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INTRODUCTION

FIGHTING EPIDEMICS AND IGNORANCE

On a cold Chicago day in the mid-1970s, an employee of Man’s Country, the largest bathhouse in the Midwest, lay in a hospital bed recuperating from a bad bout of hepatitis B. Though doctors and scientists hadn’t yet discovered that hepatitis B could be transmitted sexually, the disease plagued the gay community. Gay men avoided interactions with doctors, however, because such visits often led to misdiagnosis, judgment, ostracism, and treatment for their sexuality rather than their medical ailments. In addition, medical care was often expensive and held the possibility of extortion, since gay men typically paid for their health care out of pocket and avoided using insurance for fear that employers would learn of their sexuality and then harass or fire them. Thus this particular patient was hardly the first gay man to appear at Chicago’s Rush Presbyterian Hospital with the flu-like symptoms and slight yellowing of the skin that signified untreated hepatitis B. In fact, on this day, he even shared a room with a friend, another gay man suffering from the same illness. Like many others before and after them, both men worried how their sexuality might influence the medical staff or their treatment and felt their vulnerability amplified by their dependence on these potentially threatening care providers. They were sick and required treatment but had a healthy and well-founded apprehension about those designated to care for them.

But on this day, a nurse of a different sort, a representative of a growing gay health network in the city, lifted their spirits and allayed their fears. Drag performer Stephen Jones from Man’s Country, dressed as stage persona Nurse Wanda Lust, made a special visit to the patients, one of whom remembered in an interview later, “All of a sudden, I was laying in my room, and there was Nurse Lust walking through the halls of Rush Presbyterian Hospital [laughs], you know, ten feet tall, and just made no bones about being who he was.”¹ Donning a short and tight-fitting nurse’s uniform, a large oversized clock necklace, fake glasses, a bright red wig, high heels, and a nurse’s hat and hairnet, Nurse Lust arrived to deliver flowers, check blood pressure, and visit with friends. As Nurse Lust walked the halls the patients could hear the hospital nurses giggle as she teased them playfully. The act of visiting in drag proved a potent tool that put the patients at ease but also signified to the hospital staff that gay patients had a community looking out for them. Nurse Wanda Lust acted as an advocate, an ambassador, and a friend in the exact spaces where gay men felt most vulnerable and threatened, and in doing so, she played an important role in changing the relationship gay men had to health care and to sexual health in the 1970s. Remembering Lust’s visit, one person reflected, “He was freedom, in my head. Outrageous could work if you made people laugh and have fun with them…. Wanda was one of those people that helped make me feel good about my life.”² Though Nurse Lust did not visit every gay patient every day, the fact that she visited at all marked a significant shift in attitudes about medical authority, gay health, and the right to quality health care that demonstrates the true importance of the gay health activism of the 1970s.

Like many other minority communities in the 1970s, gay men faced public health challenges that resulted as much from their political marginalization and social stigmatization as from any virus or disease. The incidence of venereal disease (VD) among the adult population of the United States grew to epidemic proportions in the late 1960s and 1970s, but as I conducted the oral histories that make up the backbone of this book, without exception every gay man painted a particularly bleak portrait of gay health care in that period.³ Many dreaded that disclosure of their sexual activities would not remain confidential with their doctor, leading to ridicule from their families, termination from their jobs, or both, and these concerns had merit. One former client of a city-run VD clinic in Chicago remembered, “They weren’t very nice … the help in that place, the clinic was just foul to gay people, just nasty.”⁴ Furthermore, venereal disease testing at Department of Health clinics in many cities commonly required disclosure of the patient’s name and of all previous sexual partners before treatment was given. If a patient tested positive, the Department of Health systematically contacted each partner to inform him or her of the possible exposure to disease and to facilitate testing and treatment. While this process seems logical for disease containment, it served the opposite function, as many gay men, especially those who were not completely out of the closet, avoided testing because of the notification protocol. Whether because they did not want to deal with ignorant or homophobic staff members, make themselves and all of their sexual partners vulnerable to a very public coming out, or simply did not know the names of their sexual partners, gay men often felt alienated from many city-run health clinics and from mainstream medicine writ large.

