HOW TO CREATE POLICY IN AN EPIDEMIC:
AIDS IN SACRAMENTO, 1981-1989
Amber Elena Piona
B.A., University of California Davis, 2005
Thesis
Submitted in partial satisfaction of
the requirements for the degree of
MASTER OF ARTS
in
HISTORY
(Public History)
at
CALIFORNIA STATE UNIVERSITY, SACRAMENTO
FALL
2010
HOW TO CREATE POLICY IN AN EPIDEMIC:
AIDS IN SACRAMENTO, 1981-1989
A Thesis
by
Amber Elena Piona
Approved by:
__________________________________, Committee Chair
Dr. Chloe S. Burke
__________________________________, Second Reader
Dr. Patrick Ettinger
____________________________
Date
ii
Student: Amber Elena Piona
I certify that this student has met the requirements for format contained in the University format
manual, and that this thesis is suitable for shelving in the Library and credit is to be awarded for
the thesis.
__________________________, Graduate Coordinator
Dr. Mona Siegel
Department of History
iii
___________________
Date
Abstract
Of
HOW TO CREATE POLICY IN AN EPIDEMIC:
AIDS IN SACRAMENTO, 1981-1989
by
Amber Elena Piona
The disease that would become known as Acquired Immune Deficiency Syndrome
(AIDS) was first identified in June of 1981. The original Center for Disease Control
article identified five cases of Pneumocystis carinii pneumonia, an opportunistic
infection, in otherwise healthy men in Los Angeles. The article speculated that there was
a potential relationship between the patients’ homosexual “life-style” and their infections.
The association of AIDS with a gay life-style and the LGBT community’s decision to
embrace AIDS as community cause profoundly influenced AIDS history. This thesis
explores the differing agendas of Sacramento city/county’s public health officials and
Sacramento’s LGBT community and how they were based on differing understandings of
AIDS. These two intersected in the creation of the first public document regarding AIDS
in Sacramento, the published findings of the 1986 Mayor’s AIDS Task Force.
The 1986 Mayor’s AIDS Task Force provided the framework for this project,
supplemented by primary source material from the Gay, Lesbian, Bisexual, Transgender
Historical Society in San Francisco and the Center for Sacramento History. Newspapers,
both from the gay and mainstream press in Sacramento, also provided valuable context
for Sacramento during the 1980s. Additional sources consulted to provide context
include books and journal articles on the AIDS epidemic, LGBT history, AIDS activism,
and the cultural and linguistic construction of AIDS.
_______________________, Committee Chair
Dr. Chloe S. Burke
_______________________
Date
iv
DEDICATION
This is dedicated to the many people who worked in the AIDS movement in Sacramento
during the 80s. Although not as well known as those who worked in San Francisco or
Los Angeles, your work mattered. Your work matters.
Thank you.
v
ACKNOWLEDGEMENTS
I would like to thank Ed Turner, who, through no fault of his own, was subjected to a
two-year long series of lectures on the history of AIDS every time he had the misfortune
to come home. Thank you, Ed, for helping me get this out of my head and onto paper.
vi
TABLE OF CONTENTS
Page
Dedication ................................................................................................................................. v
Acknowledgments.................................................................................................................... vi
Chapter
1. INTRODUCTION .............................................................. ……………………………… 1
2. AIDS AND ITS HISTORIES ............................................................................................. 5
3. AIDS IN PRINT ............................................................................................................... 23
4. SACRAMENTO RESPONDS........................................................................................... 42
5. CONCLUSIONS ……………………………………………………………………. ...... 76
Bibliography ........................................................................................................................... 82
vii
1
Chapter 1
INTRODUCTION
A Brief History of AIDS
Those who have studied the progression and transmission of the disease indicate
that Acquired Immune Deficiency Syndrome (AIDS) first came to the United States in
the 1970s. A vague, inexplicable cluster of diseases that normally affect the severely
immunocompromised, known as “Junkie Pneumonia,” began appearing amongst the
intravenous (IV) drug users of New York, Los Angeles, and San Francisco.
1
Most of
these cases went unrecognized by health care professionals because of the general lack of
access to health care for IV drug users, combined with the perception that IV drug users
were, through their addiction, normally unhealthy. It was not until young, middle-class,
otherwise healthy men with access to healthcare began contracting exotic diseases in high
frequency that the medical community became interested. And interest turned quickly to
urgency.
AIDS is an elusive disease that, prior to the identification of the retrovirus
responsible as well as the invention of a blood test to determine exposure, commonly
presented with a complex cluster of exotic diseases.
The first identified diseases,
Kaposi’s sarcoma, pneumocystitis carinii pneumonia, and Cytomegalovirus—a cancer
formerly seen mostly in elderly men from the Mediterranean, a pneumonia caused by a
fungus, and a herpes virus, respectively—have very little in common. The seemingly
sudden appearance of these diseases in previously healthy people in locations all around
1
Douglas Crimp, “How to Have Promiscuity in an Epidemic,”AIDS Cultural Analysis, 249.
2
the world inspired much public panic. In addition, the long latency period between
infection and first symptoms made it an impossibly difficult disease to contain with
traditional public health measures. Lastly, the methods of infection, blood and especially
sex, made it uncomfortable to discuss. These factors combined to make the public health
dimension of AIDS especially complex.
This public health crisis happened on a global and international scale, but it also
happened on a local scale. Early AIDS activism on both a national and local scale was
directly rooted in the LGBT communities around the nation.
The gay and lesbian
community was both small in number and much quieter in Sacramento than in those in
Los Angeles and San Francisco, but it was present. Although there was an annual Gay
Pride Parade held during the month of June, the parades in the early 1980’s were smaller
and more conservative than their San Francisco counterparts. In June of 1981, a few
hundred people attended the parade and listened to Assemblyman Art Agnos (D-San
Francisco) and Josette Mondanaro give speeches in Capitol Park. In San Francisco of the
same year, the newly re-christened International Lesbian and Gay Freedom Day Parade
had an estimated attendance of 250,000.2 Although not as politically active or vocal as
San Francisco, the local gay and lesbian monthly publication Mom…Guess What! was an
influential political voice for the community.
From 1982 to 1985, the treatment of AIDS in Sacramento was managed solely
through the effort of the gay community, who, as the group most directly affected by the
SfPride “June 28, 1981 “Frontline of Freedom”.
[http://www.sfpride.org/heritage/past/1981past.html] accessed 25 January 2010.
2
3
epidemic, had taken up AIDS as a community cause. Gay and lesbian activists saw AIDS
as an internal threat to be managed; elsewhere, it was presented as an external threat to be
feared and avoided. This attitude is reflected in the gay and mainstream press. For
example, Mom… Guess What!, ran an article in August of 1983 entitled “AIDS Risk
Reduction” which outlined how the virus spread, four months later the Sacramento Bee
ran an article “Debate Grows: AIDS Spread Through Household Contacts?”3
In 1986, through lobbying by the gay community, the Sacramento government
began to address the problem of AIDS as a public threat. That year Mayor Anne Rudin
formed the Sacramento Mayor’s AIDS Task Force to address AIDS in Sacramento. The
recommendations of this task force, released as a report, were the defining document of
the early years of the AIDS epidemic in Sacramento. Not only did it define what AIDS
was, but the subheading of the document prioritized the ways in which the city of
Sacramento could approach AIDS: “Transmission and Prevention, Education, Human
Services, and Discrimination.”
The task force also represented the intersection of several interested parties in the
AIDS epidemic, each with differing agendas. The Sacramento city/county Public Health
Agencies and Sacramento city officials were seeking ways to control the spread of the
disease while keeping the public calm. Doctors, central in the public health arena,
traversed both groups. Some, like Doctors Harvey Thompson and Sandy Pomerantz, were
members of and advocates for the gay community in the medical arena. Others, such as
3
Sandy Pomerantz, “AIDS Risk Reduction,” Mom… Guess What! August 1983, 8.; “Debate
Grows: AIDS Spreak Through Household Contacts?” Sacramento Bee, 9 December 1983, Sect. C, p.5.
4
Doctor Neal Flynn and Doctor Paul Hom, were less focused on the gay community and
more concerned with educating IV drug users and at-risk teens. The latter group was
worried about spread of the disease, and less concerned with treatment.
The final interest group in the early years of the AIDS epidemic is perhaps the
least participatory, but still influential: the public. A city’s responsibility to its citizens is
to keep them safe while being fiscally responsible with their tax money. Sacramento was
forced to navigate between its citizens’ two contradictory desires; the public wanted
AIDS contained and eradicated, but without a corresponding increase in taxes.
Furthermore, since public sentiment was opposed to homosexuality and IV drug use
Sacramento citizens did not want to see or pay for policies which would condone these
practices. Throughout this entire epidemic, there was a moral view of AIDS patients that
influenced public perception: on the one hand, gays and drug users were “guilty” AIDS
victims; on the other children and hemophiliacs or recipients of blood transfusions were
“innocent” victims. The public did not want to see the guilty infecting the innocent. It
was the public’s urgency that motivated both the decisions of the task force and the
implementations of those recommendations. This thesis argues that Sacramento’s policy
response to AIDS was rooted in the often conflicting agendas of the LGBT community
and the city’s public health officials, and that the decision to emphasize prevention or
treatment was based upon the perception of AIDS as an internal or external threat.
5
Chapter 2
AIDS AND ITS HISTORIES
A Literature Review
AIDS is often conceived of as a disease affecting “life-styles” or “risk groups,”
and understanding the history of AIDS requires that one unpack the meaning of this
designation. It is nearly impossible to remove culpability or moral complicity from the
process of “acquiring” a disease through the life decisions one makes, or the risks that
one takes, especially when the life-styles in question involve gay sex or IV-drug use, two
activities that were already weighted with moral judgments. Both “life-style” and “riskgroup” are artificial demarcations that separate the infected and potentially infectious
from everybody else. The artificiality is highlighted by the fact that neither group is
physically or geographically distinct from the general population. The Sacramento city
government first responded to AIDS, three years after the first cases were diagnosed in
the county, and only after the medical community realized that AIDS was beginning to
affect people outside of previously demarcated risk groups. The Mayor’s Task Force on
AIDS was organized in 1986 in response to pressure from both the LGBT community for
better treatment services and from the rest of the public for better prevention and
containment of the disease. Prioritizing treatment and prevention during an epidemic is
always a struggle for any public health agency. However, local governments with access
to fewer resources have an especially difficult decision. With a supposed “life-style”
disease like AIDS, this decision has greater connotations. When contextualizing the
history of AIDS, scholars have had to grapple with the connotation of a life-style disease.
6
The complex history of the epidemiological life-style model of AIDS is important
in understanding the greater social implications of AIDS. Although the epidemiological
“life-style” theory first advanced in 1981, the theory that some aspect of being a sexually
active gay man (such as a high volume of partners leading to high levels of STDs which
may compromise the immune system or the use of “poppers” or amyl nitrates) was
replaced by a biomedical explanation with the discovery of HIV in 1984, its tenacity in
not just the minds of the public but also the medical community should not be
overlooked.
Medical historian Gerald Oppenheimer examines the role of epidemiology in the
early years of the AIDS epidemic in “Causes, Cases and Cohorts: The Role of
Epidemiology in the Historical Construction of AIDS.” Noting that original gay life-style
model proposed in the June 1981 Morbidity and Mortality Weekly Report (MMWR),
based on only five cases, was rooted in the recent completion of a multi-year study of the
high levels of Hepatitis B infections in the gay population which sparked an
epidemiological curiosity about the gay male, Oppenheimer argues:
One might fairly infer that the CDC was prematurely ready to find the etiology of this
mysterious disease in an exotic subculture. This inference is strengthened by the ensuing
scientific work of epidemiologists within and outside the CDC, who found in gay
culture—particularly in its perceived ‘extreme’ and ‘non-normative’ aspects (that is
promiscuity and recreational drugs)—the crucial clue to the cause of this new syndrome. 1
Oppenheimer offers several reasons for the omission of heterosexual intravenous drug
users in the creation of a life-style model for AIDS, including the decision of the National
Gerald Oppenheimer, “Causes, Cases and Cohorts: the Role of Epidemiology in the Historical
Construction of AIDS,” in AIDS: The Making of A Chronic Disease, edited by Elizabeth Fee and Daniel
Fox, (Berkeley: University of California, 1992) 53-54.
1
7
Institute of Drug Abuse study drug use in isolation, ignoring other diseases that affected
the IV drug user population and the reluctance of researchers to work with IV drug users.
“Partly justified by the disinclination of addicts to cooperate in interviews and follow-up,
their unwillingness may also in part, be explained by a feeling among many clinicians
and researchers (in this respect reflecting the attitudes of the public at large) that addicts
are of less social consequence than other patients.”2 Epidemiological curiosity about the
gay community is rooted in the scientific acceptance or legitimation of homosexuality, in
the same way that the dismissal of IV drug user populations in early studies is rooted in
the rejection of IV drug use as a life-style.
In 2004, medical geographer Michelle Cochrane published When AIDS Began:
San Francisco and the Making of an AIDS Epidemic, which examines the medical history
surrounding the first AIDS cases in San Francisco. Based on her work with the San
Francisco’s AIDS Office Seroepidemiology and Surveillance Branch (ASSB) in the mid
1990s, Cochrane looks at the first twenty-four cases of people diagnosed with AIDS in
San Francisco in 1981 and closely examines how expectations and assumptions about the
disease and AIDS patients shaped how the medical community represented AIDS.
Cochrane argues:
“surveillance practices and policies jointly produced and continue to produce
representations of the AIDS epidemic that overtly simplify the demographic of risk for
acquiring the disease.... the construction of the central tenets of clinical, epidemiological,
and surveillance knowledge that established the unambiguous infectious nature and risk
for sexual transmission of AIDS began immediately and in earnest in the first months of
the official discovery of the epidemic.” 3
Oppenheimer, “Cases, Causes, Cohorts,” 59.
2
3
Michelle Cochrane, When AIDS Began: San Francisco and the Making of an Epidemic (New
York: Routledge, 2004), xxvii.
8
Cochrane posits that the assumption in the early 1980s—that AIDS patients were young,
gay, previously healthy and affluent men—influenced surveillance methods to reflect that
representation. These reporting practices included eliding over intravenous drug use in
gay AIDS patients and assigning AIDS patients without a residence as residing in gay
neighborhoods for census information. Cochrane argues that “throughout the course of
the epidemic, the general tendency inherent in surveillance activities and epidemiological
research was to magnify the role of gay male or (hetero)sexual intercourse in driving the
HIV/AIDS epidemic and minimize the contribution of chronic urban poverty, poor public
health care and services, and injection drug use and substance abuse in producing and
sustaining this epidemic.”4
In 1987 journalist Randy Shilts published his popular work, And the Band Played
on: Politics, People, and the AIDS Epidemic. Although it would be misleading to say that
Shilts created the idea of AIDS as a life-style disease, he did produce the first coherent
AIDS narrative that popularized and legitimized this frame. Shilts was an openly gay
journalist for the San Francisco Chronicle who covered AIDS during the 1980s. Shilts
makes a very clear correlation between a gay life-style and AIDS. He strongly equates
the promiscuity of gay men and bathhouse culture with the prevalence of sexually
transmitted diseases in general and AIDS in specific. “This commercialization of gay sex
was all part of the scene, an aspect of the homosexual life-style in which the epidemics of
4
Cochrane, When AIDS Began, 191.
