A Comparison of Community Responses to HIV/AIDS
in San Francisco and Melbourne.
In honour of the fortieth anniversary today of the first article to ever be published on AIDS, by Dr Lawrence Mass in the New York Native.
In 1988, a mere seven years into the epidemic, the Mayor of San Francisco told the US Presidential Commission on AIDS that his city had already lost more young men to AIDS than it had to World Wars I and II, Korea and Vietnam – combined and doubled. (Agnos, 1988, 1).
This rather horrifying thought evokes the assertion by Leslie Banks that ‘geographical aspects of disease date back to the earliest of written records’, linking locality and disease as being both interdependent and interactive (Banks, 1959, 199). Thus historians have traditionally examined how local conditions may have given rise to the spread of disease across place and time, as demonstrated in the 1854 cholera outbreak in London, where we can see the clustering of cases around a polluted water pump in London (Snow, 1854).
A study of place, however, can also show vectors of infection through forms of human migration, as demonstrated by the spread of diseases such as Bubonic Plague beyond their place of origin (May, 1953, 22 – 27). HIV/AIDS may have been the first worldwide pandemic to enjoy international transmission at the speed of the jumbo jet, but it will not be the last.
The trans-national spread of HIV/AIDS has been compounded through its interweaving with what Dennis Altman refers to as the ‘globilisation of human welfare’ (Altman, 2001, 73). His concern over the dominance of western medical discourse is understandable when considering its possible incompatibility or inappropriateness in other places or cultures. In studying the responses to HIV/AIDS in San Francisco and Melbourne, we can see a mix of varied outcomes within two locations that are geographically distant but culturally and socially interactive.
The arrival of HIV/AIDS in the 1980s transformed both San Francisco and Melbourne. Rodgers et al assert that: ‘During the early 1980s, when the epidemic began, AIDS had no social meaning. Individuals had to create meanings regarding its definition, social context, epidemiology, and causes.’ (Rodgers et al, 1995, 665) While the USA and Australia were still formulating their national, political and cultural responses to HIV/AIDS – responses that would at times include hysteria, fear, stigma, vilification and discrimination – it was the gay communities that led the fightback, which they defined within the context of saving lives, caring for the sick, celebrating diversity and promoting gay rights.
San Francisco and Melbourne can be seen to share some historic and social intersections. Both are locations in relatively affluent ‘western’ democracies which were originally inhabited by indigenous peoples who were later dispossessed by white European colonizers; both cities received a boost in economy and population from the mid-19th century Gold Rush; and both places are now seen as centres of culturally and linguistically diverse communities.
Despite such similarities, San Francisco and Melbourne also have differences of population, status and local culture which are as disparate as are San Francisco’s Golden Gate Bridge with Melbourne’s Westgate Bride. San Francisco is both a city and a county, registering some 805,235 residents in its 2010 census (US Census Bureau, n.d.; Office of the Mayor, n.d.) but serving as a major focus for the San Francisco Bay Area, comprising 7.1 million residents (Focus: Bay Area Focused Growth, n.d.) A 2006 study reports that 15.4% of San Francisco’s residents identify themselves as being gay, lesbian or bisexual, the highest percentage of any city in the USA (Turnbull, 2006). The municipality of Melbourne contains an estimated 100,611 residents (2011 estimate) and its greater metropolitan area covers some 4,169,103 residents (City of Melbourne, n.d) but there are no known estimates of the size of Melbourne’s gay community.
While Melbourne was traditionally viewed by many as a city where much of its culture appeared to stop upon six o’clock closing, its post-war immigration encouraged the evolution of a more cosmopolitan, multicultural society. Meanwhile, San Francisco was popularly known as a centre for bohemian culture. In 1950, legal protections for gay people were already being established by law in San Francisco (San Francisco History Index, n.d.), while this did not commence in Melbourne until the decriminalisation of homosexuality in 1980. In the 1960s, Scott McKenzie was encouraging people to join the hippie counter-culture by travelling to San Francisco – and ‘be sure to wear a flower in your hair’ (Phillips & McKenzie, 1967). In the 1970s, the Village People encouraged young gay men to ‘Go West‘ and to join the gay community of San Francisco because ‘life is peaceful there’.
