come out, to be identified as gay. Also the American Psychiatric Association had to deal with the whole issue of whether homosexuality was even a mental disorder, and in 1973 the APA, after much debate, did remove homosexuality from the list of mental disorders. That debate made the issue of being gay much more visible for psychiatrists.

Hughes

What impact if any did that have on BAPHR, the fact that it was heavily weighted towards psychiatry?

Andrews

I don't know. There were so many community issues that were psych issues. They were really human relations issues, but they became psych issues. Maybe we were better able to handle some of the issues that came along.

But you know, really, some of the nonpsychiatrist folks handled it just as well. It really wasn't like the shrinks took over the philosophy of BAPHR by any means. But there were so many of us and we came out sort of en masse. Even before BAPHR was formed I was asked to come to a group of gay psychiatrists, so the ball had gotten started there a bit earlier.

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Hughes

I wonder if that isn't related to the fact that the American Association of Psychiatry had a subcommittee or a subgroup of gay psychiatrists? Did it precede BAPHR?

Andrews

I don't think it preceded BAPHR; I think it was after it.

Hughes

In 1979, there was already a subcommittee on psychiatric--when it was actually founded, I don't know. As of June 1979, out of a total membership of 279, sixty-five were psychiatrists.

You were really heavily represented.

Andrews

We were, that's right.