9
venereal disease, hepatitis, and enteric disorders thrive.”5 A large portion of the book
focuses on bathhouses and the gay community’s resistance to their closure, which Shilts
characterizes as not only misguided but life-threatening. Unfortunately, Shilts argues,
gay men were unable to separate their sexual freedom from their sexual identity, saying:
“Promiscuity…was central to the raucous gay movement of the seventies.”6 Gaeton
Dugas or Patient Zero, one of the first North Americans diagnosed with AIDS and a
single-person disease vector, is the epitome of this life-style. Dugas’ literal hundreds of
sexual partners combined with his globe-trotting career as a flight attendant damn him in
Shilts’s eyes as the Typhoid Mary of AIDS.
The response of the city of Sacramento to AIDS was rooted in the multiple
understandings of what AIDS was. Although much of the earlier media representation in
Sacramento and nationwide was that of an AIDS hysteria, and beneath that a greater
“AIDS truth,” a truth rooted in scientific understanding, AIDS scholars and activists
argue that this dichotomy is inherently false, and that any discussion of AIDS carries with
it invested meanings, or what Paula Triechler calls an “epidemic of signification.”
Although “life-style disease” began as an epidemiological model, the connotations, or
metaphoric meanings, of a life-style disease run throughout various AIDS discourses.
Life-style disease can mean a disease that affects certain people of a certain life-style, but
also mean that these life-styles themselves, being gay or an IV drug user, are diseased.
No one calls lung cancer or Type II diabetes a life-style disease. This paradigm was
5
Shilts, And the Band Played On, 19.
6
Shilts, And the Band Played On, 19.
10
directly reflected in how the Sacramento government approached AIDS; although the
first major city and county document, the report of the 1986 Mayor’s AIDS Task Force,
was instigated through the agitations of the LGBT community in Sacramento, seeking
local government help specifically in the treatment of AIDS and of people with AIDS,
the focus of the final document was on prevention, or how to keep Sacramento safe from
AIDS.
Literary theorist Susan Sontag wrote that “Illness is not a metaphor, and the most
truthful way of regarding illness…is one that is the most purified of, most resistant to,
metaphoric thinking.”7 Although Sontag was originally writing in response to her own
diagnosis of cancer, she later expands her argument against metaphoric thinking to AIDS
in a companion essay, “AIDS and Its Metaphors.” Sontag’s call for the rejection of
metaphoric thinking regarding illness in general, and cancer and AIDS in particular, has
been influential for scholars looking at the cultural construction of AIDS. Significantly,
emphasis has shifted from her original intent, “to calm the imagination, not to incite it.
Not to confer meaning…but to deprive something of meaning: to apply that quixotic,
highly polemical strategy, ‘against interpretation,’ to the real world this time.”8 Sontag
draws a distinction between AIDS the physical illness that exists in “the real world” and
AIDS metaphors, arguing that the scientific understanding is divorced of cultural
meaning.
7
Susan Sontag Illness as Metaphor and AIDS and Its Metaphors (New York: Picador, 1989) 3.
8
Sontag, Illness as Metaphor and AIDS, 102.
11
Other cultural critics and scholars beginning in the late 1980s, though recognizing
Sontag’s illustration of the metaphoric realm of AIDS, do not call for the elimination of
that realm, but instead seek to unpack or reveal the underlying cultural and linguistic
constructions of AIDS. During the late 1980s the majority of academic works about
AIDS were written by AIDS activists. Although they came from a variety of academic
disciplines these activists were mainly from the LGBT community and were writing in
the midst of the epidemic. These writers were interested in the cultural construction of
AIDS, specifically in outlining how these constructions were oppressive. Additionally,
these writers called into question the supremacy and purity of the scientific construction
of AIDS as a disease.
Jan Zita Grover based her article “AIDS Keywords” upon Raymond Williams’s
Keywords: A Vocabulary of Culture and Society. Grover analyzes eighteen words and
phrases that are often used when discussing the AIDS epidemic in order to “identify and
contest some of the assumptions underlying our current knowledge.”9 Contesting the
words of AIDS, such as “AIDS victim” or ”risk group” is the way to contest our
fundamental understanding of AIDS, and is, Grover argues, “[E]ssential to our
understanding of and response to AIDS as the cultural construction that it is. AIDS is not
simply a physical malady; it is also an artifact of social and sexual transgression, violated
taboo, fractured identity -- political and personal projections. Its keywords, like those
Jan Zita Grover, “AIDS: Keywords” in AIDS: Cultural Analysis, Cultural Activism, ed. David
Crimp (Cambridge: MIT, 1988) 17.
9
12
isolated by Williams, are primarily a property of the powerful."10 AIDS “victims” are
linguistically doomed and rendered insignificant, at the same time that by being classified
as members of a “risk group” isolates them from the general public and condemns them
for their “life-style” transgression.
Art historian Douglas Crimp, best known for his involvement in ACTUP (AIDS
Coalition to Unleash Power), in his article “How to Have Promiscuity in an Epidemic,”
challenged some of the dominant narratives about AIDS in the late 1980s. Crimp
contested the idea that AIDS is a “gay disease” or that it even affected the gay population
first, instead arguing that it was not until middle-class gay men with health coverage
began dying that doctors began to take notice. He cites the preponderance of deaths in the
seventies and early eighties caused by so-called “junkie pneumonia” which went entirely
unremarked upon as anything more than the natural effect of the compromised immune
system caused by a drug user’s life-style; “a class-based and racist health-care system
failed to notice, and an epidemiology equally skewed by class and racial bias failed to
begin to look until 1987.”11 Although AIDS is not a gay disease or a life-style disease,
Crimp argues that this pervasive notion had a lasting affect on the conception of AIDS in
America and placed gay activists in the center of the disease, saying, “The idea of AIDS
as a gay disease occasioned two interconnected conditions in the U.S.: that AIDS would
be an epidemic of stigmatization rooted in homophobia, and that the response to AIDS
10
11
Grover, “AIDS Keywords,” 16.
Douglas Crimp, “How to Have Promiscuity in an Epidemic,” in AIDS Cultural Analysis,
Cultural Activism ed. by Douglas Crimp (Cambridge: MIT Press 1988). 249. Emphasis in original.
13
would depend… on the gay movement.”12 Crimp embraces promiscuity, arguing that
safer-sex does not mean a rejection of an active sex life, and that the only effective safersex campaigns are ones that acknowledge this fact. He critiques the governmentsponsored AIDS education, which, as he points out, is not addressed to a gay audience,
privileges condoms, and advises monogamy and abstinence. In the introduction of the
collection AIDS: Cultural Analysis/ Cultural Activism, which includes “How to Have
Promiscuity in an Epidemic,” Crimp rejects science’s role as impartial guardian of the
“truth” about AIDS, arguing that there is no impartial truth about AIDS:
AIDS does not exist apart from the practices that conceptualize it, represent it, and
respond to it. We know AIDS only in and through those practices… [this book contests]
the notion that there is an underlying reality of AIDS upon which are constructed the
representations or the culture or the politics of AIDS. 13
Throughout “How to Have Promiscuity in an Epidemic,” Crimp advocates for what he
calls “cultural producers,” specifically the gay community, to take an active and direct
role in the management of AIDS. Crimp is not arguing for a new conception of AIDS, but
for working within the existing framework, if AIDS is to be thought of as a gay disease, it
is up to the gay community to step up and manage it.
Sociologist Cindy Patton, in her book Inventing AIDS (1990), seeks to understand
the cultural shifts brought on by the AIDS crisis. One part critique, one part how-to
manual, Inventing AIDS covers a wide spectrum of cultural arenas. As an activist, Patton
12
Crimp, “How to Have Promiscuity,” 250.
Douglas Crimp “AIDS Cultural Analysis, Cultural Activism,” in AIDS: Cultural Analysis,
Cultural Activism, ed. by Douglas Crimp (Cambridge: MIT Press, 1988) 3 .
13
14
challenges the scientific hegemony in what she terms “AIDS knowledges.” Patton
critically outlines the privileged role of science in AIDS discussion, saying:
…science serves as the master discourse that administers all other discourses about
AIDS….the common assumption underlying debates on public policy or the voicing of
personal views about safer sex is that science can, ultimately, answer any troubling
questions. Knowledge is perceived to arise from science and filter out into the social and
imaginary world.”14
By privileging the scientific community, Patton argues that the experiences and
knowledge of AIDS patients is deemed unprofessional and ignored; “The AIDS narrative
exists as a technology of social repression; it is a representation that attempts to silence
not only the claims of identity politics, but the people marginalized by AIDS.”15 Patton
examines the shift in focus from a home-grown activism within gay communities to a
professionalized and democratized, mainstream activism, with the death of Rock Hudson
being the approximate turning point. When Hudson revealed he was both gay and
infected, it symbolized the greater population’s awareness, paradoxically, of AIDS as a
threat outside of the gay community. After the revelation, AIDS service organizations felt
a pressure to mainstream and professionalize, and they did so at the expense of the
grassroots activism that had fueled them for the first four years of the epidemic. It was
because of the revelation of Rock Hudson’s diagnosis, Patton argues, that “AIDS marked
bodies, already marked out by medical and popular discourse. The pretty-faced
homosexual, the richly scarified African, the needle-tracked drug-userbodies naturally
14
Cindy Patton, Inventing AIDS (New York: Routledge, 1990), 31.
15
Patton, Inventing AIDS, 131.
15
marked different were now branded unnatural through the somatic revelations of AIDS
symptomatology.”16
Paula Treichler analyzes the cultural and linguistic dimensions of AIDS in How to
Have Theory in an Epidemic (1999). Treichler argues that the social and biomedical
discourses of AIDS should not be considered a dichotomy but a continuum that manifests
itself in language. In looking at the construction of AIDS as a gay life-style disease,
Treichler argues that this framework rests on a scientifically fabricated idea of gay men,
“AIDS is a story, or multiple stories… read to a surprising extent from a text that does
not exist: the body of a male homosexual. People so want –need– to read this text that
they have gone so far as to write it themselves.”17 In her examination of AIDS as
analyzed by scientists in the early 1980s, Treichler lists a series of conceptions of the gay
male body and AIDS created by researchers:
AIDS is caused by multiple and violent gay sexual encounters: exposure to countless
infections and pathogenic agents overwhelms the immune system.
AIDS is caused by killer sperm, shooting from one man’s penis to the anus of another.
Gay men are as sexually driven as alcoholics or drug addicts.
AIDS cannot infect females because the virus cannot penetrate the tough mucous
membranes of the vagina.
Women cannot transmit AIDS because their bodies do not have the strong projective
capacity of a penis or a syringe.
Prostitutes can transmit the virus because their contaminated bodies harbor massive
quantities of killer microbes.18
Treichler argues that the assumptions formed by scientists caused researchers to record
AIDS cases that fell outside the demarcated risk groups, especially AIDS cases among
16
Patton, Inventing AIDS, 127.
17
Paula Treichler, How to Have Theory in An Epidemic: Cultural Chronicles of AIDS (Durham:
Duke University Press, 1999), 19.
18
Treichler, How to Have Theory, 37.
16
women, as “unclassified” or “other.” Unlike homosexual men who were infected with
AIDS through their identified life-style, women with AIDS “were given that status only
by virtue of their sexual or familial attachments-their men and children- and even the
country to which they were connected, rather than by virtue of their own activities and
identities.”19
The Sacramento local government response to AIDS existed within a greater
framework of governmental responses to AIDS.
The federal government and state
government failed to provide significant funding in the early years of the epidemic. The
burden of dealing with the day-to-day aspects of the disease was placed squarely in the
hands of local government and local non-profit AIDS services organizations, such as the
Sacramento AIDS Foundation. However, that does not mean that AIDS policies were not
being rapidly created and set on a national and international level, trying to stop the
spread of this disease using either traditional epidemiological measures or medical
research. Scholars have recently turned their attention to contextualizing the history of
AIDS policies, both on a national and on a comparative, international level.
In AIDS and the Policy Struggle in the United States, political scientist Patricia
Siplon examines AIDS through the lens of the government policy enacted in response to
HIV/AIDS. Siplon argues that the AIDS policy process is not a unique phenomenon, but
is affected by the roles of three elements: organization, values and changes to funding
distribution. AIDS in particular is so contentious not because it is unprecedented but
19
Treichler, How to Have Theory, 63.
17
because the decisions made had life or death consequences, and resulted in policies that
involved both rapid change and affected life-styles.
Struggle is central to this
examination of AIDS policy; Siplon argues that “all of these decisions are the results of
struggles among groups and individuals, so I also closely examined some of the struggles
to see how they resulted in the policy options that ultimately were chosen.”20
Siplon looks at five aspects of AIDS policy: AIDS drug testing, government
regulation of blood products, prevention education, domestic HIV/AIDS funding, and
U.S. foreign policy in response to international AIDS. Each of these policy struggles is
representative of a different underlying policy discussion. According to Siplon, the
contention over AIDS drug testing in the United States is the struggle over whether
healthcare is a right or a commodity, and the debate over whether HIV/AIDS education
should focus on harm reduction or abstinence is a result of competing value systems.
Although this approach ignores how policy debates can intersect one another—the
organization of the hemophilia community against the blood industry for their failure to
promptly institute costly heat-sealing procedures on blood product (a failure that infected
hemophiliacs and other blood transfusion patients with HIV in the 1980s) is a debate
about the nature of healthcare as a right or commodity as well as one about the role of
federal regulation in the blood industry—it does demonstrate dimensions of public health
policy.
20
Patricia Siplon, AIDS and the Policy Struggle in the United States (Washington DC:
Georgetown University Press, 2002), 6.
18
Peter Baldwin, in Disease and Democracy, compared the public health responses
of the United States and other European countries. Baldwin argues that each country’s
response is rooted in their individual 19th century public health history. The United
States, although popularly conceived of as a laissez-faire, liberal nation, responded to the
AIDS epidemic in a more socially restrictive ways than many of its European
counterparts, with mandatory testing, contact tracing (tracing the sexual contacts of
infected individuals), and restrictive immigration policies including HIV screening and
the quarantining of Haitian immigrants.
These restrictive approaches, which were
created and enforced on a local or regional level, were in line with the United States’
approach to the cholera epidemics of the mid 19th century. Additionally, the United
States far outstripped other countries in funding medical research, over funding public
health education measures, prioritizing finding a biomedical cure over changing
behaviors. Baldwin posits that “In a heterogeneous nation with multiple moral and
religious standards, even providing consistent information was fraught with the delicate
issue of what could be said to whom… seeking biomedically to cure or avoid a
stigmatized disease—one spread via behaviors and life-styles widely regarded as
immoral—was the socially and politically most liberal approach.”21
In Sacramento the LGBT community was the first to mobilize in response to
AIDS. LGBT historian Jeffrey Escoffier argues that in the same way that the Stonewall
riots served as a catalyst for lesbian feminist thought, AIDS was the catalyst for gay men
21
Peter Baldwin, Disease and Democracy: The Industrialized World Faces AIDS (Berkeley:
University of California Press, 2005), 259.