Figure 1. Nurse Wanda Lust with an inset of performer Stephen Jones. Photograph by Thousand Words Unlimited and from the collection of Gary Chichester.

Figure 2. Nurse Wanda Lust visiting a patient with friends at Rush Presbyterian Hospital. Photograph by Thousand Words Unlimited and from the collection of Gary Chichester.

Compounding the problem of distrust of mainstream medicine within the gay community was a general ignorance of gay health issues among medical professionals. Until the 1970s, nearly all the medical literature and education on homosexuals focused on homosexuality itself as an illness in need of treatment.⁵ As a result, doctors remained uninformed about how to diagnose and treat actual illnesses within the gay community, particularly those that manifested in slightly different ways than in the heterosexual population. Survey responses from doctors in 1978 showed that more than 84 percent of doctors believed they did not have adequate education in medical school to address these issues.⁶ Consequently, sexually transmitted diseases among gay men often went undetected and untreated until in advanced stages.⁷ Uneducated doctors could easily overlook gonorrhea symptoms in a gay man if the examination did not include a throat culture, a test not included in the standard examination for a heterosexual man. Unless a gay patient felt comfortable enough to inform his doctor of his sexual practices and the doctor knew the appropriate medical response, syphilis could go undetected and untreated.⁸ By the end of the 1970s, some venereal diseases appeared much more frequently among gay men than in the general population.⁹ Desperate for health care but with nowhere to turn gay men looked to one another for medical advice and treatment. A Chicago bathhouse owner became a sought out medical “expert” on how to perform reasonably reliable at-home tests for VD: “Milk the penis and if you get a white discharge, you probably got it.”¹⁰ The rare private doctor that neither price gouged nor violated patient confidentiality quickly became a local celebrity and was in high demand.

In response to these insufficient solutions, a colorful cast of doctors and activists built a largely self-sufficient gay medical system that challenged, collaborated with, and educated mainstream health practitioners. By decade’s end, the health network included community clinics, outreach programs, national professional organizations, and a research infrastructure. Taking inspiration from the political health rhetoric employed by the Black Panther, feminist, and antiurban renewal movements and putting government funding to new and often unintended uses, gay health activists of the 1970s changed the medical and political understandings of sexuality and health to reflect the new realities of their own sexual revolution.

The history of this national gay health network challenges our understanding of gay politics in the 1960s, 1970s, and 1980s. The usual declension narrative, in which the leftist politics of the 1960s gives way to a rightward political shift, is insufficient for capturing both the creativity and the effectiveness of those gay health activists in the 1970s and 1980s who were determined to save lives and survive a changing political climate. LGBTQ activists did not tame their politics in the face of strengthening conservative opposition but rather adapted their tactics and political framing to affect change in the new political landscape.¹¹ From this perspective, the relationship between the state and homosexuality appears more nuanced, assimilating, and productive than a simple case of antagonism and oppression might suggest. Though historians have demonstrated the state’s attempts to demand straightness from its citizens, this history of gay health activism suggests that the state can overlook, and at times even nurture, homosexuality as long as it also results in submission to state power.¹² In other words, the state in the 1970s cared less that there were gay citizens than that they left state systems and structures unchallenged. Indeed, the gay health network that arose in this period grew directly out of Great Society programs. The links between gay health networks and the federal state grew stronger throughout the 1970s and set the stage for a strained relationship during the early AIDS crisis.¹³

Moreover, an examination of the roots of gay health clinics and their central activists brings the interdependence and complementary nature of various radical groups during this period into sharper focus.¹⁴ Gay health activism, which began to emerge in the 1970s, had firm roots in the social movement politics of the late 1960s. Many gay health activists were veterans of these movements, and gay activists employed health as a political organizing tool in ways similar to many movements in the early 1970s. Gay health activism reflected the capitalist critiques of the antiwar and social medicine movements by incorporating free and sliding-scale fee structures in clinics. Building on the examples of the Black Panthers and Brown Berets, gay health activists learned to frame the struggle for health care as a form of political liberation by arguing that health disparities both exemplified and fueled discrimination. Gay health activists also embraced the idea of empowering individuals and communities to be their own health advocates and sources of information, much like feminist women’s health movement activists. In many ways, gay health activists borrowed the best attributes of health activism occurring in other social movements and combined them as they built a national gay health network.

