Before AIDS. Katie Batza

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.