19
to enter the sex wars.22 The other major life-style identified as at risk of AIDS, IV drug
users or advocates (recovered addicts or treatment centers), did not agitate for
government action. Nor did communities disproportionately affected by both IV drug
use and AIDS and HIV in Sacramento (the Hispanic and African American
communities), embrace AIDS as a community cause the same way the LGBT community
did. Although by no means did gay men make up the entirety of the AIDS activists in
Sacramento during the 1980s, the identification of AIDS as a gay white man’s disease
had repercussions within and without AIDS activism.
In 1995 sociologist Steven Epstein published Impure Science: AIDS, Activism
and the Politics of Knowledge, which examines the interactions of scientists, healthcare
professionals, government agencies, activists, and people with AIDS over the credibility
of knowledge about AIDS. The realm of so-called “pure” science, or science free from
external pressure or scrutiny, underwent a “sustained lay invasion of the domain of
scientific fact-making” in the face of AIDS.23 Epstein argues that AIDS knowledge has
been created through a series of credibility struggles amongst a variety of classes of
AIDS experts. Impure Science examines how various actors have gone about establishing
credibility as authorities on AIDS. One half of Epstein’s argument is dedicated to
unpacking the scientific and political debate of HIV as the sole causative agent of AIDS
and the other to the debate amongst scientists and AIDS activists about finding treatments
22
Jeffrey Escoffier, American Homo: Community and Perversity (Berkeley: University of
California press, 1998), 118.
23
Steven Epstein, Impure Science: AIDS, Activism and the Politics of Knowledge (Berkeley:
University of California Press, 1995), 330.
20
for AIDS. Activists were able to participate in these debates through self-educating
themselves on the disease and being gateways of information and through making the
moral argument that the quest for “pure” science could interfere with the goal of serving
patients. Epstein focuses his examination of AIDS on the medical and scientific
discussion surrounding the disease, the social dynamics of AIDS are only explored to the
extent that they overlap the scientific discussion. Epstein acknowledges that the AIDS
activists that are able to acquire the most authority in the medical debate are white,
affluent, gay men and that “it was crucial that gay communities possessed a relatively
high degree of ‘cultural capital’ that they had cultivated a disposition of for appropriating
knowledge and culture.”24 However, he does not examine how and why other AIDS
activists were less successful.
In Activism Against AIDS: At the Intersections of Sexuality, Gender and Class
sociologist Brett Stockdill analyzes the AIDS movement, specifically focusing on how
race, gender, class and sexuality divide AIDS activists and how “various strains of
dominant, or hegemonic consciousness within oppressed communities and within
organizations operated as obstacles of AIDS prevention and intervention.”25 Stockdill
examines the ACTUP chapters in three major cities—Chicago, Los Angeles and New
York City—and how race, gender and class differences within ACTUP created
movement conflict. Stockdill argues that an individual activist’s experience and social
24
25
Epstein, Impure Science, 12.
Brett Stockdill, Activism Against AIDS: At the Intersections of Sexuality, Race, Gender and
Class (Boulder: Lynne Reinner, 2003) 23.
21
geography influenced their perception of AIDS. He specifically focuses on the work of
activists who viewed AIDS as operating in multiple systems of oppression: “Just as
interlocking inequalities have shaped the epidemiology of the disease they have affected
the collective battles waged against AIDS. At every step activism has been complicated
by multiple systems of oppression. Internal movement conflict, activist strategies, and
elite repression have been intertwined with heterosexual, gender, racial, and class
domination.”26 Stockdill argues that the larger AIDS activist organizations’ adherence to
a single front strategy for confronting AIDS forced other activists, those who did not fit
in the middle-class gay white male mold, to separate from major activism groups and
operate within smaller communities, which prevented them from tapping into larger
resource pools, thus reducing the funding they received.
Sacramento’s response to AIDS in the 1980s was shaped by the notion that AIDS
was a lifestyle (primarily gay and secondarily IV drug user) disease. The local media,
both gay and straight, reported on AIDS as a disease affecting the gay community. The
perspective differed significantly depending on whether the audience was perceived as
being inside a designated risk group to being outside it, fearful of a breach. The borders
of this risk group were not physical, but imagined. In the same way that gay men and
drug users could ‘pass’ for straight or clean, so too could the infected pass as healthy.
Although other cities such as San Francisco and Los Angeles were available as models
for how to confront AIDS, no federal or state model or funding reservoirs existed for
26
Stockdill, Activism Against AIDS, 147.
22
treatment or education. The city, in response to pressure from the gay community for
improved treatment services and the public for improved prevention measures, acted.
The result of this action, the Mayor’s AIDS Task Force, framed Sacramento’s
understanding of AIDS, and the resulting conflicts over implementing the Task Force’s
recommendations outline the epidemiological, political, and cultural dimensions of a lifestyle disease.
23
Chapter 3
AIDS IN PRINT
Community and Mainstream Press Coverage, 1981-1985
The first mention of the pandemic came to Sacramento quietly, in a short article
by Dr. Harvey Thompson in Mom… Guess What! in August, 1981. A monthly
gay/lesbian newspaper, Mom... Guess What! (MGW), was founded by Linda Birner in
1978.
Her goal was to create a paper that would pull together the gay/lesbian
community, while also increasing awareness of the gay/lesbian movement in the general
public. In the 1980s, Mom... Guess What! was a small newspaper with an informal tone
that covered a variety of topics, including community sports, local entertainment,
gardening, and politics. MGW was very closely tied to politics, with a regular feature
entitled “Under the Dome” that outlined various state legislation that affected the gay
community as well as a “Write!” section that set forth various causes and informed
readers of ways to make their opinions heard. MGW also was involved in local politics,
and endorsed local candidates in city and county elections, as well as at the state and
national level. MGW was a community-run newspaper; many of the contributors
volunteered their time at the paper in addition to the many other community causes and
organizations they participated in outside of MGW.
Dr. Harvey Thompson, Sacramento’s fist openly gay doctor, opened a practice at
921A 21st Street in Sacramento in 1978 that primarily addressed gay men’s health needs.
In 1981, he partnered with Dr. Sandy Pomerantz, a recent transplant from San Francisco.
Thompson and Pomerantz served as a bridge between the medical community and the
24
first recognized “risk group”: gay men. As a monthly columnist for Mom… Guess What!,
Thompson kept his audience informed on health issues that affected the gay community,
although he generally restricted himself to articles on gay men’s health issues. His
column, originally called “Our Bodies Our Minds” (later shortened to “Health”) was
eventually syndicated in several other gay publications across the nation. In the early
1980s his columns frequently addressed sexually transmitted diseases, such as amoebic
dysentery and hepatitis B, in an informal, nonjudgmental and humorous fashion, with
titles such as “Warts in Your Shorts?” which begins “QUESTION: Can you tell if a man
is Gay right from his physical examination. ANSWER: Sure, bend him over and see if
there are anal warts; they don’t come from toilet paper, ‘ya know!” 1 In August 1980,
Thompson attended a conference at UC San Francisco hosted by the San Francisco
Center for Disease Control, in which Dr. Selma Dritz, head of the University of
California at San Francisco’s clinic, announced that amoebic dysentery had increased
from 17 reported cases in 1969 to over 1000 during 1980, and that Hepatitis B cases had
quadrupled from 1977 to 1980.2
One year later, in August 1981, Thompson’s article “Gay Medical Symposium:
Two New Gay Illnesses,” was the first mention of the disease that would be known as
AIDS in Sacramento. The phrase “would be known as AIDS” is a cumbersome but
illustrative one. Although the terminology we use now to discuss AIDS has largely been
Harvey Thompson, “Our Bodies Our Minds: Warts in Your Shorts?,” Mom…Guess What!, May
1
1982, 4.
Harvey Thompson, “Our Bodies, Our Minds,” Mom…Guess What!, August 1980, 11.; Shilts,
And the Band Played On, 40.
2
25
standardized, this has not always been the case. Acquired Immune Deficiency Syndrome
or AIDS did not officially get that name until July 1982. Early reports used a variety of
names, both formal and informal, to reference a constellation of separate opportunistic
diseases people were experiencing. Tellingly, these early names, such as GRID (GayRelated Immune Deficiency) or ACIDS (Acquired Community Immune Deficiency
Syndrome), or the informal names “gay plague” or “gay cancer,” referenced the first
certified “risk group,” homosexual men. Although the alternative formal names for AIDS
fell out of use after the CDC re-christened it in 1982, “gay cancer” and “gay plague”
lived on longer in the media and the public consciousness. The term the “Four Hs” was
used as shorthand for the early identified populations affected by AIDS: Homosexuals,
Hemophiliacs, Heroin Users (or IV drug users in general) and Haitians. Other
terminology used in the 1980s that has fallen out of use include: ARC (AIDS Related
Complex), used to describe a middle step between asymptomatic sero-positivity; and
“full blown AIDS” (this has since been replaced with the World Health Organization’s
four-stage process). Additionally, PWA (Person With AIDS) or PLWA (Person Living
With AIDS) as non-judgmental terms to describe people with the disease (rather than
“sufferers”, “victims”, or “patients”) has fallen out of use. Lastly, the isolation of the
retrovirus behind AIDS caused a debate over nomenclature. HTLV-III (Human T-cell
Leukemia virus III) was the name given to the virus by American scientist Robert Gallo,
on the reasoning that it was related to his earlier work on retroviruses. The Pasteur
Institute in France identified the retrovirus as LAV (lymphadenopathy associated virus).
The controversy over which group discovered the virus first and allegations of
26
professional misconduct led to the adoption of the name Human Immunodeficiency Virus
by the International Committee on the Taxonomy of Viruses in May of 1986.3
Stripped of its usual humorous tone, Thompson’s August 1981 article in MGW
covered a conference sponsored by Bay Area Physicians for Human Rights entitled
“Medical Aspects of Sexual Orientation.”
The major topic of discussion was the
mysterious incidences of CMV and Kaposi’s sarcoma that had been diagnosed in San
Francisco, New York, Florida, and Los Angeles.4
It also briefly outlined Kaposi’s
sarcoma (KS) and pneumocysis carinii pneumonia (PCP), and described the symptoms.
The conference topic was in response to a report published in the Centers for
Disease Control Morbidity and Mortality Weekly Report on June 5, 1981. The report
“Pneumocystis pneumonia- Los Angeles,” outlined five cases of PCP in Los Angeles, and
made connections between PCP and other opportunistic diseases. The report made a link
between the incidence of a rare pneumonia and the patients, saying, “The fact that these
patients were all homosexuals suggests an association between some aspect of
homosexual life-style or disease acquired through sexual contact and Pneumocystis
pneumonia in this population.”5 This relationship would continue to define the disease in
the mind of the public even after medical thought had dismissed its relevance.
3
For further discussion of the discovery of HIV and the scientific debate surrounding both the
nomenclature and the validity of a single virus as the causative agent see Steven Epstein, Impure Science:
AIDS, Activism, and the Politics of Knowledge (Berkeley: University of California Press, 1996).
Harvey Thompson, “Gay Medical Symposium: Two New Gay Illnesses,” Mom…Guess What!,
August 1981, 19.
4
5
MMWR report quoted in Shilts, And the Band Played On, 67.
27
Over the next six months or so, both Thompson and his partner Pomerantz
contributed a few short medical articles on the new diseases. The serious tone of these
articles contrasted greatly with the lighthearted tone that characterized their regular
contributions and underlined the seriousness of the diseases they described. The brevity
of the articles also signified the lack of information available about these diseases and
why they were affecting previously healthy men. “Update on ‘Gay’ Cancer and
Pneumonia,” written by Pomerantz, outlined the current mortality rates of those identified
(30% for Kaposi’s sarcoma and 60% for pneumocystis pneumonia), but also stated that
no effective treatment had been found for these diseases.6 Although the articles generally
refrained from speculation, a thread of grave concern and even fear ran through them. In
an article describing Cytomegalovirus, in addition to describing both the symptoms and
the increasing numbers of gay men who developed the disease, Thompson and Pomerantz
also mentioned that “There is this worrisome link however to that ‘gay skin cancer’ and
also to the ‘gay pneumonia,’ a connection which remains to be elucidated.”7
By August 1982, coverage of the new disease had jumped to the first page of
MGW, with a headline that asked its audience if this were the “Return of the Pink
Triangle?”
The pink triangle is a reference to the pink triangular (point facing
downwards) badge Nazis used to identify gay men in concentration camps. This symbol
was taken up again in the late 1980s by AIDS activists in New York City in their
6
Sandy Pomerantz, “Update on ‘Gay’ Cancer and Pneumonia,” Mom…Guess What!, October
1981, 21.
7
Sandy Pomerantz,“CMV- Cylomegalo…What?,” Mom…Guess What!, May 1982, 4.
28
“Silence = Death” campaign. The article in MGW discussed the identification of AIDS in
several heterosexual hemophiliacs and blood as a possible carrier for the syndrome. In
particular, the author, Mark Vandervelden, was concerned about a policy officials at the
CDC were considering to quarantine gay blood. “The civil liberty consequences for gay
people should the quarantine option be choosen [sic] are sweeping.
How will the
government determine who is or isn’t a public health threat by donating blood? A
computer registry? A Volunteer system? How will public attitudes towards gays change
as a result of an official declaration that gay blood could contaminate banks?”
In
addition, the author voiced his concerns, and the concerns of gay activists, that the
socially conservative politicians in power might use this information against gays, saying
it could be a “…potent propaganda tool in the hands of a federal administration, which
has not made a name for itself as a strong force for civil rights generally. There are some
activists who fear that there may return a time where the pink triangle used to identify
gays in Nazi Germany may again find a place in society.” 8
Until late 1982, while new cases of the cluster of diseases affecting gay men had
been reported in San Francisco and Los Angeles, MGW discussed the diseases as a
worrying phenomenon that was happening at a distance. In July 1982, the Center of
Disease Control gave an official name to the disease: Acquired Immune Deficiency
Syndrome (AIDS). In late 1982, a member of Sacramento’s gay community died of an
8
Mark Vandervelden, “Return of the Pink Triangle” Mom…Guess What!, August 1982, 1.
29
illness with symptoms that mirrored those reported in San Francisco; the epidemic had hit
home.
In November of 1982, Dr. Harvey Thompson and Dr. Sandy Pomerantz hosted a
meeting with several members of the gay/lesbian community to decide what they should
do about AIDS.
People attending this meeting included psychiatrist Dr. Elizabeth
Harrison and MGW contributor and aide to State Senator David A. Roberti, Stanley
Hadden. From this meeting sprang the organization that came to be known as the
Sacramento AIDS/Kaposi’s Sarcoma Foundation, later shortened to the Sacramento
AIDS Foundation (SAF). The organization was based on San Francisco’s organization
(SFAF) and was, for the first few years, affiliated with it. Dr. Pomerantz summed up the
need for an organization, saying “Our community needed to help itself since we could not
expect the general community to help us at a time when they didn’t see the need that we
saw.”9
In April of 1983, SAF’s doors opened. SAF offered both educational information
about AIDS and a support service entitled Hand to Hand, in which volunteers provided
first emotional and then later practical support, such as house cleaning and transportation,
for people with AIDS. The board members of SAF made a concerted effort to have a
diverse representation (men and women, gay and straight, minority groups, doctors and
people with AIDS).
However, as a volunteer-driven and community-funded
organization, most of the staff had connections with the gay community, and many of the
Jan Corine Strook, “The Sacramento AIDS Foundation: A Case Study,” (Master’s Thesis,
California State University, Sacramento, 1992), 47-48.