The analysis of these clinics brings clarity to how concepts of health factored into gay sexual and political culture, demonstrating in particular a much greater concern for sexual health in gay culture in the 1970s than previously depicted. Early AIDS literature, particularly fictionalized depictions of the early epidemic, often portrayed the preceding decade as a carefree decade-long orgy of sorts, paving the way for critiques that blamed “promiscuity” and personal irresponsibility for the early spread of the disease. The relatively meager literature on the gay liberation period has not yet erased this notion, or at least not with enough heft to change public perception of the decade. In fact, histories of gay liberation rightly claim newfound sexual freedom and decreased policing of homosexuality as defining attributes of the 1970s, but in doing so often inadvertently reinforce the portrayal of the decade as a sexual free-for-all with no concerns for sexual health. The work of these clinics and their relationships to the larger communities they served suggest that sexual health was often intertwined with gay liberation and the shifting gay sexual norms of the decade. In short, many men had a lot of sex with a lot of other men without the shame or harassment of previous decades, but they also got tested and treated for VD regularly and saw that as a necessary part of being sexually active. From this new vantage point, the early spread of AIDS becomes not about multiple partners or irresponsibility, but rather about a new disease with poorly understood modes of transmission. While I anticipated that many of these topics would surface in the course of my research, I was often surprised by the nuance my findings bring to the literature.

Though I desperately wanted to devote equal attention to the health activism of gay communities and lesbian communities, all sources showed that lesbians, though active in women’s health and to a lesser extent gay health activism, worked far less on addressing lesbian-specific health concerns in the 1970s than their gay counterparts. Furthermore, the lesbian health activism that did exist was largely done within women’s health clinics with little regard for, or communication with, gay health organizing. A focus on health issues specifically often exacerbated preexisting political (and biological) differences between gay men and lesbians during this decade so that they commonly approached health from different physical experiences and political frameworks. One gay and lesbian health guide from the 1980s attributed the segregation of gay health services from lesbian offerings, “in large part, [to] lesbian and gay men’s health issues [being] radically different.”¹⁵ With the differences between gay and lesbian health activism far outweighing their similarities, a cohesive narrative arc that could move through time became extremely difficult to develop and maintain. Finally, because lesbian health activism around lesbian-specific health issues was relatively minor in this period, identifying and collecting archival sources that could sustain an equal study of gays and lesbians proved impossible. Here, then, I focus predominantly on gay health activism. Where possible, this history illuminates the difficult and complex relationship between gay men and lesbians in the 1970s, particularly when it came to issues of health and health services, as lesbians were at best left to fend for themselves, and at worst excluded entirely.

While the gay health network of the 1970s reorients our view of the relations between sexuality and the state and between various political movements, the individual clinics profiled in this study came to gay health from different local political contexts, and different activists propelled them. Over the course of the 1970s more than two dozen gay community health clinics came into existence, many of them lasting from only a few weeks to only a few years and leaving little historical evidence beyond ads scattered across local gay newspapers. Out of these many clinics, three case studies anchor Before AIDS: Fenway Community Health Clinic in Boston, the Gay Community Services Center in Los Angeles, and Howard Brown Memorial Clinic in Chicago. I interweave the stories of these three clinics with brief examples from other clinics around the country, examinations of individuals who were influential at multiple sites, and analyses of national networking among organizations. By focusing on these three cities and revealing them as the three major centers of gay health activism in the period before AIDS, I move beyond a historical narrative that centers on New York City and San Francisco.¹⁶ These three clinics were trailblazers of gay health activism in the 1970s and the most influential, innovative, and lasting organizations of that period. By the early years of the AIDS crisis, when their volunteers, practitioners, and researchers became first responders to an epidemic whose treatment and epidemiology were not yet understood, these clinics had already solidified their significance to the gay and medical communities. They gained that significance and those reputations by navigating unique social and political terrains in ways that resonated with their local clients through ideology, organizational structure, and service offerings.