Both cities became a destination for an influx of young gay men who were seeking escape from oppressive country towns, as fictionalised in San Francisco’s Tales of the City books by Armistead Maupin. San Franscisco’s gay culture was epitomised by Harvey Milk and civil rights activism. Historian Alan Petersen gave an example of the dichotomy between Melbourne’s private/public spaces and the restrictions that were traditionally placed upon Melbourne’s gay community, with a cluster of gay venues as the central, covert focus of its social existence and the majority of gay people being more hidden in suburbia (Petersen, 2012, 4). In my own studies, I have been told by gay men that they socialised in Melbourne’s gay venues on weekends and then went and lived more closeted lives at home and work.
In November 1980, a gay man named Ken visited his doctor’s office in San Francisco and was diagnosed with Kaposi’s sarcoma, a type of cancer connected with AIDS, and he would later become the first officially registered Person With AIDS (Stryker and Van Buskirk, 1996, 85 & 86). His life and death are documented, along with those of other early protagonists in the fight against AIDS from San Francisco and New York City, in Randy Shilt’s study And the Band Played On. It is reported that by 1989, almost half of the gay men over age 26 in San Francisco were infected with HIV (Rodgers et al, 1995, 669) and that by 1995, the city had the highest per capita infection rate of any city in the USA as well as the highest percentage of AIDS-related deaths (1.7%)” (ibid, 666).
In December 1981, young Bobbi Campbell from San Francisco publicly disclosed his status as a person living with Kaposi’s Sarcoma. He created a poster about “Gay Cancer” which he placed in a pharmacy window (Stryker and Van Buskirk, 1996, 86 & 87.) Campbell was one of the first gay men to attempt to seize control of his situation and agitate for public education and action. We can see the start of local activism that would affect not only San Franciscans but also have an international impact. San Francisco not only served as a place where local conditions – in this case, a large collectivised gay community – would provide one locus for an infective agent; the city also demonstrated that epidemics – and human responses to such epidemics – could ebb and flow into and out of localised geographical centres and travel the world.
San Francisco received no prior warning of AIDS, and by the time they rallied, many people had already been lost. By contrast, Melbourne’s gay community received warnings in advance, and they had time to develop community support networks and distribute information. There are no statistics available on the estimated number of gay men living in Melbourne in the 1980s or 1990s due to the covert nature of homosexuality at the time and due to the absence of a strongly united gay community as there had been in San Francisco. Statistics do show that in the early 1980s, hundreds of gay men were diagnosed annually with HIV/AIDS (Author unknown, 1999).
At the 25th anniversary of the Victorian AIDS Council, founding President Phil Carswell recalled the dread and apprehension which they all felt back in those early days and their inability to fully grasp the gravity of the coming problem:
“Looking ahead, we thought we could see a tsunami was coming. What we failed to understand was that it wasn’t a tsunami; it was a whole climate change” (Carswell, 2009).
In 1983, when Australia’s first AIDS fatality occurred in Melbourne, the story appeared on page 3 of The San Francisco Chronicle (United Press, 1983). Its prominence in this newspaper might suggest that the patient – known to have lived in the USA for some years – may have had friends in San Francisco.
A number of comparisons could be made between community responses in San Francisco and Melbourne, and this is the first and most obvious. In San Francisco, the Kaposi’s Sarcoma Foundation was started in April 1982 and was later to be renamed the San Francisco AIDS Foundation (SFAF, 2012). In Melbourne, the Victorian AIDS Action Committee was founded in July 1983, later renamed the Victorian AIDS Council. Both organisations were started by coalitions of gay activists and doctors, and both were born out of a groundswell of community concern. There was open liaison between both cities, as is demonstrated in this 1984 Melbourne document, which talks of the San Francisco response (Carr, 1986 (1990) 196 – 203; Author unknown, n.d. (Ian Goller Collection); Goller & Carswell, 1985; Scroope & Carswell, 1987.
The San Francisco model of health care became somewhat of a template for the Melbourne response. This ‘model’ encompassed medical staff, carers and volunteers working collaboratively in every aspect of patient care and treatment, including collaborating closely with local community organisations. This included the emergent, grass-roots volunteer care teams and other support structures; thousands of hours of volunteer work from both homosexual and heterosexual people, possibly the first time that so many volunteers had rallied to confront an epidemic.
Randy Shilts wrote of this model in 1992:
“The importance of San Francisco General Hospital in the history of the AIDS epidemic cannot be overstated. The model of care now used the world over was pioneered in those buildings.” (Shilts, 1992, ix and x.)