9
30
early contributors were local gay bars, including the $4,000 from the Wreck Room that
helped SAF set up shop.10
Throughout the 1980s, the Sacramento AIDS Foundation had a strong connection
with the gay community in general and MGW in particular. In addition to running ads,
members of SAF contributed articles, including SAF director Kale Guzman’s numerous
“AIDS Update” articles that outlined the available medical information and services that
SAF provided. On the one-year anniversary of SAF, MGW published a line-by-line
expense and income statement, as well as a list of goals accomplished by SAF in the
interest of transparency. In its first year of operation, $33,922.84 of SAF’s income came
from the Sacramento County Public Health Department, and $30,963.82 came from
donations, pledges, and fundraisers.11
SAF was a vital source of information about AIDS in Sacramento County. SAF
operated an informational hotline, distributed educational pamphlets, provided lists of
doctors who treated AIDS patients, and held conferences in conjunction with the UC
Davis Medical Center. In the early years of the epidemic SAF was the only organization
providing these services, as Sacramento city had relinquished its public health
responsibilities to Sacramento County.
Over the next year AIDS began to dominate the news coverage of MGW. While
Thompson and Pomerantz’s column “Our Bodies, Our Minds” continued to be featured
monthly until Thompson’s death in 1986, it was both not exclusively dedicated to AIDS
10
Strook, “The Sacramento AIDS Foundation,” 51.
“AIDS Foundation Update,” Mom…Guess What!, June 1984, 4.
11
31
coverage nor was it the only source for AIDS information in MGW. In 1983, MGW
published 46 articles on various aspects of AIDS: from informational (articles on state
and federal funding of AIDS and discrimination of people with AIDS in employment and
civic participation) to social (a poem about AIDS, the role of lesbians in the AIDS crisis,
lifestyle implications with AIDS, fundraisers and vigils).
This number is more
impressive in light of the fact that MGW averaged 20 to 24 pages per issue. In 1984 and
1985, the overall number of articles dropped (27 and 30, respectively), with fewer articles
on general information about AIDS, more on specific treatments, and more political
articles addressing the legislative funding battle.
Around 1985, awareness of AIDS as a threat to the general public health grew.
Journalist Randy Shilts cites Rock Hudson’s announcement of his contraction of AIDS
on July 25th, and then his subsequent death in October, as a public wake-up call, saying:
For decades, Hudson had been among the handful of screen actors who personified
wholesome American masculinity; now, in one stroke, he was revealed as both gay and
suffering from the affliction of pariahs. Doctors involved in AIDS research called the
Hudson announcement the single most important event in the history of the epidemic, and
few knowledgeable people argued.12
Paula Triechler argues that Rock Hudson’s announcement had a direct effect on the
“evolution of consciousness about AIDS” and that major media outlet coverage of AIDS
increased from 18 to 111 stories per month and newspaper coverage increased 270
percent.13 Suddenly there was a sense of urgency and panic, as well as a strong desire for
information on how AIDS was transmitted.
12
Shilts, And the Band Played On, 578-579.
13
Paula Triechler, How to Have Theory, 74.
32
MGW approached AIDS from an activist perspective. By embracing AIDS as a
community threat, MGW framed the disease as an extension of the larger gay rights
cause. In an article on lesbians and AIDS, columnist Jill Kelly wrote, “AIDS is not just a
devastating disease that kills gay men— it’s a plague on the houses of all gay people,
including lesbians… we are susceptible to catching the virus of moral superiority as we
place ourselves apart from our gay brothers. And it is our plague again as all gay people
including lesbians suffer the backlash of fear and hatred of a homophobic society.” 14
Articles in the political column “Under the Dome” informing readers of AIDS
legislation occupied the same page as information on the progress of AB1 (antidiscrimination in employment legislation) and on how to write to their elected officials.
Additionally, during the 1983 Sacramento mayoral election season, candidates seeking
support were asked how they would meet concerns relevant to the gay community, which
included an anti-discrimination ordinance, employment rights, and support for AIDS
funding. Both MGW and the River City Democratic Club, a Sacramento gay and lesbian
business organization, endorsed Anne Rudin.
In a sharp contrast, the mainstream news media’s coverage was of a reactive
tenor.
In 1982, out of the less than fifty articles in major newspapers (as collected by
The Kaiser Family Foundation) on AIDS, half covered the June 1981 CDC report linking
gay lifestyle to AIDS, while only three percent covered the experiences of people living
14
1983, 3.
Jill Kelly. “The Plague on Our House: Women and AIDS,” Mom…Guess What, November
33
with AIDS.15 Timothy Cook and David Colby, in “The Mass-Mediated Epidemic: The
Politics of AIDS on the Nightly Network News,” argue that the nightly news coverage,
which began in 1982, contextualized AIDS as a human-interest story affecting gay men,
defining the outbreak as “‘mysterious’ and ‘fascinating.’” saying only once it was
perceived to have spread beyond the gay risk group that it turned “deadly.”16 Once it was
seen as a threat, starting in 1985, Cook and Colby argue that the networks “defined the
problem [of AIDS] not as the lack of a cure for those already afflicted, but as the lack of a
vaccine that would control the spread to the ‘general population.’”17
This trend was mirrored in Sacramento’s mainstream press. While MGW
presented coverage that assumed the reader to have a personal stake in AIDS news, The
Sacramento Bee addressed AIDS during the years 1983-1985 as an outsider’s disease,
one that affected marginal members of the populace. In 1984, only 14 articles addressed
AIDS, including three front-page articles: two on AIDS and research, (“AIDS Toll Rises
- Vaccine Hopes Sink” and “UC Davis Develops Blood Test to Spot AIDS Signs in
Humans”) and the third on the spread of AIDS beyond the gay community, entitled
“AIDS Seen as Threat to Heterosexuals.”18
Mollyann Brodie, Elizabeth Hamel, Lee Ann Brady, Jennifer Kates and Drew Altman, “AIDS at
21: Media Coverage of the HIV Epidemic 1981-2002,” (Menlo Park: Henry J. Kaiser Family Foundation,
2003) 3-4.
15
Timothy Cook and David Colby. “The Mass-Mediated Epidemic: The Politics of AIDS of the
Nightly Network News” in AIDS: The Making of a Chronic Disease, edited by Elizabeth Fee and Daniel
Fox; 84-122 (Berkeley: University of California Press, 1992) 95.
16
17
Cook and Colby, “The Mass-Mediated Epidemic,” 112.
18
Deborah Blum, “AIDS Toll Rises - Vaccine Hopes Sink,” The Sacramento Bee, 24 October
1984, sect. A, p. 1; Deborah Blum, “UC Davis Develops Blood Test to Spot AIDS Signs in Humans,” The
34
In the last article, “AIDS Seen as Threat to Heterosexuals,” the author Deborah
Blum outlined new data which indicated that AIDS was infecting people who did not fit
into the four “Hs” (homosexuals, hemophiliacs, IV drug users and Haitians), and now
was affecting heterosexuals of the general population. And yet, of those four accepted
risk groups, “Haitians” as a category did not clearly align to a “high risk” method of
transmission the way that homosexuals (anal sex, it was assumed, being an activity
restricted to homosexual men), and hemophiliacs and IV drug users (through the transfer
of blood) do.
Marking Haitians as a whole as a risk group not only elided over the reality of
heterosexual transmission of AIDS but also implied that they as a people were diseased.
Instead of discussing prevention methods for the threat to the public, the article focused
on potential explanations for how the disease had spread from the previously defined
groups to the mainstream; the culprits identified were bisexuals and foreign prostitutes.
Although Blum acknowledged at one point that the sexual partners of IV drug users were
the greatest group of female AIDS patients in the United States, she also mentioned
foreign prostitutes as a disease vector four separate times. There is a strong implication
that heterosexual transmission of AIDS was a foreign problem. Blum wrote that although
homosexual activity alone was originally thought to be risky, “People who are bisexual
may act as carriers of the disease between the homosexual and heterosexual populations,
scientists say. Prostitutes also may encounter someone with AIDS and pass it along to
Sacramento Bee, 4 December 1984, sect. A, p.1; Deborah Blum, “AIDS Seen as Threat to Heterosexuals,”
The Sacramento Bee, 14 December 1984, sect. A, p. 01.
35
other clients. An investigator from the National Institute of Health reported recently that
prostitutes on three continents have tested positive for the virus.”19 Finally the article
emphasized the rise in children who were acquiring the disease, and fearfully posited that
other unknown “indirect” methods of transmission may be possible.
Many Sacramento Bee articles written during this period used war imagery when
discussing AIDS, such as “AIDS Stalks Hemophiliacs’ Sons” and “AIDS: One Battle
Won,” 20 again emphasizing the notion that the healthy body of the United States was
being invaded by outside forces, be they so-called marginal groups of society like IV
drug users or gay and bisexual men, or foreign forces of contagion. Susan Sontag writes
“AIDS has a dual metaphoric genealogy. As a micro-process, it is described as cancer is:
an invasion.
When the focus is transmission of the disease, an older metaphor,
reminiscent of syphilis, is invoked: pollution.”21
MGW coverage stressed what was known and what could be done. For example,
an article from July of 1985 in MGW arranged specific sexual activities into categories of
risk, with dry kissing, mutual masturbation, hugging and light S&M (with no bruising or
bleeding) as safe; French kissing, anal sex with a condom and water sports as potentially
safe; and needle sharing, semen in mouth, anal intercourse without condoms, rimming
19
Blum, “AIDS Seen As Threat,” sect. A, p.1.
Judy Tachibana, “AIDS Stalks Hemophiliac Sons; 1 Dies,” The Sacramento Bee, 17 January
1985, sect. A, p. 01; “AIDS: One Battle Won,” The Sacramento Bee, 5 August 1985, sect. B, p. 10.
20
21
105.
Susan Sontag, Illness as Metaphor and AIDS and Its Metaphors (New York: Picador, 1990),
36
and fisting all categorized as unsafe.
22
In contrast, during the same month The
Sacramento Bee published four articles about AIDS. One was about religious response to
AIDS, two were about the state budget funding, and only one about the disease
specifically, entitled “Experts Say AIDS Raging Unchecked,” which warned readers
against “high-risk behavior, specifically anal intercourse.” Unlike the MGW article, the
Sacramento Bee article focused on what was unknown. “Despite the relentless rampage
of the disease, no definitive diagnostic test, cure, vaccine, or treatment for AIDS has yet
been developed.
The culprit virus has not been identified.”
23
The same article
confusingly mentioned that the blood test for AIDS had been successfully applied to
blood banks.
The conflicting and vague mainstream coverage of AIDS in many ways added to
the general atmosphere of panic.
Readers of The Sacramento Bee in 1985 were
inundated with articles that were heavy with speculation and fear but light on specific
information. A week after the article about AIDS “raging unchecked,” The Sacramento
Bee published “AIDS: One Battle Won” announcing the blood banks to be safe from
infection. A week later, “Deputies get Warning on AIDS Danger” was published, in
which the Sacramento Sheriff’s Department told staff that, “the decision to start CPR on
a high-risk victim, such as a male homosexual or IV drug user, should be carefully
22
“Health,” Mom…Guess What!, July 1985, 10.
Ellen Robinson-Haynes, “Experts Say AIDS Raging Unchecked,” The Sacramento Bee, 21 July
1985, sect. A, p. 22.
23
37
weighed as to the potential consequences and an individual decision made in ease case.”24
In discussing AIDS in schools, the Bee article noted that: “several school systems around
the nation are barring young victims of AIDS from their classrooms, but the California
Department of Education will recommend that students afflicted with the deadly virus be
permitted to attend regular classes.”25
The longest article The Sacramento Bee published in 1985, “On the Trail of A Silent
Killer,” highlighted the themes of fear and uncertainty surrounding the disease:
…they still do not know where [AIDS] came from. Or how it destroys the body’s
diseases against those waiting infections. Or how—absolutely—it moves from person to
person. Or what will stop it. …The single certainty about AIDS in the public mind is
uncertainty. And with reason. No one, not even the most devoted tracker of epidemics,
is sure of the shape of this one.26
While acknowledging that no one has yet caught AIDS from tears or kisses, it also
warned that AIDS was very mutative and that not even doctors would “guarantee any one
that he will never catch AIDS from a shared glass of water, a rough-and-tumble fight
with a virus-infected child, or dirty equipment in a dental office.”27 It is hard to tell if this
was a sincere attempt at scientific skepticism or fear mongering, playing into people’s
fear to sell papers. By 1985, if nothing else, The Sacramento Bee’s coverage of the AIDS
epidemic demonstrated that the general public was very interested in and worried about
the disease, and eager for something to be done in response to the epidemic.
24
Faizah Alim, “Deputies Get Warning on AIDS Dangers,” The Sacramento Bee, 14 August 1985,
sect. B, p.1.
25
Elizabeth Fernandez, “The Sacramento Bee, 8 September 1985,sect. B, p.1.
Deborah Blum, Hilary Abramson and Herb Michelson, “On the Trail of a Silent Killer,” The
Sacramento Bee, 27 October 1985, sect. A, p.1.
26
27
Blum, Abramson and Michelson, “On the Trail of a Silent Killer,” sect. A, p.1.
38
In part, the reluctance for a mainstream paper to delve into specifics regarding
transmission stemmed from a concern about the propriety of discussing specific sex
activities not shared by the independent press.
Yet the omission of condoms as a
preventative measure is notable. Condoms are mentioned in reference to AIDS only
twice in 1985, both times as precautions for gay men, and neither reference mentioned
condoms’ efficacy against the virus.
Perhaps the preoccupation with potential
transmission through casual contact or saliva allowed people to elide over the specifics
regarding the known methods of transmission, blood. As long as the possibility of
contracting AIDS through sex was limited to the innuendo heavy “high-risk” “gay
lifestyle,” then a discussion of AIDS and sexual practices could be ignored.
Likewise, there was little effort expended at the level of state government. In
1985, state government activity was limited. The passage of SB 910 created the State
AIDS Advisory Committee in August of 1984. The committee listened to testimony on
AIDS issues and assisted the Office of AIDS, a part of the California Department of
Health Services in awarding educational contracts for the disease. The 1987 review of
these contracts awarded to 65 local Education and Prevention Programs across the state
indicated that the state still had work to do: “The lack of state leadership, coordination,
and overall planning impedes progress and diminishes program effectiveness…There is
still a lack of awareness, understanding, and sensitivity to the diverse cultures and
peoples in California.”28
28
Office of AIDS, Second Year Evaluation of California’s AIDS Community Education Program,
by Paul Harder (Sacramento: California Office of AIDS, 1988) 92.
39
When the local residents of Sacramento began responding to the crisis, they
turned to the state government for aid. Unfortunately, AIDS legislation was quickly
turned into a battleground between the liberal members of legislature and the
conservative Governor George Deukmejian. The Senate Pro Tem, Senator Roberti (DHollywood) emerged early as a proponent for increased funding for AIDS research and
treatment and was the author or co-author of many bills affecting state policies regarding
AIDS.
These included bills to set up a state task force, provide easier access to
healthcare for people with AIDS, and to protect confidentiality of people participating in
studies.29 Deukmejian cut funding for AIDS from $3.9 million to $2.9 million in the 1984
state budget, and from $21.5 million to $4.9 million in 1985 (a compromise between the
legislature and the governor brought the final amount up to $9.9 million).30 In 1985, the
senate published a pamphlet to raise awareness about the need for education and outlined
what the legislature was doing to address AIDS.