Activists determined to protect their neighborhood from redevelopment first started the Fenway Community Health Clinic in Boston as equal parts community-organizing effort and health service. The idea of opening a health clinic in the Fenway neighborhood came to two resident activists after the pair visited a newly opened Black Panther–operated health clinic that earned notoriety in the local press and fame among Boston activists.¹⁷ That clinic, consisting of just a trailer, provided health services to the surrounding community and politically mobilized area residents. It also stood directly in the path of bulldozers slated to raze the neighborhood in preparation for the Inner Belt Road, or what would have been called I-695.¹⁸ David Scondras, the director of community services at the Boston Center for Older Americans in the Fenway neighborhood, remembered that he saw the Black Panther Clinic as “an organizing tool to get everyday people who otherwise were not very political involved in the Black Panther Party…. It gave all of us an idea, which was that we should go out to the neighborhood and start organizing our community.”¹⁹ The political strategy behind the Black Panther Clinic resonated with the Fen way activists as developers and bulldozers from the Boston Redevelopment Authority also threatened their financially struggling neighborhood, having already demolished three hundred low-income housing units in 1968 and with plans to level more. Aware of both the political power of the Black Panther Clinic and the unmet medical needs of their own racially diverse and economically disadvantaged residents, Scondras and Linda Beane, a Northeastern University graduate nursing student, teamed up, using their complementary interests to open the renegade Fenway clinic in the Boston Center for Older Americans.²⁰ The clinic was one of many community-based organizations, including a food co-op, newspaper, and childcare, designed to make residents more politically engaged, unified, and organized to combat the state-approved developers attacking their neighborhood. Among its many health offerings and programs, the clinic offered gay-friendly VD testing.

In Los Angeles, a small group of gay men cast the gay health services they sought to offer in a different political light, that of gay survival of what they termed oppression sickness. Infusing gay liberation politics with the political rhetoric of many radical political movements in Los Angeles, veteran activists Don Kilhefner, Morris Kight, and John Platania understood the political, physical, mental, financial, and chemical struggles of gay community members as all symptoms of the same illness—oppression sickness. Oppression sickness was a broad concept that encapsulated any of the negative personal experiences that could be traced back to oppression or discrimination. The Gay Community Services Center Kilhefner, Kight, and Platania founded to address these symptoms and battle the larger societal illness of oppression offered a wide range of services from VD testing to support groups and from job training programs to drug rehabilitation. Oppression sickness infected the gay community, but these founders saw the larger society as the carrier of the disease and positioned the Gay Community Services Center as a service provider for the gay community as well as an idealistic catalyst for inoculating the larger society by fighting homophobia and structural forms of oppression. Each of the center’s offerings placed gay identity and politics at its core. This political framing resonated with many local gay communities but had to be bridled and recast in order to garner the state funding and tax status the founders deemed imperative for the center’s long-term success.

If Boston’s clinic emerged out of a neighborhood threatened and Los Angeles’ clinic grew from gay liberation politics applied to health disparities, Chicago’s Howard Brown Memorial Clinic can be traced back to gay doctors’ frustration over incomplete medical training. As a medical student at the University of Chicago, David Ostrow realized that none of his medical training prepared him for the medical needs he saw in the gay bars and social gatherings he visited in his downtime. In response, he started a group to provide a supportive community for gay medical students who encountered homophobia in their classes and medical training. Ostrow envisioned that these medical students could offer emotional support to one another as well as academic and scientific collaboration as they sought to supplement their formal education by identifying and addressing the medical needs of the gay community. After an autumn 1973 ad in the Gay Crusader, the local gay newspaper, instructed those interested in joining the group to call, the rotary phone in Ostrow’s small one-bedroom apartment rang off the hook.²¹ Surprised, he found himself discussing with callers needs much more numerous and complicated than those of gay medical students simply needing social support. He realized that a large portion of the gay community, far larger than just gay medical students, was hungry for medical services and information. Ostrow described in an interview the scores of calls he received: “A third were from gay medical students … another equally large group of calls were people wanting to know where they could go to get good, respectful, nonjudgmental medical care for gay related health issues … and a third of these calls were from people who wanted to have sex with the gay medical students and they usually started out, ‘Hello, are you a gay medical student?’ and it went downhill from there.”²² As he took each call, answering questions in his native New Jersey accent, the need for gay health services became more and more apparent. Ostrow relayed the situation to other group members in meetings held at bars, businesses, and members’ homes over the course of several weeks. As the long Chicago winter began to thaw into spring in 1974, the group began expanding their mission to include services beyond solely providing social support for medical students and professionals. By decade’s end, the Howard Brown Memorial Clinic was the leading national research institution on gay health, serving thousands of clients annually through both in-clinic and outreach services.

