John A. Carranza // In 2009, I joined the San Antonio AIDS Foundation (SAAF, pronounced “safe”) as a volunteer. I graduated with my BA in history the previous year and had a job with a flexible schedule that allowed me to engage in this work. I was drawn to the organization because of its history of caring for AIDS patients. Robert Edwards, who was also called “Papa Bear,” established the organization after his son died from the disease and wanted to provide an effective response to the epidemic in 1986. Since my leaving the organization in June 2009, SAAF grew from offering free HIV testing, education and outreach, a meal program, and hospice care (later phased out of the organization) to including an on-site pharmacy, transitional housing, behavioral/mental health counseling, and dental care.

The success of the San Antonio AIDS Foundation had its roots in the AIDS activism of the 1980s, but in many ways that activism was a result of the gay health activism of the 1970s and its reaction to the state. Katie Batza, assistant professor of Women, Gender, and Sexuality Studies at The University of Kansas, argues that gay health activism emerged earlier than AIDS. In Before AIDS: Gay Health Politics in the 1970s, Batza argues that by the end of the 1970s, the gay “health network included community clinics, outreach programs, national professional organizations, and a research infrastructure.”[1] This argument is supported by Batza’s elaboration on gay liberation, the challenges posed to medical authority by marginal groups, the continuation of 1960s radicalism (Black Panther party, feminism, antiurban renewal movements), and the promises of the Great Society era that motivated community health. Together, these components suggest that the growth of gay health as an element of the state did not limit the healthcare provided to gay men, but laid a strong foundation for addressing AIDS when it hit the gay community hard in the early 1980s.

Before AIDS grounds its analyses of these complex themes and gay health activists in three clinic locations, the survival of which depended on the sometimes tense relationship with the state. The first chapter introduces the reader to the clinics that comprise this study: the Fenway Clinic in Boston, the Howard Brown Memorial Clinic in Chicago, and the Los Angeles Gay Community Center. Dispensing with the psychiatric models of understanding gays and lesbians, Batza instead establishes gay health as a concept shaped by the gay community and its allies. A particularly interesting unit of analysis that would be interesting to see taken up in future scholarship is that of “oppression sickness.” This concept was introduced by activists in the  Los Angeles Gay Survival Committee and outlined the mechanisms that made gay people sick, which included the “physical, mental, financial, and political issues and ailments common in the gay community.”[2] Oppression sickness blurred the lines between medicine and politics, but in several instances, activists found opportunities with which to challenge it. We know that oppression inherently can cause illness, but can we conceptualize this as a unique framework for understanding the future of gay health? Does it apply to other marginalized communities? Can we more clearly elaborate its relation to the state?

The second chapter outlines how activists at all three clinics defined appropriate healthcare and made it accessible by offering free, pay-what-you-can, or sliding scale services to all clients. The availability of such services were crucial to gay men who were in the closet, and did not want to risk notifying their insurance companies about trips for medical care. The models in which these clinics operated were highly dependent on the influence of the various social movements of the decade. These clinics would come into conflict with what Batza calls the antiqueer state, which “encouraged assimilation while quashing the possibility of structural transformation…”[3] This is further discussed in the third chapter where the Fenway Clinic in Boston had to reorganize to further align with rules that allowed for them to receive federal and municipal funds. This effectively caused resentment among the volunteers and activists who had grown accustomed to the hands-off approach used upon the clinic’s founding. Gay health activists at the Howard Brown Memorial Clinic fought against the antiqueer state when staff members refused to turn over the names of patients tested for sexually transmitted diseases. Because federal guidelines mandated blood tests from local clinics be run, the local government had no choice but to acquiesce to the demand for anonymity. These tensions highlight the ways in which the gay community sought to protect its own members by coming face to face with the state.

Chapter 4 recounts how sex positivity in the gay community led to increased trust in the mainstream medical community. Trust was solidified by the Centers for Disease Control’s experimentation with a vaccine for hepatitis B. Many gay men, through social networks, participated in the trials and even offered plasma for the earlier incarnation of the vaccine. This led to a stronger relationship with the medical establishment. By participating in trials, gay men affirmed their relationship with the state, which would then be called into question by the fifth and final chapter of the book. The rise of conservatism and a rollback in funding for public health allowed for the proliferation for AIDS, but Batza maintains that the gay health services established throughout the 1970s laid the groundwork for the gay community’s response.

Before AIDS is a welcome contribution to the history of gay liberation and the history of medicine, which tends to focus on the AIDS epidemic where they intersect with one another. Batza draws on archival resources, oral history, and a variety of ephemera to illustrate her case, and does so effectively. One hole in this examination of gay health is that lesbian voices are often limited. Batza acknowledges this, and does her best to include lesbians when possible, but overall, this work centers on the experiences of gay men. A second point of interest for future research would ask to what extent gay teenagers and young adults utilized these clinics. An extensive body of literature on sex and young adults exists, but it would be an interesting aspect to see explored. Nevertheless, Batza’s examination of  change over time in the three clinics and their interaction with the state at all levels remains necessary. This book provides a framework for understanding how medical activism challenged and cooperated with the state for healthcare for gay men. Specifically, this helps the observer understand how organizations such as the San Antonio AIDS Foundation came into being during the turbulent AIDS epidemic.

[1]Katie Batza, Before AIDS: Gay Health Politics in the 1970s (Philadelphia: University of Pennsylvania Press, 2018), 5.

[2]Ibid., 25-26.

[3]Ibid., 67.

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