The lack of motivation or enthusiasm in the state legislature for AIDS funding, for
either research or treatment, in the early 1980s was directly connected to a general lack of
awareness, and the public association of AIDS as a disease restricted to the gay
community. Legislation that would seemingly affect only a small portion of the public
did not have broad appeal.
LGBT activists had run into this attitude before.
Assemblyman Art Agnos presented AB1, a bill to make illegal discrimination in
29
California Legislature Senate, AIDS: Senate Responds to a Public Health Crisis, by Kathryn
Duke (Sacramento, California State Senate, 1985), 9.
30
Shilts, And the Band Played On, 454-455, “AIDS: Senate Responds,” 11-12.
40
employment on basis of sexual orientation, four times in seven years, and was finally able
to garner enough support to push the bill through the House, and later the Senate only to
have Governor Deukmejian veto it, arguing that there was “absence of compelling
evidence” that people were experiencing discrimination in employment. 31 At the same
time, socially conservative members of the legislature downplayed the importance of the
gay and lesbian community in politics.
Senator H.L. Richardson wrote that it is
“unreasonable to assume that California’s overall population of homosexuals is sizable.
They are a tiny, pathetic part of any population and will always remain so. Their political
influence, however, has exceeded their numbers.”
32
The Sacramento Bee ran a letter to
the editor in which the author challenged the gay community to “put their money where
their mouth is… if they are so unwilling to change what causes AIDS, then why should
we pay, and continue to pay, for their stupidity? I think [AIDS funding] should be spent
to make the life easier for the poor, innocent victims who are dying because of AIDSinfected blood.”33 As long as AIDS remained a “gay man’s” issue, the state government
ignored it.
Given the general atmosphere of fear and uncertainty surrounding AIDS in 1985,
it was clear that some government action needed to be taken, and the legislative budget
conflict indicated that the state would have a minimal role in providing aid or direction.
31
Jill Kelly, “AB 1: We Won’t Disappear,” Mom…Guess What!, April 1984, 3.
32
Sen. H.L. Richardson, “The Tail that Wagged the Bear,” reprinted in Mom…Guess What!, June
1984,13.
33
Patricia A. Macy, “Letters from the People: Money for AIDS,” the Sacramento Bee, 29 July
1986, Sect. B, p. 11.
41
Although nonprofit agencies like the Sacramento AIDS Foundation were attempting to
serve the city’s needs, they were volunteer-run and unable to provide the breadth of
services that the city of Sacramento needed. The city government would have to step up
and provide direction for how to deal with the growing epidemic. Those consulted in the
decision-making process would have a profound impact on the direction the city’s
response would take.
42
Chapter 4
SACRAMENTO RESPONDS
The Mayor’s Task Force on AIDS
On November 26, 1985 Mayor Anne Rudin began the procedure to set up a
city/county Task Force to address AIDS. The Task Force would meet for six months in
1986 and publish their findings and recommendations to the city and county. The
Mayor’s Task Force on AIDS was significant to the history of AIDS in Sacramento in the
1980s for several reasons. As the first city-instigated response to AIDS, the Task Force
and its recommendations shaped the city’s response to AIDS. It was to answer two
questions for the people of Sacramento, the first informational: “what is AIDS?”; the
second prescriptive: “what do we do about it?” The Task Force was made up of the
people who were deemed important to understanding and addressing the AIDS epidemic.
Who was included in this process (doctors, many of whom were public health officials
and AIDS activists) and who was not (community organizations, law enforcement) later
became crucial in understanding both the policies that came out of the Task Force and
their reception.
Mayor Anne Rudin’s history as a civil servant and a community organizer
influenced her response to the AIDS public health crisis. Anne Rudin was a member of
the Sacramento chapter of the League of Women Voters, and served as the chapter
president from 1963 to 1965 and as president of the League of Women Voters of
43
California from 1969-1971.1 Elected to the City Council in 1971, Rudin was the first
woman on the Council since 1951. In 1983 she was the first woman to be elected mayor
of Sacramento. During her tenure as mayor Rudin fought for the expansion of the
regional light rail, campaign finance reform, environmental causes, and an anti-smoking
ordinance. She was also involved in politics beyond the local level and was a fervent
supporter of Geraldine Ferraro for vice president on the Mondale/Ferraro Democratic
ticket in 1984, and was the only Mondale delegate from Sacramento at the Democratic
National Convention in San Francisco.2 As mayor she was criticized for her preference
for delegation and for her distaste for the informal closed-door meetings that made up
backdoor politicking. Critics of her governing style accused her of wanting to rule by
committee. In a Sacramento Bee article Rudin responded to her critics saying that they
“did not understand that the feminist school of politics teaches consensus, cooperation
and equality.”3 The task force format, in which representative members from multiple
government bodies and other stakeholders come together and openly discuss important
issues and suggest city policies to address them, was especially well suited for Rudin’s
theory of government.
The city response to AIDS was initiated in response to a concerted effort by AIDS
activists from the gay community. In the wake of the summer legislative budget battle, it
Patrick Hoge, “Service Award Goes to Rudin,” Sacramento Bee, 9 May 1989, sect. B, p. 3.
1
2
Amy Chance, “News Makes Rudin’s Day,” Sacramento Bee, 13 July 1984 sect. B, p.1.
Amy Chance, “Rudin Leaves Some Asking: Who’s the Boss?” Sacramento Bee, 24 November
1984, sect. METRO A, p.1.
3
44
was clear that funding for AIDS programs would have to come from local governments,
and it was here that activists focused their efforts. On November 18, Anne Rudin
received a letter from Stanley Hadden suggesting that the city create an AIDS city/county
Task Force to coordinate activity in prevention and education (including general
education about the disease and prevention education), diagnosis and care services and an
evaluation of current programs. In addition to his work with Mom… Guess What!, the
Sacramento AIDS Foundation, and his job as aide to Senator Roberti, Stan Hadden also
served on the California AIDS Advisory Committee and the California AIDS Strategic
Planning Commission. Hadden informed Rudin that the plan being developed on the state
level would “require local planning related to AIDS education and service delivery” and
that “establishing [a Task Force] at this time would be helpful in appraising community
needs and resources…[and] in seeking state and federal funding in the coming year.”4
Hadden’s experience as a minority representative, an AIDS activist, and as a policy
maker made his proposal especially persuasive. Hadden’s seven-page letter would
provide the basic framework for the Mayor's AIDS Task Force, and guaranteed that
AIDS activists, specifically those representing the gay community would have a stake in
policy making.
Hadden outlined the need for the city to take action to address AIDS. The major
issues addressed included the lack of staffing at the UC Davis AIDS clinic, which was the
only facility in the county treating AIDS. The UC Davis Clinic for AIDS and related
Letter from Stanley Hadden to Anne Rudin, “AIDS Task Force Letter, dated November 18,
1985, “AIDS,” Anne Rudin Collection, Center for Sacramento History.
4
45
disorders, run by Dr. Neil Flynn, saw over 20 people a week with an entirely volunteer
staff.5 Additionally Hadden’s letter argued that “the slow and unsympathetic response,
lost applications and lost documentation by Social Security and other assistance
programs,” the lack of sub-acute care or non-emergency for AIDS patients, the lack of
attention to the mental health of AIDS patients, and a systematic lack of communication
and disorganization amongst current resource agencies necessitated the formation of a
Task Force.6 He also suggested a list of around 30 groups to involve in the Task Force,
including public agency representatives, community organizers, health care and
emergency services personnel, and “ethnic minority representation.”
It is not clear
whether Hadden simply wanted to increase the diversity of the task force, or if he
specifically felt that AIDS was an issue that affected minority communities in
Sacramento. Rudin forwarded Hadden’s letter to all City Council members and to city
and County Public Health Officials.
Stanley Hadden was not the only activist to express concern about the lack of
publicly coordinated responses and services for addressing AIDS to the mayor. Rudin
also met with Kate Guzman, the executive director of the Sacramento AIDS Foundation,
and Ron Gray, the president of the River City Democratic Club (a Sacramento gay and
lesbian business organization), on November 18, 1985 to discuss the need for a task
force.
At the meeting Rudin asked Guzman and Gray to come up with potential
candidates for Task Force membership. Many of the names that Ray and Guzman put
5
Hadden, “AIDS Task Force Letter,” 5.
6
Hadden, “AIDS Task Force Letter,” 5.
46
forth made it onto the Task Force: Dr. Neil Flynn, UC Davis AIDS Clinic; Dr. Paul
Hohm, Sacramento County Health Department Chief of Epidemiology; Dr. Sandy
Pomerantz, co-director of the Sacramento AIDS Foundation; Dr. Michael Tscheu, Sutter
Hospital hospice director; Stanley Hadden, aide to Senator Roberti; and Kate Guzman.
Ron Gray offered his name for inclusion, however, he was not invited to join the Task
Force.7 Unlike Stanley Hadden or Kate Guzman, Gray, as a representative for the River
City Democratic Club, did not have a background as a policy maker, and it is most likely
for this reason that he was not included.
On December 11, 1985, Rudin went before the City Council and officially
proposed the formation of the Task Force. In explaining the need for a task force Rudin
stated: "AIDS has become epidemic in our society and I see it as a public health problem
very similar to the health problems [that] existed in the early part of this century when
typhoid and other diseases were rampant."8 She argued that an education program was
needed for residents and policy officials alike to inform policy decisions, "I want to see a
body of knowledge built up so we can deal with these issues in a more rational and less
hysterical way."9
The final list of fifteen Task Force members is related but differs significantly
from the recommendations originally made by gay activists Hadden, Gray, and Guzman.
Letter from Ron Gray to Anne Rudin, dated November 18, 1985, “AIDS,” Anne Rudin
Collection, Center for Sacramento History.
7
Mary Crystal Cage, “Rudin: Urgent Need for AIDS Plan,” Sacramento Bee, 12 December 1985,
sect. A, p.1.
8
9
Cage, “Rudin: Urgent Need,” sect. A, p.1.
47
Six, or around one third, of the final list of Task Force members were doctors and eight
members were involved in the public health profession. The only local organizations
represented were the Sacramento AIDS Foundation and the Aquarian Effort (a drug
treatment program). Although they were officially listed as the SAF representative and
as a representative of Senator Roberti’s office respectively, Kate Guzman and Stan
Hadden were also representatives of the gay community. Two education members were
included, a representative of the school board and one from the PTA. The secretarytreasurer from the police and fire union was also part of the committee. Noticeably absent
were representatives from women's organizations, minority organizations, local business
associations, or legal services. In her opening remarks to the Task Force on February 8,
1986 Anne Rudin explained the selection process saying:
We wanted people who, not only could handle the problems with expertise on our board,
but also people who would be dealing with the decision-making policy. We, as
policymakers, will be asked to take steps to find which slate of remedies. I felt that
having people who have the expertise that all of you have, your various points of view,
we could accomplish results much faster. 10
Rudin primarily wanted to include the people who would be responsible for enforcing
public health policy in the decision-making process, the degree to which Task Force
members also represented or advocated for communities directly affected by the disease
was a secondary consideration. For the mayor, discussion of AIDS public health policy
should be held by policy makers and doctors.
Detailed Report Opening Meeting, Mayor’s AIDS Task Force 6 February1986, Sacramento
County: "Mayor's AIDS Task Force" 1986-1988, Stanley Hadden Papers 1997-33, The Gay, Lesbian,
Bisexual, Transgender Historical Society, 1.
10
48
The minimal presence of law enforcement amongst its members would influence
the recommendations of the Task Force.
The Task Force had one law and order
representative, Rick Martinez, a fireman and the secretary-treasurer of the police and fire
union. The absence of a representative from either the Sacramento City Police
Department or the Sacramento County Sheriff’s Department is surprising. Although
Rudin expressed a desire to staff the Task Force with policymakers, it does not appear
that she was concerned with policy enforcers.
This omission, combined with the
overwhelming representation of healthcare professionals, had a distinct influence on the
Task Force's recommendations regarding IV drug users and the subsequent political
conflict over decriminalization of possession.
In her opening remarks to the Task Force, Rudin also set out the mission of the
Task Force, asking them to define the disease. While Hadden's inquiry letter stressed the
inadequacies of current city programs to address the needs of people with AIDS, Rudin
was interested more in stopping spread of the disease:
How is it transmitted? Who is the population at risk? What is it? What is it not? ...What
are the means of controlling the disease? What kinds of policies can you recommend to
us for dealing with it? ...Should bathhouses be closed or shouldn't they? Should we have a
quarantines [sic] for everybody that has AIDS? Is that effective, or isn't it? Should
children be permitted to go to school with AIDS? Is there a risk to themselves and to
other children?11
The tone for the Task Force clearly emphasized preventative measures over expanding
treatment options.
11
Opening meeting, 1.
49
The Mayor's Task Force was split into subcommittees to address specific areas;
these included public information and education, human services, and modes of spread/
methods of prevention. These subcommittees met over the next six months to discuss
and then formulate recommendations for the city. Unfortunately, the records of the AIDS
Task Force are incomplete. The two available sources, the papers of Mayor Anne Rudin
and Stanley Hadden, have no comprehensive list of meeting minutes. The majority of the
meeting minutes come from Hadden, and these minutes are only from the subcommittee
meetings he attended.
Kate Guzman, as acting head for the Task Force, released a memorandum on
April 26, 1986, which outlined the major questions each subcommittee needed to
consider when formulating recommendations. They were asked first to define the scope
of the subcommittee and address the impact to those with the disease and the general
public. Then they were to identify what public agencies should do and how, while
keeping in mind how realistic the recommendations were. Most importantly, Guzman
stressed, "What will be the public reaction to the recommendation? ... the ability of the
Mayor to adopt our recommendations will depend in part on our ability to predict and
address public concerns."12 The Task Force members were very aware of the necessity of
balancing the public health needs and public sentiment, and the notes from the meetings,
such as Guzman’s, reflect this awareness.
12
Memorandum April 25, 1985, Sacramento County: "Mayor's AIDS Task Force" 1986-1988,
Stanley Hadden Papers 1997-33, The Gay, Lesbian, Bisexual, Transgender Historical Society. Emphasis in
original.
50
The members of the Mayor's Task Force made a concerted effort to involve the
public in their decision-making. The Task Force held a public meeting on May 13, 1986
to address the public's opinions and concerns about AIDS and public policy in the City
offices at 1231 I Street. Unfortunately the Task Force had difficulty engaging public
interest and media attention. The public input meeting was set up, as the name implies,
as a meeting to hear the public's opinions. Since the Task Force had yet to write a report,
members did not make a presentation and were specifically instructed to not voice
personal opinions. In order to be more accessible, the Task Force postponed its April
input meeting to May 13, since the previous date of April 22 conflicted with the Kings
basketball game.13 In addition, meeting notes indicate that invitations were sent out to
specific members of the public with the public interest in the meeting, although they do
not specify anyone in particular. Task Force members also participated in conferences
and spoke to reporters about their opinions and findings regarding AIDS as a way to get
media attention. After the public input meeting, the Sacramento Bee ran an article,
“Capital AIDS Cases Expected to Soar,” which heavily quoted several members of the
task force, including Kate Guzman and Dr. Sandy Pomerantz, outlining the need for
increased AIDS services. Pomerantz warned that “One-third of the AIDS cases we're
seeing now are medically indigent people with no insurance…. If that continues, the
county will have to pay $3.5 million for their care by the end of the decade.”14
13
Meeting notes 17 April 1986, Sacramento County: "Mayor's AIDS Task Force" 1986-1988,
Stanley Hadden Papers 1997-33, The Gay, Lesbian, Bisexual, Transgender Historical Society.