My own study in 2011 suggests that Fairfield Hospital in Melbourne was also a centre of medical excellence and innovation, one of synergy between doctors and activists; a place where patients became self-empowered to define and determine their own treatment options (Allshorn, 2011). Although it was closed in 1996, the hospital’s legacy is a paradigm of collaborative discourse between patients and doctors, a redefinition of the medical discourse away from the traditional western model proposed by Foucault, in which medicine has been constructed and regimented as a form of social control (Gordon, 1980, 175).
When we look at both cities, we can see differences emerge even when close correlation is apparent: the SFAF expanded its services to assist affected cohorts, including gay men, injecting drug users, women, and CALD communities (SFAF, 2021). By contrast, the VAC focussed its work predominantly on gay men. This may reflect differing social hierarchies in these cities: San Francisco’s gay community had enjoyed greater civil rights, whereas Melbourne’s gay community was more covert and emergent, and evidently saw a need to establish their own exclusive support structures.
Strangely, the activism in both cities may have been energised by converse governmental responses to HIV/AIDS. In the USA, Ronald Reagan became President in 1981, just as AIDS was being discovered. Many commentators criticise his failure to significantly address AIDS as a public health issue for the first seven years of his eight year administration. Suggested one critic: ‘Ronald Reagan cared more about UFOs than AIDS’ (Pareene, 2011). The San Francisco Mayor stated in 1988 that: ”What threatens to overwhelm San Francisco is not the increased caseload of AIDS, but the continued lack of leadership from the federal government’ (Krohn, 1988).
In Australia, our federal government took steps to work cooperatively with affected communities in order to develop effective responses to the epidemic (Carswell, 1986). This meant that unlike San Francisco, where the activist community was forced into activism due to the inaction of their national government, Melbourne’s activists were being empowered by governmental recognition. Despite somewhat tangential political actuation, both cities achieved a similar result and created a powerful local activist movement.
Community activism in both cities did include forms of protest. The group ACT UP (AIDS Coalition to Unleash Power) was a radical protest group founded in New York City to fight for those with AIDS, particularly to demand their access to potentially life-saving drugs. Chapters of ACT UP formed around the world. ACT UP Melbourne was enthusiastic but short-lived, perhaps lacking the rage of their US counterparts because of our more collaborative government.
AIDS memorial rituals were also developed in San Francisco and exported to the world. These include Candlelight Vigils, starting in San Francisco in 1983 and continuing to this day (SFAF, 2012). Melbourne’s Candlelight Vigil has almost disappeared in recent years. Similarly, San Francisco boasts a National AIDS Memorial Grove, while Melbourne’s AIDS Gardens remain largely forgotten.
The AIDS Quilt, created by San Francisco gay activist Cleve Jones in 1987, remains available for display across the USA, while most of Australia’s AIDS Quilt is now stored in a Sydney museum and Melbourne – perhaps surprisingly – boasted its longest surviving chapter. These varied outcomes demonstrate that even when community activism is directly transmitted by human and cultural interaction, the resulting outcomes are reliant upon local conditions and personalities.
Rodgers et al assert that “When a major event threatens the stability of a system, it forces the members of the system to construct new and changing meanings of their community.” They also suggest that HIV/AIDS reconstructed the social fabric of San Francisco (Rodgers et al, 1995, 676). Dennis Altman has recently called for greater acknowledgement that HIV/AIDS has contributed to the development of Australia’s modern gay community. My study demonstrates the complexities faced by trans-national communities even when they are facing a similar problem or share some cultural antecedents and aspirations. This comparison also shows the ability of local communities to develop their own systems of self-empowerment and to adapt templates to suit local needs when facing challenging times. Such a template might be adapted to suit local conditions in other places.
The world needs to learn lessons from this history because there will be another time, another place and another epidemic. Cleve Jones recalls that the SFAF’s phone started to ring before they had even advertised its existence. He evokes a universal symbolism for local activist communities everywhere: ‘The phone never stopped ringing. Thirty years later, it’s still ringing’ (SFAF, 2012).
Original paper entitled, ‘AIDS Response in San Francisco and Melbourne’ was presented at the ‘Putting History In Its Place’ Conference, La Trobe University, 28 September 2012, and can be found here as part of the conference program that was available on iTunes. This work was supported by an Australian Government Research Training Program Scholarship.
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©2012 Geoff Allshorn