Just as each of these clinics had a different political origin, they each presented their own research challenges. Boston proved the most difficult, as most of the organization’s archives from the 1970s were discarded during a move to a new facility in the early 1980s. With only a thin file of organizational archives to work from, I took full advantage of the neighborhood newspaper, the Fenway News, as well as one of its founding editors, Stephen Brophy, to chart the history of the growing health clinic and identify the names of key figures in its development. I also contacted the existing Fenway Clinic, asking for any historical documents they still had as well as the names of any longstanding staff members. Fortunately, they had just commissioned a history of the organization and had contact information for a handful of clinic veterans from the 1970s willing to meet with me.²³ Combining these sources, I was able to piece together a fairly complete timeline of the clinic’s development and conduct a dozen interviews (both on and off the record) that then pointed me to other sources, such as granting agencies and state records. In comparison, both Los Angeles and Chicago were far easier, as each clinic’s records from the 1970s resided in community archives, though unprocessed when I went through them.²⁴ Even in their slightly jumbled state, these archives were extensive and made obvious the names of collaborative agencies and important figures that I pursued for interviews. I also sought out opportunities to present my research in public settings and would often have audience members come forward afterward with recollections or suggestions for additional sources. I then layered these individual clinic archives that I had compiled on top of deep readings of local newspapers, state archives, proceedings of medical and public health conferences, medical journals, and a broader national political context gleaned from national newspapers.

Interviews and individuals made this history possible to tell. I formally interviewed over twenty activists, doctors, and patients, most of them multiple times and over a series of years. The majority of these interviews were conducted in person in people’s homes, offices, local coffee shops, or nearby parks, though some were via phone. They were difficult to set up, as many potential interview subjects were impossible to find after forty years, or they had passed away, many from AIDS. Some of those who remained saw their work in the clinics as tangential to their lives (then or now) and not worthy of my time or theirs despite my assurances to the contrary. Many argued that they hadn’t really “done anything important.” Another portion of those who refused to be interviewed suggested that the real story was AIDS or that the seriousness of AIDS made their contributions in the 1970s less significant. A handful refused to talk with me because the memories were too painful, as AIDS had claimed so many of their friends or coworkers. Even though I asked specifically about events and issues that predated AIDS, the epidemic cast a shadow over all the interviews, resulting in much emotional labor for both the interview subjects and me as well as posing a real challenge in reconciling recollections with historical timelines. Thankfully, I quickly learned to come equipped with tissues and deploy the gay community press and newspapers that abound in each of these cities to spark memories and serve as cross-references. Those I interviewed often suggested others to interview, occasionally even providing contact information or introductions. For every person that agreed to be recorded and quoted, there were others who kindly refused while also sharing their memories in short introductory conversations. I sometimes used these informal interviews as opportunities to clarify an event or issue that I didn’t fully understand or simply to get a better sense of the clinics. Many of those I interviewed, even those who did not want to be quoted or recorded, opened their basements, closets, and attics to reveal their personal records and ephemera from the clinics, sometimes simply handing them over to me. These dust-covered binders, boxes, envelopes, and folders contained much of the archival treasure that undergirds this book.