14
1.
Deborah Blum, “Capital AIDS Cases Expected to Soar,” Sacramento Bee, 30 May 1986, Sect. A, p.
51
In June 1986 Dr. Neil Flynn, a member of the Task Force and the head of the UC
Davis AIDS Clinic, participated in a conference hosted by the UC Davis School of
Medicine entitled “AIDS: Public Policy and Social Concerns.” In his presentation and
then later during a question-and-answer phase, Dr. Flynn repeatedly referenced his
experiences treating AIDS in Sacramento.
He stressed the need for education and
outreach, characterizing the current program for the prevention and treatment of IV drug
users as "totally ineffective."15 He also emphasized the need for prevention education in
the schools saying "I would comment that if condoms are to work they have to be used
and the person using them has to know how to use them... how do we get that kind of
information across in this puritanical society we live in ...this is a major sociopolitical
problem that we have no good answers for. School boards don't want to touch the issue
of sexuality in high school or even IV drug use in high school."16 It is likely that Dr.
Flynn was speaking not just as a healthcare professional but also as someone currently
negotiating public policy.
On August 1986, the Task Force released its recommendations. The
recommendations were divided into four separate sections: Transmission and Prevention,
Education,
Human
Services,
and
Discrimination.
The
organization
of
the
Murray Gardner, moderator, “Public Policy and Public Health in California: a Forum for
Questions and Discussion,” in AIDS: Public Policy and Social Concern: Conference Proceedings of the
University Extension and the School of Medicine University of California, Davis, Held in Sacramento,
California 16 June 1986, eds. Ann Scheuring and Neil Flynn. 19-37 (Davis: University of California, 1986)
27.
15
Gardner, “Public Policy and Public Health,” 29.
16
52
recommendations indicates a hierarchy of priority: first, to find out how AIDS is spread;
second, to educate citizens on how not to spread or contract the disease; third, to treat
those who have AIDS; and fourth, to prevent those with HIV/AIDS from being
discriminated
against.
Each
section
had
two
subsections:
Findings
and
Recommendations. The Findings section outlined the current issues Sacramento was
facing in a particular category while the Recommendations section suggested concrete
actions the city and county could take to address these issues.
The Task Force framed AIDS as a disease that could be understood as affecting
“risk groups” and that the population can be divided into two groups, those that engage in
risky behavior (falling into one or more defined risk group) and those who do not. This
was not a new way of understanding the epidemic but one that epidemiologists had used
to track the disease since it was first recognized in 1981 and as an epidemiological model
it makes sense. However, there are limitations to viewing HIV/AIDS this way as a model
for the creation of public health policy. Trying to understand a group of people by risk
group alone leads to oversimplification. Education geared towards people of a certain
risk group makes assumptions about their identity based on a single aspect. Safer sex
education to gay organizations alone would not reach men who do not identify as gay or
bisexual, but who did have sex with men.
Additionally, these risk groups were seen as discrete, which ignored the
possibility of people traversing risk groups. By viewing IV drug users in isolation, as if
IV drug use had no social or racial dimension to it, the Task Force concentrated its
recommendations on reaching people in drug and alcohol treatment centers, but did not
53
consider reaching the African American community or the Hispanic community although
both were disproportionately affected by drug use and HIV infection in Sacramento.
CDC statistics in 1987 showed that African Americans and Hispanics accounted for 40
percent of AIDS cases in the United States, and were more than three times more likely
to contract the disease than whites. Of the 1,600 women who had contracted the disease,
70 percent were black or Hispanic. Additionally, African Americans represented 58
percent and Hispanics 22 percent of the 350 AIDS cases among children under 15.17
Given these statistics, it can seem surprising that the African American community of
Sacramento was not more active in the AIDS policy process. Professor of law Harlan
Dalten, in his article “AIDS in Blackface,” offered several overlapping explanations for
the reluctance of the African American community to “own” AIDS: “many African
Americans are reluctant to acknowledge our association with AIDS so long as the larger
society seems intent on blaming us as a race for its origin. Second, the deep-seated
suspicion and mistrust many of us feel whenever whites express a sudden interest in our
well-being…” Additionally, Dalton cited homophobia, a complicated relationship with
drug abuse, and resentment of being dictated to by whites as contributing factors. 18 The
predominance of doctors on the Task Force as well as the exclusion of community
organizations from the policy process contributed to the adoption of a framework for
AIDS policy formation that did not take information like this into account.
CDC statistics quoted from Gracie Bonds Staples, “An Alarmed Black Community Mobilizes
Against AIDS” Sacramento Bee, 7 June 1987, Sect B, p. 1.
17
18
Harlan Dalton, “AIDS in Blackface,” Daedalus 118 (3) (Summer 1989), 212.
54
The first section of the Task Force’s report, Treatment and Prevention, outlined
the known facts about AIDS transmission and made strongly worded recommendations
about how to prevent the spread of the disease. The Sacramento AIDS Foundation’s
report in June 1986 listed the official reported cases of AIDS at 43, a significant jump
from 11 cases the year before, and projected that this number would continue increasing
exponentially.19 The number of AIDS cases cited by SAF represented the number of
people diagnosed as having AIDS, not ARC, and so did not include the number of people
infected with HIV.
In answering why HIV was not included in SAF’s statistics one must examine the
history of AIDS and HIV reporting. California mandates that certain diseases, when
discovered, be reported to the California Department of Public Health. These diseases
listed in the California Administrative Code (now the California Code of Regulations) in
1986 included such public health threats as rabies (in humans or animals), diphtheria,
yellow fever, anthrax, gonorrhea, and viral meningitis.20 AIDS became a mandatory
reportable disease in March of 1983.
AIDS reporting was confidential but not
anonymous, patients’ names were listed. California instituted HIV reporting in 1985;
Sacramento AIDS Foundation, “Update on the Incidence of Acquired Immune Deficiency
Syndrome” found in “AIDS” Anne Rudin Collection, the Center for Sacramento History, 2.
19
“Diseases Currently Reportable: Section 2500 California Administrative Code,” referenced in
California Legislature, Senate, AIDS: Senate Responds to a Public Health Crisis, by Kathryn Duke
(Sacramento, California State Senate, 1985), 42.
20
55
however, until 2006 HIV cases were reported anonymously.21 Patients were assigned
code numbers and these were forwarded to the California Department of Public Health.
Projections of the number of HIV positive individuals in Sacramento County in
1986 varied. SAF put the total HIV positive population at 10,000 for the county, but the
numbers the Task Force subcommittee considered when making its recommendations
were more conservative, placing the number between 1,500 and 6,000.22 At this time, the
CDC’s recommendations for people with HIV solely consisted of means to avoid
spreading the disease.23 The emphasis was on preventing people from acquiring the
disease, and having HIV put a person in a limbo; there was nothing the medical
community could do to treat HIV, so they only focused on preventing the infection from
spreading.
The first five recommendations were fairly broad and straightforward. They
recommended that: the city and county “first responders" (emergency services personnel)
receive training on infection control practices for AIDS; the public be educated about the
availability of HIV antibody testing; the city and county institute a five-year renewable
plan for AIDS education and that public officials support and participate in a visible
AIDS education program. Additionally the Task Force recommended that the city and
21
California Health and Safety Code, Section 120975.
22
Modes of Spread/Methods of Prevention Subcommittee Preliminary Report 20 March 1986,
“Sacramento County: Mayor's AIDS Task Force" 1986-1988, Stanley Hadden Papers 1997-33, The Gay,
Lesbian, Bisexual, Transgender Historical Society, 1.
CDC, “Current Trends Additional Recommendations to Reduce Sexual and Drug-Related
Transmission of Human T-Lymphotropic Virus Type-III/ Lymphadenopathy-Associated Virus” Mortality
and Morbidity Weekly Report, March 14 1986.
23
56
county adopt CDC guidelines and definitions. These guidelines and definitions were
provided in the Morbidity and Mortality Weekly Report (MMWR), the main publication
for the CDC.
The MMWR’s mission is to be “the primary vehicle for scientific
publication of timely, reliable, authoritative, accurate, objective, and useful public health
information and recommendations.”24
The most contentious of all of the recommendations made by the Task Force was
the
recommendation
to
decriminalize
IV
drug
paraphernalia.
The
official
recommendation was not to change the law itself because that would be outside of the
purview of Sacramento, but that “the City and County recommend to the state that in
light of the AIDS crisis the state should decriminalize laws which define possession of IV
drug paraphernalia as criminal."25 From a purely public health perspective the
decriminalization of IV drug paraphernalia made sense. Although IV drug users made up
a small portion of the reported cases of AIDS in Sacramento, Task Force members were
aware of the high level of HIV transmission amongst IV drug users in cities such as New
York City and were eager to find solutions to stop or slow transmission in Sacramento.
The informal meeting notes of the Prevention/Transmission subcommittee indicate that
the Task Force felt that IV drug users were especially a threat to the general population
CDC, “About the Morbidity and Mortality Weekly Report Series,” [http://www.cdc.gov/mmwr/
about.html] Accessed 20 June 2010.
24
City of Sacramento, “Mayor’s Task Force on AIDS” (Sacramento: City of Sacramento, August
25
1986), 4.
57
because they were the “most out of control group and effect so much of society [sic].”26
Presumably the effect that IV drug users have on the general public is as carriers;
spreading disease from populations engaged in high-risk behaviors (and therefore
complicit in their contraction of the disease) to their heterosexual sex partners (who could
potentially be unaware of their partners’ drug use and therefore were less complicit) or to
children (the ultimate innocent victims). Unlike the gay community, IV drug users were
considered to be less able, if not entirely unable, to be educated about behavior
modification such as not sharing needles or practicing safer sex, for if they were able to
change their behavior they would not continue to engage in IV drug use. In 1987, when
discussing needle decriminalization, the Sacramento County Sheriff would say “Giving
an addict a syringe is like giving a child a loaded gun.”27
The Education section of the recommendations asked for mandatory AIDS
education for drug treatment facilities, although the Task Force suggested that “education
alone may have little impact on the spread of the AIDS virus amongst IV drug users."28
IV drug users were identified by the Task Force as a very difficult population to reach
with education, lacking the cohesive social networks for the dissemination of information
26
Meeting notes, Prevention/Transmission Ideas that May Be Acceptable/Legally Sound by Risk
Group, undated, “Sacramento County: Mayor's AIDS Task Force" 1986-1988, Stanley Hadden Papers
1997-33, The Gay, Lesbian, Bisexual, Transgender Historical Society, 1.
Mari McQueen, “Battling AIDS Crisis with Free Needles County Considers Controversial
Program” Sacramento Bee, 31 October 1988, Sect. A, p. 1.
27
28
City of Sacramento, “Mayor’s Task Force,” 5.
58
that were present in the gay community. Other treatment options than education alone
had to be employed to stop the spread amongst this particular population.
The immediate response to the decriminalization recommendation was subdued
but telling. The Sacramento Bee article about the Task Force report focuses specifically
on this particular recommendation, writing that the task force believed that:
…much of the spread of the disease in Sacramento can be blamed on intravenous drug
use. The report estimates that only 1 to 5 percent Of Sacramento's IV drug users are now
infected with the AIDS virus. But it says that within a few years, the rate probably will
approach New York's, where 50 to 80 percent of the drug users are known to carry the
AIDS virus.29
The Sacramento Bee also stated that this recommendation was controversial within the
Task Force itself, although the article did not illustrate any specifics. Members of the
reading public were more direct. One woman wrote a letter to Mayor Anne Rudin in
protest of the recommendation stating that she was appalled at the decision saying, “Drug
paraphernalia elimination? How much reading do you people do? …I won’t be at your
meeting…I don’t care to become infected by breathing the air in cramped quarters of
homosexuals, including lesbians and lesbians practicing cunnilingus, treating themselves
with illegal drug paraphernalia for consumption (TB) or hepetitus [sic].”30 Although this
was an extreme example, it does reflect both the fear that people had about the disease as
well as the pervasive idea that those people with AIDS were complicit in their infection;
AIDS was the physical manifestation of its victim’s own wrongdoing and that the city
Ellen Robinson-Haynes, “Anti AIDS Plan: Educate, Allow Drug Paraphernalia,” Sacramento
Bee, 16 August 1986, sect B page 1.
29
30
Letter to Mayor Anne Rudin from Joyce Klein Lopez Foreman, 18 August 1986, found in
“AIDS,” Anne Rudin Collection, Center for Sacramento History.
59
and county should focusing not on treating those already ill but preventing the spread to
the innocent.
The response from other local government agencies was fairly negative. In the
official response from the Sacramento County Public Health Department, Director of
Health/Mental Health, Ron Usher, wrote: “Although the County Health Officer supported
this recommendation from a public health perspective, the Health Department finds it
troublesome in that it appears to condone illegal drug use.”31 He forwarded a suggestion
from staffer Larry Valterza that instead the city and county institute a needle exchange
program, which would not lead to the “indiscriminate dispensing of sterile needles”
which would conflict with the philosophical approach of drug treatment programs of nondrug use. The forwarded report was also supportive of AIDS education in drug and
alcohol treatment programs, stating that the most difficult obstacle these programs would
have to overcome would not be funding but “the public and program employee’s
perceptions that drug users cannot be reached. Most people hold a stereotypical image of
drug users, believing they do not want to change.”32 Mayor Anne Rudin’s staff response
to the decriminalization recommendations was vague; it did not address the feasibility of
such a recommendation or express an opinion as to the effectiveness of the proposal but
instead simply noted that “the Sacramento police Department is opposed to the
Letter from Ron Usher to City Council representative “Response to Recommendations of the
Mayor’s Task Force on A.I.D.S. p. 3, ” “Sacramento County: Mayor's AIDS Task Force" 1986-1988,
Stanley Hadden Papers 1997-33, The Gay, Lesbian, Bisexual, Transgender Historical Society.
31
32
Interdepartmental correspondence between Larry Valterza and Walter Schauer, September 5
1986, “Sacramento County: Mayor's AIDS Task Force" 1986-1988, Stanley Hadden Papers 1997-33, The
Gay, Lesbian, Bisexual, Transgender Historical Society.
60
recommendation that possession of IV drug paraphernalia be decriminalized.”33 This
conflict between AIDS public health policy and anti-drug policy would continue to be
unresolved for the rest of the 1980s.
Beyond this controversial issue, the Education section encompassed a significant
part of the recommendations of the Task Force. The recommendations outlined two
groups to educate: “people who engage in high risk activity” and “the general public who
do not engage in high risk activities." The designation of “high risk” used by the Task
Force specifically avoided previous categorizations, such as the Four Hs: homosexuals,
hemophiliacs, heroin users, and Haitians.
