The Many Legacies of Aids

Josh Sides is the Whitsett Professor of California History and the Director of the Center for Southern California Studies at California State University, Northridge.  His most recent book, Erotic City: Sexual Revolutions and the Making of Modern San Francisco, looks at America’s capital of sexual libertinism and a potent symbol in its culture wars.  In the excerpt below Sides introduces the history of AIDS in San Francisco.

Selma Dritz was the last person you would expect to be an expert on the outlandish gay sex scene South of Market.  Born in Chicago to Russian parents in 1917, Dritz finished medical school in 1941 and became the chief resident of the Cook County Contagious Disease Hospital before retiring in 1947 to raise her three children.  She and her family moved to San Francisco in 1949, where they bought a house in the sleepy southwestern edge of the outer Sunset District, and Dritz became a stay-at-home mom for almost two decades.  Once her kids were grown, she got a master’s degree in public health at Berkeley in 1967 and quickly accepted a post as assistant director of disease control for the SFDPH.  As a doctor and a mother, she already knew the terrain well.  “At first,” she later recalled, the work “was the usual standard chasing down of measles, mumps, whooping cough, making sure that children in school had their proper immunizations.”

Very little in Dritz’s daily work routine changed during her first decade at the SFDPH.  To be sure, rates of syphilis and gonorrhea increased, “but that didn’t bother anybody; one shot of penicillin and you were cured.”  But by the end of 1977, Dritz remembered, there was a “complete change”: the number of enteric diseases, typically associated with the fecal contamination of food, escalated dramatically.  Because virtually all of the patients were men, she knew that “these cases weren’t coming from eating establishments.”  Instead, she came to learn, they had been transmitted through the exotic sex taking place in South of Market bathhouses and sex clubs.  When she followed up her observations with close research, the findings were alarming: between 1974 and 1979, the annual number of amebiasis cases in San Francisco had risen from 10 to 250; annual cases of giardiasis had risen from fewer than 2 to 85; annual shigelosis and hepatitis A cases had doubled, and hepatitis B cases had trebled.  By 1980, she estimated that 70-80% of all the patients at the SFDPH Veneral Disease Clinic were homosexual men.  Dritz’s findings paled in comparison to those of Edward Markell, a doctor who conducted research among a sample of Castro District residents in 1982.  Almost 60% of the subjects in Markell’s study tested positive for intestinal parasites.

“Too much is being transmitted,” Dritz warned a group of San Francisco physicians in 1980.  “We’ve got all of these diseases going unchecked.  There are so many opportunities for transmission that, if something new gets loose here, we’re going to have hell to pay.”  Dritz was no scold; she was a consummate professional, and she never indulged in moralistic hand-wringing.  Instead, she immediately reached out to the city’s prominent gay political clubs, gay business associations, and gay physicians to warn them about the threat.  Her professionalism immediately earned her the trust of the gay community, and that of gay physicians in particular.  In her early sixties and nearing retirement, Dritz had unwittingly become – as her children joked – “sex queen of San Francisco” and “den mother of the gays.”

In June 1981, an article in Morbidity and Morality Weekly Report reported on an unusual pneumonia appearing in gay men in Los Angeles.  This was the first official announcement of the new condition that would become known as AIDS.  Within one month of its publication, Dritz began seeing the first cases of Kaposi’s sarcoma and Pneumocystis carinii pneumonia, opportunistic diseases that accompanied the AIDS infection.  Dritz recognized before other did that the sexual revolution, as it had been understood, was over.

That the AIDS epidemic was devastating to San Francisco is very well known.  Yet the full complexity of the epidemic’s impact on the city’s disparate communities and neighborhoods remains elusive and largely unexplored.  The gay male community of the Castro – indisputably the hardest hit in the epidemic’s first twenty-five years – has collectively, and justly, claimed responsibility for telling the story of the epidemic.  Yet despite the legitimate authority of the gay Castro to tell the story of AIDS, their influence has obscured other dimensions of the story.  Peoples’ social and economic class status, race, and location within the city all shaped responses to AIDS in ways that elude quick calcuation.  And the changing epidemiology of the disease after the early 1980s also changed the meaning of the disease for San Franciscans.  In short, the historic devastation to the Castro must be seen in its proper context – as the most affected district of a city in which other affected districts and numerous people were also deeply transformed by the debilitating virus.