The 1970s offered a brief historical moment during which four major social and political factors converged to create and nurture gay health activism: gay liberation, the questioning of medical authority by various marginalized groups, the continuation of 1960s radicalism, and Great Society–era government policies that encouraged community health efforts. The confluence of these four forces allowed for gay health activism to take many forms in the period before the AIDS crisis, including community clinics, outreach programs, and research collaborations. Gay health activism in the 1980s responded to the AIDS crisis and a much more hostile fiscal and political environment by relying on and adding to the strong gay medical infrastructure laid by activists in the previous decade under much easier and more politically supportive circumstances.

The 1970s witnessed a militant shift in the political organizing of gay and lesbian communities that translated into proud declarations of homosexuality and an unprecedented number of services, commercial businesses, and organizations aimed at obtaining greater political power and rights for gays and lesbians. Many within gay communities point to the Stonewall riots of 1969, during which patrons of the Stonewall Inn in New York City’s Greenwich Village, many of whom were gender nonconforming people of color, retaliated against police attempting a raid, as the spark that set off the gay rights movement of the 1970s.²⁵ However, the history of gay communities and political activism suggests that the roots of gay liberation go back to the years immediately following World War II, when, prompted by the social and financial freedom and common single-sex environments of the war, homosexual men and women began to create communities and underground political organizations for themselves.²⁶ Starting in the 1950s, the Mattachine Society for men and the Daughters of Bilitis for women blazed the early trails for mounting a political response against the discrimination of homosexuals, or as they called themselves, homophiles. While the politics and tactics of these early groups were later deemed too tame and assimilationist by their radical successors, they were the first to mobilize homophile communities and create a national political network complete with newsletters, national conferences, and a political platform.²⁷ As the late 1960s became engulfed in social protests, political unrest, and sexual revolution, gay political activism began to shift toward a more militant and radical focus.²⁸ Starting in 1966 with the Compton Cafeteria riots in San Francisco and the Black Cat riots in Los Angeles, spontaneous and anger-filled protests, often by some of the most marginalized members of the community, began to replace the carefully planned and choreographed pickets of the homophile movement.²⁹ These protests and the emotions they represented came to epitomize gay politics in the 1970s as lesbians and gay men rejected their historical oppression, demanded political rights, and created social services and organizations to achieve their equality.³⁰ This zeitgeist and politics provided the political underpinning of gay health activism, the creation of gay community clinics, and the motivation for all the necessary volunteers. By the end of the 1970s, the radicalism at the heart of gay liberation had faded, giving way to a more commercial, assimilation-minded politics.³¹ For the brief period of the 1970s, however, the politics and ethos of gay liberation proved invaluable to gay and lesbian health activists as they challenged mainstream medicine’s long-standing identification of homosexuality as a physical and mental illness.³²

Gay health activists represented just one of many groups that questioned medical authority during this period. A broad range of social and political movements of the late 1960s and early 1970s incorporated a critique of mainstream medicine and a demand for access to quality health care into their larger rhetoric and politics. The Black Panthers created a number of community health services to address a lack of access in poor, urban, black communities.³³ Women organized for quality reproductive care, with women of color fighting for protection from sterilization abuse, and middle-class, mostly white, women seeking access to abortion.³⁴ Disabled and institutionalized people also began to demand greater say in their treatment and autonomy.³⁵ The discovery of the Tuskegee Syphilis Experiment and the revelation about widespread Medicare and Medicaid fraud within the medical profession also encouraged the questioning of medical authority by marginalized groups during this period.³⁶