The Task Force also recommended the
education policies should target specific risk groups, be explicit, and be written in such a
way as to be received by members of these groups. Among these specific and
straightforward recommendations were: that the city encourage "community risk
reduction and health education" programs (to include mandatory education for prisons);
institute mandatory education for those in drug/alcohol treatment programs, and develop
an AIDS curriculum for grades K through 12; that the city and county distribute
brochures to parents with school children and AIDS information to all of its residents;
and that AIDS education be added to teacher credential programs.
Although the Task Force recommended mandatory AIDS education for the
incarcerated, this particular recommendation was generally elided over in agency
responses and in the newspapers, both straight and gay. The incarcerated were often
33
Staff Response to Recommendations of the Mayor’s Task Force on A.I.D.S., undated, 6, found
in “AIDS,” Anne Rudin Collection, Center for Sacramento History.
61
overlooked as an audience for AIDS education during the 1980s and this practice
continues today.34 The reasons behind this are twofold: first, both major methods of
contracting the virus, IV drug use and sex, are forbidden activities within the prison
system—public health measures such as needle exchanges or condom distribution were
non-starters with the correctional system. Secondly, public opinion of the incarcerated
has never been sympathetic. Prisoners are often seen as themselves a disease within
society, and their seropositivity is both a physical representation of their diseased status
and yet another danger they present to the general public. Brett Stockdill argues that we
create a false dichotomy between society and prisoners, in spite of the fact that “most are
imprisoned for non-violent offenses, and they are members of society, over ninety
percent of whom return to their communities.”35 Prisoners live in highly restricted
environments that limits communication both within and without the prison, and which
drastically limits their ability to engage in activism on their own behalf. In his response
to the Task Force’s recommendations, the Sacramento County Director of Public Health
indicated that the County Health Officer did provide education to correctional facility
staff and also stated “We have not been requested by the Sheriff’s Department to provide
education of incarcerated individuals and facility staff with reference to sexual
34
This is not limited to the United State alone. Internationally the rates of HIV/AIDS in prisons is
generally higher than the general population. See World Health Organization and Joint United Nations
Programme on HIV/AIDS, HIV/AIDS Prevention, Care, Treatment and Support in Prison Settings: A
Framework for an Effective National Response (United Nations 2006).
35
Brett Stockdill, Activism Against AIDS: At the Intersections of Sexuality, Race, Gender and
Class (Boulder: Lynne Reinner, 2003) 100.
62
transmission and needle use; however, we would consider the feasibility of providing
such services if requested”.36 The Sheriff’s Department, again a group that was not
included in the Task Force, did not make such a request. There were no other actions
taken with regard to this recommendation during the 1980s.
The Task Force members were especially concerned with AIDS education in
schools. This concern was twofold. Firstly, the topic of children with AIDS and the
school system was one that inspired much hysteria with the general public. In 1985, with
only five children diagnosed with AIDS in California, such concern may seem
overblown. Although children with AIDS made up a very small percentage of the total
population of people with AIDS in the United States, the general and scientific confusion
over how infants with HIV-positive mothers contracted the disease—either through
umbilical blood, during the birth process, lactation or other means—fanned the flames of
fear. If doctors could not clearly explain how infants contracted the disease, the panicked
logic went, then perhaps there were many more ways that it could spread. By taking
steps to educate children and their parents about AIDS, the Task Force hoped to address
very real fears. The recommendation also indicated that teachers receive dual AIDS
education, that they might act both as distributors of information and, in recognition that
teachers are often dispensers of first aid, in an infection-prevention capacity.
The second reason the Task Force emphasized AIDS education in school was a
prevention measure. By informing adolescents about the realities of AIDS prevention
36
Letter from Ron Usher to City Council representative, “Response to Recommendations,” 3.
63
and risk reduction measures, specifically condoms, they would be able to make
responsible decisions. This recommendation was explicitly stated in the findings section,
which reads that AIDS education should “emphasize that AIDS is a sexually transmitted
disease” and should “reach all sexually active populations (including adolescents).”
However, the actual policy recommendations were vaguely worded, merely
recommending that the city “encourage County Superintendent of schools to rapidly
develop appropriate AIDS curriculum for grades 4 to 12."37 The wording leaves the
definition of "appropriate AIDS curriculum” up to interpretation and, additionally, only
recommends that the city encourage the county superintendent to act but does not impel
any action. Although parents were concerned about their children contracting AIDS, they
were reluctant to acknowledge the realities of teenage sex or drug use. Many parents
feared that education on safer sex and clean needle use would go against the philosophy
of abstinence from both sex and drugs. Michael Tscheu, Task Force member and hospice
director for Sutter Community Hospitals, was quoted in the Sacramento Bee assuaging
parents’ fears about the school system exposing their children to pornographic material in
AIDS education programs, saying: “The information you're going to utilize in a
bathhouse is not at all appropriate for what you're going to use in a classroom.”38 For
AIDS education to be effective, the Task Force argued, it had to be explicit and while
sexually active teens were targeted for education, the absolutist moral stance towards sex
prevalent in Sacramento, as well as elsewhere, directly conflicted with this goal.
37
City of Sacramento, “Mayor’s Task Force,” 6.
38
Robinson-Haynes, “Anti AIDS Plan,” sect A, p 1.
64
Sex education as whole was a hotly disputed topic in Sacramento County during
the 1980s. In 1985, the San Juan School District in Sacramento County set up a sex
education program for high school students that proved a source of considerable
controversy. The San Juan School District, located directly northeast of Sacramento city,
proposed a three week “family-life” parental permission required course that would
instruct tenth graders in addition to the 14 hours of sex education already given to
elementary and junior high students.
The existing program was equivalent to the
Sacramento Unified School District’s program, with education at the elementary and
junior high school level in place. After months of debate the San Juan School District
curriculum was approved as a pilot program on the condition that all mention of
homosexuality, sexual dysfunction, prostitution, rape, abortion, masturbation, diaphragm,
and birth control pills be removed (other forms of contraception, including condoms and
withdrawal were retained).39 Additionally, an optional teen mother panel was proposed
in which teen mothers could talk to high school students about their experiences and
answer questions. David Woodel, a member of the Curriculum and Standards Committee
which reviewed the program, and founder of the local Citizens Against Pornography,
objected to the optional panel, saying “I'm not going to glorify people with a low moral
standard…I believe in teaching chastity and modesty, not sexual promiscuity…They
should say that they made a mistake and that it caused dire consequences… I'm opposed
Elizabeth Fernandez, “Lines Drawn in San Juan Sex-Ed Fight Trustees Will Review Plan for
District-Wide Course” Sacramento Bee, 7 April 1985, sect. B, p. 1.
39
65
to their glorifying being sexually promiscuous.”40 Over 150 people attended the school
board meeting where discussion went on for several hours about the merits of sex
education. Many detractors equated sex education with increasing promiscuity. One
attendee argued, “You get informed about drugs, drug rates go up. You get informed
about alcohol, alcoholism goes up… I'm moral from the Bible. I don't want some teacher
forcing good morals on me.”41 In defense of the compromise, Curriculum and Standards
Committee chairwoman Kathy Knepshield said “We have to make compromises in order
to get something. Right now, we have nothing.”42
Although AIDS education in schools was debated on a state level right after the
completion of the Task Force’s report, eventually the political stalemate in the capitol
pushed the decision back to local school districts.
In 1987 the Senate Education
Committee, headed by Senator Gary Hart (D-Santa Barbara), proposed a bill that would
mandate AIDS education in 11th and 12th grade, including the showing of a stateauthorized film made by the Walt Disney Co. The Superintendent of Instruction, Bill
Honig, supported the measure and was quoted in the Sacramento Bee as saying “‘If you
don't require it, the tendency at the local level is to duck it…It's a good idea.'” 43 Although
it passed both houses, Governor Deukmejian ultimately vetoed the bill.
40
Part of
Fernandez, “Lines Drawn,” sect B, p. 1.
Elizabeth Fernandez, “San Juan Sex-Ed Will Stay in Schools,” Sacramento Bee, 7 April 1985,
sect. B, p. 1.
41
42
Fernandez, “Lines Drawn,” sect B, p. 1.
Deb Kollars, “AIDS Bill Seeks to Educate Would Show Video to All in Grades 7-12,”
Sacramento Bee, 7 January 1987, sect A, p1.
43
66
Deukmejian’s objection to the bill was a matter of political wrangling, he wanted the
State Board of Education to select appropriate material rather than the Superintendent of
Instruction and the State Health Director, but his veto was also motivated by moral
conservatism. The Sacramento Bee quoted Deukmejian in his veto message as saying
“Districts may prefer to use other films than those that are state- approved, may find that
the state-approved films contain materials morally offensive to the local community or
may wish to present AIDS instruction without the use of video materials.''44 In 1988,
Hart abandoned the unified state approach and instead proposed that local school districts
be required to create their own AIDS education programs, and that these programs reflect
the US Surgeon General’s recommendations “that abstinence from sex and drugs ‘are the
primary methods of avoiding AIDS.’”45 It was under these recommendations that the
Sacramento school system adopted its AIDS education program, which educated seventh
and tenth graders about AIDS through stressing abstinence.
The largest section of the AIDS Task Force report addressed the needs of human
services, or public assistance services. The Task Force identified mental health as an area
of special concern, not just for patients with HIV/AIDS but also for family, friends and
healthcare providers. The human services section clearly outlined the need for improved
services and that the responsibility for improvement would have to fall to the city and
county, not state or federal government. Although AIDS (but not ARC or AIDS-Related
Rick Kushman, “Duke Vetoes Bill to Require AIDS Instruction” Sacramento Bee, 22
September 1987, sect A, p3.
44
Jon Matthews, “Another Try at AIDS Education Required School Classes Would Replace
Duke-Rejected Videos,” Sacramento Bee, 17 December 1987, sect A, p. 3.
45
67
Complex) was considered a disability and entitled the patient to state and federal funds,
the medical reimbursement for skilled nursing care was only $35 a day in 1986.46
Additionally, the Task Force acknowledged the reluctance of many private nursing
homes to admit AIDS patients for residential treatment, both because of the low
reimbursement level and for fear of losing other paying patients.
In this section, the Task Force issued two types of recommendations, ones that
called for education measures and ones that called for the allocation of funds and
services. There were two education measures in the Health Services section. The first
advocated for education and in-service training for mental health practitioners and social
workers, and the second for AIDS education in family planning clinics and other
community clinics at "the initial visit of all women at risk for HIV infection." 47 The latter
recommendation was fairly unclear in that it did not discuss which women were at risk
for HIV infection or how the staff of family planning clinics was to know that they were
at risk. The classist and racist undertones of a discretionary policy of disseminating
information about AIDS based on who appears “at risk” are hard to deny.
The recommendation acknowledged that women in Sacramento were capable of
getting AIDS, which was something that both the medical community and the
mainstream media had only recently begun to discuss. Although prostitutes were included
as a potential risk category in subcommittee meeting minutes, they were dropped as a
46
City of Sacramento, “Mayor’s Task Force,” 6.
47
City of Sacramento, “Mayor’s Task Force,” 7.
68
category for the report to the Task Force on March 30th. 48
Within that report
“…evidence is accumulating that spread can occur readily from an infected man to a
woman during heterosexual intercourse. It is likely that spread from an infected woman
to her male partner occurs, but the risk may be lower.” 49 The December 1985 issue of
Discover carried an article by John Langone which argued that, as opposed to the male
“fragile urethra” and the “vulnerable anus,” the “rugged vagina” was built to withstand
childbirth and was safe from AIDS. Langone further argued that “Contrary to what
you’ve heard AIDS isn’t a threat to the vast majority of heterosexuals… It is now and
likely to remain—largely the fatal price one can pay for anal intercourse.50
Paula
Treichler notes in her article “AIDS, Gender, and Biomedical Discourse” that one year
later, many major newsmagazines such as Newsweek, U.S. News and World Report,
Time, and Scientific American all began reporting AIDS as a threat to the heterosexual
population without a corresponding major medical breakthrough.51 The policy
recommendation by the Mayor’s Task Force reflected the shifts in medical opinion, and
its vague and loaded phrasing was indicative of the exclusion of women’s organizations
and minority organizations from the Task Force.
48
Meeting notes, Prevention/Transmission Ideas that May Be Acceptable/Legally Sound by Risk
Group, undated, “Sacramento County: Mayor's AIDS Task Force" 1986-1988, Stanley Hadden Papers
1997-33, The Gay, Lesbian, Bisexual, Transgender Historical Society, 1.
49
Modes of Spread/Methods of Prevention Subcommittee Preliminary Report, 20 March 1986,
“Sacramento County: Mayor's AIDS Task Force" 1986-1988, Stanley Hadden Papers 1997-33, The Gay,
Lesbian, Bisexual, Transgender Historical Society
50
John Langone, “AIDS: The Latest Scientific Facts,” Discover (December 1985), 27-52.
Paula Treichler, “AIDS, Gender, and Biomedical Discourse” in AIDS: the Burdens of History
ed. Elizabeth Fee and Daniel Fox (Berkeley: University of California Press, 1988) 212 .
51
69
Fund allocation recommendations formed the second part of the Human Services
section of the Task Force’s report. They encompassed the largest section of the report
and recommended that the city and county: provide funding/assistance to the UC Davis
AIDS clinic and the Sacramento AIDS Foundation, prioritize providing mental health
services for people with AIDS and ARC, establish an independent residential nursing
home for those with HIV, find a coordinator for organizing AIDS-related services in the
county, and advocate to the state legislature for resolution of liability insurance issues for
nursing convalescence board and care facilities to encourage private facilities to accept
AIDS patients.
In addition, the Task Force recommended that the county provide
medical care for indigent HIV infected people at county facilities and the UC Davis
AIDS Clinic, as well as either establish a clinic for people with AIDS or contract out
services to private companies.
The allocation aspect of the Task Force's recommendations addressed the
unambiguous needs for medical and mental health care for people with AIDS, and yet
they also called for a large investment in public health programs on the local level,
without addressing how the city or county might go about paying for these programs.
The lack of adequate state and federal funding for AIDS services meant that Sacramento
officials were unable to tap into larger reservoirs for funding. The State Department of
Health and Human Services provided $147,920 to the Sacramento AIDS Foundation for
1985-86 fiscal year, and the Sacramento County Health Department provided an addition
70
$75,000.52 This meant that although public-health officials did not deny the real need for
services no single agency was eager to take on the burden in addition to their already
strained resources. In his response to the Task Force’s recommendations the county
Director of Health and Mental Health, Ron Usher, argued that many of the
recommendations were already being carried out. Usher stated that the county already
provided funding to the UC Davis Medical Center for non-discriminatory services which
would include the AIDS Clinic, implying that more funding was not necessary. He also
dismissed the need for funding an AIDS services coordinator, stating the Health
Department:
…recognizes the need for a coordinated effort in dealing with AIDS. This responsibility
lies within the purview of the County Health Officer. Under the State law, the Health
Officer is responsible for the prevention, management and control of communicable
disease…Any additional staffing requirements should be addressed through the normal
budget process.53
Because the city of Sacramento had delegated public health responsibilities to the county
of Sacramento, the city staff’s response to the allocation recommendations was especially
brief, six of the eight recommendations were categorized as requiring “no action,” and
that any potential funding of the UC Davis AIDS Clinic or the Sacramento AIDS
Foundation would have to go through the City Council. Although the city was amenable
to assisting in the finding and creating of an independent residential care facility for those
with HIV, the County Health Department argued that the county could have no role in
Bee Metro Staff, “Capital City Has Few AIDS Cases,” Sacramento Bee, 27 October 1985, Sect.
