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Aidsepidemicinsf01chinrich.Pdf Regional Oral History Office University of California The Bancroft Library Berkeley, California The San Francisco AIDS Oral History Series THE AIDS EPIDEMIC IN SAN FRANCISCO: THE MEDICAL RESPONSE, 1981-1984 Volume I Selma K. Dritz, M.D, M.P.H. CHARTING THE EPIDEMIOLOGICAL COURSE OF AIDS, 1981-1984 Mervyn F. Silverman, M.D., M.P.H. PUBLIC HEALTH DIRECTOR: THE BATHHOUSE CRISIS, 1983-1984 Introduction by James Chin, M.D., M.P.H. Interviews Conducted by Sally Smith Hughes in 1992 and 1993 Copyright 1995 by The Regents of the University of California Since 1954 the Regional Oral History Office has been interviewing leading participants in or well-placed witnesses to major events in the development of Northern California, the West, and the Nation. Oral history is a modern research technique involving an interviewee and an informed interviewer in spontaneous conversation. The taped record is transcribed, lightly edited for continuity and clarity, and reviewed by the interviewee. The resulting manuscript is typed in final form, indexed, bound with photographs and illustrative materials, and placed in The Bancroft Library at the University of California, Berkeley, and other research collections for scholarly use. Because it is primary material, oral history is not intended to present the final, verified, or complete narrative of events. It is a spoken account, offered by the interviewee in response to questioning, and as such it is reflective, partisan, deeply involved, and irreplaceable. This manuscript is made available for research purposes. All literary rights in the manuscript, including the right to publish, are reserved to The Bancroft Library of the University of California, Berkeley. No part of the manuscript may be quoted for publication without the written permission of the Director of The Bancroft Library of the University of California, Berkeley. Requests for permission to quote for publication should be addressed to the Regional Oral History Office, 486 Library, University of California, Berkeley 94720, and should include identification of the specific passages to be quoted, anticipated use of the passages, and identification of the user. It is recommended that this oral history be cited as follows: To cite the volume: The AIDS Epidemic in San Francisco: The Medical Response. L98I-1984. Volume I, an oral history conducted 1992-1993, The Bancroft Library, University of California, Berkeley, 1995. To cite an individual interview: [ex.] Selma K. Dritz, M.D., M.P.H., "Charting the Epidemiological Course of AIDS, 1981-1984," an oral history conducted in 1992 by Sally Smith Hughes in The AIDS Epidemic in San Francisco: The Medical Response, 1981-1984. Volume I. Regional Oral History Office, The Bancroft Library, University of California, Berkeley, 1995. Copy no. \ Cataloguing information THE AIDS EPIDEMIC IN SAN FRANCISCO: THE MEDICAL RESPONSE, 1981-1984, VOLUME I, 1995, xv, 276 pp. Selma K. Dritz (b. 1917), epidemiologist, San Francisco Department of Public Health, 1967-1984; enteric disease in gay community; early cases of AIDS: etiology, diagnosis, risk groups; San Francisco General Hospital's Kaposi's Sarcoma Clinic; transfusion AIDS; Medical Advisory Committee on AIDS formed; June 1982 meeting, New York City, on AIDS opportunistic infections; San Francisco bathhouse issue; discussion of funding, AIDS drugs, AIDS in women. Mervyn F. Silverman (b. 1938), director, San Francisco Department of Public Health, 1977-1986; health department links with San Francisco's gay community; AIDS education strategy, programs; hospital admission of AIDS patients; the San Francisco model of AIDS care; the bathhouse issue; AIDS testing, and AIDS drugs; AIDS and the media and the federal government response; funding for AIDS. Appendices include AIDS Chronology, 1981-1984, list of key participants, documents from interviewees . Introduction by James Chin, M.D., M.P'.H., Clinical Professor of Epidemiology, School of Public Health, University of California, Berkeley Interviews conducted 1992 and 1993 by Sally Smith Hughes, Ph.D for the San Francisco AIDS Oral History Series. The Regional Oral History Office, The Bancroft Library, University of California, Berkeley. ACKNOWLEDGEMENTS The Regional Oral History Office wishes to express deep gratitude to Evelyne and David Lennette of Virolab, Inc., for their financial support of this project, incisive conceptual contributions, and sustaining interest and enthusiasm. TABLE OF CONTENTS- -The AIDS Epidemic in San Francisco: The Medical Response, 1981-1984, Volume I PREFACE--by David and Evelyne Lennette i SERIES INTRODUCTION- -by James Chin iii SERIES HISTORY--by Sally Smith Hughes vi INTERVIEW WITH SELMA K. DRITZ INTERVIEW HISTORY--by Sally Smith Hughes BIOGRAPHICAL INFORMATION I EDUCATION AND EARLY CAREER 1 Education 1 Early Career 1 Pre-San Francisco 1 Epidemiologist, San Francisco Department of Public Health, 1967-1984 4 Enteric Disease in the Gay Community 5 II THE AIDS EPIDEMIC 10 Early Cases of AIDS 10 Kaposi's Sarcoma 10 Pneumocystis carinii Pneumonia 11 