Gay health activists demanded that the medical establishment change its pathological diagnosis of homosexuality to ease the social and political oppression of gay and lesbian patients. For almost a century leading up to the 1970s, doctors equated homosexuality with an illness that should be prevented, treated, and eradicated. By branding homosexuals as innately ill, doctors cemented their social and political marginalization and opened the door to various forms of “treatment” ranging from intensive therapy to electro-shock treatments and experimental surgeries.³⁷ As a result of the work of gay health activists and gay liberationists, the 1970s witnessed a shift in the relationship between homosexuals and the medical profession, making it the first decade in which homosexuals were not classified as sick or diseased because of their sexuality. Through a combination of protests, gay men and lesbians coming out within the medical profession, and gay and lesbian community organizations offering their own health services, mainstream medicine began to divorce homosexuality from illness in the 1970s.³⁸ The successful action at the 1973 American Psychiatric Association annual meeting to have homosexuality officially removed from the Diagnostic and Statistical Manual of Mental Disorders, a list of symptoms and illnesses used to diagnose and treat mental illness, serves as perhaps the best-known example of these efforts.³⁹ Gays and lesbians employing the militancy of gay liberation and the larger attack on medical authority by numerous minority groups combined to challenge successfully the medical theories linking sexuality to illness. The AIDS epidemic in the 1980s posed a new challenge to decoupling homosexuality and illness among medical professionals and in society at large, as the disease was initially deemed a “gay plague.”⁴⁰ However, the political ethos of the gay community and the mounting opposition to medical authority combined in the 1970s to create a period ripe for gay health activism and the renegotiation of the relationship between homosexuality and illness.

The political climate and government policies of the early 1970s also proved central to the birth and growth of gay health activism during this period. Many of the main actors in gay health began their political, and even medical, careers in the social and political movements of the late 1960s. As they focused their attention on gay health, their earlier experiences clearly informed the ways in which they organized gay health institutions and services. In Boston, former antiwar activists used the protest and community-organizing tactics learned in that movement to create a community health clinic as a means to save their neighborhood from gentrification and redevelopment. In Los Angeles, gay liberationists used their limited access to quality and affordable care as an example of their larger political oppression, borrowing directly from the Black Power and women’s movements of the period.

Equally important to the political mind-set of individual activists were the government policies and national political conversations of the late 1960s and early 1970s. The Great Society programs that made up much of President Johnson’s domestic policy in the 1960s not only set the stage for gay health activism in the 1970s through funding and public health initiatives but also provided insight into some of the important debates and concerns of the post–World War II period.⁴¹ Johnson faced a health crisis created by rising medical costs, growing dependence on employment-based medical insurance, and a shrinking number of medical professionals. In the 1960s, an increasing number of people, often those with the greatest need for medical care, experienced a decrease in their access to quality and affordable medical care. In response, Johnson employed an approach that had been effective in addressing many of the issues that grew out of the nation’s high poverty rates: community-based programs. Great Society policies placed individual communities at the center of government programs, allowing for federal monies to support services that were often designed by local community members to address the specific problems they faced.⁴² These policy initiatives informed the development of gay health activism in two ways. First, they created a mind-set within struggling communities that community members could create solutions to their problems and that the government would help. Second, and more practically, Great Society programs encouraged the creation of community health clinics for underserved communities through direct funding and fund-matching programs. In this context, state initiatives actually provided, albeit unintentionally, for gay and lesbian health activism.

Against this larger backdrop, Before AIDS makes five central claims, with one chapter dedicated to each. First, gay liberation emanated from distinctly local circumstances and is better understood as local gay activism happening in multiple locations across the country rather than as a unified national movement. Second, and relatedly, gay health activism emerged from a wide variety of 1960s social and political movements, such as feminism, antipoverty programs, and civil rights activism, and often reflected a local political context more than any national gay political agenda. From these two perspectives, gay liberation is one among many contributing factors in the development of gay services and institutions, rather than the sole impetus. Third, despite the continued marginalization of gays in U.S. society during the period, the state actually contributed significantly, though often unintentionally, to the health activism of gay men in the 1970s. This occurred through funding and policy making that led indirectly to the founding and evolution of gay community health clinics throughout the decade. Fourth, as a consequence of community clinics, outreach programs, and research efforts, the meanings of sexuality and health within both gay political and mainstream medical communities changed significantly over the course of the 1970s. Finally, a substantial and multifaceted gay medical infrastructure predated the AIDS crisis of the 1980s, a fact that is, with few exceptions, overlooked in the vast literature on AIDS (not to mention my initial daydreamed history of gay community health clinics). This existing infrastructure made significant contributions to gay health and mainstream medicine in the 1970s and was well positioned to serve effectively on the frontlines of the early AIDS epidemic of the 1980s.