METRO A, p.16.
52
53
Letter from Ron Usher to City Council representative, “Response to Recommendations,” 5-6.
71
establishing a facility and that “state action [was required to] establish appropriate
licensure and reimbursement so as to provide incentive to residential care operators to
establish such facilities.”54 The realities of city politics meant that even though AIDS
was acknowledged to be an important public health issue and the Task Force made
Human Services its largest section, without state or federal aid officials were much more
likely to explore solutions that did not require more funding.
The last section of the Task Force's recommendations addressed discrimination
issues facing people with AIDS in Sacramento. These included discrimination in
employment, housing, insurance, education, research, and medical services. The Task
Force acknowledged that "People's natural, but very volatile fears and anxieties about the
unknown, death and sexuality have fueled an almost hysterical paranoia related to the
AIDS epidemic."55 The Task Force recommended that the city adopt an antidiscrimination ordinance to allow those discriminated against to pursue civil remedies.
This ordinance was clearly influenced by the passage of an anti-discrimination ordinance
on the basis of sexual orientation that had just passed through the City Council that April.
In 1985 gay activists began a campaign to create an anti-discrimination ordinance
that eventually became city ordinance number S6-042. Originating in the Human Rights
Commission, the ordinance was forwarded to the City Council in June of 1985. At that
meeting the ordinance did not pass and was sent back to the commission for rewording.
“Staff Response to Recommendations of the Mayor’s Task Force on A.I.D.S,” 3; Letter from
Ron Usher to City Council representative, “Response to Recommendations,” 5.
54
55
City of Sacramento, “Mayor’s Task Force,” 8.
72
After being reworded and pushed through the City Council again, the ordinance was
finally made law in April 1986 by a vote of 7-2. It made discrimination in employment,
business, city services, education, and real estate transactions a civil matter to be reported
no later than eighteen months after the incident. The only criminal action would be in a
failure to post the sign listing the discrimination notice. The 1986 discrimination
ordinance is important to the discussion of AIDS in Sacramento because it clearly linked
gay activism and AIDS activism—the two ordinances were virtually identical.
Sacramento Bee coverage of the ordinance S6-042 encapsulated the discussion thusly,
“Proponents of the gay rights law said discrimination is a fact of life and should be
banned, while opponents argued such an ordinance could lead to more homosexuality and
an AIDS epidemic.”56 Mom…Guess What! presented a more nuanced view, quoting a
local activist against the ordinance as calling it "sign ordinance" and “not worth the fight”
and other activists who felt the ordinance a step in the right direction and praised the City
Council and the mayor for "their courage, strength, and commitment to human rights."57
The 1987 AIDS anti-discrimination ordinance shared much of the same
framework as the earlier anti-discrimination ordinance. In February of 1987 Mayor Anne
Rudin sent a memo to the members of the City Council reminding them of the Task
Force’s recommendation and informing them of her intent to formally introduce it at the
Jim Sanders, “Gay Rights Backed After Heated Council Session,” Sacramento Bee, 26 March
1986, sect. A, p. 1.
56
“Sacramento Ordinance Back to Council,” Mom … Guess What!, March 1986, 1; “Antidiscrimination Law Takes Effect,” Mom … Guess What!, May 1986, 7.
57
73
March 1987 meeting. The form and much of the language from the earlier ordinance
were used in the AIDS ordinance. Like the earlier discrimination ordinance, the adopted
ordinance makes discrimination in employment, business, city services and education a
civil matter (it does not include a section on discrimination in real estate transactions). In
her memo to the City Council, Mayor Rudin included a copy of Los Angeles City
ordinance on AIDS discrimination passed in 1985 to use as a model. Given that the
content is very similar to both of the Sacramento ordinances passed after it, it is likely
that the Los Angeles ordinance was used as a model for both. It also covered the same
topics in the same order as the two Sacramento ordinances, although the language did
differ.
The Los Angeles Ordinance defined “condition related thereto” as “any
perception that a person is suffering from the medical condition AIDS whether real or
imaginary.”58 The Sacramento AIDS ordinance provided a much more explicit definition,
defining “an individual who has AIDS” as:
…anyone who has AIDS, as defined in subsection (a) of this section or anyone who is
infected with the HIV virus (seropositive for HIV infection); anyone who is suspected of,
or perceived as having such a condition; anyone who is believed to be at risk of
contracting such a condition; or anyone who is believed to associate with individuals who
have AIDS. 59
Although it is possible that members of other “risk groups” such as IV drug users or
hemophiliacs could take advantage of protection against discrimination by being
“suspected of or perceived as having” AIDS, the wording seems to most clearly reference
gay men.
United States Conference of Mayors. “City of Los Angeles Ordinance 160289” AIDS
Information Exchange, 2 (October 1985): 3.
58
59
City of Sacramento, “Ordinance no. 87-045,” May 1987.
74
The ordinance was approved 6-0 (one member, Councilperson David Shore was
absent) by the City Council in May of 1987. During the council hearing two people
spoke against it. The first, Rev. W.B. Timberlake spoke against the ordinance, saying
that it “bar[s] employers from testing workers for the deadly virus, thereby causing
insurance rates to rise” and the second, Frank Hurd, felt that the passage of the ordinance
would “assure that the AIDS epidemic will be maximized. But this good; for God is
cleaning out the perverts.” The mayor responded that that was “the most sickening
testimony I've ever heard.”60 The AIDS discrimination ordinance passed without much
discussion.
Additionally the Task Force recommended that the City/County Human Rights
and Fair Housing Commission act as the advisory body for cases of AIDS discrimination.
The Human Rights and Fair Housing Commission had worked with the Mayor's Task
Force, with Commissioner Palmer serving as the group's representative on the Task
Force. Furthermore, the commission had volunteered to serve as the advising body for
AIDS discrimination in a motion passed unanimously at its April of 1986 meeting.61
Lastly, the Task Force recommended that the city and county advocate for the federal
recognition of ARC in addition to AIDS as a disability, so that those with ARC could
fully participate in the available aid programs. The city speedily adopted these two
recommendations.
Jim Sanders and John Robin Witt, “Council OKs Ban on AIDS Discrimination,” Sacramento
Bee, 13 May 1987, sect. A, p.1.
60
61
Meeting minutes, April 16th, Stan Hadden Collection.
75
The Mayor’s Task Force on AIDS had a significant impact on Sacramento’s
response to HIV/AIDS. The recommendations of the Task Force provided the city and
county with direction for how to understand and respond to the HIV/AIDS epidemic.
The makeup of the Task Force influenced the recommendations and the public reception
of those recommendations. The inclusion of gay AIDS activists from the Task Force’s
inception contributed to the relative easy adoption of recommendations that primarily
affected the gay community, such as the anti-discrimination ordinance.
The more
contentious recommendations were those that affected IV drug users, and the absence of
law enforcement and other community leaders was directly connected to the contention.
Unfortunately, the section that was the least contentious, the human services section,
managed to be both the one everyone agreed was necessary but also one that the city and
county were the least able to act upon for lack of funds. Although Sacramento could and
did make strides in HIV/AIDS prevention following the Task Force, the costly act of
improving AIDS management was something that required funding on the state and
federal level.
76
Chapter 5
CONCLUSIONS
The Mayor’s Task Force on AIDS had a profound impact on the city and county
policies regarding HIV/AIDS. Those parties that were included in the Task Force shaped
its final recommendations.
Mayor Rudin’s decision to include only policy makers
excluded both policy enforcers, specifically law enforcement, and members of the public
affected by these policies. Sacramento’s response to AIDS activists who had the biggest
voice in the discussion came from the gay community, IV drug users were represented
only through the Aquarian Effort drug treatment program
The largest dispute over AIDS public health in Sacramento was over policies
affecting IV drug users. Although the Task Force’s recommendation for the
decriminalization of drug paraphernalia was deemed unfeasible local government did not
give up on solving this issue. Seeing that the original recommendation was unworkable
in the political environment, Dr. Flynn set up a panel to evaluate the possibility of needle
exchange. The panel was established in November of 1987 and met monthly for the next
six months. The makeup of this panel was significantly different than the Task Force.
Unlike the previous Task Force, this one did include representatives from law
enforcement. Both representatives from the Sacramento Police Department and two
members of the Sacramento County Sheriff’s Department were on the panel as well as
representatives from both the City Attorney’s Office and the County Prosecutor’s Office.
Additionally, two representatives from the Aquarian Effort and two from the Sacramento
AIDS Foundation. There was no official representation from the Mayor’s Office. In a
77
letter to Dr. Neil Flynn, Mayor Rudin indicated that “In light of Chief Kearn’s resistance
to the concept” she did not want to place a staff member in “a difficult position.”1 The
Sacramento Bee quoted Kearns as against the entire proposal at its outset, saying,
“Regardless of how we feel about AIDS there are ethical and legal problems to Dr.
Flynn’s proposal. Giving an addict a syringe is like giving a child a loaded gun.” 2 The
content of the panel discussion did not change the Chief of Police’s opinion. In June,
after the panel recommended starting a pilot needle-exchange program, the Sacramento
Bee summarized Chief Kearns nine-page report against the program:
The program would be a ‘dangerous governmental sanction for the possession of
paraphernalia among those least willing to control their illegal drug use.’ Shared needle
use is ‘an integral part of the drug culture and will, in many instances, continue.’ ‘I
cannot condone the use of illegal drugs. I cannot expect to reduce the occurence [sic] of
drug-related crimes … or even hope to maintain the current level of law enforcement if I
were to promote an activity which would increase crime in the form of robberies, thefts,
prostitution and child abuse and neglect.’3
Although IV drug users would have had to volunteer to participate, the Chief of Police
argued that IV drug users were like children in that they were incapable of making
decisions about their health given the fact that they also use drugs. Unlike gay men who
could and did make a conscious effort to education themselves and participate in public
health discussions, IV drug users were considered unreachable.
Passive and
Letter from Mayor Anne Rudin to Dr. Neil Flynn, dated 21 December 1988, found in “AIDS,”
Anne Rudin Collection, Center for Sacramento History.
1
2
Mari McQueen, “Battling AIDS Crisis with Free Needles County Considers Controversial
Program” Sacramento Bee, 31 October 1988, Sect. A, p. 1.
Ted Bell “Needle Swap Opposed Police Chief Attacks Anti-AIDS Proposal” Sacramento Bee, 16
June 1989, sect.B, p.1.
3
78
fundamentally incapable of behavior modification, IV drug users were considered a body
upon which public health policy had to be enacted upon to save the general population.
By discussing AIDS public health policy solely through the lens of “risk groups,”
much of the policies ignored the realities of HIV/AIDS as a disease with racial and class
based elements. In response to criticism, Sacramento County Public Health Officer Dr.
Paul Hom said “Each risk group is going to be dealt with differently. To that extent, I’m
focusing on the risk factor and not the race... A population has never gotten enough
information if they continue to practice high-risk behavior.”4
Although the gay community had a significant role in the Task Force, future
cooperation was not guaranteed. In light of the actions of the Mayor’s AIDS Task Force,
Sacramento County formed its own task force in 1987. Kate Guzman, executive director
of the Sacramento AIDS Foundation, expressed her unhappiness with the new task force
and the lack of representation from the gay community in a letter to several gay
organizations saying,
“When [County Task Force Member] Dr. Acuna… openly
requested that a gay representative be appointed to the Task Force, both Drs. Hom and
Flynn considered their medical expertise and work experience sufficient to represent the
interests of the gay community…the gay community will not have a direct voice in the
Gracie Bonds Staples, “An Alarmed Black Community Mobilizes Against AIDS,” Sacramento
Bee, 7 June 1987, sect METRO, p.1.
4
79
formulation of the recommendations.
Thus, actual appropriateness and cultural
sensitivity of such recommendations is in serious jeopardy.”5
Implicit in this statement is the assumption that in order to combat AIDS, doctors
must understand and consider the appropriateness of their recommendations to the gay
community; no one ever questioned the doctors’ ability to represent the interests of IV
drug users. By looking, as Dr. Hom suggests, at risk factor in isolation, the difference in
meaning between a gay “life-style disease” and an intravenous drug use “life-style
disease” becomes apparent: one has been accepted as a legitimate life-style, the other as
an illegal behavior. The LGBT community in Sacramento, by embracing AIDS as a
community cause, forced doctors to look beyond behavior in isolation and acknowledge
culture when assessing how to approach AIDS. There was no equivalent for IV drug
users, leaving doctors at a loss as how to approach education or other preventative
measures in venues outside of drug treatment centers.
In March of 1988, Mayor Anne Rudin spoke at the Hearing of Western States
Response, part of the Presidential Commission on the Human Immunodeficiency Virus,
held San Francisco. She outlined Sacramento’s response to AIDS/HIV and asked for
federal aid in two areas, prevention education and human services saying “We think
Sacramento has done exceedingly well to meet the demands of the HIV epidemic….More
Letter from Kate Guzman to Stanley Hadden, dated 19 August 1987, found in “Sacramento
County: Mayor's AIDS Task Force" 1986-1988, Stanley Hadden Papers 1997-33, The Gay, Lesbian,
Bisexual, Transgender Historical Society.
5
80
must be done, but the financial support is needed to meet the crisis head on.”6 She asked
for $1 million for prevention education for both the general population and high-risk
groups such as IV drug users. She also asked for aid in the creation of a regional AIDS
care center and for increased Medi-Cal reimbursements. AIDS patients in Sacramento
were unable to get into skilled nursing facilities and were instead staying in acute care
hospitals that cost three times as much and deprived other patients of needed beds. Rudin
quoted the Medi-Cal reimbursement rate for skilled nursing was $44.00 a day for a
service that that cost nursing homes $150.00 a day. Upon hearing her testimony one
Commission member was shocked, saying, “You could not possibly be talking about
inpatient [services]. It must be outpatient services…it certainly is a spectacularly low
figure.”7 The regional care facility that Mayor Rudin asked for was completed in 1989.
The Center for AIDS Research and Education Services or C.A.R.E.S. still serves
Sacramento city and county today.
The AIDS policies created in Sacramento during the 1980s were developed as the
result of two conflicting views of AIDS, views from inside the artificially demarcated
risk groups which prioritized treatment while those from the outside prioritized
prevention. It was the threat of AIDS crossing boundaries into low-risk groups (or “the
general population”) that precipitated the creation of the Mayor’s AIDS Task Force. As
we enter the fourth decade of living with AIDS there is still no cure on the horizon.
6
Testimony Submitted by Mayor Anne Rudin, to the Presidential Commission on the Human
Immunodeficiency Virus Epidemic, 24 and 25 March 1988, found in “AIDS,” Anne Rudin Collection,
Center for Sacramento History, 299.
7
Testimony to Presidential Commission on the Human Immunodeficiency Virus Epidemic, 305.
81
Although the availability of new drugs, especially protease inhibitors, has shifted the
perception of AIDS from an automatic death sentence to a chronic disease to be treated,
access to those life-lengthening drugs is not guaranteed on a national level, much less an
international level. Furthermore, the perception of AIDS as a lifestyle disease--a disease
of outsiders and the abnormal--has not faded from the public consciousness, nor is there
any indication that it will do so in the years to come.
82
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