Kaposi's Sarcoma Study Group and Clinic 13 Simon Guzman: An Early Patient 14 Investigating the Etiology of AIDS 15 Possible Causes 15 The CDC Questionnaire 15 Suspicions of a Transmissible Agent 17 Diagnosing AIDS 17 Recognizing Immune Suppression 20 More on Etiology 21 Retrovirology 22 AIDS Progression 25 Risk Groups 25 Press Coverage 26 Funding Problems 27 More on the Kaposi's Sarcoma Clinic 29 Support from Community Groups 31 The Health Department's Community Ties 32 Gaetan Dugas and the Cluster Study 34 Transfusion AIDS at UCSF 36 The Centers for Disease Control Blood Transfusions Workshop/ Advisory Committee Meeting, January 4, 1983 39 Testing Blood for Viruses 44 The Medical Advisory Committee on AIDS, San Francisco Department of Public Health 46 Purpose and Membership 46 Giving Advice 47 The Bathhouses 49 Fear of Infection 51 San Francisco Medical Society 52 San Francisco Board of Supervisors 52 Health Department Relationships with Other Agencies 53 Local, State, and Federal Agencies 53 The News Media 55 Private Physicians and Other Health Departments 55 San Francisco Coroner's Office 56 Confidentiality 56 The HIV Antibody Test 57 Gay Issues 61 Meeting on Kaposi's Sarcoma and Opportunistic Infections, New York City, July 13, 1982 62 Medical Grand Rounds on AIDS, July 1983 69 Stuart Anderson and Vitamin C 71 Lecturing on AIDS 72 Learning to Recognize Opportunistic Infections 74 The Health Department's AIDS Program 75 Development of Program Components 75 Education Program 78 The Department's Ties with Various San Francisco Organizations 82 San Francisco Men's Health Study 84 The Bathhouses 85 Meeting with the Bathhouse Owners, 1982 86 Relying on the Gay Community for Information 87 Threat of a Temporary Restraining Order 88 Open Hearing at the Health Department, March 30, 1984 89 Bathhouse Closure, October 9, 1984 90 Divided Opinion in the Gay Community 92 The Continuing Problem of AIDS Etiology 93 The Effects of Insufficient Funding 94 Testing Stored Hepatitis B Blood for HIV Antibody 95 The Impact of Discovering the AIDS Virus 96 Broadening the Definition of AIDS 99 Health Care Workers and the Risk of AIDS 100 Finding Treatment for AIDS 102 Accelerated Approval of AIDS Drugs 103 AIDS in Women 104 Retirement 105 INTERVIEW WITH MERVYN F. SILVERMAN INTERVIEW HISTORY--by Sally Smith Hughes BIOGRAPHICAL INFORMATION I EDUCATION AND CAREER 107 Education and Early Career 107 Interest in Public Health 108 Director, San Francisco Department of Public Health, 1977-1986 109 Comparison with the Department of Public Health in Kansas 109 Relations with Other San Francisco Institutions 110 Threat to Remove the Health Department's Jurisdiction over San Francisco General Hospital 112 Departmental Links with the Gay Community 113 II THE AIDS EPIDEMIC 115 Becoming Aware of the Epidemic 115 Turf Battles 116 Conceptualizing AIDS as a Gay Disease 117 AIDS Education Programs 118 Educational Approach 118 Attacks by Randy Shilts and Harry Britt 119 Diversity within the Gay Community 122 ' Complexity of the AIDS Problem 123 The AIDS Activity Office 124 Selma Dritz 126 Hospital Admission of AIDS Patients 127 Initial Opposition to the AIDS Ward 129 San Francisco's Unique Response to the Epidemic 130 The Health Director's Powers 133 The Health Director's Medical Advisory Committee on AIDS 133 The Community Advisory Committee on AIDS 135 AIDS Screening Clinics 135 Government's Role 137 More on AIDS Education 138 Strategy 138 More Criticism 140 City Money for AIDS Services 140 The Census Track Study, 1983 142 The Bathhouse Episode, 1983-1984 143 Regulation Rather than Closure 143 City Attorney's Opinion 145 Deciding on Education Rather than Closure 146 Paul Lorch's Editorial 149 Press Conference on Regulations, April 9, 1984 149 Reactions from the Gay Community 150 Canceling the March 30, 1984 Press Conference 152 Deciding to Close the Bathhouses 156 The Mayor's Reaction 156 Leon McKusick's Studies 158 The Baths Reopen 159 Civil Liberties versus Public Health 160 Assessing the Decision Regarding Closure 163 Resigning as Health Director 165 Silverman's Recent Positions 169 Testing Advocate 171 Blood Screening 172 Setting Up Anonymous Testing Sites 172 The Epidemic's Impact on Medicine 173 The Doctor-Patient Relationship 173 Accelerated Drug Approval 175 San Francisco Model of AIDS Care 177 Definition 177 Transfer of the Concept 178 Robert Wood Johnson AIDS Health Services Program 179 The Media 181 The Federal Government's Response to the Epidemic 182 TAPE GUIDE 185 APPENDICES 186 A. AIDS Chronology, 1981-1984 187 B. Key Participants in San Francisco AIDS History, 1981-1984 199 C. Dritz materials--San Francisco City Clinic Forms and Guidelines 202 D. Curriculum vitae, Selma K. Dritz, M.D. , M.P.H 230 E. Silverman materials documents relating to the closing of the bathhouses 234 F. Curriculum vitae, Mervyn F. Silverman, M.D., M.P.H. 268 INDEX 272 PREFACE--by David A. Lennette, Ph.D., and Evelyne T. Lennette, Ph.D. As two young medical virologists working in Pennsylvania, we experienced first hand some of the excitement of medical detective work.
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